Editor’s Note: This is an excerpt of Sarah Erdreich’s book, Generation Roe: Inside the Future of the Pro-Choice Movement. See the accompanying blog post by Mandy Van Deven, In The Fray’s managing editor.

When people know you work in the pro-choice movement, the stories come out. All of the sudden, you’re a safe person. You can be trusted to hear personal stories about terminating a pregnancy because you won’t judge or criticize. When you go through life hearing such stories, one thing becomes quite clear to you: all kinds of women have abortions. According to the nonpartisan Guttmacher Institute, one in three American women will have an abortion before the age of forty-five.

Rachel (not her real name) is one of my mother’s oldest friends. I have known her and her husband practically all of my life. But it wasn’t until I told them I was writing a book about reproductive rights that Rachel opened up about her own experience with abortion, back in the mid-seventies.

Several years into her marriage, Rachel became pregnant. She had already had two healthy pregnancies, but this pregnancy didn’t progress normally. Rachel was vague on the details when she recounted her story to me, but she made it clear the abortion was medically necessary.

Had I not been offered that option, I very well could have lost my life.… There will always be doubts if I did right or I did wrong, but the right thing is that people can make the choice. I was fortunate that I had good medical care, and I was able to understand my options. But not everyone has that liberty.

“I’m not the least bit ashamed of what I did,” Rachel added. “In fact, I feel somewhat empowered by the choice because that was my right.” Yet Rachel only agreed to be interviewed if her real name was not used.

The day after I spoke with Rachel, I spent some time with a longtime friend of my father’s family. Toward the end of our visit, she mentioned that she had had an abortion many years earlier. Months later, Vicki (also a pseudonym) told me the whole story.

In the early seventies, Vicki became pregnant. Her husband threatened to leave her unless she had an abortion. They were living in a city that was hundreds of miles from her parents, siblings, and closest friends – and in one of the few states that had liberalized its abortion laws by then. “It was [the state’s] law to first see a psychiatrist,” Vicki said. “I remember I told the psychiatrist that if my husband wasn’t in the picture I would not consider abortion, but I guess obtaining the husband’s approval was routine.”

The entire procedure was covered by Vicki’s health insurance. After it was done, her husband — who, she said, had “badgered” her to get the abortion — called her a murderer. She later divorced him.

Vicki never told her family about her abortion.

My ex-husband is the only one who knows. I wanted to tell my mother, but that wasn’t news I wanted to break in a long-distance telephone call. That was back when long-distance calls meant something.… If I’d had more confidence to trust my feelings, and realized I was capable of supporting and raising a child on my own, I would not have had an abortion.

When I worked for the National Abortion Federation, I heard many women express gratitude that they could legally have an abortion, even as they regretted the particular circumstances — an unstable relationship, economic hardship, age, or a lack of education — that made abortion their best choice. To appreciate the right to make your own decision, even as you deplore the circumstances that led to that decision, is a complicated set of emotions that established pro-choice organizations haven’t always successfully addressed.

Groups like Planned Parenthood, NARAL Pro-Choice America, and the National Abortion Federation generally stick to messages about how common and safe abortion is, but they don’t offer a great deal of in-depth discussion about the range of emotions women may experience after having an abortion. Instead, they offer first-person stories, which overwhelmingly talk about abortion in positive terms. While studies have shown that most women feel relief after their abortions, women who have more ambivalent feelings afterward may not find comfort or support in these stories and messages.

The anti-abortion movement has been incredibly persuasive in its insistence that if a woman has mixed feelings following an abortion, then abortion itself must be unethical. In testimony before Congress in 1981, pro-life advocate and therapist Vincent Rue coined the term “post-abortion syndrome” to refer to an adverse physical or emotional response to abortion. While neither the American Psychological Association nor the American Psychiatric Association recognize post-abortion syndrome as an official diagnosis, the term quickly gained traction in the anti-abortion community.

In 1987, Ronald Reagan asked his surgeon general, C. Everett Koop, to write a report about the effects of abortion on women. An avowed opponent of abortion, Koop believed that the procedure traumatized women. He had even coauthored a book, Whatever Happened to the Human Race, which discussed post-abortion trauma. Even so, he was reluctant to do as Reagan asked. Koop was careful to distinguish between his personal beliefs and scientific evidence, and he refused to let ideology pressure him into taking a stance that the available evidence did not support. Answering Reagan in a January 1989 letter, Koop wrote that he could not conclude one way or another whether abortion was harmful to women.

Koop’s position shocked and incensed his fellow conservatives. President George H. W. Bush declined to appoint him secretary of health and human services in the new administration, and Koop left office one month before the end of his second term as surgeon general.

In 1988, the American Psychological Association commissioned a study to review the research on the psychological effects of abortion. After a survey of over two hundred studies, a panel of six experts found that only nineteen or twenty met what they considered reliable scientific standards. Based on those studies, the panel concluded that “legal abortion of an unwanted pregnancy in the first trimester does not pose a psychological hazard for most women.”

While some women did experience distress, they were in the minority. One study found that “seventy-six percent of women [who had a first-trimester abortion] reported feeling relief two weeks after an abortion, and only seventeen percent reported feeling guilt.”

It is important to note that women seeking later abortions reported more distress after their abortion, as did women who had difficulty making their decisions. While eighty-eight percent of abortions are performed within the first twelve weeks of pregnancy, women who have the procedure done in the second or third trimester overwhelmingly say that the timing was due to a delay in making the necessary arrangements — including raising money and securing an appointment. Fetal abnormality is another reason: many birth defects that are incompatible with life are not discovered until the fourth or fifth month of pregnancy, or even later.

My college years were shaped by the experiences of several close friends who chose to have an abortion following unplanned pregnancies. I learned from their situations that no matter how deeply pro-choice someone might be, it is still normal to have mixed feelings about having an abortion.

“I would never fault a woman who had an abortion for not wanting to share that with other people, because it’s too difficult,” Shannon Connolly, a medical student at the University of Southern California, told me. “But I hope they would be able to. Until abortion is normalized and people are able to say it’s just another part of health care, we won’t be able to talk about it in a meaningful way.”

Sarah Erdreich is a women’s health advocate, writer, and pro-choice activist. Her work has appeared in On The Issues, Lilith, Feminists For Choice, and RH Reality Check.

This excerpt has been slightly edited to adhere to In The Fray‘s style. 

Read the accompanying blog post by managing editor Mandy Van Deven.

Correction, July 15, 2013: Due to an editing error, the writer’s name was misspelled in several references.

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