Abortion counseling: attention to the whole woman

Maria Ladi Londoiio

E.

women io designing and provxiing comprebe”siVe s-xvicer .

X~~words: Abonion: Ccunsclirg; America: Ethics; ?@rsonal gr~th.

Latin

To support and svaIrin WWIPP rhrougb *he experience of tti- anted pregnancy and abortion. it is necessary to reviev, and reflect ott our basic understanding of pregnancy, both wanted and unwaoted, and the multiple effects that the abortion decisior. and experience have for the woman who goes through it. This essay argues that the experienx is likel:r to be more than a ‘matter of simply physical or eve” cmotior,al health. It reviews oar common df%irions of unwrnted pregnancy ZL”.Jabortion aAd ?hair effcc.z Q? YO~PII as whole persons :.nd s.*cia! beings; the political dimenkz of the abortion exoerience: and the need for new

When a wcman’s plans for her life include roles and actil:ities other than motherhood! or she does no, want chJdreo an4 therefore rejects prcgmmcy, t’len rhe term “o”\mG& pregnancy" i ; appropriate, as it is when preg nanny is the xesolt of rape. BW there are also other circumsraufi under wf~ich a wor:.au VW decide o I abortion. The decisio” to ““dergc abortion does not xspssariljj mean that a woma” is not kttcrestzd in motherhr,od. I” our work, we have frequerrtly found that a. prcgntincy sow unwanted ,,a~ very much w;\ntcd, ,r’en sough; at a” earlier stage; or that megnancy IS a desired state at some point bat has OCCL..ciat a time vhc” d;cum.itances comtme to make it ill- imcd. Some of the factors tilat may make a wanted pr,:gnancy ill-timed are: . Sudder!deat::~fthehusb~ndorv;~rtner: . Ftreak up of tbe CCW&. or -Lb&don:.lent by tht :>aitr.ei; i Scnoe3 iii”% C!’ :hp “.zxmm “! l-f :?a children, h Isband, mo!h@., or anyone importanttoordr pendentonher;

e Emotionalcrisisorseveredepresjion: u Lackofeconolr~cresourcesS Award of a scholarshin. or iob or other oppmunity;

e Problems with thr iaw, or many other eveuts that could uo: have been foreseen, or cannot be changed, and that substantially affect th:: -ornan’s life. Unt;i more precise termiao:ogy ;i found, a that a wonxin wants to interrum .ore~nancv vo!imt.a& should be understood clearly as ill-timed. cr unwanted.. or both. in order to insure ripportix coun&ug f& ritahle to the won\;n’s needs.

Abortiw has of& been narrowly cxceived or understood as a historical, demographic, mora!. legal. or nnblic health concern, F&n my &an&&t, ‘not all r ese approaches are valid, nor should Snq ::r.i.irtu&y sidusivr. Speaking ar a Litin American woman and feminist, abortim. is more than a matter of public he:tlth; more I; ?.n a slirgical operation, a moral issue or a siu; rwh: ihan a political cause; md more :h?n 1 right o: a health intexention that sionid be legalized or decriminalized. .%bortion is a multidimensiou6! 2nd highly complex human issue vith profound philosophic content. The vxawn is tha we have Learned to consider moth&o& .md ihe creation: of new life as the central element of human wisieuce. When knowledge about conception and th.: development of the evnbryo was less extensive, liie, motheri;rtnd, and abortion, and the emot;ouai repcrcuss+ons associated G& &s..., !zri differ:nt meaning. Modern western history ha: gradually attached particular values ts th:,e phenomena. In future, WhPn tn:: =a. uic n.ny not xdy hqin but aiso may develop outside the uterus, either in other Lindr of g!ed or in laboratories, perhaps our c.m ent concept ot abortion will be valued diikreutly, or will even disappear. Tine YXWSoi ;k scientisi, the !echni&r, or V->T health profesr,c~ml respon-

sibie for fertiliz-tion olay reign. Pxbaps then tha woman’s feeliny would CPSS to matter and they could be ignored, if they exist. ;or now, however, what happens in the pregnant wornau is fxdwmtal. aud her emotions, desires, indecision and fears should be the central concern. The characterist;cs which define us as a sex are a critical source of our personal identity. Thus, auythiag related to auf reproductive potential motherhood, menstruation, menopause, prekiumcy, neuvtxy. abcidun, miecrrriage dre zot events that -K approach with indifference or as purely health matters. Nor CBF abortion be Likened to an operation on ow appendix or tonsils. Pregnancy aud abortions impact on our idimaie feeliugs and sensibilities, touching hidden fibers far more deeply than auy pc~ticular conflicts or prsblems they may bring with them. Pregn;lwj and abortion change many women’s lives, or the way in which those women see their lives. Although abortion can give a woman respite and tremeudaus relief when performed under appropriate condit.ions, relief is not ncxxssarily its most important effxt. NO mzw how bcdkhl. i! is au expe&ucc :hat forces women te- &mlizc themselves. How thev do this. and with what consequences, depends on thk o&we of the abwrion .XpariellCC Abcitron ha a kaleidoscope of psycholo&. uuauces and interval dimensions. It -wX form part &the construction or reconstruction of the woman’s identity, and mw; therefore be ccusidereci with utmost EIU’C It is essential to grasp its complexity iu ord,; to forestail uegative coosequences from the emotional burden. Abonion, when seriously analyzed, can facilitate or advaux the pru;rss of acquiriug personal awareness and identity as few othv experiamtr can, over and above a wB;man’s doubts or ambiva!w:e abcxt bccomlng a mother. Fcr this reason, even women who approach the need for abortion with cIearsi#htednew ,md certainty, and who face nu morzl or Iegal reservations, experience

ab~xtion as something transcendent in the” fives, a responsible act thal must not be undertaken lightly. As unique events in a wom~lll’s life, the W”DliO”al dimensions of p1%“aKTf, motherhood and abortion may &ailen& and/Or women’s rzaffitm exis’ence. D=?pe”ding 0” the extent of tbr woman’s growth, they ca” enable her io mOve to hipher ievels of understamling rather like the “yeak expcrimces” 0?C Xaslow describe4 in his psyci;dogy of the human person 121. If approached correctly, abortion fzm te cxpeiieaced as a Of f”ltil:me”t. source transcendence, and prowth. Approached incorrectly, it sa” be a Iost opportlmitp or have short- or long-term conseuences that are damaging to women, or to their plaw ior their lives. It is only very rccent~ t3at we women have dared to examine ;1;:4 idcntifv how we reallv fee! aboot abortion and to make OUTopinion\ kno=” 9”biicly. Earlier, we t&4 to fit our feelings into the categories that were gwe” us, such &J medicine, law and morality. We htd whatever did not fit i”:o thesc categories in the belief that they were pathological reactions that only we experienced. Neither we nor me”, who cannot understand abovtion unless they have a spedd sensitivity to and knowledge of women, could grasp abonic.x in ail its dimei:sions. h, we women gradually gti” control over ourselves, our bodies, ooi sexwiity, our rights ;ind OUT freedom, we acquire a different understanding of fertility and abortion. We experience our reprodwtive system and or!w?s differentlv from the rest of our bodies, wd they Law more sipniticancr and impact. -4s a ie~xlt. hysterectomy, steriiiitio”, aboa.ion 2nd other such experiz”ces need 1, be approxched as complex de&ions. It is “ot enough for women to med%itl necessity or underrtar,d the appropriateness of sorb operatio”r; women most a”alyrr and understand the far-xaching emotiooai ipt?dpolitical dimensio”s c,f them. Mothcrbood. the oiinins of life. and atotio” have .been su&u”ded by myths,

CSfuscation and fear determined by a wide range of values. As a result, abortion is not simply the intexruptiou of a biological process b-d aiso a psychological evict invo!vi”g fe&“gs. fews and am&tier, of maoy kimIs, just as 3111 i”apprOpriar.5, ill-timed or anwanted ~~gwxy dces. Attention mttst 5e paid to all these dbnensions rhf both abortion aad ill-timed or unwanted pmgnaocy.

Women’s stn%&e to zxhieve freedom of choice goes beyond the sphere of biology or health into that of tights and politics, because of the status assigned to us historically and preferentiaily a* reproductive agents Abortion is the m.ist &My subversive thing that VP: woxtw” can do for several reasons. About 3% of the world’s population live in axarries -here abortion is prohibited or legally restricted, w‘bich means women vho dwide TV abort go aga&st powerful conventions [I!. T!K decision to abort COEtlicts with allegedly widespread values regarding the purposr: of life, women’s maternal function, and the perpetuatioi: of humankind. It can be liberathlg for women -as individuals n: :ogetber - to decide whether gestation should continue. but such !iberagnon mq I;c fiez-rxy oppszi. Ever. ‘zheo aborti.on is le~xii~ XKI s~&!ly ;ix@ed, services rray be dsrcrmi~e4 by those in pow-~ - ttoctors or government a”thorities - ra:ber than women rhe;,,s;:ves unless we women gai” sufficient power to participate in deteminin~ th5 kinds and quality of services we realty need. Gaining the tight to irecdom of chvice is a oolitiCa: isstie of tiemeadous mtpottance for the female popuLti~ in ndturcs dominated by maswline ideoloopi.;sad distrust of wornen’s capacity to manage their own de.stini~s. Where the rigb? to &edom of choice ‘:, motherhood id not respected, juristr, moralists artnddocurs cnuociate a”d control corxqrs, opi,liocs: and discussion< zb,our illtimed or unwI - 2~’ pregnancy md abortioo.

Civcn the changing tides of history, it has been an advance for abortion to be defined as a hralth problem and to have been rescued from do&‘&on by moral precepts. We must go further, however. Rather then fearing and distrusting women’s feeiings, both women and men ueed to recognize that these f%elings are ths- most r&able guide’ in deciding whethei 3r not to be?ome mothers. Thomas Bcasz has said: “Abotticn on medical of psychiatric grounds. 3” opposed to voluntary abortion, makes doctors and psychiatrists responsible for d&ding whether or not a physiological and sexuel chain reaction that began with the sexual act end cuiminates in childbirth must be iuterruoted. instead of _ entrusting that responsibility to adult citizens who are masters [I would sr, mistresses] of their own destiny [4] .” 3 the Latin American political context, those in power have been hostile to !vomen’s rights es “mistresses of their own destiny.” hostility This prevents from them iulderstanding women’s situation. objectively, attaching impwtance to it, and helping provide appropriate solutions to their probl:ms. :t may also reflect fear of allowing women the decision whether or not to procreate, a decision that carries tremendour pov+S. The age-old, senseless distrust of women, combined with envy of women’s biological con?101 over reproduction, have xsulted in punitive legislation, social norms and emotional pressures to prevent us from controlling our fecundity in the manner we consider correct. Were it not for such repression, perhaps the world’s population would be more balanced! Were abortion no longer considered a dissident act with far-reaching poiiticzii connotatio~ir, in Latin America, women who abort would be spared the loneliness and guilt now imposed on them. Feminism’s struggle to rescue women’s II& :o control their own bodies and lives is essential. We camot allow decisions about this to be made without us. It is our task to help transform prejudice-ridden institutions

end prof&onal attitudes. Our struggle must go beyond ctforts to legalize or dr&nmalize abortion or to provide medically safe services. The abortion decision and experience mwt include oppcrtunity and support for reflection bccars: of all the conseqwxes it entails. The ceaimal importance of cows&tg the far-reaching and Given social emotional roots of abortion, “... the situation requires drastic changes in our objectives, values and conduct and in the principles governing our lives” [3]. Society does not yet prepare women to handle illtimed or unwanted pregnancy. Rather it is almost always ignored as if it were such a closely guarded Secret that it must remain in the closet. So long as this is the case, careful psychological counseling is essential. Counseling must help a woman understand and handle not only the technical aspects of abortion, but also abort& as an act of selfaffirmation, and as a complex decision that goes against both social norms and an abstract preaise that favors life. The conflicts, ambivalerpe and fears a woman choosing to abort experiences are as debilitating as physical effects. Services must therefore create an oDportuuity to explore as widely as possible the psychological risks and the life potential of the woman. Thus supported, the woman can begin to discover for herself the intema! world involved in the experience, whose existence she often does not even suspect. The professionals who zre involved in services must feel with us and understand or at least respect our indecision, our fears and our internal contradictions. All of us know that the medical and DsYcholoEica! risks arisina from abortion & avoidable and it G therefore unforgivable not to deal with them. Expanding our undersranding of the multiple dimensions of the abortion experience will help to demystify it. Such understanding will take from it the elements that make it a

tortured so&i and personal issue, without mininGing it or oversimp!ifying it. if, in a moment of psychological vulnerabiljty such as that caused by unwanted or ill-timed pregnancy and abortion, women rePec% adequately on the evect and receive counseling, the result may be to help them ‘;row, efihance their ability to choose other behavior voluntarily, and to begin to acquire greater confidence in their own decisions. Wben we women make informed and thoughtful choices and run risks in the economic, academic or employment spheres but do not dare to do :o in our sexual and reproductive lives, we make ourselves vulnerable to manipulation. When we choose but do not realize the value of our choice, we waste a valuable ‘. -perience that would help us to reinforce tJr owfi self-esteem. In undertaking this p,ocess of reflection, we can b:eak the ties which bind us unreasonably. painfully o* illogicatly to cultural traditions. Those of us women who have had the abortion experience, or wno have had the experience of serving other women, know thic verjj well. When guidance is available from a sincere, knowledgeable and experienced counseior, the feelings and emotions aroused by abortion make it possible to begin or advance personal changes in a very short time. The counseling cannot therefore be simplv a set of questions or a session to persuade her to use contraceptives o: to siay quiet during the operation to avoid annoying the doctor. It is nit meaut :o anesthetize her abilhy to EXPXSSherself. Rather. it is a P~OECSS in which she can confront herself and her situation, a p~occss which, from my fer._li:t standpoint and from my c ~erience, has a definite political content. The whole person Services should be organized according to the needs and wishes of the women who are to use them. We must not reproduce the errors typical in the area of family planning where,

for i?staoce. information about contraceptioa haa been divorced from sex education contrary to the realities of people’s lives. Similarly public campaigns that ad .ocdte the benefits of contraception by dramatizing or condemning aborticn, damage both individual rights and tbe so&l good and should be discorraged. To ~-UL abortion simply 8s a matte1 of public health requiring safe medical conditions prevents us from dealing wirb i: properly. An attempt must be made to mxjeistand the extstential dimension of abonion which means, among other things. that the expression of fear 07 anxiety it GoLses must no: be interpreted as ambivalence or a vestige of moral vzlues. The conflicts, problems or anxiety associated with interruption of pregnancy dc not concern only its obvious necessity - there are other, often mixed, emotions present. In x&es where abortion senices are introduced without the oolitical and educational component (e.g. ‘Cuba), myths aw:+ motherhood and WO~~IL’Sreproductive d _stiny persist, together with a high level of wchismo and lack of understanding of the ‘;:male condition. Rather our obiectiy:e stould be to advance beneficial so& aad personal c:%3uges. The imp.wt the abortion experiexe has depends on L’ICstage the woman has ieachei in her persond developvent. Women who ha-w liot begun to qzsdon anything are in a “backward” pAtion but, with strong counseling, feel hater and more relaxed, with a greater awweness of their situation and more possibiliii.x for formulatiog opinions. When a woman is a totally active particiyant in he; wm reality, her personal growth progresses ihrough the abortion experience. She acquires the ability to criticize psychiatric approaches or moral premises which might disconcert her and make her believe, erroneously, that abortion necessarily leads to a lot of problems. Major changes are possible in the lives of v;omen when they recognize that they are

mistresses of their own reproductive choice and wher: they overcome an edncation which has pr:vcr,ted them from taking decisions, allegedly for the benefit of others. When women ax transformed internally by revising and overcoming the myths abxt motherhood and abortion, the changes will soott be visible socta!!y. Conclusion I am committed to this problem and I hope that many other womett will be also. Any struggle that seeks to make our lives casi~r, reduce our misfortunes or make us happier is worth the effort. To achieve this, we women must ignore generally discriminatory codes and laws. If we were not present before, let us try not to be absent in filture whw it comes to rezo!ving situations such as ill-timed or

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