Sheets bijeenkomst 14 mei 2004
Wetenschappelijke situatie

1987: frustration at the limitations of the data and the poor methodology of those
studies available1
-

subjectief vs psychometric measurement
‘Research to date has not focused on psychometric measurement but instead
has relied almost entirely upon subjective reactions’2
1992: there is now virtually no disagreement among researchers that some woman
experience negative psychological reactions postabortion. Instead, the
disagreement concerns the following3:
 the prevalence of woman who have these experiences
 the severity of these negative reactions
 the definition of what severity of negative reactions constitutes a
public health or mental health problem
 the classification of severe problems
 Hoe komt dit?
Wetenschappelijke moeilijkheden
Among other complications4:
1. The cooperation of the study population is inconsistent and unreliable
2. The variety of negative reactions reported by women is so broad that it is
impossible to encompass every claimed dysfunction in a single study
3. The intensity of many reactions appears to be time variant, with many women
reporting delayed reactions
4. The use of questionnaires and other standardized survey instruments may be
inadequate for uncovering deep-seated reactions
1
Rue et al., 1987, 16
Barnard, 1991 15
3 Wilmoth, 1992 in Reardon, 1997 34
4 Reardon, 1997 34
2
Ad 1: inconsistent and unreliable study population

Bias (attrition)
Various studies have shown that women for whom the abortion was more stressful
are less likely to participate in a study5; ‘women who are more likely to find the
abortion experience stressful may be underrepresented in volunteer samples’ 6
(Of the random sample of 984 woman who had abortions during 1984-1986
Baltimore, Maryland metropolitan, only 160 could be contacted 3-5 years later and
only 80 completed and returned the questionnaire)7
Causes:
- Repression, Shame, Grief
Bij abortus blijkt responspercentage heel laag te zijn. Verklaring in de
literatuur: vrouwen willen liever niet aan herinnerd worden8
‘Of the 114 women, 11 refused to participate because ‘they feared the
interview would stir up painful memories’ = 12%!9

Concealment
In longitudinal and retrospective studies, approximately 50% of women who have
had an abortion will conceal their pas abortion(s) from interviewers. Even in shortterm follow-up studies, there are high sample attrition rates, typically in the range of
20 to 60%10
Validiteit: hebben de antwoorden die je krijgt betrekking op de werkelijkheid?

Social desirability
1993: Religie en Abortus (L.G.M. Spruit): meer dan de helft van de Nederlanders
staan op levensbeschouwelijke gronden afwijzend tegenover abortus
Rekening gehouden met feit dat onze mij de verdringing van deze gevoelens van
(vaak existentieel ervaren) schuld in de hand werkt en dat als deze gevoelens
verdrongen zijn, dat ze dan in een interview met een wildvreemde niet zo
gemakkelijk geuit zullen worden?11
5
Adler, 1976 in AIRVSC, 1991, 15
Adler et al, 1990 in Speckhard & Rue, 1992, p.97 9; Rue et al., 1987 16
7 AIRVSC, 1991, 15
8 Van Luijn in verslag studiedag VBOK, 1993 29
9 Sachdev, 1993 in McGovern, 1993 6
10 Reardon, 1997 34
11 Studiedag VBOK, 1993 29
6
Ad 2: variety of negative reactions

Multiple symptoms
Tot nu toe in literatuur 40 tot 50 soorten negatieve psychische reacties op abortus
gevonden. Exclusief sociale en lichamelijke gevolgen.
‘it appears likely that women experience a wide variety of psychological reactions to
abortion’12

Classification
e.g. “I am extremely depressed and emotionally upset”, one young woman told Prof. Sachdev.
“I am sad and on the verge of tears right now because of having the abortion. I don’t feel
unhappy for ending a life. I don’t condemn myself. I know I can start another life if I want to; I
can go sleep with my boyfriend right now and get pregnant again. I’m sad that the whole thing
had to have happened and that George had to go through with this. I still feel depressed and
cry a lot, not for having an abortion, but for having to have one…
Prof. Sachdev’s diagnosis: Her depression was not related to the fact that she had
her pregnancy terminated. Turning to his table entitled Degrees of Guilt or
Depressive Reactions as Reported by Seventy Women, Prof. Sachdev marked the
young woman under the subtitle ‘none’13.
Meetinstrumenten verschillend. De een noemt het een depressie, de ander niet. De
een meet depressie of depressieve gevoelens met behulp van uitgebreide
bestaande meetinstrumenten, schalen of hele vragenlijsten waar waar kruisjes
gezet moeten worden. Andere onderzoekers stellen enkele open vragen over
depressieve gevoelens14.
Ad 3: time variance of intensity reactions
‘This pattern of delayed reaction has made it much more difficult to measure, evaluate,
and define the problem’15.
12
Reardon, 1997 34
Sachdev, 1993 in McGovern, 1993 6
14 Van Luijn in verslag studiedag VBOK, 1993 29; Reardon, 1993 34
15 Franz, 1987 VII
13
Ad 4: inadequate research tools
-
Reardon: the effectiveness of standardized questionnaires has also been called into
doubt, since these research instrument may be inadequate for uncovering
repressed feelings16
-
Kent: an initial reaction of emotional numbness may distort questionnaire based
studies. He concluded that an underlying sense of loss and pain can only be reliably
identified in a clinical setting17
-
Petersen: diepte interviews18
-
Glas: is onderzoek (NISSO) is in wetenschappelijke zin representatief, want
wetenschappelijk aangepakt, maar is het ook representatief voor de toestand van
de cliënt?19
(Ad)5: oorzaak-gevolg
Is abortus gevolg van oorzaak stress/depressie, of stress/depressie gevolg van oorzaak
abortus, of gevolg van oorzaak ongewenst zwangerzijn, of is ongewenst zwangerzijn
gevolg van stress/depressie, etc.
Opmerking
Goed onderzoek probeert te achterhalen waarom vrouwen niet meedoen. Is bij NISSO
onderzoek vrijwel niet bekend. Bij onderzoek naar ap-gevolgen echter WEL van belang!
Vrouwen die wel meedoen een selectieve groep.
Conclusion
Furthermore, great care should be taken to avoid overgeneralizing findings or advocating a
"majority rules" perspective. As an example of the latter, research reports showing that 15
to 20 percent of abortion patients experience certain negative reactions have been
reported in the media as proof of the "fact" that "the majority of abortion patients" benefit
from abortion or that "post-abortion trauma does not exist". Such interpretations improperly
dismiss the suffering of the minority, neglect the limitations of the study population and
methodology, and project the unsubstantiated conclusion that women who do not complain
of a specific symptom within the time frame of a study must necessarily have benefited
from their abortions.
16
Reardon, 1997 34
Kent, 1981 in Reardon, 1997 34
18 Petersen, 1987 31
19
Glas in verslag van studiedag VBOK, 1993 29
17