The experience of reproductive loss is a difficult and stressful one physically and mentally. The circumstances around reproductive loss may result in disenfranchised or complicated grief and require specialized psychological care or counselling.
In the United States approximately half of all recorded pregnancies are unintended and four in 10 of these pregnancies will end in abortion (The Guttmacher Institute, 2011). The subject of abortion is often viewed as a controversial and stigmatized one; therefore the need for support and emotional care for women going through this process is necessary. The unique circumstances for a woman seeking this procedure may influence her emotional stability throughout the process, with some feeling more emotional distress than others. Mental health history, interpersonal relationships, belief systems, culture and therapeutic support all contribute to the well-being of an individual before and after the abortion (Brien & Fairbairn, 1996). There are limited resources for women experiencing emotional distress throughout the abortion process (Casey, 2010). Basic counselling is usually offered as a short-term service through abortion clinics, but there is little comprehensive literature outlining any abortion counselling interventions or programs.
Culture will determine the social climate and attitudes regarding abortion. In most cases abortion is a controversial subject and is stigmatized or simply not acknowledged. The grief experienced around abortion is therefore disenfranchised and discounted due to the nature of the loss (Doka, 1989).
The differing views on abortion present abortion clinics and their clients with individuals strongly opposing the procedure. These attitudes may create great difficulty for the individuals requesting the procedure. Additionally, individuals working in academics and research with firm attitudes, either supporting or opposing abortion, are publishing biased research, confusing, undermining or exaggerating the experience of abortion and mental health (Ring-Cassidy & Gentles, 2002).
Miscarriages are another type of loss that can be psychologically challenging and complicated for a woman. For many, pregnancy is the culmination of a dream for a family; it is a significant stage in a woman’s life and is generally a psychologically vulnerable time (Gerber-Epstein, Leichtentritt, & Benyamini, 2009). Women going through this type of loss have experienced an immense closeness with their unborn, yet few have little, if not no immediate experiences to reflect upon or remember (Brier, 2008). Secrecy surrounding the early stages of pregnancy can also complicate and impede a woman’s need to express her feelings and grieve (Brier, 2008). Immediate family and close friends may have never known of the pregnancy and will not be able to understand or provide the support necessary for bereaved women. Here, the relationship with the unborn is not recognized and the grief is disenfranchised (Doka, 1989).
In the United States approximately 10% to 25% of recognized pregnancies result in miscarriages, with an estimated 80% occurring within the first trimester of pregnancy (Kobler, Limbo, & Kanavaugh, 2007; Shreffler, Greil, & McQuillan, 2011). These statistics suggest pregnancy loss is a moderately common experience and this notion can be invalidating for the woman grieving this loss (DeFrain, Millspaugh, & Xie, 1996). The research around miscarriage, grief and mental health is limited, but growing (Shreffler, Greil, & McQuillan, 2011). Wright (2011) highlights the need for interventions in perinatal grief and loss. Insufficient care and support from health care professionals is a problem and adds additional distress to the bereaved (Wright, 2011).
Qualitative studies explain how mothers felt their health care professionals and physicians minimized their loss, avoided their emotional needs, failed to educate and inform them about what had happened and what to expect, and failed to deliver information with sensitivity (Abboud & Liamputtong, 2005, as cited by Wright, 2011). These studies attempt to measure the emotional outcomes and experiences of women and their partners post reproductive loss. Exploring the full emotional impact miscarriage has on women and their partners and assessing how their needs can be met, will help develop therapy interventions necessary to encourage and aid in healing.
This research intends to establish the fundamental emotional needs regarding reproductive loss and identifies the counselling practices in place for women across North America. It outlines the circumstances regarding complicated and disenfranchised grief and identifies the way in which it relates to reproductive loss. By integrating this information with bereavement models within an art therapy framework, it provides counsellors and individuals seeking support with new resources, as well as with a potential art therapy program that may be implemented in abortion clinics, maternity wards and into general art therapy practices.