Induced abortion is the intentional ending of pregnancy. In the United States there are approximately 1.3 million abortions performed every year. In the western world, the most common presentation of a patient seeking an abortion is a young, unmarried woman who is pregnant for the first time. A normal pregnancy takes 38 weeks and is divided into three trimesters, 88% of abortions occur in the first trimester. There is a fierce debate around the world regarding philosophical and political issues surrounding abortion (Kaplan and Sadock, 2007, p. 863). Most healthy women who choose to have an abortion are satisfied with their decision, with a minimum of psychological consequences. Indeed, Women who spontaneously miscarry report significantly higher psychological problems than women who had abortions, likely because they already had formed a bond with their unborn child (Kaplan and Sadock, 2007, p. 864). A history of abuse, substance abuse, and emotional disturbances on the other hand, is correlated with high levels of psychological sequelae following an induced abortion. Furthermore the abuse of certain substances is known to have many anatomic and physiological consequences for developing fetuses.
In a series of case reports presented by Hennelly, et al, two patients with a history of substance dependence were admitted to the psychiatric hospital and reported on (2011). Both women were in their mid-thirties. One of the patients was 20 weeks pregnant and had a long history of substance abuse starting during adolescence. Alcohol, tobacco, heroine, and cocaine, were all part of her daily habits. 5 months before her admission she had undergone rehabilitation and managed to remain clean for 4 months. During this time she became pregnant, grew in despondency, and relapsed to substance abuse. The relapses lead to depressive symptoms and went to the emergency room seeking an abortion and treatment. The second patient also presented with a long history of substance abuse, including: cocaine, marijuana, beer, and liquor, daily, since adolescence. The patient went to the emergency department on referral from her substance abuse program because she was suicidal. The patient already had three children, aged 2, 14, and 19 at the time. A few weeks prior to her admission she had learned that she was pregnant again, sought to enter a perinatal substance abuse program and expressed a desire for an abortion, stating that she wanted to take pills to kill herself and the fetus.
De Santis, et al, put the matter of substance abuse, pregnancy, and abortion, as an issue of high-risk behaviors (2011). Using a population of 503 pregnant Italian women who called an abortion center, it was found that a significant number admitted to smoking cigarettes (22.7%), drinking alcohol (17.7%), and substance abuse (.4%). Of the women who reported substance abuse problems, 13.7% stated that they were having an abortion because they were scared of teratogenicity. Ultimately, they found that women with one high-risk behavior were more likely to engage in other high-risk behaviors, so substance abusers were more likely to engage in risky-sex, leading to pregnancy, and often abortion.
Substance abusers engage in risky behavior every time they fulfill their habits. Women may be particularly vulnerable and at-risk when they are substance dependent. Their habits may put them in compromising positions that they otherwise would not allow themselves to be placed in. This may lead to unwanted sex, and unwanted pregnancy. Substance abuse is linked to many other co-morbidities, including major depression, adding to the risks. The consequences of these events will be life changing to the woman that goes through them, and efforts must be made to prevent unintended pregnancies in this group, and to help them overcome their substance dependence.
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Hennelly, M., et al. (2011). Termination of Pregnancy in Two Patients During Psychiatric
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Sadock, B.J., Sadock, V.A. (2007). Psychiatry and Reproductive Medicine. In J.A Grebb
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