# Amicus Curiae Brief — Acuna v. Turkish (No. 07-1328)

> Briefs, arguments, decisions, and more.

URL: https://www.frixlaw.com/law-library/documents/brief%3Amicro_IA40386020_1381%3A4

## Record

- **Collection:** Supreme Court brief
- **Document type:** Amicus Curiae Brief
- **Published:** January 1, 2008

## Text

es, FILED

No. 07-1328 MAY 2 { 2003

FFICe OF THF
SUPREME Co

3 Bu The
Supreme Court of the Anited States

4

ROSA ACUNA,

Petitioner,

V.

SHELDON C. TURKISH, M.D., et al.,

Respondents.

¢

On Petition For A Writ Of Certiorari
To The Supreme Court Of New Jersey

¢

BRIEF OF SANDRA CANO, THE FORMER
“MARY DOE” OF DOE V. BOLTON; WOMEN
INJURED BY ABORTION; AND, AMERICAN

ASSOCIATION OF PRO-LIFE OBSTETRICIANS
AND GYNECOLOGISTS (AAPLOG) AS AMICI
CURIAE IN SUPPORT OF PETITIONER

¢

LINDA BOSTON SCHLUETER
Counsel of Record

KATHLEEN CASSIDY GOODMAN
TRINITY LEGAL CENTER

11120 Wurzbach, Suite 206
San Antonio, Texas 78230
Telephone: 210-697-8202

Counsel for Amici Curiae

COCKLE LAW BRIEF PRINTING CO. (800) Zz5-5Yt
OR CALL COLLECT 402) 342-2831

TABLE OF CONTENTS

Page

TARE CF COR 8 es accor cexeesrsarnersenneiermmaienmneiions
TABLE OF AUTHORITIES
STATEMENT OF INTEREST OF THE AMICI

SUMMARY OF THE ARGUMENT
ARGUMENT :

I. THIS CASE IS CERTWORTHY BECAUSE
THE NEW JERSEY SUPREME COURT
MISINTERPRETED ROE V. WADE AND
ITS PROGENY AND ONLY THIS COURT
CAN CORRECT THE ERROR

A. The New Jersey Supreme Court Erred
Because the ‘tate Should Not Endorse
a Physician Giving Medically False
Information about the Status of a
Woman’s Unborn Child as It Interferes
with Her Constitutional Right to De-
cide Whether to Abort the Child

This Court Has Established That
There Cannot Be a Waiver of a Consti-
tutional Right Without a Full Under-
standing of That Right, and Therefore,
There Was an Infringement of Rosa
Acuna’s Right to Decide to Abort Her

TABLE OF CONTENTS -— Continued
Page

II. FAILURE TO PROPERLY INFORM A
WOMAN PUTS HER AT RISK OF
GREATER PSYCHOLOGICAL HARM,
AND THEREFORE, THIS COURT
SHOULD REQUIRE THAT ACCURATE
AND TRUTHFUL INFORMATION BE
GIVEN SO THAT SHE CAN MAKE AN
INTELLIGENT AND KNOWING DECI-
SION CONCERNING HER CONSTITU-
TIONAL RIGHTS

A. Recent State Legislative Findings
Demonstrate That There Is Serious
Physical, Emotional, and Psychological
Harm to Women Who Have an Abor-
tion, and Therefore, Women Should Be
Fully Informed

The Real Life Experiences of Post-
Abortive Women and _ Scientifically
Validated Research Demonstrate That
Abortion Hurts Women Physically and
Psychologically, and Therefore, This
Court Should Require That Full and
Accurate Information Be Given to a
Woman Prior to Exercising Her Right
to Decide

CONCLUSION

APPENDIX
Appendix A: Affidavit of Sandra Cano
Appendix B: Affidavit of Dr. Priscilla

il
TABLE OF AUTHORITIES

CASES

Acuna v. Turkish, 192 N.J. 399, 930 A.2d 416
(2007)

Boykin v. Alabama, 395 U.S. 238 (1969)

Doe v. Bolton, 410 U.S. 179 (1973)

Gibbons v. Ogden, 22 U.S. (9 Wheat.) 1 (1824)
Godinez v. Moran, 509 U.S. 389 (1993)........ dias cs aie 14

Gonzales v. Carhart, U.S. __, 127 S.Ct.
1610 (2007)

Henderson v. Morgan, 426 U.S. 637 (1976)

Marone v. United States, 10 F.3d 65 (2d Cir.

Patterson v. Illinois, 487 U.S. 285 (1988)

Planned Parenthood v. Casey, 505 U.S. 833
(1992) 1, &, 9, 10, 11

Women’s Medical Center v. Bell, 248 F.3d 411
gS. SARIN a UA RRC a on aRaeD trey fe 7 0 re ed HORE" 22

STATUTES

Women’s Right to Know Act, TEX. HEALTH &
SAFETY CODE § 171.001 et seq. (2003)

iV

TABLE OF AUTHORITIES — Continued
Page
RULES
Fed. R. Crim. P. 11

Books
Willke & Willke, ABORTION 50 (Hayes Pub. Co.

“The Aftereffects of Abortion,” www.afterabortion.
info/complic.html

Texas Department of Health, “A Woman’s Right
to Know” (2003), available at http://www.
dshs.state.tx.us/wrtk/pdf/booklet.pdf.....7, 10, 17, 18

Report of the South Dakota Task Force to Study
Abortion at 37 (December 2005), available at
http://ivotemyvalues.com/pdf/contentmgmt/Task_
Force_Report.pdf A 20, ay

STATEMENT OF INTEREST
OF THE AMICI CURIAE

Consent to file this amici curiae brief was given
by both parties. This brief supporting Petitioner was
prepared by counsel for Amici.’

This case is of great national importance and
consequence because the issue faced by Rosa Acuna is
the principal issue facing approximately one million
women each year in the United States who need and
are entitled to full, accurate, and truthful information
to exercise their constitutional right to decide
whether to abort their unborn child. Due to the well-
established physical and psychological risks and
consequences for women, this decision has far-
reaching and long-lasting implications.

The heart of this case relies on cases previously
decided by this Court in Roe v. Wade, Doe v. Bolton,
and Planned Parenthood v. Casey in which this Court
justifiably expected that there would be a normal
doctor-patient relationship and that a woman would

* The parties were notified ten days prior to the due date of
this brief of the intention to file. The parties have consented to
the filing of this brief. No counsel for a party authored this brief
in:whole or in part, and no counsel or party made a monetary
contribution intended to fund the preparation or submission of
this brief. Trinity Legal Center is a nonprofit corporation and is
supported through private contributions of donors who have
made the preparation and submission of this brief possible. No
person other than amici curiae, their counsel, or donors to
Trinity Legal Center made a monetary contribution to its
preparation or submission.

2

receive truthful and non-misleading information. A
woman expects to get full, accurate, and truthful
information from her doctor. Failure to give such
information prevents her from making an informed
and knowing exercise of her constitutional right to
decide whether to abort her unborn child.

Many women who have an abortion suffer from
both physical and psychological harm. Failure to
properly inform a woman with full, accurate, and
truthful information puts the woman at even greater
risk of psychological harm when she learns the truth.
This case exemplifies the problem.

Amici Sandra Cano is the “Doe” of Doe v. Bolton.
It was Doe v. Bolton which provided for the health
exception that led to abortion on demand and partial
birth abortion; however, Sandra never wanted an
abortion. She only sought legal help to get a divorce
and regain custody of her two oldest children. See
Appendix A. Years later when she realized that her
name and life were used to bring abortion on demand
and partial birth abortion, she suffered from the
devastation of being misled as to the true nature of
her case, which was in direct contradiction to her
intent, requests, and beliefs. In addition, she has
suffered the devastation of knowing that it was her
case that has been responsible for approximately 45
million abortions. Thus, she too understands the
psychological trauma that post-abortive women suffer
when they learn the truth that abortion killed their
unborn child and experience the negative physical
and psychological consequences of abortion.

3

Other Amici are post-abortive women who have
suffered and attest to the fact that adverse physical
and psychological effects of abortion have negatively
affected their lives. They regret the fact that they
were never given full, accurate, and truthful informa-
tion concerning the nature and risks of abortion. All
of the women have used their full name in the origi-
nal Affidavits on file at the office of Trinity Legal
Center, but some have requested that only their
initials be used publicly to protect their privacy and
confidentiality.

Amici American Association of Pro-Life Obstetri-
cians and Gynecologists (AAPLOG) was founded in
1973 as a recognized group within the American
College of Obstetricians and Gynecologists (ACOG).
AAPLOG has approximately 2100 members, mostly
ob-gyn physicians from across the United States.
These physicians understand the importance and
value of pregnant women having full, accurate, and
truthful information to make an informed decision.
AAPLOG believes that it is the responsibility and
duty of the physician to properly advise and inform
his/her patient. They have experience with patients
who were not fully informed and who experienced
adverse physical and psychological effects of abortion.
Members of AAPLOG have served as expert wit-
nesses on the abortion issue in the courts and before
legislative bodies.

Because abortion was generally not legal or
widespread prior to the decisions in Roe v. Wade and
Doe v. Bolton, this Court made non-evidence based

4

assumptions concerning abortion. Now, thirty-five
years later, post-abortive women Amici provide this
Court with their real life experiences and attest that
abortion in practice hurts women’s psychological
health which is confirmed by medical research. See
Appendix B. The post-abortive women Amici are:

Tina Brock (Georgia)

Kay Lyn Carlson (Kansas)

Cynthia Carney (Oklahoma)

T. C. (North Carolina)

Karen R. Hartman (Arizona)

Sherri Hayden (Texas)

Tammy Holly (Michigan)

Dawn Jackson (Texas)

Alveda King (niece of Dr. Martin Luther King, Jr.)
(Georgia)

Kay Painter (Idaho)

Rebecca Porter (Florida)

Kathy Rutledge (Kentucky)

Caron Strong (California)

Norma Tanton (Texas)

Julie Thomas (Georgia)

Cynthia Ann Williamson (Florida)

Ann M. Younger (Texas)

Joyce Leslie Zounis (Colorado)

SUMMARY OF THE ARGUMENT
I

The issue in this case is whether the state inter-
fered with a woman’s constitutional right to decide to
abort her unborn child by explicitly or implicitly
endorsing the physician’s medically false information

5

about the status of her unborn child. While this Court
held that a woman has a right to decide whether to
have an abortion, it also expected, as with any medi-
¢al treatment, that a woman would be given truthful
and non-misleading information by her physician.
When a woman is given false or misleading informa-
tion, it impacts on her decision regarding whether to
exercise her constitutional right to decide and poten-
tially causes greater psychological harm when she
learns the truth. Therefore, this Court should require
that a physician give a woman full, accurate, and
truthful information to make an informed decision.

II

Rosa Acuna’s case is not an isolated incident.
State legislatures have determined that women have
a right to know certain information about the physi-
cal and psychological risks of abortion. In addition,
legislative findings demonstrate that women are not
given this information prior to an abortion. Medical
research confirms what Rosa Acuna and other post-
abortive women have experienced that abortion
places women at an increased risk for depression,
suicidal ideation, suicide, anxiety, and substance
abuse. Lack of pre-abortion counseling and informed
consent are key factors in post-abortion difficulties.
Furthermore, avoiding a discussion of fetal develop-
ment by describing a fetus in terms of “blood” or
“tissue” is not truthful and can lead to devastating
psychological consequences when a woman obtains
truthful information. Because the absence of truthful

6

information increases the risk of psychological prob-
lems, this Court should require that a physician
provide truthful and non-misieading information, and
therefore, this Court should grant the Petition for
Writ of Certiorari to ensure that pregnant women are
given full, accurate, and truthful information before
they exercise their constitutional right to decide.

ARGUMENT

THIS CASE IS CERTWORTHY BECAUSE
THE NEW JERSEY SUPREME COURT
MISINTERPRETED ROE V. WADE AND
ITS PROGENY AND ONLY THIS COURT
CAN CORRECT THE ERROR.

A. The New Jersey Supreme Court Erred
Because the State Should Not Endorse
a Physician Giving Medically False
Information about the Status of a
Woman’s Unborn Child as It Interferes
with Her Constitutional Right to De-
cide Whether to Abort the Child.

Because this Court constitutionalized the abor-
tion issue in Roe v. Wade’ and Doe v. Bolton,’ only this
Court can correct the lower court’s errors in interpre-
tation and application. The New Jersey Supreme

' 410 U.S. 113 (1973)
’ 410 U.S. 179 (1973)

7

Court, relying on Roe v. Wade, allowed the physician
to give Rosa Acuna false information.‘

When Rosa Acuna specifically asked her physi-
cian if her eight-week-old unborn child was a baby, he
said “Don’t be stupid, it’s only blood.” It cannot be
disputed that this information — that her eight-week-
old unborn child was merely “blood” — was clearly
false.” After being taken to the emergency room
because of massive hemorrhaging, she was told that
because of an incomplete abortion parts of the baby
were left inside her.’ Upon doing research, she
learned the truth about the gestational development
of her baby which led to psychological problems and a
diagnosis of post-traumatic stress syndrome."

The question posed in this case is whether the
state interfered with a woman’s constitutional right
te decide to abort her child, by explicitly or implicitly

* See Acuna v. Turkish, 192 N.J. 399, 930 A.2d 416, 426
(2007).

* Id. at 419.

* For example, the Texas “Woman’s Right to Know” booklet
describes an eight-week-old unborn child as having all essential
organs beginning to form; elbows and toes are visible; the
fingers have grown to the first joint; facial features — the eyes,
nose, lips, and tongue — continue to develop; the outer ears begin
to take shape; organs begin to be controlled by the brain, and
the baby’s length is about 1/2 to 3/4 inch. “A Woman’s Right to
Know” by the Texas Department of Health (2003), available at
http://www.dshs.state.tx.us/wrtk/pdf/booklet. pdf.

Acuna v. Turkish, 192 N.J. 399, 930 A.2d 416, 419 (2007).

* Id

8

endorsing the physician’s medically false information
about the status of her unborn child.

In Roe v. Wade’ and its progeny,” this Court held
that a woman has a right to decide whether to have
an abortion. Amici believe that Roe was incorrectly
decided and should be overruled; however, because
Roe and its progeny are the law, it is clear that Rosa
Acuna’s constitutional right to decide whether to have
an abortion was significantly infringed upon by the
state court in rejecting her claims. This Court af-
forded a woman’s right to decide constitutional pro-
tection as a part of her substantive liberties as an
individual.'’ A woman’s right to make this decision in
a fully-informed manner is critical because, as this
Court recognized, abortion

is an act fraught with consequences for oth-
ers; for the woman who must live with the
implications of her decision; for the persons
who perform and assist in the procedure; for
the spouse, family, and society which must
confront the knowledge that these proce-
dures exist, procedures some deem nothing
short of an act of violence against innocent
human life; and depending on one’s beliefs,
for the life or potential life that is aborted.”

* 410 U.S. 113 (1973).

' Planned Parenthood v. Casey, 505 U.S. 833 (1992)
Id. at 852-53.

* Td. at 852.

9

Living with the consequences and implications of
that decision is exactly what Rosa Acuna suffered as
well as the post-abortive Amici and other post-
abortive women who suffer from the psychological
consequences of abortion.” This Court also recognized
that women can suffer from depression, regret, guilt,
and a loss of self-esteem following an abortion.“

The assumption in Roe v. Wade and its progeny is
that a woman’s decision to have an abortion would be
made after consulting with her physician.” The
assumption presumes that the advice and counsel of
the physician will be based on sound medical advice
concerning the gestational age of the unborn child,
the health risks associated with an abortion, and the
nature of the medical procedure.” This Court ex-
pected that the physician would give “truthful, non-
misleading information.”” Rosa Acuna was given
false information about the characteristics and
development of her eight-week-old unborn child.
Furthermore, if it were just “blood,” she would not
expect the risk of being rushed to the emergency room

‘“ Dr. Coleman discusses the psychological problems post-
abortive women can have including depression, thoughts of
suicide, anxiety, feelings of regret, shame, guilt, bereave-
ment/loss, and lowered self-esteem. See Affidavit of Dr. Priscilla
Coleman, Appendix B.

‘ Gonzales v. Carhart, ___: U.S. __,, 127 S. Ct. 1610, 1634
(2007).

* Roe v. Wade, 410 U.S. 113, 163 (1973).

‘ Planned Parenthood v. Casey, 505 U.S. 833, 882 (1992)

*

10

due to an incomplete abortion with “parts of the baby
left in” her. This Court expected that truthful, non-
misleading information would be given; now, to
protect the right to decide, it should require that
women, like Rosa Acuna, are given accurate and
truthful information.

Roe v. Wade recognized that at a minimum a
pregnancy evidences potential life’ — something more
than simply a collection of cells, blood, tissue, or body
fluids. Thirty-five years after Roe, through the ad-
vancement of medical technology, it is well-recognized
that life begins at fertilization.” The New Jersey
Supreme Court erred in relying o; thirty-five-year-
old science to justify Rosa Acuna’s physician giving
her false information.”

Roe v. Wade” and its progeny” also recognized
the state’s interest in promoting life. The state has an
obligation to avoid placing an undue burden on a
woman’s decision; but, it has an equally compelling
obligation to ensure that the information given to a
woman comports with sound medical judgment,

Roe v. Wade, 410 U.S. 113, 163 (1973).

‘* For example, see “A Woman’s Right to Know” by the Texas
Department of Health (2003), available at http://www.dshs.state.
tx.us/wrtk/pdf/booklet. pdf.

* See Acuna v. Turkish, 192 N.J. 399, 930 A.2d 416, 426
(2007).

” Roe v. Wade, 410 U.S. 113 (1973).

“ Planned Parenthood v. Casey, 505 U.S. 833 (1992).

11

advice, and current medical knowledge to ensure a
° ° . 23
woman’s decision is informed.

False or misleading information impacts a
woman’s decision on how to exercise her constitu-
tional right to decide. If the state explicitly or implic-
itly minimizes the dangers and thereby impacts the
woman’s decision, it is significantly interfering with
the woman’s decision regarding the life within her.
This is certainly true in this case where Rosa Acuna
specifically asked if the life within her was a baby
because the question was the ultimate factor in her
decision-making process. This Court recognized that
the impact on the fetus would be “relevant, if not
dispositive” for most women.”

Furthermore, Rosa Acuna’s experience is not an
isolated event.” Abortionists are not giving women full,
accurate, and truthful information as anticipated by
Roe and Casey. For example, in the largest government

~ Id. at 878 (stating “to promote the State’s profound interest
in; potential life, throughout pregnancy the State may take
measures to ensure that the woman’s choice is informed...”).

* Id. at 882.

* For example, the post-abortive women Amici were asked
on the affidavit: When and how did you learn it was a baby? The
following are typical examples: Tina Brock (Georgia) — “When I
became pregnant with my daughter and had an ultrasound.”
Cynthia Carney (Oklahoma) — “22 years later someone gave me
a pamphle’ on the development of a preborn.” T.C. (North
Carolina) — I realized the truth right after the abortion.” Norma
Tanton (Texas) — “2 years later when Time Magazine came out
with an article and photos of how life began.”

12

study since Roe, the South Dakota Task Force con-
cluded that “virtually all of the credible objective
evidence” compelled the conclusion that abortions in
South Dakota were not informed.” The Report stated
that the record reflects the following concerning
informed consent: (a) The abortion providers fail to
disclose the essential nature of the procedure — that it
terminates the life of the woman’s existing child; (b)
When they do discuss the procedure, they provide
misleading information in misleading terms; (c) The
abortion providers give misleading information about
the psychological and physical risks to the mother,
and do not disclose the direct injury to the child that
leads to its death; (d) The abortion providers assume
the women have made their decisions before they
reach the facility; and, (e) The abortion providers
place the burden upon the mothers to discover mate-
rial facts on their own.”

In summary, the New Jersey Supreme Court
erred in its endorsement of a physician providing
medically false information which interfered with
Rosa Acuna’s constitutionally protected right to
decide. The answer to the specific question that
she asked was crucial to her decision to abort her
unborn child. At a minimum, this Court should
require that a woman be given full, accurate, and

* Report of the South Dakota Task Force to Study Abortion
at 37 (December 2005), available at http://ivotemyvalues.com/
pdf/contentmgymt/Task_Force_Report. pdf.

~ Id.

13

truthful information as it expected in Casey. Other-
wise, a woman’s constitutionally protected right to
decide to abort ner child is meaningless.

B. This Court Has Established That
There Cannot Be a Waiver of a Consti-
tutional Right Without a Full Under-
standing of That Right, and Therefore,
There Was an Infringement of Rosa
Acuna’s Right to Decide to Abort Her
Child.

As with other constitutional nghts, a person can

waive or invoke the right. In other contexts, however,

this Court has recognized that certain constitutional

rights are so important, and the concomitant risks so
high, that the government must ensure that those
rights are exercised or waived only after receiving
competent advice, including a warning about poten-
tial negative effects. For example, Miranda” warn-
ings are designed to ensure that a suspect’s privilege
against self-incrimination is protected. Similarly,
there is a range of decisions that the defendant must
make in a criminal trial including the assistance of
counsel in deciding whether to exercise, for example,
the decision to speak to the police, take the stand,
waive a jury trial, or plead guilty.”

** Miranda v. Arizona, 384 U.S. 436 (1966).

* See, e.g., Miranda v. Arizona, 384 U.S. 436 (1966) (rights
warnings to insure protections associated with Fifth Amendment
(Continued on following page)

14

The decision on whether to have an abortion has
physical and psychological risks and negative effects
for the mother and is an issue of life or death for the
unborn child. These factors are certainly as important
as to whether to speak to the police, waive a jury
trial, or plead guilty.

The same approach should apply in the context of
a woman’s decision to bear or not bear a child. The
role of the physician, who is in the position to give
sound medical advice to the woman, is to provide
her with accurate medical facts. The New Jersey
Supreme Court, however, impermissibly shifted the
right from the woman to make an informed decision
to the physician’s right of conscience. Thus, the court

allowed the physician to not disclose accurate and
truthful information instead of enforcing the right of
a woman to have accurate and truthful information to

privilege against self-incrimination); Boykin v. Alabama, 395
U.S. 238 (1969) (valid guilty plea requires an intentional
relinquishment or abandonment of a known right or privilege);
Henderson v. Morgan, 426 U.S. 637 (1976) (guilty plea is not
valid unless the defendant knows the nature of the offense to
which he or she pleads); Patterson v. Illinois, 487 U.S. 285
(1988) (Miranda warnings sufficient to apprise defendant of
Sixth Amendment right to counsel before post-indictment
interrogation); Godinez v. Moran, 509 U.S. 389 (1993) (judge
must be satisfied that defendant’s waiver of his constitutional
right to assistance of counsel at trial is knowing and voluntary);
Marone v. United States, 10 F.3d 65 (2d Cir. 1993) (setting out
procedures for trial judges to use in accepting waiver of jury
trial in federal courts); see also Fed. R. Crim. P. 11 (providing
detailed guidelines for judges conducting plea inquiries before
accepting a guilty plea from a defendant).

15

decide whether to abort her unborn child. This Court
has never recognized the right of any physician in
any context to falsify critical, factual information
involving the patient’s medical procedure.

The New Jersey Supreme Court also tried to
justify giving false information by stating that a
doctor is not compelled to give the information when
he has “a different scientific, moral, or philosophical
viewpoint.”” Even assuming arguendo that the
physician’s moral or philosophical viewpoint was
different from current medical science, he could have
provided known medical facts, such as the physical
characteristics of an eight-week-old unborn child. In
other words, he would not have to violate his beliefs
while still providing her with medically sound infor-
mation. She could then decide for herself if the hu-
man life within her is in fact a “baby.”

The New Jersey Supreme Court in this case
ignored these fundamental principles and relied on
this Court’s decision in Roe to justify the doctor’s
advice that the child growing within the woman was
only “blood” — a grossly misleading characterization
which reduced the woman’s decision to nothing more
significant than giving a blood sample or losing blood.
Therefore, the New Jersey Supreme Court erred.

As Justice Ginsburg wrote, “The Court is surely
correct that, for most women, abortion is a painfully

* Acuna v. Turkish, 192 N.J. 399, 930 A.2d 416, 428 (2007).

16

difficult decision.”” At this most difficult time in a
woman’s life, she should have full, accurate, and
truthful information before exercising her constitu-
tional right to decide whether to abort her unborn
child.

Il. FAILURE TO PROPERLY INFORM A
WOMAN PUTS HER AT RISK OF GREATER
PSYCHOLOGICAL HARM, AND THERE-
FORE, THIS COURT SHOULD REQUIRE
THAT ACCURATE AND TRUTHFUL IN-
FORMATION BE GIVEN TO A WOMAN SO
THAT SHE CAN MAKE AN INTELLIGENT
AND KNOWING DECISION CONCERNING
HER CONSTITUTIONAL RIGHTS.

A. Recent State Legislative Findings Dem-
onstrate That There Is Serious Physi-
cal, Emotional, and Psychological Harm
to Women Who Have an Abortion, and
Therefore, Women Should Be Fully In-
formed.

As this Court recognized, “whether to have an
abortion requires a difficult and painful moral deci-
sion” and is “fraught with emotional consequence.””

** Gonzales v. Carhart, __ U.S. ___, 127 S. Ct. 1610, 1648
n.7 (2007) (Ginsburg, J., dissenting).

* Gonzales v. Carhart, __ U.S. __, 127 S. Ct. 1610, 1634
(2007).

17

This Court also noted that “severe depression and
loss of esteem can follow” an abortion.”

Prior to Roe v. Wade” and Doe v. Bolton,” health
issues like abortion were decided by the states”
where hearings could be held to determine whether
the medical and scientific knowledge are more ad-
vanced to warrant a different legal conclusion. In the
thirty-five years since Roe and Doe, legislatures have
determined that there are physical and psychological
health risks from abortion and that women should be
provided with this information prior to an abortion.

For example, the Texas Legislature passed the
“Women’s Right to Know” Act” in 2003. As a result,
the medical board of the Texas Department of Health
held hearings and ultimately produced a _ booklet
entitled “A Woman’s Right to Know” which is to be
distributed to women who are considering an abor-
tion.” The booklet provides information concerning

ai”
* 410 U.S. 113 (1973).
*® 410 U.S. 179 (1973).

* Gibbons v. Ogden, 22 U.S. (9 Wheat.) 1, 204 (1824)
recognized that under what was later called the state’s “police
power” the states could regulate “health laws of every descrip-
tion.”

*’ Women’s Right to Know Act, Tex. HEALTH & SAFETY CODE
§ 171.001 et seq. (2003).

'* The booklet is available through the Texas Department
of Health or on its website at www.dshs.state.tx.us/wrtp/pdf/
booklet. pdf.

18

the baby’s unique DNA,” calls the baby an “unborn
child,” shows the growth and development from four
to thirty-eight weeks gestation,” describes the abor-
tion procedure,” and explains the physical, emotional,
and psychological risks to women.”

The Texas Department of Health’s booklet warns
of the “emotional side of an abortion.” It states:

Some women may feel guilty, sad, or empty,
while others may feel relief that the proce-
dure is over. Some women have reported
serious psychological effects after their abor-
tion, including depression, grief, anxiety,
lowered self-esteem, regret, suicidal thoughts
and behavior, sexual dysfunction, avoidance
of emotional attachment, flashbacks, and
substance abuse. These emotions may ap-
pear immediately after an abortion, or
gradually over a longer period of time. These
feelings may recur or be felt stronger at the
time of another abortion, or a normal birth,
or on the anniversary of the abortion.”

Currently, a number of state legislatures are
considering removing or in some other way limiting

* “Women’s Right to Know” booklet at 2.
” Id.

* Id. at 3-8.

“ Id. at 14-15.

“Id. at 15-17.

“ Id. at 16.

* Id.

19

the health exception.” A notable example is South
Dakota which has made substantial and detailed
findings after extensive hearings that led to a ban on
abortion except to save the life of the mother.”

After hearing all of the evidence from experts and
post-abortive women, the Task Force stated:

Further, the Task Force finds that the pre-
abortion counseling provided often does not
prepare women who have abortions for the
psychological outcomes they may experience
after their abortions. In addition, women
who receive little or no information about
possible emotional health risks of this proce-
dure may significantly compromise their
mental health and the quality of their lives
for years to come. Due to the very limited in-
formation disclosed by abortion providers,
women are not fully aware that abortion car-
ries with it the potential to damage their
physical, emotional, interpersonal, and spiri-
tual well-being.”

The Task Force also addressed the issue of the
psychological consequences of terminating the life of
the child. The Task Force stated:

“For example, Alabama, Indiana, Georgia, Kentucky,
Louisiana, Missouri, Michigan, Mississippi, Ohio, Oklahoma,
Tennessee, and West Virginia.

* Report of the South Dakota Task Force to Study Abortion

(December 2005), available at http://ivotemyvalues.com/pdf/
contentmgmt/Task_Force_Report.pdf.

* Id. at 47.

20

Perhaps worse, the pregnant mother is not
told prior to her abortion that the procedure
will terminate the life of a human being. The
psychological consequences can be devastat-
ing when that woman learns, subsequent to
the abortion, that this information was
withheld — information that would have re-
sulted in her declining to submit to an abor-
tion. Her anger at being deceived and being
prevented from making an informed decision
for herself is exacerbated by her realization
that she was implicated in the killing of her
own child in utero. Aside from the injustice of
her being deprived of making her own in-
formed decision (see Section [1-D), the psy-
chological harm of knowing she killed her

child is often devastating.”

In addition, the Task Force found that:

..it is simply unrealistic to expect that a
pregnant mother is capable of being involved
in the termination of the life of her own child
without risk of suffering significant psycho-
logical trauma and distress. To do so is be-
yond the normal, natural, and healthy
capability of a woman whose natural in-
stincts are to protect and nurture her child.”

The Task Force heard testimony from Dr. Vincent
Rue, Ph.D., who is a psychotherapist and a professor,
and was special consultant to then-U.S. Surgeon

" id.
” Id. at 47-48.

21

General Dr. C. Everett Koop on abortion morbidity.
Dr. Rue provided the first clinical evidence of post-
abortion trauma in 1981 and identified this psycho-
logical condition as ‘Post-Abortion Syndrome’ in
testimony before the U.S. Congress.”” The Task Force
heard evidence that individuals with Post-Abortion
Syndrome “experience symptoms of avoidance (efforts
to escape from reminders of the event), intrusion
(unwanted thoughts, nightmares, and flashbacks
related to the event), and arousal (exaggerated startle
reflex, sleep disturbance, irritability) for a month or
more following exposure to a traumatic event.””
Although for some women, the initial response is one
of relief, many women later avoid the problem
through repression and denial, usually for years — “5

years is common, 10 or 20 is not unusual.”

Abortion hurts women emotionally and psycho-
logically, and therefore, this Court should grant the
Petition for Writ of Certiorari to ensure that women
are entitled to full, accurate, and truthful information
before they exercise their constitutional right to
decide.

*" Td. at 53.
” Id. at 44.
Willke & Willke, ABORTION 50 (Hayes Pub. Co. 2003).

22

B. The Real Life Experiences of Post-
Abortive Women and Scientifically
Validated Research Demonstrate That
Abortion Hurts Women Physically and
Psychologically, and Therefore, This
Court Should Require That Full and
Accurate Information Be Given to a
Woman Prior to Exercising Her Right
to Decide.

The Court of Appeals for the Fifth Circuit recently
cited testimony that abortion as practiced is “almost
always a negative experience for the patient...”“ The
post-abortive women Amici’s real life experiences
attest that there are harmful and negative physical
and psychological consequences to abortion.”

“ Women’s Medical Center v. Bell, 248 F.3d 411, 418 (5th
Cir. 2001).

“ For example, post-abortive women Amici attest: Tina
Brock (Georgia) — “I suffered from severe depression for years
after my abortion until | found healing.” Cynthia Carney
(Oklahoma) — “I had a replacement child. But after I gave birth
to him, I couldn’t shake the depression or the feeling that
something was wrong. The relationship with my 1 year old
changed, I felt detached from him & didn’t know why - there
was an aching hole in my heart.” T.C. (North Carolina) — “I
regret it more than anything else in my difficult life;’? Karen
Hartman (Arizona) — “I hated myself and told myself that daily.
‘TI hate myself, I hate myself!” I cried on my horses necks each
morning. I would try to escape the pain by riding the horses,
working hard, trying to please others. I wore a plastic smile,
inside I was a hole of despair. I wanted out, but I had not the
tools to climb from this deep dark hole. My nightmares involved
trying to pull a baby out of a hole, never succeeding.” Sherri

(Continued on following page)

23

One of the largest pregnancy resource centers,
Care Net” and other pregnancy resource centers
attest that their organizations hac over 100,000
women in post-abortion recovery programs in 2004
alone. It is estimated that there are more than one
million abortions each year. If even 1 in 10 women
suffer from negative psychological consequences of
abortion, then this Court should require that women
are given full and accurate information to make an
informed decision.

Medical research confirms what Rosa Acuna and
other post-abortive women have experienced. Dr. Priscilla
Coleman attests after approximately eighteen years

Hayden (Texas) — “...depression, loss of joy, I isolated myself,
fearful, loss of peace, emotionally numb.” Kathy Rutledge
(Kentucky) — “My abortion placed a dark cloud over my life that
never lifted — I was never the same. It was as if two people died
that day — my baby died physically, and I died emotionally and
spiritually. I continued to manage my life mentally, but in a fog,
devoid of the enormous amount of creativity and energy J had
displayed in high school. Looking back, it was an unfortunate
waste of two lives.” Norma Tanton (Texas) — “It has left a hole in
my soul — I have had to work through depression, guilt, shame,
condemnation & suicidal thoughts thru post abortion counsel-
ing. 24 years after my abortion, I never knew that was available
until 2 years ago — I tried to commit suicide once — I felt unwor-
thy of being a mother to my step daughter — I had a lot of
suppressed anger over the situation and disassociated myself
from people distrusting them. Learn to live w/a mask -— full of

fear & anxiety of others finding out.”

‘** Care Net was founded in 1975. Its focus is to develop,

equip, and promote more than 900 pregnancy centers across
North America. See www.care-net.org.

24

of extensive research that women are at an increased
risk for depression, suicidal ideation, suicide, and
death.” In addition, other well-established psycho-
logical difficulties include anxiety, substance abuse,
unrelenting feelings of regret, shame, guilt, bereave-
ment/loss, and lowered self-esteem.”

Dr. David Reardon, one of the world’s leading
experts on the effects of abortion on women, further
demonstrates the devastating psychological conse-
quences of abortion. Dr. Reardon states that following
temporary feelings of relief, there is emotional “pa-
ralysis” or post-abortion “numbness,” guilt and re-
morse, nervous disorders, sleep disturbances, sexual
dysfunction, depression, loss of self-esteem, self-
destructive behavior such as suicide, thoughts of
suicide, and alcohol and drug abuse, chronic problems
with relationships, dramatic personality changes,
anxiety attacks, difficulty grieving, increased ten-
dency toward violence, chronic crying, difficulty
concentrating, flashbacks, and difficulty in bonding
with later children.”

As Dr. Coleman attests, pre-abortion counseling
and informed consent are key factors in post-abortion

*’ Affidavit of Dr. Priscilla Coleman, Appendix B.
” ed.

°” “The Aftereffects of Abortion,” www.afterabortion.info/
complic.html] (calling abortion a public health issue and listing
the physical and psychological effects of abortion).

25

difficulties.” Avoiding discussion of fetal development
or using terms like “tissue” or “blood” encourages
consent based on false and misleading information,
but a woman may not give consent if she is told the
truth.” Furthermore, when a woman obtains truthful
information concerning fetal development, devastat-
ing psychological consequence are more probable.”

Although it is frequently overlooked, a critical
factor in a woman’s decision-making process is that
abortion is legal.” Therefore, most women assume

* Affidavit of Dr. Priscilla Coleman, Appendix B.
61

Id.
° Id.

“ For example, post-abortive women Amici attest: Tina
Brock (Georgia) — “I felt if it was legal it must be OK. Since I
was lied to and told it was just a blob, I didn’t know it was
murdering a human being & at 9 weeks it is very much a human
being therefore it was murder & murder is not legal — well
except abortion.” Cynthia Carney (Oklahoma) — “I would have
never had an abortion if it was illegal. Simply went into an office
that was offering free pregnancy tests, and when I left they told
me it was just tissue. No one had ever said that to me before.”
Karen Hartman (Arizona) — “We would not have considered an
abortion had it been illegal. I thought ‘It’s legal, it must be okay,
my government couldn’t hurt me!” Sherri Hayden (Texas) — “It
made it too easy and accessible.” Kay Painter (Idaho) — “Never
would have considered abortion had it been illegal. Laws are to
protect you. If it’s legal it must be a good choice and safe.” Kathy
Rutledge (Kentucky) — “My mother didn’t give me any options
and threatened that my Dad (my parents were divorced) would
kill' her if he found out I was pregnant. I believed her, and since
abortion was legal, it seemed like a legitimate way to resolve the
‘family’ crisis. Legalized abortion caused undue pressure to
terminate my pregnancy without consideration of other options.”

(Continued on following page)

26

that abortion is not fraught with physical and psycho-
logical consequences.

This Court recognized that a state requirement
that a woman be informed does not create an undue
burden. It also expected that a woman would be given
truthful and non-misleading information. Amici urge
this Court to grant the Petition for Writ of Certiorari
to ensure that physicians will provide a woman with
truthful and non-misleading information at what has
been recognized as the most difficult time in her life.

CONCLUSION

When this Court granted women the constitu-
tional right to decide whether to abort their unborn
child, it assumed that each woman would be given
accurate and truthful information to make an in-
formed decision. At this most difficult time in a
woman’s life, the women of this nation need to trust
that physicians will provide accurate and truthful
information. As this Court recognized, abortion can
cause psychological harm such as depression, regret,
guilt, and low self-esteem. However, a woman is at
greater risk of these complications when she later

Norma Tanton (Texas) — “If abortion wasn’t legal I wouldn’t have
had an abortion. I was already going through an emotional
trauma by being disowned by his parents’ when my mother-in-
law pressured and talked me into an abortion. She made the
appt and took me.” Cynthia Williamson (Florida) — “If it wasn’t
legal I wouldn’t have had one. You think laws and legal things
are right. Wouldn’t be legal if it was going to hurt or kill. The
law does not protect women.”

27

learns the truth that her choice to have an abortion
was instead the choice to kill her unborn child.

_ Rosa Acuna directly asked her doctor if her eight-

week-old unborn child was a baby. He gave her false
information when he said it was just “blood.” It was
only after suffering physical complications due to an
incomplete abortion that she was told parts of her
baby had been left inside her. Upon doing research,
she learned the truth about the gestational develop-
ment of her baby. This led to psychological problems
and a diagnosis of post traumatic stress syndrome.

The New Jersey Supreme Court erred in condoning
the physician giving Rosa Acuna false and misleading
information. This Court expected that a physician would
give truthful, non-misleading information. Without
accurate and truthful information, a woman cannot
make an informed decision to exercise her constitu-
tional right to decide whether to have an abortion.

Therefore, Amici urge this Court to grant the
Petition for Writ of Certiorari as this important issue
affects millions of women who are considering
whether to abort their unborn child.

Respectfully submitted,

LINDA BOSTON SCHLUETER
State Bar Card No.: 24000127
Supreme Court Admission: 1976

KATHLEEN CASSIDY GOODMAN
State Bar Card No.: 24000255
Supreme Court Admission: 2001
Counsel for Amici Curiae

App. l

APPENDIX A
AFFIDAVIT OF SANDRA CANO

IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF GEORGIA
ATLANTA DIVISION

Sandra Cano, formerly
known as MARY DOE,

Plaintiff,
V.

ARTHUR BOLTON, Attorney
General of the State of
Georgia Through His
Official Successor in Office,
THURBERT E. BAKER;
LEWIS R. SLATON, as Dis-
trict Attorney of Fulton
County, Georgia Through
His Official Successor in
Office, PAUL L. HOWARD,
JR.; And HERBERT T. JEN-
KINS, as Chief of Police of
the City of Atlanta Through
His Official Successor in
Office, Richard Pennington,

Defendants.

CIVIL ACTION
NO. 13676

STATE OF GEORGIA

COUNTY OF FULTON

App. 2

AFFIDAVIT OF SANDRA CANO

KNOW ALL MEN BY
THESE PRESENTS:

§
§
§

BEFORE ME, the undersigned authority, on this
day personally appeared SANDRA CANO, who after
being duly sworn upon his oath deposed and said as

follows:

i

My name is Sandra Cano, and I reside in
Georgia. I am competent to make this Affi-
davit. I have personal knowledge of the facts
stated herein and the following is true and
correct.

In 1973, I was the woman designated as
‘Mary Doe’, the Plaintiff in Doe v. Bolton, 410
U.S. 179 (1973), the companion case to Roe v.
Wade, 410 U.S. 113 (1973). Although the
courts understood that ‘Mary Doe’ was not
my real name, what the courts did not know
was that, contrary to the facts recited in my
1970 Affidavit, I neither wanted nor sought
an abortion. I was nothing but a symbol in
Doe v. Bolton with my experience and cir-
cumstances discounted and misrepresented.
During oral arguments before the United
States Supreme Court one of the Justices
stated that it did not matter whether I was a
real or fictitious person. This is where the
Court was so very wrong. It did matter. I was
a real person, and I did not want an abor-
tion.

App. 3

Abortion is just like Doe v. Bolton. It dis-
counts the real experiences of the mothers. It
misrepresents that abortion is for them. Just
as Mary Does’ true desires were hidden from
the courts by those promoting abortion, so,
too, have the real facts about abortion been
hidden. Today, this Court will know the real
truth about the real woman who was used to
deceive, not only the courts, but the women
of this nation about the reality of abortion.

‘Sandra Race Bensing’ was my real name in
1970. I was twenty-two years old and preg-
nant with my fourth child when I first met
the Doe v. Bolton attorney, Margie Pitts
Hames. I had gone to legal aid to get a di-
vorce and to find an attorney to help me re-

gain custody of my two children. My husband
was not supporting us, and we had to live at
the Salvation Army. At times we lived with
my mother, but my stepfather did not want
us there. I loved my children, but I could not
care for them financially.

I was a trusting person and did not read the
papers placed in front of me by my lawyer. I
truly thought Margie Pitts Hames was hav-
ing me sign divorce papers. I did not even
suspect that the papers related to abortion
until one afternoon when my mother and my
lawyer told me that my suitcase was packed
to go to a hospital, and that they had sched-
uled an abortion for the next day. They ad-
vised me that my doctor, Dr. Donald Block,
was going to perform an abortion. I told both
my mother and my lawyer that I would not

App. 4

have an abortion. Not then. Not ever. They
persisted in their demands upon me.

When the demand for an abortion persisted,
I fled to Oklahoma and stayed at the home of
my ex-husband’s grandmother. I remained in
Oklahoma until my mother and lawyer as-
sured me that they would cease their pres-
suring me to have an abortion. I was relieved
that the ordeal was ended. Because they
promised never to force me to have an abor-
tion, I returned to Georgia.

My lawyer sent me a plane ticket so I could
fly from Oklahoma to Georgia. She wanted
me to be in a courtroom with other pregnant
mothers. The night before I went to court,
my mother and my lawyer expressed concern
that I would leave again, and so they had me
stay at the apartment of a legal-aid lawyer.
Before the court appearance, I was told by
my lawyer not to say anything in court. As a
result, I never did say anything in court.

My predicsment made it difficult for me to
take care of my children, but I didn’t need an
abortion. I needed help, but all of the people
around me — my husband, my mother and
my lawyer — refused to help me with my
children.

Instead of real help, my mother, stepfather
and my lawyer persisted in their demands
that I have an abortion. Those demands were
made for themselves so they would not be
burdened. It was, in my mind, a demand for
what they thought was the easiest way for .

App. 5

them to get out from under any obligation to
help my new baby and me. But the abortion
was not in my interest. I was the mother of a
baby for whom I was responsible. I had a
natural desire to have my baby and to raise
her. I carried my child to full term and gave
birth. Because no one would help me I felt
compelled to surrender my rights and give
my baby up for adoption.

. One day in 1973, my mother and stepfather
called me into their bedroom. Their televi-
sion was on. They shouted to me excitedly,
“Look! You won! You won!” Margie Pitts
Hames was on television and the story re-
ported that the United States Supreme
Court had made abortion legal. At that time,

I did not fully comprehend what my role was
in the Court’s decision in Doe v. Bolton.

. Over the years, I gained a greater and
greater sense that I was wrongfully used in
Doe v. Bolton. A number of years ago, I de-
cided that I wanted to see my file in the case
so I could see what was said about me. I
went to the courthouse to see my records
which were under seal. An attorney, Wendell
Bird, agreed to represent me and he asked
that my records in my case be unsealed. I
produced my driver’s license, my birth cer-
tificate, and my marriage certificate. The at-
torney who represented me in Doe v. Bolton,
Margie Pitts Hames, tried to stop me from
getting my own records, and [ did not under-
stand why.

App. 6

12. It was only when I first saw the opened re
cords in Doe v. Bolton that I understood why
Margie didn’t want me to see them. The re-
cords stated that I applied for an abortion,
was turned down, and, as a result, sued the
state of Georgia. According to the records, I
had applied for an abortion through a panel
of nine doctors and nurses at a state-funded
hospital, Grady Memorial Hospital. That was
a false statement. After reading the court re-
cords, I contacted the hospital and tried to
obtain my records. At first I was told there
were records, but when my new attorney
sent his legal assistant to review the records,
we were told that they did not exist. The
hospital said they didn’t have any records. I
never sought an abortion there or anywhere
else.

At times, I have been forced to reflect upon
the events that led up to that day in 1973
when my mother and stepfather told me
about the Supreme Court decision in Doe v
Bolton. In 1970, my life was a mess. I was
having my fourth child, but no responsible
husband or real place to live. I was unedu-
cated. When I came back from Oklahoma, |
was so relieved that no one was going to
pressure me to have an abortion that I took
part in a court proceeding without under-
standing what was really happening. I was
used wrongly, but I didn’t inquire enough. In
retrospect, there were big signs which re-
vealed what was happening.

App. 7

Once a television man came to Margie’s office
and I was asked what I thought of abortion. I
told him that, “I don’t believe in abortion and
I don’t want an abortion.” I also said I didn’t
care if anyone else had an abortion, that it
wasn’t my business. All I cared about, at that
time, was that I didn’t want an abortion. I
was not thinking of the other women. I did
not understand that I was involved in a case
that sought to legalize abortion. I was naive.
In retrospect, perhaps, I could have discov-
ered what was going on. But I was in a crisis.
I depended on my mother’s help. My lawyer
became upset with me because I would never
say to anyone that I would have an abortion.
I should have, perhaps, understood what was

happening, but I was simply attempting to
survive. I remember Margie debating me.
She claimed we were involved in a liberation
right. She said women were entitled to equal
pay for equal work, and I agreed. I never saw
the pleading filed in court.

Many years later, when I saw the unsealed
records in my case, I could not believe what
the certification filed in my name said. I am
certain the signature on the affidavit that
said I wanted an abortion was not mine. I
never saw that affidavit until the records
were unsealed. If it was my signature, it was
obtained without my knowing the contents of
the affidavit. I had fled to Oklahoma to avoid
an abortion. My lawyer knew I would never
say I wanted one. The only reason I went to
a lawyer was to get my children back. My

App. 8

predicament was used to argue that my new
baby’s life should be terminated.

I have often rethought how my involvement
in Doe v. Bolton came about. Over the years
it has haunted me. I never had an abortion,
but I know what it is like to feel responsible
for one. I know what it is like to feel like a
mother who helped terminate the life of her
own child. After Doe v. Bolton was decided
and I was told about my involvement, I felt
responsible for the experiences to which the
mothers and babies were being subjected. In
a way, I felt that I was involved in the abor-
tions — that I was somehow responsible for
the lives of the children and the horrible ex-
periences of their mothers. | have felt that

experience that the death of a child is my
fault; the helplessness the mother feels as
events occur around her without any power
to stop them; and the guilt that is associated
with being told by the courts and society that
the child’s death was performed for the
mother and only the mother.

. This last assertion — that abortion is per-
formed for the mother — is the cruelest mis-
representation of all. My own circumstance,
the one used to justify legal abortion in the
first place, is a perfect example of this real-
ity. There are many doctors, and clinics and
others who were plaintiffs in Doe v. Bolton.
As Mary Doe, I was the only pregnant
mother who was a plaintiff. All of these other
people — the doctors, nurses and clinics were
using the Court to do what they thought was

App. 9

in my interest. They pressured the Court
claiming I need the right to terminate the
life of my own child. It was their solution, not
mine. They claimed they did it out of com-
passion for me. But it was a false compas-
sion. A true compassion would result in the
fathers living up to their responsibilities. A
true compassion, once a mother is in the
predicament that the child’s father aban-
doned her, would advise her how to get help
and would provide her help. Unfortunately,
the legal right to an abortion was sought in
my case because others thought it was too
hard for them to give me real help. The abor-
tion was sought for them, not for me.

. But no matter how hard life happens to be,
no one has the right to kill a baby — espe-

cially the baby’s mother. Se is the trustee of
her child’s life. She, of all people, has the sa-
cred duty to protect the child. But the child’s
interests are not at odds with her own. They
are in concert with one another. The mother
derives a great benefit from her relationship
with her child. It is as beneficial to her as it
is the child. It is never in the interest of a
mother to terminate the life of her own child.

. I have been forced to live with the conse-

quence of this false compassion for too long
for me not to bring to the attention of the
Court the fact that abortion is not in a
woman’s interest, and the fact that legaliza-
tion of abortion began with manipulations
and misrepresentations. Too many women
who lost their children through abortion

App. 10

have told me of their emptiness, their sad-
ness, the void in their lives, and how others
forced them to have abortions and then
blamed the abortion on the mother.

20. The experience of Doe v. Bolton must be un-
derstood and accounted for, not simply to cor-
rect the record in my own case, but to correct
the law of abortion in general: abortion is not
in the interest of a mother. It is a false solu-
tion imposed upon a mother by others.

21. Doe v. Bolton and my circumstanced {sic]
were misused. Doe v. Bolton was a fraud
upon the court. Doe v. Bolton was a secret
case about abortion, which is a secret proce-
dure. This secretiveness allows others to
prevail upon the mother and others can act
against her interest. Women have told me
how they were forced to have an abortion
against their will. If it was alleged that I
spoke for other women in Doe v. Bolton, then
I gladly speak for other women in this case to
say that abortion is too coercive by nature;
too much the will of others; too much the will
of a society which finds abortion more con-
venient for it than a commitment to the well
being of the mother and the child.

22. The real experiences of the women must be
known and taken into consideration by the
court. Abortion is too much what others
would like a woman to do, rather than what
is in her interest and what she really wants.

App. ll

23. Others told the court that I wanted an abor-
tion. The law has developed, in part, based
upon what my lawyer claimed I wanted, and
that abortion was in my interest. I feel I
have the duty to tell this Court the truth
about what I really thought then, and what I
think now. As the Plaintiff in Doe v. Bolton, I
have a very substantial interest in the litiga-
tion before this court in the matter of Roe v.
Wade and I can provide the court a unique
perspective of the Doe v. Bolton case not
available from any other source.

24. In the 1970s the people closest to me success-
fully manipulated my circumstances to jus-
tify abortion and wanted me to have an
abortion, but I refused. Today this Court has
the opportunity to review, not just the real
facts surrounding the Roe v. Wade and Doe v.
Bolton, the original abortion decisions, but
the opportunity to review the testimony of
hundreds of women who have real, true, ex-
periences with abortion and not perpetuate
the Doe v. Bolton fraud upon the Court.

Further Affiant sayeth not.”

/s/ Sandra Cano
Sandra Cano a.k.a. Mary Doe of
Doe v. Bolton

App. 12

SWORN TO AND SUBSCRIBED BEFORE ME,
the undersigned authority, on this 12th day of Au-
gust, 2003.

/s/ Justin [Illegible]
NOTARY PUBLIC IN AND FOR
THE STATE OF GEORGIA
My commission expires:
Notary Public, Fulton County, Georgia
My Commission Expires Oct. 18, 2005

App. 13

APPENDIX B
Affidavit of Dr. Priscilla K. Coleman, Ph.D

TATE OF GE .
a OF GEORGIA 8 NOW ALL MEN BY

8 THESE PRESENTS:
COUNTY OF WOOD §

BEFORE ME, the undersigned authority, on this
day personally appeared Priscilla K. Coleman, Ph.D.
who is personally known to me, and after being by me
first duly sworn according to law on her oath did
depose and say that:

1. “My name is PRISCILLA K. COLEMAN. I am
over the age of eighteen (18) years of age and I reside
in Bowling Green, Ohio. I am fully competent to make
this Affidavit. I have personal knowledge of the facts
stated herein and the following is true and correct.

2. Iam a developmental psychologist and an Associ-
ate Professor of Human Development and Family
Studies at Bowling Green State University in Ohio. I
have written 44 peer-reviewed scientific articles (42
published to date), of which 29 arc on the psychology
of abortion.

3. The opinions expressed in the Affidavit are based
upon my education, professional experience, the
psychological research I have conducted, and my
extensive and ongoing review of the abortion and
mental health literature. The references in Exhibit A
and Tables 1-4 in Exhibit B list publications that
have been formative in shaping my opinions on the

App. 14

issues identified in this Affidavit, as well as other
publications too numerous to mention in my ongoing
review of the scientific literature.

Overview and Synopsis of Opinions

4. Over the course of my professional career, I have
spent approximately 18 years conducting research,
publishing the results of studies, analyzing the re-
search of others, and performing systematic reviews
of the literature for publication in peer-reviewed
journals. Based on the research I have done, it is my
opinion and I can say with a reasonable degree of
scientific and medical certainty that abortion is a
substantial contributing factor in women’s mental
health problems, including depression and increased
risk of death from suicide, natural causes and acci-
dental injury.

5. Scientific evidence accrued over the last two
decades and published in leading peer-reviewed
journals in psychology and medicine indicates that
abortion places women at an increased risk for de-
pression, suicidal ideation, suicide, and death in
general. Other well-established psychological difficul-
ties associated with abortion include anxiety and
substance use disorders. Women undergoing this
procedure often report additional adverse conse-
quences including unrelenting feelings of regret,
shame, guilt, bereavement/loss, and lowered self-
esteem. Many women withdraw from family and
friends, become preoccupied with the abortion, and

ata i i a i i ta tlh it ll crete

App. 15

develop a sense that their lives will never feel right
again.

6. Furthermore, pre-abortion counseling and _ in-
formed consent are key factors in post-abortion
difficulties. It is my opinion and research supports
that when a woman feels she was misinformed or
denied relevant information, this often precipitates
post-abortion difficulties.

7 Avoiding discussion of fetal development or using
terms like “tissue,” “blood,” “content of the uterus,” or
“a clump of cells” to refer to the fetus often encour-
ages consent that would not have been made if she
were told the truth. This deceitful practice denies
a woman the information a reasonably prudent
person would expect in considering whether or not to
pursue the abortion. Subsequently, if a woman ob-
tains truthful information concerning fetal develop-
ment, devastating psychological consequences become
more probable.

Suicide Ideation and Suicide

8. Abortion is a significant contributing factor in
suicidal ideation and suicide. In Table 1 of Exhibit B,
I provide a synopsis of the 6 available studies dealing
with abortion and suicidal behavior. When considered
in totality, the scientific criteria for isolating a signifi-
cant risk factor are sufficiently met. Abortion is a
consistent and strong risk factor for suicidal behavior.
The studies are all large scale, prospective in nature,
and they incorporate a variety of different types of

App. 16

comparison groups as well as additional control
techniques, effectively fortifying the level of confi-
dence in the results derived. In a review of the largest
and strongest published literature, Thorp and col-
leagues (2003) arrived at a similar conclusion.

Alcohol and Drug Abuse

9. Alcohol and drugs may be used as convenient
means for suppressing or blunting painful memories.
There are numerous obvious problems associated
with use of substances for coping with a painful
abortion experience. Specifically, it is likely to facili-
tate avoidance and hinder women from coming to
terms with the underlying cause of their discomfort.
Further, the many physical, psychological, social, and
practical problems associated with substance abuse
will in all likelihood introduce new sources of stress
which can exacerbate the traumatic impact of an
induced abortion.

10. There are numerous studies affirming associa-
tions between abortion and both depression and
substance abuse (reviewed below and in Tables 2 and
3, Exhibit B). Substance abuse, which constitutes a
dysfunctional coping response, and depression have
been long established as primary risk factors in the
etiology of suicidal ideation and behavior (Gliatto
& Rai, 1999). As indicated in the tables, the studies
meet the scientific criteria for establishing abortion
as a substantial, contributing factor in the etiology
of substance use and depression (time sequence,

App. 17

co-variation, control, and magnitude of effect). There-
fore, abortion is both directly and indirectly associ-
ated with suicidal ideation and suicide.

Mental Health Problems

11 Abortion is a significant contributing factor in
mental health problems. A minimum of 20-30% of
women who have had an abortion suffer from serious
negative psychological complications (Adler et al.,
1990; Bradshaw & Slade, 2003; Coleman, 2005;
Coleman et al., 2005; Lewis, 1997; Major & Cozza-
relli, 1992; Zolese & Blacker, 1992). With more than
1.3 million abortions performed annually in the U.S.,
using the conservative 20% figure would yield over
260,000 new cases of mental health problems each
year.

12. The results of the four largest, record-based
studies published to date have uniformly revealed
that abortion increases the risk of serious mental
health problems. In Denmark, David et al. (1981)
found the overall rate of admission for psychiatric
hospitalization was 18.4 and 12.0 per 10,000 for
women who had aborted and delivered respectively.
For those who were divorced, separated, or widowed,
the psychiatric admission rate was 63.8 per 10,000 for
women who aborted versus 16.9 for those who deliv-
ered. The outcome variable employed was admission
to a psychiatric hospital for a psychotic episode, a
worst case mental health outcome.

App. 18

13. In Canada, Ostbye, et al. (2001) compared
41,089 women with an abortic» history to a matched
group of 39,220 women without a history of abortion,
relative to hospitalization for psychiatric problems,
with the results revealing a 165% higher rate of
hospitalization for the abortion group.

14. The remaining two studies were conducted in
the U.S. using data from over 54,000 low-income
women on state medical assistance in California.
Women who had an abortion in 1989 with possible
subsequent pregnancies had significantly higher
rates of outpatient psychiatric diagnoses than women
with only birth experience in the target year and no
history of subsequent abortions after eliminating all
cases with psychiatric claims 12-18 months prior to
the initial pregnancy (Coleman et al., 2002). This
difference was apparent when data for the full time
period were examined (17% higher) and when only
data from women with claims filed on their behalf
within 90 days (63% higher), 180 days (42% higher), 1
year (30% higher), and 2 years (16% higher) of the
pregnancy event were considered. Across the 4 year
study period, the abortion group had 40% more
claims for depression compared to women who deliv-
ered. Data using the same sample and focusing on
inpatient claims revealed similar findings (Reardon
et al., 2003); this is the fourth study.

App. 19

Psychological Problems

15. In addition to these four studies, numerous
additional research reports have been _ published
throughout the world indicating that abortion is a
substantial contributing factor to decrements in
women’s mental health.

16. Abortion is a significant contributing factor in
specific psychological problems. The literature per-
taining to adverse psychological effects of abortion
has grown tremendously in the last two decades,
rendering it beyond the scope of this Affidavit to
describe in detail all the available evidence demon-
strating that abortion is a significant contributing
factor to negative psychopathologies. Therefore, in
Tables 3 and 4 of Exhibit B, I have provided synopses
of the published literature pertaining to depression
and anxiety. Application of the criteria for assessing
associations between variables definitively demon-
strates that within a reasonable degree of scientific
probability abortion is a significant contributing
factor in depression and anxiety. The analysis of
published research offered in this Affidavit further
shows that within a reasonable degree of scientific
probability abortion is a primary cause in many
women’s anguish and prolonged mental health strug-
gles.

17. I will highlight the results of one particularly
informative prospective study published in January
2006 by New Zealand researchers Fergusson, Hor-
wood and Ridder. Results of the Canterbury Health

App. 20

and Development Study published in the Journal of
Child Psychology and Psychiatry and Allied Disci-
plines revealed that young women who aborted were
at a significantly higher risk for depression, anxiety,
suicidal behaviors, and substance use disorders
compared to both women who carried a pregnancy to
term and those who were never pregnant.

18. The study was led by pro-choice researcher,
David Fergusson of the Christchurch School of Medi-
cine & Health Sciences who did not expect to find
adverse psychological consequences associated with
abortion. This study of 1,265 children born in Christ-
church in 1977 has a number of positive methodologi-
cal advantages over other studies: (a) it is
prospective, following women over many years; (b) it
used comprehensive mental health assessments
employing standardized diagnostic criteria of DSM
III-R disorders; (c) it reported considerably lower
estimated abortion concealment rates compared to
previously published studies; (d) the sample repre-
sented between 80 — 83% of the original cohort of 630
females; and (e) the study used extensive controls.

19. While 42% of the women who aborted reported
major depression by age 25, 39% of post-abortive
women suffered from anxiety disorders. In addition,
27% reported experiencing suicidal ideation, 6.8%
indicated alcohol dependence, and 12.2% were abus-
ing drugs. Compared to the pregnant/no abortion
group, the abortion group scored significantly higher
on all these variables except anxiety. Compared to the

App. 21

never pregnant group, the abortion group scored
significantly higher on all variables.

20. Dr. Fergusson and his colleagues challenged the
American Psychological Association’s recent assertion
that “well-designed studies of psychological responses
following abortion have consistently shown that risk
of psychological harm is low.” Dr. Fergusson noted
that this claim was based on a small number of
studies that suffer from significant methodological
problems as well as a general disregard for studies
showing negative effects.

21. Ten months after Fergusson’s study was pub-
lished, a prestigious group of psychiatrists and obste-
tricians wrote a letter to the London Times citing
the Fergusson study and advocating for more accu-
rate pre-abortion information dissemination: “Since
women having abortions can no longer be said to have
a low risk of suffering from psychiatric conditions
such as depression, doctors have a duty to advise
about long-term adverse psychological consequences
f abortion.”

Increased Risk for Negative Post-Abortion
Outcomes

22. There is a vast literature describing women at-
risk for negative abortion experiences. Among the
most commonly reported risk factors for poor adjust-
ment are difficulty with the decision, emotional
investment in the pregnancy, timing during adoles-
cence or being unmarried, involvement in unstable or

App. 22

violent relationships, conservative views of abortion
and/or religious affiliation, second trimester abor-
tions, and feelings of being forced into abortion by
one’s partner, others, or by life circumstances (Allan-
son, & Astbury, 2001; Bracken, 1978; Bracken et al.,
1974; Campbell et al., 1988; Cozzarelli et al., 1994;
Kero et al., 2004; Lewis, 1997; Lyndon et al., 1996;
Osofsky & Osofsky, 1972; Osofsky et al., 1973; Re-
mennick & Segal, 2001; Russo & Denious, 2001).
Internalized beliefs regarding the humanity of the-
fetus, moral, religious, and ethical objections to
abortion, and feelings of bereavement/loss also fre-
quently distinguish those who suffer profoundly (see
Coleman et al., 2005 for a review).

23. The percentage of women falling into “high-risk”
groups is in actuality quite high. For example, Hus-
feldt and colleagues (1995) reported that 44% of the
women surveyed had doubts about their decision
upon confirmation of pregnancy and 30% continued to
express doubts when the abortion date arrived.

24. If a woman has doubts about her abortion and
believes it was morally wrong, guilt feelings, which
are often implicated in depression are likely to arise.
Guilt associated with abortion has been consistently
reported (Broen et al., 2004) and identified in the pre-
abortion counseling literature (Baker et al., 1999).
Rue and colleagues’ (2004) study revealed that 78% of
U.S. women felt guilt in association with a past
abortion. Further, close to 50% of Russian women
who reside in a culture that is very accepting of
abortion reported guilt feelings.

App. 23

25. Kero et al. (2001) found that 46% of women who
aborted indicated that their thoughts regarding
termination evoked a conflict of conscience. The
source of such conflict is likely women’s understand-
ings of the humanity of the fetus. In Conklin and
O’Connor’s (1995) study of 800 women who had an
induced abortion, those who reported perceiving the
fetus as human experienced significantly more post-
abortion negative affect and decision dissatisfaction
than women who did not. Awareness of the humanity
of the fetus is common among women who are seri-
ously contemplating an induced abortion. For exam-
ple, using semi-structured interviews Smetana and
Adler (1979) found that 25% of women confronting an
induced abortion decision understood that the fetus
was a human being and understood induced abortion
as terminating his or her life. In a recent study
conducted by Rue et al. (2004), 50.7% of American
women and 50.5% of Russian women who had an
induced abortion felt induced abortion was morally ~
wrong.

26. The decision to abort is obviously often conflict-
ridden with many women seriously questioning their
decision and suffering from their choice to abort.
Coleman and Nelson (1998) noted that 38.7% of
female college students voiced regret in the first few
years following an abortion. Moreover, the results of a
study by Soderberg and colleagues (1998) indicated
that 76.1% of women who had a past abortion would
never consider repeating the experience.

App. 24

Pre-Abortion Counseling

27. The importance of pre-abortion counseling and
informed consent for women considering abortion has
been well-documented in the scientific literature. The
overwhelming preponderance of objective scientific
evidence published in prestigious academic journals
world-wide indicates that abortion does indeed pose
serious mental health risks and significantly in-
creases a woman’s chance of dying, particularly by
her own hand. These facts were known by the end of
2000 and earlier, and have been strongly reaffirmed
with studies since that time.

28. Rosa Acuna had the right to be informed of these
risks, as do all women who seek an abortion. Affirma-
tive statements that minimize the risks of mental
health problems are incorrect and should never be
made when the scientific/medical evidence is to the
contrary.

29. Criticism leveled against pre-abortion counsel-
ing has focused on insufficient assistance with the
decision-process (Butlet, 1996; Stites, 1982). Profes-
sionals will more effectively serve women by helping
them to avert a decision that can cause later suffering
through dissemination of accurate and objective
scientific information regarding the risk factors for
emotional problems, listening sensitively for any
feelings of ambiguity, and offering assistance that
facilitates the woman’s autonomous decision-making.
This idea was emphasized by Miller (1992, p. 91) who
stated that “a woman considering abortion who

App. 25

expresses enjoyment in being pregnant or the desire
to have a child to take care of deserves some pre-
abortion, exploratory counseling regarding these
teelings.” A related opinion was expressed by, Lemkau
(1991, p. 100) who noted “in a political environment
in which a woman’s right to choose abortion is con-
stantly challenged, it is easy to forget the importance
of the right to choose not to abort.”

30. Furthermore, professionals working with women
contemplating an abortion need to be encouraged not
to interject their own opinions regarding what they
perceive to be the best decision for an individual and
should help instill confidence in women to not yield to
pressures from others as they weigh their options.

Informed Consent

31. Unfortunately, many women who make the
decision to abort do so without a thorough under-
standing of the procedure. Research suggests that
feeling misinformed or being denied relevant infor-
mation often precipitates post-abortion difficulties
(Congleton & Calhoun, 1993; Franz & Reardon,
1992).

32. Provision of accurate information pertaining to
fetal development would help to insure that women
are making decisions that are consistent with their
beliefs and value systems. Avoiding discussion of fetal
development or using terms like “tissue,” “blood,”
“content of the uterus,” or “a clump of cells” to refer to
an embryo or fetus may seem to make the women’s

App. 26

decision easier, but it can often encourage a consent
that would not have been made if she were told the
truth. This deceitful practice is wrong as it denies
women the information a reasonably prudent person
would expect in considering whether or not to pursue
the medical procedure. Moreover, employment of
ambiguous, misleading language violates a woman’s
right to make a fully informed decision and leaves her
vulnerable to adverse outcomes, unanticipated at the
time of the decision.

33. If a woman obtains subsequent information,
contradicting that provided by the abortion facility
and used as the basis of her earlier abortion decision,
devastating psychological consequences become more
probable. This fact is one that has been known in the
medical profession for decades. In a 1980 letter
published by the New England Journal of Medicine,
this position is expressed by Riggs: “Women deserve
to know exactly what would be removed before they
make a decision. The doctor who protects them from
the facts to preserve them from anxiety and guilt has
made a moral decision on their behalf ... and to
deprive a woman contemplating abortion of a descrip-
tion of the fetus whether or not she requests it, is to
deprive her of truly informed consent” (p. 350).

34. In a paper published in the top-rated medical
ethics journal, The Journal of Medical Ethics, Reardon,
Lee, and I found that 95% of a socio-demographically
diverse group of women wished to be informed of all
possible complications associated with drugs, surgery,
and/or other forms of elective treatments, including

App. 27

abortion (Coleman et al., 2006). In addition, a fre-
quency of complications of 1:100 or higher would
factor into most women’s elective treatment decisions.
As indicated by Gissler and colleagues as a key point
in their 2005 article “Elevated mortality risk after a
terminated pregnancy has to be recognized in the
provision of health care and social services” (p. 462).

35. As previously noted, research firmly indicates
that when women feel they have been misinformed
regarding the specifics of an abortion procedure, they
are more inclined to suffer in the aftermath as they
acquire factual information (Congleton & Calhoun,
1993; Franz & Reardon, 1992).

Further Affiant sayeth not.”

/s/ Priscilla Coleman

Dr. Priscilla K. Coleman, Ph.D

SWORN TO AND SUBSCRIBED BEFORE ME,
the undersigned authority, on this 2nd day of May,
2008.

/s/ Karen Brueggemeier
NOTARY PUBLIC IN AND FOR
THE STATE OF OHIO

My commission expires: 5-29-11
Notary Public, Wood County, Ohio

App. 28

Exhibit A:
Scientific Literature Relied Upon in
Part in the Formation of My Opinions

Adler, N. E., David, H. P., Major, B. N., Roth, S. H.,
Russo, N. F., & Wyatt, G. E. (1990). Psychological
responses after abortion. Science, 248, 41-44.

Allanson, S., & Astbury, J. (2001). Attachment style
and broken attachments: Violence, pregnancy, and
abortion. Australian Journal of Psychology, 53, 146-
151.

Appleby L (1991) Suicide after pregnancy and the
first postnatal year. British Medical Journal, 302:
137-140.

Baker, A., Beresford, T., Halvorson-Boyd, G., & Gar-
rity, J. (1999). In Paul, M. et al. (eds). A Clinician’s
Guide to Medical and Surgical Abortion. New York:
Churchill Livingstone (a National Abortion Federa-
tion task force compendium).

Bracken, M. B. (1978). A causal model of psychoso-
matic reactions to vacuum aspiration abortion. Social
Psychiatry, 13, 135-145.

Bracken, M. B., Hachamovitch, M., & Grossman, G.
(1974). The decision to abort and psychological seque-
lae. Journal of Nervous and Mental Disease, 158, 155-
161.

App. 29

Bradshaw, Z., & Slade P. (2003). The effects of in-
duced abortion on emotional experiences and rela-
tionships: A critical review of the literature. Clinical
Psychology Review, 23, 929-958.

Broen, A. et al. (2004). Psychological impact on
women of miscarriage versus induced abortion: A 2-
year follow-up study. Psychosomatic Medicine, 66:
265-271.

Butler, C. (1996). Late psychological sequelae of
abortion: Questions from a primary care physician.
Journal of Family Practice, 43, p. 396-401.

Campbell, N., Franco, K. & Jurs, S. (1988). Abortion
in adolescence. Adolescence, 23, 813-823.

Carroll, P. S. (2007). The breast cancer epidemic:
Modeling and forecasts based on abortion and other

risk factors. Journal of American Physicians and
Surgeons, 12, 72-78.

Coleman, P. K. (2005). Induced abortion and in-
creased risk of substance use: A review of the evi-
dence. Current Women’s Health Reviews 1, 21-34.

Coleman, P. K., & Nelson, E. S. (1998). The quality of
abortion decisions and college students’ reports of
post-abortion emotional sequelae and abortion atti-
tudes. Journal of Social and Clinical Psychology, 17,
425-442.

Coleman, P. K., Reardon, D. C., & Lee, M. B. (2006).
Women’s preferences for information and ratings of
the seriousness of complications related to elective

App. 30

medical procedures. Journal of Medical Ethics, 32,
435-438.

Coleman, P. K., Reardon, D. C., Rue, V., & Cougle, J.
(2002). State-funded abortions vs. deliveries: A com-
parison of outpatient mental health ciaims over four

years. American Journal of Orthopsychiatry, 72, 141-
152.

Coleman, P. K., Reardon, D.C., Strahan, T., & Cougle,
J. (2005). The psychology of abortion: A review and
suggestions for future research. Psychology & Health,
20, 237-271.

Congleton, G. & Calhoun, L. (1993). Post-abortion
perceptions: A comparison of self-identified distressed

and non-distressed populations. International Jour-
nal of Social Psychiatry, 39, 255-265.

Conklin, M. & O’Connor, B. (1995). Beliefs about the
fetus as a moderator of postabortion psychological
well-being. Journal of Social Psychiatry, 39, 76-81.

Cozzarelli, C., Karrasch, A., Sumer, N., & Major, B.
(1994). The meaning and impact of partner’s accom-
paniment on women’s adjustment to abortion. Jour-
nal of Applied Social Psychology, 24, 2028-2056.

Daling, J. R., Malone, K.E., Voigt, L., White, E. &
Weiss, N. S. (1994). Risk of breast cancer among
young women: Relationship to induced abortion.
Journal of the National Cancer Institute, 86, 1584-
1592.

App. 31

David, H., Rasmussen, N. & Holst, E. (1981). Post-
partum and postabortion psychotic reactions. Family
Planning Perspectives, 13, 88-91.

Fergusson, D. M., Horwood, J., & Ridder, E. M.
(2006). Abortion in young women and subsequent
mental health. Journal of Child Psychology and
Psychiatry, 47, 16-24.

Gliatto, M. F.,, & Rai, A. K. (1999). Evaluation and
treatment of patients with suicidal ideation. Amert-
can Family Physician, 59.

Foster, V., & Sprinthall, N. A. (1992). Developmental
profiles of adolescents and young adults choosing
abortion. Adolescence, 27, 655-673.

Franz, W., & Reardon, D. (1992). Differential impact
of abortion on adolescents and adults. Adolescence,
27, 161-172.

Gissler, M., et al. (2005). Injury deaths, suicides and
homicides associated with pregnancy, Finland 1987-
2000. European Journal of Public Health, 15, 459-
463.

Hofler, M. (2005). The Bradford Hill considerations
on causality: a counterfactual perspective. Themes in
Epidemiology, 2, 11.

Hunsfeldt, C., Hansen, S. K., Lyngberg, A., Noddebo,
M., & Pettersson, B. (1995). Ambivalence among
women applying for abortion. Acta Obstetricia et
Gynecologia Scandinavica, 74, 813-817.

App. 32

Khlat, M., Ronsmans, C. (2000). Deaths attributable
to childrearing in Matlab, Bangladesh: Indirect
causes of maternal mortality questioned. American
Journal of Epidemiology, 151, 300-06.

Ronsmans, C. et al. (2001). Evidence for a ‘healthy
pregnant woman effect’ in Niakhar, Senegal? Interna-
tional Journal of Epidemiology, 30, 467-473.

Kero, A., Hoegberg, U., Jacobsson, L., & Lalos, A.
(2001). Legal abortion: A painful necessity. Social
Science and Medicine, 53, 1481-1490.

Kero, A., Hogberg, U., & Lalos, A. (2004). Well-being
and mental growth — long-term effects of legal abor-
tion. Social Science & Medicine, 58, 2559-2569.

Lamson, H. W. et al. (1994). Obsterrics: Abortion
Mortality, United Sates, 1972 Through 1987. Ameri-
can Journal of Obstetrics & Gynecology, 171, 1365-
1372.

Lewis, W. J. (1997). Factors associated with post-
abortion adjustment problems: Implications for

triage. The Canadian Journal of Human Sexuality, 6,
9-17.

Lyndon, J., Dunkel-Schetter, C., Cohan, C. L., &
Pierce, T. (1996). Pregnancy decision making as a
significant life event: A commitment approach. Jour-
nal of Personality and Soctal Psychology, 71, 141-151.

Major, B., & Cozzarelli, C. (1992). Psychological
predictors of adjustment to abortion. Journal of
Social Issues, 48, 121-142.

App. 33

Martin, C. D. (1973). Psychological problems for the
unwed teenage girl. Genetic Psychology Monographs
88, 23-110.

Marzuk, P. M., et al. (1997). Lower risk of suicide
during pregnancy. American Journal «af Psychiatry,
154, 122-123.

Miller, W. B. (1992). An empirical study of the psycho-
logical antecedents and consequences of induced
abortion. Journal of Social Issues, 48, 67-93.

Osofsky, J. D., & Osofsky, H. J. (1972). The psycho-
logical reaction of patients to legalized abortion.
American Journal of Orthopsychiatry, 42, 48-60.

Ostbye, T., Wenghofer, E. F., Woodward, C. A., Gold,

G., & Craighead, J. (2001). Health services utilization
after induced abortions in Ontario: A comparison

between community clinics and hospitals. American
Journal of Medical Quality, 16, 99-106.

Perez-Reyes, M. G., & Falk, R. (1973). Follow-up after
abortion in early adolescence, Archives of General
Psychiatry 28, 120-126.

Reardon, D. C., Cougle, J., Rue, V. M., Shuping, M..,
Coleman, P. K., & Ney, P. G. (2003). Psychiatric
admissions of low-income women following abortion
and childbirth. Canadian Medical Association Jour-
nal, 168, 1253-1256.

Reardon, D.C., Strahan, T.W., Thorp, J.M., & Shup-
ing, M.W. (2004). Deaths associated with abortion
compared to childbirth: A review of new and old data

App. 34

and the medical and legal implications. The Journal
of Contemporary Health Law and Policy, 20, 279-327.

Remennick, L. L., & Segal, R. (2001). Sociocultural
context and women’s experiences of abcrtion: Israeli

women and Russian immigrants compared. Culture,
Health, And Sexuality, 3, 49-66.

Riggs, V. P. (1980). Regulating abortion service (let-
ter). New England Journal of Medicine, 302, 350.

Rue, V. M., Coleman, P. K., Rue, J. J., & Reardon, D.
C. (2004). Induced abortion and traumatic stress: A
preliminary comparison of American and Russian
women. Medical Science Monitor 10, SR 5-16.

Russo, N., & Denious, J. E. (2001). Violence in the

lives of women having abortions: Implications for
policy and practice. Professional Psychology Research
and Practice, 32, 142-150.

Saul, R. (1998). Abortion reporting in the United
States. Family. Planning. Perspectives, 30 244-247.

Simonds, W., Ellertson, C., Springer, K., & Winikoff,
B. (1998). Social Science and Medicine, 46, 1313-
1823.

Smetana, J., & Adler, N. (1979). Understanding the
abortion decision: A test of Fishbein’s Expectancy
Value Model. Journal of Population, Behavioral,
Social, and Environmental Issues, 24, 338-357.

Soderberg, H., Janzon, L., & Slosberg, N. (1998).
Emotional distress following induced abortion: A
study of its incidence and determinants among

App. 35

adoptees in Malmo, Sweden. European Journal of
Obstetrics, Gynecology, and Reproductive Biology, 79,
173-178.

Stites, M. C. (1982). Decision making model of preg-
nancy counseling. Journal of American College
Health, 30, 244-247.

Thorp, J Hartmann, K., & Shadigan, E (2003). Long-
Term Physical and Psychological Health Conse-
quences of Induced Abortion: Review of the Evidence.
Obstetrical and Gynecological Survey, 58, 67-79.

Zolese, G., & Blacker C. V. R. (1992). The psychologi-
cal complications of therapeutic abortion. British
Journal of Psychiatry, 160, 742-749.

Exhibit B
Tables 1-4

Table 1: Scientific Studies Identifying Abortion as a

TELS Factor in Su

1. Fergusson, D. M.,
Horwood, J., &
Ridder, E. M.
(2006). Abortion in
young women and
subsequent mental
health. Journal of

* Child Psychology
and Psychiatry, 47,

16-24.

oe Gilchrist, A. Cc
al (1995).
Termination of
pregnancy and
psychiatric
morbidity.
Journal of
Psychiatry 167:243-

et

British

oe

es

Lag AeY at quay orth digg Wits ? + Sisal
ri Tit T Bee sai ni de tc ‘Co- “mati paai sida came! AAD, Oly get ea aicebe
te Atuences MY ariation: RENE a cigipnatareauerad Sa.

NV

J

licidal ideation and Suicide.
nwa pannaulee/Taap ude. OF

weer effect

7. AROS ¥3: °

Pewee ote aca

Those who delivered
and were never
pregnant used as
comparison groups.
Statistical control for
maternal education
childhood sexual abuse,
physical abuse

Child neuroticism
Sclf-esteem

Grade point average
Child smoking

Prior history of
depression, anxiely
Prior history of suicide
ideation

Living with parents

| 3. Gisster, M., et al.
(1996). Suicides
after pregnancy in
Finland, 1987-94:
Register linkage
study. British
Medical Journal,
313, 1431-4

4. Gissler, M., et al.
(2005). Injury
deaths, suicides and
homicides
ussociated with
pregnancy, Finland
1987-2000.

European Journal of

Public Health,
459-463.

15,

V
27% of women who
aborted reported
expericncing suicidal
ideation This effect was
significant at the >.001
level, meaning there was
ona lin 1000 chance that
the result was due to
chance. ‘The risk was 4
times greater for women
who aborted compared to
never preynant women
and more than 3 times
greater than women who
for women who delivered

Living 4a iui ”
Comparisons included
women who were
refused abortion

and women who chose
abortion but changed
their minds

. skican

Among women with no
history of psychiatric
illness, the rate of
deliberate self-harm was
significantly higher (70%)
after abortion than
childbirth

—

Compared women who
aborted to those who
delivered, miscarried,
and the general
population

Suicide rate was nearly G
times greater among
women who aborted
compared to women who
gave birth

VJ

Compared women who
aborted to those who
delivered, miscarried,
and were not pregnant.
Distinguished the level
of risk associated with
suicide and other forms
of death.

V

Abortion was associated
with a 6 times higher risk
for suicide compared to
birth.

gg ‘ddy

pela iat

Fi : -Co--

"ER tS

< variation.”

cafepelts/. esha ean tae of

“effect - he tS

E. pre a D. C.. et

al. (2002). Deaths
associatcd with
delivery and
abortion among
California Medicaid
patients: A record
linkage study.
Southern Medical
Journal, 95, 834-841

Use of homogenous
population.
Controlled for prior

psychiatric history, age,

and months of
eligibility for state
medical coverage

Suicide risk was 154%
higher among women
who aborted compared to
those who delivered

6. Rue, V.M.,
Coleman, P. K.,
Rue, J. J., &
Reardon, D.C.
(2004). Induced
abortion and
traumatic stress: A
preliminary
comparison of
American and
Russian women.
Medical Science
Monitor 10, SR 5-

_16.

yi

Controlled for severe
stress symptoms prior
to the abortion, other
stressors pre-and post-
abortion, several
demographic variables,
and psycho-social
variables (harsh
discipline, sexual,
physical, and emotional
abuse, parental divorce,
etc).

J

36.4% of the American
women and 2.8% of the
Russian women
respectively reported
suicidal ideation.

Lg ‘ddy

Table 2: Scientific Studies Identifying Abortion

as a Risk Factor in Substance Use/Abuse

| Time.
Sequence’

Con
variation | |:

“"]" Resuits/ Magnitude of effect |

. Amaro H.,
Zuckerman B, &
Cabral H. (1989).
Drug use among
adolescent
mothers: profile of
risk. Pediatrics,
S84, 144-151.

2. Coleman, P. K.
(2006). Resolution
of Unwanted
Pregnancy During
Adolescence
Through Abortion
versus Childbirth:
Individual and
Family Predictors
and
Consequences.
Journal of Youth
and Adolescence.

3. Coleman, P. K.,
Reardon, D. C.,
mue, V., &
Cougle, J. (2002).
IHistory of induced
abortion in
relation to
substance use
during subsequent
pregnancies
carried to tenn.
American Journal
of Obstetrics and
Gynecology, 187,
1673-1678.

Other forms of perinatal
loss as comparison
groups

vi
Adolescent drug users when
compared to nonusers were
significantly more likely to
report a history of elective
abortion (33% vs. 16.3%).

No associations were identified
between drug use and parity or
other forms of perinatal loss
(miscarriage /stillbirth).

J

Demographic,
educational,
psychological, and
family variables found
to predict the choice to
abort

Exclusive focus on
unwanted pregnancies

After implementing controls,
adolescents with an abortion
history, when compared to
adolescents who had give birth
were 6 times more likely to use
Marijuana.

Results were stratified
by potentially
confounding factors
(marital status, income,
ethnicity, and time
elapsed since a prior
abortion or birth)

|

Compared with women who had
previously given birth, women
who aborted were significantly
more likely to use marijuana
(929%), various elicit drugs
(460%), and alcoho! (122%)
during their next pregnancy.

Differences relative to marijuana
and use of any elicit drug were
more pronounced among
married and higher income
woirnen and when more time had
elapsed since the prior
pregnancy.

Differences relative to alcohol
use were most pronounced
among the white women and
when more time had elapsed
since the prior pregnancy.

i

>
per eS SF

Set oP B
“‘Wariation @ [sends

oD atoms hate

[aREesalts/ Magnitude of
Mig sx $35 a eee

man, P. K.,
Reardon, D. C., &
Cougle, J. (2005)
Substance use
among pregnant
women in the
context of
previous
reproductive loss
and desire for

current pregnancy.

British Journal of
Health
Psychology, 10,
255-268.

Other forms of loss
Age

Marital status
Trimester in which
prenatal care was
sought

Education

Number in household

No differences were observed in
the risk of using any of the
substances measured during
pregnancy relative to a prior
history of miscarriage or
stillbirth.

A prior history of abortion was
associated with a significantly
higher risk of using marijuana
(201%), cocaine-crack (198%),
cocaine-other than crack
(406%), any illicit drugs (180%),
and cigarettes (100%)

S. Reardon, D. C.,
Coleman, P. K., &
Cougle, J. (2004)
Substance use
associated with
prior history of
abortion and
unintended birth:
A national cross
sectional cohort
study.

Am. Journal of
Drug and Alcohol
Abuse, 26, 369-
383.

6. Fergusson, D.
M., Horwood, J.,
& Ridder, E. M.
(2006). Abortion
in young women
and subsequent
mental health.
Journal of Child
Psychology and
Psychiatry, 47,
16-24.

V
Aye
Eth city
Marital status
Income
Education
Pre-pregnancy self-
esteem and locus of
control

J

Maternal education
Childhood sexual
abuse, physical abuse
Child neuroticism
Self-esteem

Grade point average
Child smoking

Prior history of
depression, anxiety

Prior history of suicide

ideation
Living with parents
Living with partner

Compared to women who
carried an unintended first
pregnancy to terin, those who
aborted were 100% more likely
to report use of marijuana in the
past 30 days and 149% more
likely to use cocaine in the past
30 days (only approached
significance).

Women with a history of
abortion also engaged in more
frequent drinkir z than those who
carried an unintended pregnancy
to term.

Except for less frequent
drinking, the unintended
delivery yroup was not
significantly different from the
no pregnancy group

6.8% indicated alcohol

dependence, and 12.2% were
abusing drugs. By age 2S.

. Time =

. i 3% ° x 38 Pe Pee ~ Sis Sequence” Variation Hid FE * at eevee % eS & Bock 3 ca : £5 ait. pe Pe fuss Poe Se ie iiedo Spetmencbaems ey
7 V V V
gee a a» Controls for a wide Compared to adolescents who
rhea TI ‘ range of socioeconomic ended their pregnancies through
f lati )- Ses and demographic abortion, those who keep their
Bite adotesccint variables likely to babies experienced a dramatic
influence juvenile reduction in smoking and

regnancy, . “
bei sine delinquency. marijuana use
gna ;

resolution, and
juvenile
delinquency, 7he
Sociological
Quarierly, 44,
555-576. eee
8. Reardon ID.C., Ni
Ney, P.G. (2002)
Abortion and
subsequent
substance abuse.
American
Journal of Drug
and Alcohol Women who aborted a first
Abuse, 26, 61-75. pregnancy were 4 times more
likely to report substance abuse
compared to those who suffered
from a non-voluntary pregnancy
loss

Le Gon ay (ERT a Col trol: 5 Results/Magnitude of effect |

Controlled for Women who aborted a first
substance use prior to pregnancy were 5S times more
the abortion and age likely to report subsequent
substance abuse than women
who carried to term.

9. Yamaguchi D, Pt & J

aut es sem , The use of illicit drugs other

¢ d > eg — than marijuana was 6.1 times

ee ans ie ell higher among women witha
i ae aang history of abortion when

premarital
ES ROSEN ro compared to women without a
Pres y history.

outcome: A
dynamic analysis
of competing life
events. Journal of
Marriage and the
Family, 49, 257-
270.

Table 3:

Scientific Studies Identifying Abortion

as a Risk Factor in Depression.

HP ay

Times] 5
“sequence

-Co-;

eS etdan ii bes

control

akestey hd Maguicude oF =
3 effect’ debibsircseet

~~ IK. CF
cigeay Abortion and
subsequent
pregnancy.
Canadian Journal of
Psychiatry, 29, 494.

Women with and
without a history of
abortion had similar
demographic
characteristics, obstetric
experiences, and
attitudes about labor and

Women, who aborted, when
compared to women without
a history of abortion, were
significantly more likely to
report depressive affect
during pregnancy and in the
postpartum period.

2. Coleman, P.K.,&
Nelson, E.S.

(1998). The quality
of abortion decisions
and college students’
reports of post-
abortion cmotional
sequelae and
abortion attitudes.
Journal of Social
and Clinical
Psychology, 17, 425-
442.

birth.
VV

Compared men and
women with abortion
experience.

‘Time elapsed since
abortion

wa

Depression increased after
abortion: female: S6.7%;
male: 25.9%

3. Coleman, P. K.,
Reardon, D. C., Rue,
V., & Cougle, J.
(2002). State-funded
abortions vs.
deliveries: A
comparison of
outpatient mental
health claims over
four years. American
Journal of
Orthopsychiatry, 72,
141-152

4. Congicton, G. &
Calhoun, L. (1993).
Post-abortion
perceptions: A
comparison of self-
identified distressed
and non-distressed
populations.
International
Journal of Social
Psychiatry, 39, 255-
2065

“ig

Compurison groups
likely very similar
except for the abortion
experience

Controls for pre-
pregnancy psycho-
logical difficulties, age,
and months of eligibility

Across the 4-yrs, the abortion

OZ a
group had 40% more claims
for neurotic depression than
the birth group

J

Compared women who
self-identified as
distressed and non-
distressed only.

J

Depression reported in 20%
of women who aborted.

ol sequence.

Tete],

i

S. orn 5.
Reardon, D.C., &
Coleman, P. K.
(2003). Depression
associated with
abortion and
childbirth: A long-
term analysis of the
NLSY cohort
Medical Science
Monitor, 9, CR105-
112

6. Cozzarelli, C.
(1993). Personality
and self-efficacy as

predictors of coping

with abortion.
Journal of
Personality and
Social Psycholoxy,
65, 1224-1236.

Pe Fayote, F.O.,
Adcyemi, A.B.
Oladimeji, B.Y.
(2004). Emotional
distress and its
correlates. Journa/
of Obstetrics and
Gynecology, 5, 504-
oe.

8. Fergusson, D. M.,

Horwood, J., &
Ridder, F. M.
(2006). Abortion in
young women and
subsequent mental
health. Journal of
Child Psycholozy
and Psychiatry, 47,
16-24.

Controlled for prior
psychological state and
several other variables:
age, race, marital status,
divorce history,
education, and income
(stratification by
ethnicity, current marital
Status, and history of
divorce)

lised a matched control
group

V
Maternal cducation
Childhood sexual abuse,
physical abuse
Child neuroticism
Sclf-esteem
Cirade point average
Child smoking
Prior history of
depression, anxiety
Prior history of suicide
ideation
Livings with parents
Living with partner

Women whose 1*
pregnancies ended in abortion
were 65% more likely to
score in the “high-risk” range
for clinical depression.

Differences Between the
abortion and birth groups
were greatest among the
demographic groups least
likely to conceal! an abortion
(White: 79% higher risk;
married: 116% higher risk;
marriage didn’t end in
divorce: 119% higher risk).

,*

3 weeks after the abortion,
depression was higher than
zencral population norms, but
lower than psychiatric norms.

Previous abortion was
significantly associated with
depression among the
preznant women

—y

42% of the women who had
aborted reported major
depression by age 2S.

ea He ‘scquance.

pResulte/magnieuas Fs
Se effect + sigs

“9. tistoo E | 2 as oe

Cohen, L. S., Otto,
M. W., Spiegelman,
D., & a ae D. W.
(2004). Early life
menstrual
characteristics and
pregnancy
experiences among
women with and
without major
depression: the
Harvard Study of
Mood and Cycles.
Journal of Affective
Disorders, 79,
167176.

10. Major, B.,
Cozzarelli, C.,
Cooper, M.L.,
Zubek, J., Richards
C., Wilhite, M., &
CGramzow, R.H.
(2000).Psych
ological responses
of women after
first trimester
abortion. Archives of
General Psychiatry,
S7, 777-84.

11. Major, B.
Cozzarelli,

C., Sciacchitano,
A. M., Cooper, M.
i_., Testa, M., &
Mueller, P.M.
(1990). Perceived
social support,
self-efficacy, and
adjustment to
abortion. Journal of
Personality and
Social Psychology,
S59, 186-197.

Employed demographic

controls (age, age at

menarche, educational
attainment, and history

of marital disruption

Compared to women with no
history of induced abortion,
those with two or more were
2-3 times more likely to have
a lifetime history of major
depression at study
enrollment.

When only antecedent
induced abortions were
compared to no history of
abortion, there was a three
fold increase risk of
developing depression later in

life.

V
Controls for
demographic
characteristics,
medical
complications, and
prior mental health

—+——

Two years post-abortion,
28% were not satisfied with
their decision, 31% would not
have the abortion

again, and 20 % were
depressed.

Younger age and having more
children pre-abortion
predicted more negative post-
abortion outcomes.

—

Immediately after abortion
Mild depression 21%
Modcrate depression 11%
Severe depression 4%

ep ‘ddy

ey:

2 sie aes wy

a ime- OER

“Sequence ®

. Co-

“Wariation |

» Control...

Sinatat ch 1A otk abaonll OF
_effect™ eo

T2. "Milles, Ww. 'B.
Pasta, D. J.,
C. L. (1998).
Testing a model of
the psychological
consequences of
abortion. In L. J.
Beckman and S. M.
Harvey (eds)., The
new civil war: The
psychology, culture,
and politics of
abortion.
Washington, DC:
American
Psychological
Association.

& tiie:

13. Pope, L. M.,
Adler, N. E., &
Tschann, J. M.
(2001). Post-
abortion
psychological
adjustment: Are
minors at increased
risk? Journal of
Adolescent Heaith,
29, 2-11.

J

2 weeks post-abortion: 29.5%
felt some guilt, 36.6%
experienced some depression,
30.4% reported mood
problems, 17.3% reported
decreased relationship
satisfaction, and 26.9%
reported decreased interest in
sex.

6-8 weeks post-abortion:
35.9% felt some guilt, 35.9%
experienced some depression,
30% reported mood
problems, 22% reported
decreased relationship
satisfaction, and 26%
reported decreased interest in

pp dy

14. Reardon, D. li
& Cougle, J. (2002)
Depression and
Unintended
Pregnancy in the
National
Longitudinal Survey
of Youth: A cohort
Study. British
Medical Journal,

324, 151-152.

yi

Compared current
sample results with
those reported in other
studies using similar
samples..

J

Confined analyses to
unintended pregnancy
aborted or delivered.

Controls for the
following: prior
psychiatric state, family
income. Education,
age at first pregnancy
Stratified by marital
status

race,

Sex.

19% experienced moderate to
severe levels of depression 4
wecks post-abortion.

%

The percentage of women

who carried to term
considered to be in the high-
risk range for depression was

22.7% compared to 27.3% of
women who aborted
(OR=1.54)

Among married women, the

percentage of women who
carried to term considered to
be in the high-risk range for
depression was 17.3%
compared to 26.2% of women
who aborted (OR=2.38)

sieciataal

‘Af izaia pe SPR pecs
Variation. .}... secs:

7 Resuie/Ma

Bl etalon

*
ey

Cougle, J., Rue, V.
M., Shuping, M.,
Coleman, P. K., &
Ney, P. G. (2003).
Psychiatric
admissions of low-
income women
following abortion
and childbirth.
Canadian Medical
Association Journal,
168, 1253-1256.

J

Comparison groups are
likely very similar
except for the abortion
experience.

Controls for pre-
pregnancy psych-
ological difficulties, age,
and months of eligibility
Extended time frame

J

Across the 4-yrs, the abortion
group more claims for
depressive disorders
compared to the birth group,
with the percentages equaling
90%, 110%, and 200% for
depressive psychosis, single
and recurrent episode. and
bipolar disorder respectively.

16. Schmicge, S., &
Russo, N. F. (2005).
Depression and
unwanted first
pregnancy:
Longitudinal cohort
study. British
Medical Journal

17. Slade, P., Heke,
S., Fletcher, J., &
Stewart, P. (1998).
A comparison of
medical and surgical
methods of
termination of
pregnancy: Choice,
psychological
consequences, and
satisfaction with
care. British Journal
of Obstetrics and
Gynecology, 10S,
1288-1295.

av
Age

Age at first pregnancy
1992 marital status
Education

Family income

VJ

Percent of women exceeding
the depression cut-off score
on the Center for
Epidemiological Studies
depression scale after an
abortion:

Married White women: 16%
Married Black women: 24%
Unmarried White women:
30%

Unmarried Black women:
38%

Non-Catholic: 27%
Catholic: 20%

N

1 month post-abortion:
Cases of depression: 9%

Results/ Magnitude of:

18. Séderberg H,
Janzon L and
Sjéberg NO (1998).
Emotional distress
following induced
abortion. A study of
its incidence and
determinants among
abortees in Malmé6,
Sweden. European
Journal of
Obstetrics.and
Gynecology and
Reproductive
Biology 79, 173-8

Utilized a case control
data analysis strategy

ay

50-60% of the women
experienced emotional
distress of some form (e.g.,
mild depression, remorse or
guilt feelings, a tendency to
cry without cause, discomfort
upon meeting children),
classified as severe in 30% of
cases.

76.1% said that they would
not consider abortion again
(suggesting indirectly that it
was not a very positive
experience).

19. Suri, R,
Altshuler, L.,
Hendrick, V. et al.
(2004). The impact
of depression and
fluoxetine treatment
on obstetrical
outcome. Archives
of Women’s Mental
Health, 7, 193-200.

46 women with a history of
depression had a significantly
higher mean number of prior
therapeutic abortions than 16
women without a history of
depression (.78 vs. .31). The
mean number of prior
pregnancies and spontaneous
abortions did not differ.

20. Urquhart D.R.,
& Templeton, A. A.
(1991). Psychiatric
morbidity and
acceptability
following medical
and surgical
methods of induced
abortion. British
Journecl of
Obstetrics and
Gynecology, 98,
396-399.

J

Clinically significant feelings
of depression at 1 month post-
abortion by 10% of the
sample.

Table 4: Scientific Studies Identifying Abortion

as a Risk Factor in Anxiety Disorders.

Be Ap Rta

, pha 2 E i idan ea
‘wariation

Sige SS $5 ASS

Set ioe

3 Controbe es

|} Results/ Magnitude of «—

effect

I. Broen, A.N.,
Moum, T., Bodtker,
A. S., & Ekebergy, O.
(2004).
Psychological
impact on women of
miscarriage versus
induced abortion: A
2 year follow-up
study.
Psychosomatic
Medicine, 66, 265-

: es Ss

J

Number of children

Marital status
Vocational status

ay

10 days after the pregnancy
ended, 30% of those who
had an abortion scored high
on measures of avoidance
or intrusion, which includes
symptoms such as
flashbacks and bad dreams.

2 years after the pregnancy
ended, nearly 17% of 80
women who had an
abortion scored highly on a
scale measuring avoidance
symptoms, compared with
about 3% of those who

2. Broen, A.N.,
Moum, T., Bodtker,
A. S., & Ekeberg, O.
(2005). Reasons for
induced abortion and
their relation to
women’s emotional
distress: a
prospective, two-
vear follow-up
study. General
Hospttal Psychiatry,
27, 36-43.

i

Marital status
Psychiatric history

miscarried.

Male pressure on women to
abort was significantly
associated with negative
abortion-related emotions
in the two years following
an abortion.

Pre-abortion psychiatric
history was not
significantly related to
immediate negative
abortion related emotion or
with negative emotional
responses measured at 2
years out.

23.8% of the sample scored
high on The Impact of
Events Scale (a measure of
stress reactions after a
traumatic event) 10 days
after the abortion, 13.3% at
6 months, and 1.4% after 2
years

een Sr ae pial Bd

ait pantie vis cE
ey ta PYaET, Hicks tok thaehaae naan soceaetina

i Results/Magnitude of
setts ® aatrantte aes sitaaas effect* por

a's 3 a oka 3 eh rash: th 3
3. Coleman, P. K. a

Nelson, E.S.

(1998). The quality
of abortion decisions
and college students'
reports of post-
abortion emotional
sequelae and
abortion attitudes.
Journal of Social
and Clinical
Psychology, 17, 425-
442.

Gender: Compared
men and women with
abortion experience.

Time elapsed since
abortion

|

Anxiety increased after the
abortion: female: 13.3%;
male: 9.7%

4. Cougle, J.,
Reardon, D. C.,
Coleman, P. K., &
Rue, V. M.
(2005).General-ized
anxiety associated
with unintended
pregnancy: A
cohort study of the
1995 National
Survey of Family
Growth.

Journal of Anxiety
Disorders, 19, 137-
142

J

All women were
experiencing an
unintended pregnancy
Stratification by
ethnicity, current
marital status, and
age.

~/

The odds of experiencing
subsequent Generalized
Anxiety was 34% higher
among women who aborted
compared to delivered.

Greatest differences among
the following demographic
groups: Hispanic: 86%
higher risk, Unmarried at
time of pregnancy: 42%
higher risk; under age 20:
46% higher risk.

5. Fayote, F.O.,
Adeyemi, A.B.,
Oladimeji, B.Y.
(2004). Emotional!
distress and its
correlates. Journal
of Obstetrics and
Gynecology, 5, 504-
509.

Vv

Used a matched
control group

6. Fergusson, D. M.,
Horwood, J., &
Ridder, E. M.
(2006). Abortion in
young women and
subsequent mental
health. Journal of
Child Psychology
and Psychiatry, 47,
16-24.

Maternal education
Childhood sexual
abuse, physical abuse
Child neuroticism
Self-esteem

Grade point average
Child smoking
Prior history of
depression, anxiety
Prior history of
suicide ideation
Living with parents
Living with partner

af

Previous abortion was
significantly associated
with anxiety among the
pregnant women

“J

39% of post-abortive
women suffered from
anxiety disorders by age
a5.

Tee eh HEHE Sa iit ih i OOET ST adeeb ‘Results / Magnitude. of

£
study... itmRiee we Pe eee hee pi : Me “te 7 4
t Qe owiek ‘jah

Fededt han ea Pe eld Rosai ha wrath sequence’ ah ‘variation: , dP Fy Od ene Shee yy tg } HOHE TR ria Pesan on -effect:: ran Abbie
7. L-atmioel, P., i i VV

Rager-Achim, D.» Random sample of the Before the abortion, 56.9%

Achim, A., & Boyer, general population of of women and 39.6% of

R. (2000). ; reproductive age used men were much more

Emotional distress as the control group distressed than their

RUS scuptes. respective controls.

involved in first

trimester abortions. Three weeles after the

Canadian Family abortion, 41.7% of women

Physician, 46, 2033- and 30.9% of men were

tonietiaty a still highly distressed.

8. Major, B.,&

<sramZow, Two years after abortion:

R. Fi. : Intrusive thoughts

(i972). Abortion - quite a bit: 3%

wiht — - some intrusive thoughts:

Cognitive 62%

and emotional

implications of

concealment.

Journal

of Personality

and Social

Psychology ,77,
735-745 Me ie

9. Sivuha, S. J

ecard of 35% of women had some

eres Streas postiraumatic consequences

oasemaboantel Following of abortion (elevated

Abortion in 7 avoidance, intrusion, or

Somer ey eet hyper-arousal scores)

Union Country.

Journal of Prenatal 46% of women had

& Perinatal Psych evidence of PTSD.

& Health, 17, 41-61 exceeding the cut-offs for

(2002). both intrusion and

avoidance subscales

22% of women experienced
PTSD, exceeding the cut-

as ; ae PPE ie offs on all 3 subscales

10. Pope, L. M., ~/ VV

Adier, N. E., & Compared current Impact of Events Scale —
Tschann, J. M. sample results with Intrusion Subscale (a

(200 1). Post- those reported in other measure of stress

abortion : studies using similar associated with a traumatic
psychological samples. event) score = 13.46, which
eeemest: erated is similar to adults

Se increased experiencing a recent

ant sowed! af arental bereavement
Adolescent Health, ” . :

an, 2-1.

acelin Bia:

ened Pens WU aT Weare
sequence:

Min COBB E
wariation. ;

* sige h Cp he i

jo Results/ Magnitude of,

os @ffect

11. Rue, V. M.,
Coleman, P. K.,
Rue, J. J., &
Reardon, D. C.
(2004). Induced
abortion and
traumatic stress: A
preliminary
comparison of
American and
Russian women.
Medical Science
Monitor 10, SR 5-
16.

a

Extensive controls for
background variables:
- Severe stress
symptoms prior to the
abortion

- Other stressors pre-
and post-abortion

- Several demographic
variables

- Psycho-social
variables (harsh
discipline, abuse,
parental divorce, etc).

The percentages of Russian
and U.S. women who
experienced 2 or more
symptoms of arousal, | or
more symptom of re-
experiencing the trauma,
and 1 or more experience
of avoidance (consistent
with DSM-IV diagnostic
criteria for PTSD) were
equal to 13.1% and 65%
respectively.

i2. Slade, P., Heke,
S., Fletcher, J., &
Stewart, P. (1998).
A comparison of
medical and surgical
methods of
termination of
pregnancy: Choice,
psychological
consequences, and
satisfaction with
care. British Journal
of Obstetrics and
Gynecology, 105,
1288-1295.

J

1] month post-abortion:
Cases of anxiety: 27%

13. Williams, G. B.
(2001). Short-term
grief after an
elective abortion.
Journal of
Obstetrics,
Gynecologic, and
Neonatal Nursing,
30, 174-183.

V
Controlled for other
forms of loss and
psychiatric history
Used a control group
of women who had
not aborted

V

Women with a history of
elective abortion
experienced more grief in
terms of loss of control,
death anxiety, and
dependency than controls.

14. Urquhart D.R.,
& Templeton, A.’A.
(1991). Psychiatric
morbidity and
acceptability
following medical
and surgical
methods of induced
abortion. British
Journal of
Obstetrics and
Gynecology, 98,

| 396-399.

~J

Clinically significant
feelings of anxiety at I
month post-abortion by
10% of the sample.

---

Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/brief%3Amicro_IA40386020_1381%3A4. Public record. Not legal advice.