I think, by now, most of the readers of this blog, will know that neither of us are into running abortion "mills" where no one cares how a woman is doing, whether she is making a good decision for her life, and how she will do afterward. We do care--deeply-- and so do the folks at many clinics across the country.
I have just heard from a friend who is just one person working as a counselor who tells a familiar story. She has been talking with a woman who presented for an abortion FIVE different times for the same pregnancy. The clinic sent her away four times for more thinking, for more in depth counseling, and she did seem to be making progress at getting clearer about what she wanted to do. Ultimately, she did have an abortion at that clinic--she, and the clinic staff agreed, that she had made a decision that was right for her. And yet, when the clinic called her back a week later, she felt that she had not only made the biggest mistake of her life, she blamed the clinic for not making her realize it. Although she agreed that she was ultimately accountable for her actions, she could not really accept that, and blamed everyone and everything she could think of, including legal abortion.
Fortunately, this is not a common story--usually we CAN make a difference in helping a woman sort out her situation and make a good decision--to have a child, or make an adoption plan, or have an abortion. We really are not invested in the outcome--for those of us who do this kind of work, this is our life's WORK--it's not about abortion at all. It's helping women pull all the threads of their lives together and make a good choice for their situation. But we all have met some version of the above woman and have wondered if we could do more to prevent her particular train wreck from happening.
There are emotional risk factors that we are trained to watch out for. At the top of the list is a prior history of depression or some other mental illness, which may not be obvious. A lack of support or someone actively opposing their decision is another which is why we explore people's support system carefully. We know from studies that women who are also suffering the effects of sexual abuse, domestic violence, previous trauma or loss are also at greater risk for emotional problems after an abortion. Similarly, their belief systems about abortion prior to getting pregnant can have a huge impact if they feel they are going against their own beliefs.
None of these things mean that a woman isn't making a good decision or should not have an abortion; on the contrary, sometimes it is the best decision for her, but it does mean that as a counselor you want to explore these issues and help her find a strategy for achieving emotional health after a pregnancy decision. Like someone who is more prone to an infection, you want to take some extra measures to be sure they are OK. And a good emotional outcome is not the same as being "happy"--it's being able to cope with the feelings that a decision of this magnitude brings up. And integrate this experience into your life story so that you can be a stronger person, ideally.
When you talk to the researchers, though, you find that a "lack of self efficacy" (also called "self esteem") is the most important characteristic in bad emotional outcomes. And, unfortunately, a sense that you are competent and capable of doing the right thing for your life is not something you can "learn" or "get" in the middle of a crisis. So sometimes women who just can't help themselves sit down and you have to try to sort it out. Sometimes they are just too hard on themselves, or "perfect" and can't stand their own imperfection. Sometimes they don't think themselves capable of making any decision, much less one this big.
And those are the women that keep us up at night, wondering if there isn't something we can offer them that will help them weather this crisis. One clinic I know refuses to participate in providing an abortion for someone like this, but then she goes off to a clinic where they ask no questions. I once knew of a client who was turned down at three different clinics before finding someone to do an abortion. She went through a good year of agony because the pregnancy decision exposed her inability to make a decision about her life. I also counseled a woman who was refused by three different clinics and ultimately, had a child, after finding the courage to confront her family.
Ultimately, the burden of choice is heavy for some women, crushing even for some, and for most, quite bearable. How to help the former without crippling the latter is the question when cases like this come up. But then, helping is not a certain endeavor, and comes with its own risks. Like this one.