Men's experience of elective abortion: a mixed methods study of loss.(Report)

Abstract

A mixed methods approach was utilized to investigate men's experience of their partners' elective abortions. Data were collected through in-depth, semi-structured interviews and men were evaluated for occurrence and degree of anxiety, anger, and grief using clinical measures. Male participants were found to demonstrate clinical levels of anxiety, higher than normative anger scores, and greater levels of grief than men who experienced involuntary pregnancy loss. The primary meaning ascribed by the men to abortion was profound loss. Men experienced multiple losses following abortion that were associated with relationship difficulties, helplessness, grief, and guilt.

Key Words: men and abortion, men and pregnancy loss, male partners and elective abortion, psychological distress

Introduction

The purpose of this mixed methods study was to explore and assess men's reactions to their partners' elective abortions by converging qualitative data obtained through interviews with quantitative data obtained from clinical assessment instruments. The rationale for using a mixed methods approach was to enable investigators to triangulate results obtained (Denzin, 1978) and to use methods which would complement or offset each other's weaknesses (Creswell, Plano Clark, Guttmann & Hanson, 2003; Greene & Caracelli, 1997; Jick, 1979). Furthermore, the use of mixed methods may facilitate the development of inferences that confirm one another (Greene, Caracelli & Graham, 1989), thereby strengthening the validity of conclusions.

While a good deal of research has been published concerning women's mental health and abortion (see Coleman, Reardon, Strahan, and Cougle, 2005 for a comprehensive review), few studies have focused on male responses to abortion. A review of the limited research pertaining to men (Coyle, 2007), revealed the following commonalities: 1) abortion is not perceived by men to be a benign experience, 2) an expressed need or desire for post-abortion counseling is not unusual among male partners of women undergoing elective abortion, 3) ambivalent and painful emotions may be experienced by men after abortion, 4) the abortion decision is often deferred to female partners with concomitant repression of men's own emotions as containment of emotion is viewed as consistent with men's perceived role as one of support, and 5) relationships may be stressed by abortion.

Review of the Literature

Psychological Reactions to Abortion

Based on interviews with 50 men in abortion-clinic waiting rooms and with 100 more men in a subsequent study, Shostak (1979; 1983) found that 72-75% of the men disagreed when asked "if males generally have an easy time of it, and have few, if any, lingering disturbing thoughts" about the abortion (Shostak, 1979, p. 571). In the largest study done to date on men and abortion (N=1000 males at 30 abortion clinics), Shostak & McLouth (1984) noted that abortion was perceived by men as a "death experience" and one that is more emotionally trying than expected. Another reported consequence of abortion was the persistence of occasional thoughts about the fetus among 75 post-abortion men interviewed by Shostak and McLouth (1984). Less than one-third (31%) of the men reported having no thoughts about the fetus and 9% reported having frequent thoughts. Given that the vast majority of participants in these studies were surveyed on the day of abortion, findings are not particularly informative concerning the long-term effects of abortion on men. Furthermore, participants were not interviewed in depth to ascertain their perceived meanings of abortion nor were they assessed using clinical measures with established validity and reliability.

One of the few studies that did explore the effects of abortion over time was that by Buchanan and Robbins (1990) who investigated the consequences of adolescent pregnancy and its resolution in adulthood. As hypothesized, the psychological distress scores were lowest among those adult males who had never experienced an adolescent pregnancy. However, an unexpected finding was that men whose partners had abortions during adolescence were more distressed in adulthood than the men who became fathers during adolescence. While this study found evidence of long-term psychological stress among men whose partners had abortions, the researchers assessed general psychological distress rather than specific emotional outcomes.

Others (Gordon & Kilpatrick, 1977; Shostak & McLouth, 1984; Speckhard & Rue, 1992) have identified specific emotional reactions to abortion among men including anxiety, guilt, regret, confusion regarding responsibility, sadness, a sense of loss, and perceived threats to masculine identity. In a case study of a post-abortion male, Holmes (2004) proposed that, following abortion: "some men may relive traumatic childhood experiences and struggle with hopes and fears for families of their own" (p. 115). Still another case study (Robson, 2002) described psychological stress in a male who accompanied his partner during the entire abortion procedure. Subsequent to the experience, the man suffered from traumatic symptoms involving re-experiencing the event. Similarly, Lauzon, Roger-Achim, Achim and Boyer (2000) noted that 21.3% of those men who remained with their partners during the abortion procedure described it as a traumatizing experience.

Ambivalence

Men's responses to abortion may reflect society's considerable ambivalence on this topic. Shostak and McLouth (1984) noted that: "many men discovered they somehow agreed with two opposing positions. While 39% believed the fetus was a human life, and 26% felt that abortion was the killing of a child, 83% did not want abortion outlawed" (p. 38). In fact, "only 15% believed the fetus was not human until birth and ... as many as 60% were troubled by the irrevocable ending of the life they had helped set in motion" (p. 162). Ambivalent reactions among men following abortion have also been reported by others (Kero & Lalos, 2000). Kero and colleagues (1999) found that more than half of the men they studied "chose both positively and painfully charged words to describe their feelings in connection with abortion. Abortion as a solution to the problem of an unwanted pregnancy was expressed in such words as relief, release and responsibility but simultaneously the consequences of the choice were expressed in such words as anxiety, anguish, grief, and guilt" (p. 2674). In a follow-up study, Kero and Lalos (2004) observed that even among men who described themselves as satisfied with the decision to abort, many concurrently "expressed contradictory feelings in relation to the abortion both before, and 4 months and 1 year after," (p. 141).

Men's Perceived Role

Gordon and Kilpatrick (1977) reported that many of the men accompanying women to an abortion clinic "said they did not express their feelings to their partners and instead felt the need to be a source of support by presenting a strong front" (p. 293). This desire to support their partners by suppressing their own emotions was also observed by Shostak and McLouth (1984) who noted: "the typical man rushes to placate his partner, repress his emotions, and take his cues from an environment that others structure for him" (p. 22). Patterson (1982) corroborated this observation and found that 77% of the men present at an abortion clinic believed that the most valuable way they could help their partners was by maintaining control over their own emotions.

Those who have studied the male reaction to involuntary pregnancy loss due to miscarriage have also observed a tendency among men to assume roles of support and protection (Puddifoot & Johnson, 1997). Murphy (1998) concurred and found that "for men ... there is an expectation that they should be stronger and tougher in order to support their partner and have no need to grieve or share their feelings," (p. 329). Likewise, McCreight (2004) observed that men "confirmed the importance of having to be strong for their partner," (p. 345).

In addition to not expressing themselves to their partners, there is evidence that men are unlikely to share their abortion experience with others (Reich & Brindis, 2006; White-van Mourik, Connor & Ferguson-Smith, 1992). White can-Mourik and colleagues suggested that "58% of the men were potentially at risk of prolonged or unresolved grief" as they did not "discuss their feelings or complaints with anyone," (p. 200).

Relationship Stress

The failure rate of relationships after abortion has been reported to be from 25% (Shostak & McLouth, 1984) to 70% (Milling, 1975). Mattinson (1985) observed the following effects of abortion on marriage: inability to conceive, emotional withdrawl, sexual and interpersonal conflicts, and a loss of trust. Sexual difficulties, such as impotence, have also been reported to occur after abortion (Mattinson, 1985; Rothstein, 1977; White van-Mourik et al., 1992).

The process of abortion decision-making may also stress relationships between partners. Reich and Brindis (2006) reported that men tend to feel excluded during the decision-making process and, when …