The author argues that while the physical risks of abortion have fallen, many women don't realize how deeply they may be affected emotionally, even if they believe they've put it behind them. She lists what she sees as the most common emotional complications:
- Guilt. She describes a sense of having prevented a part of oneself from living, which intellectual reasons don't fully settle. In her view this can lead to an unconscious search for suffering ("I deserve to suffer"), including tolerating mistreatment, and to fear of being unable to conceive again, which she believes can itself act as a psychological barrier to pregnancy.
- Overprotection of later children. A mother worried that her four-year-old says "I can't" to everything and acts younger than his age. She does everything for him so he'll never struggle. The author traced this to guilt over an abortion at 18 that the mother had nearly forgotten: giving this child "everything" was an unconscious way of making amends. The result was a dependent, insecure, demanding child with little confidence, because a child who has everything done for him concludes he can't do it himself.
- Depression. Lack of motivation, low energy, oversleeping, withdrawal, hypersensitivity and crying. The author says this is a normal grief reaction, but if it lasts more than two or three months it may become chronic and needs treatment. She warns that suicidal thoughts can appear, especially if another crisis follows, and that this calls for psychotherapy. She cautions that covering up the pain causes problems later.
- Emotional disconnection from other children. A mother who withdraws into guilt may leave her children feeling unloved, and they may act out to get her back.
- Effects on sexuality. Fear of another pregnancy can cause anxiety during sex. Resentment toward a partner who pressured her, pushed for sex or didn't use protection can make intimacy difficult, which the author says can lead to dissatisfaction and even infidelity.
- Eating problems. Overeating, especially sweets, to cover pain and guilt, or not eating as self-punishment.
Note: This chapter presents one side of a contested topic. Large long-term studies (for example, the Turnaway Study) and reviews by bodies such as the American Psychological Association have found that most women who have an abortion do not develop lasting mental health problems as a result, and that relief is a common response, while some women do experience grief, sadness or regret. Anyone struggling emotionally after a pregnancy loss or abortion can benefit from talking with a counselor. If you or someone you know is having thoughts of suicide, in the US you can call or text 988 (Suicide & Crisis Lifeline).