~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The differential
treatment of a minor’s decision to have an abortion and a minor’s decision to
relinquish parental rights and consent to adoption is striking. Are the decisions so dissimilar as to justify
this difference? Three reasons are
commonly given for why minors should not be making the decision about abortion
on their own: 1) health risks associated
with all medical procedures, including abortion; 2) emotional fallout after
abortion; and 3) the seriousness of the decision. The decision about relinquishment of parental
rights and consent to adoption seem to share these characteristics with the
abortion decision.
2. Emotional Health & Wellbeing
a. Abortion
In H. L. v.
Matheson,[20]the
Court justified parental notification by arguing that "[t]he . . . emotional and psychological consequences of
an abortion are serious and can be lasting; this is particularly so when the
patient is immature.”[21] Some
studies do, indeed, support the proposition that minors’ reactions after
abortion differ from adults’ reactions.[22] For
example, younger women are more likely to feel guilt instead of relief after an
abortion,[23]
and increased feelings of guilt and depression for younger women persisted 24 hours,
6 weeks, and 6 months post-abortion.[24] Two to three months after abortion, younger
women were more likely to experience shame, guilt, fear of disapproval, regret,
anxiety, depression, doubt, and anger than older women.[25] Some
of those reactions from women under age 20 included more nightmares and sleep
disruptions, and more suicide attempts post-abortion than women over 20 at the
time of abortion.[26] Another study, of women selected from a
post-abortion support group for those experiencing difficulties, reported that
adolescents were more likely to "feel forced by circumstances to have the
abortion," and reported greater severity of psychological stress.[27]
In a study specifically
designed to test the Supreme Court’s premise that minors are particularly
susceptible to psychological distress following abortion, researchers found
differences between the reactions of minors and adults one month following
abortion, but no differences two years after abortion.[28] The study tested for depression,[29]
decision satisfaction,[30]
benefit-harm appraisals,[31]
and specific emotions related to the abortion.[32] Additionally, the study asked respondents two
years after abortion (but not one month following the abortion), if they had
the decision to do over again under the same circumstances that existed two
years ago, whether they would make the same decision to have the abortion.[33]
The results of the
study showed no difference between adolescents and adults on measurements of
depression or specific emotions related to the abortion one month following
abortion.[34]
However, the study revealed statistically significant differences between
minors and adults on decision satisfaction and benefit-harm appraisal one month
following abortion.[35]
At the two-month follow-up, those differences had disappeared, with no
significant difference between adults and minors on any factor.[36]
b. Adoption
While the majority of birth parents report
general satisfaction from their adoption decision, a significant portion
experience long-term psychological symptoms, as well as psychological symptoms pre-relinquishment
and immediately after placement.[37]
During the pre-relinquishment period, a mother experiences emotional issues in
adjusting to pregnancy, as well as difficulties in making complex decisions
regarding relinquishment.[38] Mothers considering relinquishment report
“conflicting feelings of shame, pride, desolation, excitement, fear, terror,
and denial,” which can be overwhelming and disruptive.[39]
In the
period immediately following relinquishment,[40]
birth mothers report that relinquishment brings “a powerful sense of loss and
isolation.”[41] Birth mothers reported traumatic dreams,
sleep disruption, and “a sense that the experience is surreal.”[42]
One study reported that 55% of birth mothers found signing the adoption papers
to be “one of the most difficult parts of the adoption process,” and 65% of
birth mothers six months after birth reported feeling grief.[43]
In comparing adolescents who chose to parent and those who chose to relinquish
for adoption, those who relinquished were less comfortable with their decision
than those who parented.[44] In one study of birth mothers who returned to
school after relinquishment, researchers found that the negative emotions felt
by birth mothers adversely affected school performance. [45] The birth mothers who experienced the most
deterioration in school performance were preoccupied with grief and regret
concerning the adoption decision and thought recurrently about their personal
loss. The majority of birth mothers
expressed negative future expectations, expecting the future to be a
continuation of the bleakness they currently experienced.[46] The feelings interfered with motivation, and
thus, negatively affected school performance. “The greatest deterioration in
school performance was noted when birth-mothers felt there was nothing to live
for.”[47]
Birth
mothers also experience long-term effects[48]
of adoption relinquishment on emotions and well-being.[49] While some researchers report feelings of
satisfaction by birth mothers four years after birth, and positive outcomes on
some socio-demographic and social psychological outcomes,[50]
most also experience continuing grief and loss.[51]
Long-term effects include ongoing depression, shame and negative self-image.[52]
Birth mothers report feeling unloveable.[53]
These feelings can cause birth mothers future difficulties in attaching to
romantic partners and subsequent children.[54] Issues
with future parenting include “intense attachment to and overprotection of
children born to and raised by birthmothers after the placement of a child for
adoption.”[55]
Birth mothers who kept the adoption relinquishment a secret feared that others
would reject them if the secret were discovered.[56] Birth
mothers experienced what one researcher calls the “psychological presence” of
the relinquished child, discrediting the frequently-asserted notion that birth
mothers would forget about the relinquishment experience and continue on their
pre-pregnancy life trajectory.[57] Birth mothers also experience a higher rate
of secondary infertility than the population at large, and many have no other
children.[58]
In one study, the majority of birth mothers reported “no decrease in feelings
of sadness, anger, and guilt since their relinquishment up to 30 years
[before].”[59]
[20] 450 U.S. 398 (1981).
[21] 450 U.S. at 411, citing Wallerstein, Kurtz, & Bar-Din, Psychosocial Sequelae of Therapeutic Abortion
in Young Unmarried Women, 27 Arch.
Gen. Psychiatry 828 (1972)(“The emotional and psychological effects of
the pregnancy and abortion experience are markedly more severe in girls under
18 than in adults.”); Babikian &
Goldman, A Study in Teen-Age Pregnancy,
128 Am. J. Psychiatry 755 (1971).
[22] See Wanda Franz & David Reardon, Differential Impact of Abortion on
Adolescents and Adults, 27 Adolescence
161, 163 (1992) (citing Sherry L. Hatcher, Understanding
Adolescent Pregnancy and Abortion, 3 Primary
Care 407, 410 (1976)); Brenda Major & Catherine Cozzarelli, Psychosocial Predictors of Adjustment to
Abortion, 48 Law. & Hum. Behav.
121, 137-38 (1992) (suggesting that ability to effectively cope with abortion
is linked with self-efficacy which may be undermined "by younger age and
correspondingly fewer resources"); Sharon D. White & Richard R.
DeBlassie, Adolescent Sexual Behavior,
27 Adolescence 183 (1992)
(explaining that abortion can result in medical and psychological problems,
especially for the immature teenager); Anne C. Speckhard & Vincent M. Rue, Postabortion Syndrome: An Emerging Public
Health Concern, 48 J. Soc. Issues
95, 97 (1992). But see R.C. Alter, Abortion Outcome as a Function of Sex-Role Identification, 8 Psych. Women Q.
211 (1984) (age not a significant predictor of post-abortion anxiety,
depression or hostility); L. Cohen & S. Roth, Coping With Abortion, 10 J. Human Stress 140 (1984) (5 weeks
post-abortion, no significant relationship between age and anxiety, depression,
or hostility); D.T. Moseley, D.R. Follingstad, H. Harley & R.V. Heckel, Psychological Factors that Predict Reaction
to Abortion, 37 J. Clinical Psych.
276 (1981)(in recovery room, no significant correlation between age and
post-abortion hostility, depression, or anxiety); J.D. Osofsky & H.J.
Osofsky, The Psychological Reaction of
Patients to Legalized Abortion, 42 Am. J.
Orthopsych. 48 (1972)(age and guilt over the abortion not
statistically significantly related).
[23] J.D. Osofsky, H.J. Osofsky & R. Rajan, R., Psychological Effects of Abortion: With Emphasis Upon Immediate
Reactions and Follow-up 188 in The
abortion experience (Osofsky & Osofsky, eds. 1971).
[24]E.C. Payne, A.R. Kravitz,
M.T. Notman & J.V. Anderson, Outcome
Following Therapeutic Abortion. 33 Archives
of General Psychiatry 725 (1976).
See also M.B. Bracken, M.Hachamovitch & G. Grossman, The Decision to Abort and Psychological
Sequelae, 158 J. Nervous & Mental
Disease 154 (1974).
[25] N.E. Adler, Emotional Responses of Women Following Therapeutic
Abortion. 45 Am. J. Orthopsych.
446 (1975).
[26] See Nancy B. Campbell,
Kathleen Franco & Stephen Jurs, Abortion
in Adolescence, 23 Adolescence
813, 819 (1988).
[27] See Wanda Franz &
David Reardon, Differential Impact of
Abortion on Adolescents and Adults, 27 ADOLESCENCE
161, 163 (1992). The selection of
study subjects from a group already seeking help makes the sample biased, which
may make it difficult to assess how many adolescents suffer negative
psychological effects from abortion and how many do not, the study does offer
important information about differences between the reactions of adolescents
and adults. And for comparison purposes,
it is important to note that the empirical data about women who have emotional
difficulties following adoption suffer from the same sampling bias. See supra,
n. 179.
[28] See Wendy J. Quinton
& Brenda Major, Adolescents and
Adjustment to Abortion: Are Minors at
Greater Risk?, 7 Psych. Pub. Pol.
& L. 491 (2001).
[29] Id. at 498, asking how
much six depressive symptoms bothered study participants since having the
abortion.
[30] Id., asking “All in all,
how do you feel about your decision to have an abortion?” Respondents answered
on a scale of 1 (“it was definitely the wrong decision”) to 5 (“it was
definitely the right decision”).
[31] Id. at 498-99, asking,
harm-based questions one-month following the abortion, respondents to answer on
a 5-point strongly-agree to strongly-disagree scale to “I feel stressed about
having had this abortion;” “I think this abortion has had a negative effect on
me;” and “I feel this abortion has had harmful (or bad) consequences for
me.” At the two-year appraisal, the
first question was replaced with: “I feel my life is worse today because I had
the abortion.” Benefit questions were asked, using the same
strongly-agree/strongly-disagree scale: “I think the abortion has had a
positive (good) effect on me;” “I have become a stronger person because of
having had the abortion;” and “I have grown as a person from the experience.”
[32] Id. at 499, respondents
were asked about emotions specific to the abortion experience: happy, satisfied, good, pleased, contented,
sorry, sad, guilty, grief, regret, feelings of loss, blue, low, angry at
myself, angry at someone else, disappointed with myself, and relieved. Respondents were asked to answer on a 5-point
scale from 1 (not at all) to 5 (a great deal).
[33] Id. at 499. Again, respondents were asked to answer on a
5-point scale from 1 (definitely no) to 5 (definitely yes.).
[34] Id. at 501.
[35] Id.
[36] Id.
[37] Mary O’Leary Wiley &
Amanda Baden, Birth Parents in
Adoption: Research, Practice, and
Counseling Psychology, 33 The
Counseling Psychologist 13, 15 (2005).
[38] Id. at 16.
[39] Id. See also Linda Theron
& Nadine Dunn, Coping Strategies for
Adolescent Birth-Mothers Who Return to School Following Adoption, 26 South Africa J. Ed. 491 (2006).
[40] Defined in the
psychological literature as the first two years following relinquishment. Id. at 26.
[41] Wiley & Baden at 26,
citing A. Brodzinsky, Surrendering an
Infant for Adoption: The Birthmother
Experience in The Psychology of
Adoption (A. Brodzinsky & M. Schechter, eds. 1990).
[42] Wiley & Baden at 26.
[43] Id. at 27, citing L.F.
Cushman, D. Kalmuss & P.B. Namerow, Placing
an Infant for Adoption: The Experience
of Young Birth Mothers, 38 Social
Work 264 (1993).
[44] D. Kalmuss, P.B. Namerow,
& U. Bauer, Short-term Consequences
of Parenting Versus Adoption Among Young Unmarried Women, 54 Journal of Marriage and the Family 80
(1992).But see S.D. McLaughlin, S. Pearce, D.L. Manninen & L.D. Winges, To Parent or Relinquish: Consequences For
Adolescent Mothers, 33 Social Work
320 (1988)(no significant difference in psychological outcomes for adolescents
who placed and adolescents who parented).
[45] Theron & Dunn at 495.
[46] Id. at 496. See also Wiley & Baden at 26, noting that
birth mothers consistently report that their hope to be able to “get on with
their life” doesn’t reach fruition,” citing A. Brodzinsky, Surrendering an Infant for Adoption:
The Birthmother Experience in
The Psychology of Adoption (A. Brodzinsky & M. Schechter, eds. 1990)
& A.D. Sorosky, A. Baran, & R. Pannor, The Effects of Sealed Record in Adoption, 133 Am. J. Psych. 900 (1976).
[47] Theron & Dunn at 497.
[48] From two years
post-placement.
[49] Wiley & Baden note
that research on the long-term effects of adoption relinquishment tend to be
based on self-selecting samples or samples from birth mothers seeking
treatment. Wiley & Baden at 30. Because of this sampling bias, “No data were
found in either the clinical or empirical literature on birth parents that
suggest that birth parents cope well with their decision to relinquish.” Id.
While this sampling bias may make it difficult to assess how many birth
parents suffer long-term effects and how many do not, the studies do offer
important information about negative effects that birth mothers may experience
long-term. And for comparison purposes,
it is important to note that the empirical data about women who have emotional
difficulties following abortion suffer from the same sampling bias.
[50] P.B. Namerow, D. Kalmuss
& L.F. Cushman, The Consequences of
Placing Versus Parenting Among Young Unmarried Women, 25 Marriage & Fam. Rev. 175 (1997).
[51] Wiley & Baden at 29;
A.D. Sorosky, A. Baran & R. Pannor, Adopted
Children in Clinical Child Psychology
(D. Cantwell & P. Tanguay, eds. 1978).
[52] G.M. Burnell & M.A.
Norfleet, Women Who Place Their Infants
Up for Adoption: A Pilot Study, 16 Patient Counseling & Health Ed. 169
(1979); R. Winkler & M. Van Keppel, Relinquishing
Mothers in Adoption: Their Long-Term Adjustment, Institute of Family
Studies (Melbourne, Australia) Monograph No. 3 (1984).
[53] Wiley & Baden at 29.
[54] Id. at 29-30.
[55] Cinda L. Christian, Ruth
G. McRoy, Harold D. Grotevant, Chalandra M. Bryant, Grief Resolution of Birthmothers in Confidential, Time-Limited
Mediated, Ongoing Mediated, and Fully Disclosed Adoptions, 1 Adoption Quarterly 35, 39 (1997), citing
E. Rynearson, Relinquishment and its
Maternal Complications: A Preliminary Study, 139 Am. J. Psych. 338 (1982).
[56] Wiley & Baden at 30.
Secrecy about the adoption, and the lack of opportunity to express feelings
about the adoption, correlate strongly with unresolved grief, guilt and shame
about the adoption placement. M.
DeSimone, Birth Mother Loss: Contributing
Factors to Unresolved Grief, 24 Clinical
Social Work J. 65 (1996).
[57] D.L. Fravel, R.G. McRoy
& H.D. Grotevant, Birthmother
Perceptions of the Psychologically Present Adopted Child: Adoption Openness and
Boundary Ambiguity, 49 Family
Relations 425 (2000).
[58] M.J. Carr, Birthmothers and Subsequent Children: The Role
of Personality Traits and Attachment History, 9 J. Soc. Distress & the Homeless 339 (2000); M. DeSimone,
Birth Mother Loss: Contributing Factors
to Unresolved Grief, 24 Clinical
Social Work J. 65 (1996); E.Y. Deykin, L. Campbell & P. Patti, The Postadoption Experience of Surrendering
Parents, 54 Am. J. Orthopsych.
271 (1984).
[59] Wiley & Baden at 31,
citing J.T. Condon, Psychological
Disability in Women Who Relinquish a Baby for Adoption, 144 Med. J. Australia 117 (1986).
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