Abortion and Violence

The Critical Need to Screen for Intimate Partner Violence at Abortion Clinics Confirmed by an Exhaustive Literature Review

By Priscilla K. Coleman, Ph.D.

Editor’s note. This first appeared on the web page of Wecare–the World Expert Consortium for Abortion Research and Education.
In February 2011, Philadelphia resident Tiffany Gillespie, 24, was six-months pregnant with her 3rd child when she was allegedly shot to death by her boyfriend, Aaron Fitzpatrick. The killing apparently followed an argument wherein Fitzpatrick tried to convince her to have an abortion and she refused.

A paper published this week in PLOS Medicine, “Associations Between Intimate Partner Violence and Termination of Pregnancy: A Systematic Review and Meta-Analysis” by Megan Hall and colleagues from King’s College in London is an extensive scientific review of the association between intimate partner violence and abortion, with great sensitivity to the complexities inherent in the published literature on the topic. Key results are considered briefly below; however the review is so dense with noteworthy findings that interested readers are strongly encouraged to read the original report. Moreover, by highlighting the gaps and ambiguities in the literature, the authors offer a wealth of additional ideas for research on this large, highly vulnerable, and characteristically very sad segment of the female population.

Results
1) Intimate partner violence, including history of rape, sexual assault, contraception sabotage, and coerced decision-making, was associated with abortion. Unfortunately with the limited data available to the authors, it was not possible to ascertain the typical timing of exposure to violence relative to abortion. However, it is likely that various patterns exist, with violence both preceding and following abortion in many victims’ lives. Escalation of violence after the procedure is a strong possibility, particularly when partners are against the abortion. In a high quality study by Fisher and colleagues (2005) published in the Canadian Medical Association Journal, the authors reported that women presenting for a third abortion were over 2.5 times more likely to have a history of physical or sexual violence than women presenting for their first.

 

2) Women in violent relationships were more likely to have concealed their abortion from partners compared to women who were not victims of violence. Women likely believed they could not continue the pregnancy and were afraid of the abusive partner’s behavior if the abortion had been revealed. Many women in abusive relationships may feel they have to abort, because they are trying to free themselves from the relationship, they do not want to bring a child into a home with violence, and/or they do not believe they have the emotional energy to go through a pregnancy and raise a child, among other reasons. With sensitive, appropriate pre-abortion counseling, women in abusive relationships can be identified and safely assisted out of the violent, dangerous situation and helped to continue their pregnancies if desired. Without sensitive, substantive care, abortion is often perceived as the only option available.

3) Women welcomed the opportunity to disclose IPV Intimate Partner Violence] and to be offered help. Women who present at abortion clinics are often at a point where they are quite receptive to help, and if screening and intervention do not occur, countless women will continue their lives feeling trapped and afraid in a violent relationship. If the abortion takes place, then there is a high probability that they will suffer psychological consequences as a result that further compound a life marked by significant suffering. Numerous studies from the peer-reviewed literature have documented the fact that women, who feel pressured by partners, abortion counselors, other people in their lives, and/or by life circumstances, are more likely to experience post-abortion mental health problems.
Conclusions
Strong conclusions are made by the authors: “Health-care professionals should be aware of the high rates of physical, sexual, and emotional violence among women seeking TOP (termination of pregnancy), and particularly the clinical factors associated with the greatest risk: previous TOP, lack of contraception, initially planned pregnancy, ultrasound re-dating, and the partner not funding or not being told about the TOP.” They further state: “Good practice obligates that termination services should have robust policies for ensuring women’s safety and confidentiality, providing information and referral pathways for those who disclose IPV, and exemplar guidance exists.”

This research report by Hall and colleagues is without a doubt the most extensive review of the literature on the topic of intimate partner violence and abortion. Nevertheless, the conclusions should be tempered by the limited high quality original research that has been conducted in vastly different cultural settings on the topic. To their credit, the authors went to great lengths to objectively evaluate the quality of each study summarized in the general narrative review. However, I’m not sure why they bothered to include those that were identified as being of very low quality.

Routine screening for intimate partner violence in general, and coercion to abort in particular, is far from the norm. Instead, abortion providers callously and routinely look the other way, even when women present with obvious symptoms of domestic violence. Since the majority of intimate partner homicides occur in the context of pre-existing physical abuse, identification and intervention with women at risk, particularly women seeking abortions, carries great potential to preserve women’s health and lives, while also empowering them to continue their pregnancies.

Source: NRLC News