Mental health issues surrounding the maternal debate.

The Maternal Mental Health Alliance has been campaigning for increases in availability of services in the UK for years, pointing to statistics around the heightened incidence of emergence of mental health conditions around maternity.

Considering how, in the past, it was not uncommon for women to die from physical complications in childbirth, I found it shocking to hear in a recent news report that suicide is currently a leading cause of death among women in the UK who are pregnant or who have given birth in the last year.  A GP was recently quoted in The Guardian saying the period during pregnancy or just after birth is when women are most likely to develop a mental health problem. He also said that this is a time when women can be afflicted with feelings of guilt and of course need opportunities to talk and be heard without feeling judged.

In this recent process where members of our community have asked for a review of the legislation on abortion, the question of how terminations affect mental health has been posed to me. This question initially threw me off as I have been practising talking therapies for 10 years and it’s never emerged in any of my clients as an issue which needed addressing in a clinical setting, so I thought that my response would be that abortion in itself isn’t something that appears to lead to severe or long-lasting mental distress. Then I found the following from an online educational resource, goodtherapy.org:

“Research shows that although many women experience feelings of guilt, sadness, or loss after choosing to have an abortion, these emotions are typically short-lived, and they are often overcome without professional help. However, feelings of shame and guilt may be exacerbated by a community where abortion is stigmatized, and feelings of loss or depression may be worse in cases where one felt pressured into having an abortion.”

To me it seems that abortion is obviously more difficult for those whose beliefs are at odds with the concept. The same resource provides evidence to back up my observations:  “…distress is more likely to occur in those who believe the foetus is a baby before it is born or who have other religious beliefs that conflict with abortion.”

Abortion in Gibraltar

Abortions don’t take place in Gibraltar. Local women have their terminations in other jurisdictions and then continue their lives back in a community where there is plenty of shame surrounding the issue.

In my modality of psychotherapy, we talk about the integration of experiences into the psyche. When we feel OK about something, it is described as an integrated experience. When we think that something isn’t OK and struggle to come to terms with it, the experience is thought to be requiring integration in order for psychological health to be restored. It is difficult for an individual to feel OK about a decision she has had to make if she is susceptible to opinions that abhor her actions and especially if she feels unable to talk about something important that has happened to her.

Recently, the international media has questioned our community’s respect for human rights in view of our anachronistic legislation which makes life imprisonment the penalty for breaching our abortion laws. According to the UN’s committee on the Elimination of Discrimination Against Women, the criminalization of health services that only women require, including abortion, is a form of discrimination against women. In 2014, the committee requested states to “remove punitive measures for women who undergo abortion.”

Good mental health

In Gibraltar we are still not generally familiar with the practice of psychotherapy. It seems to me that many people think that psychotherapy is for people who are unwell, although the reality is that people need to be functioning well enough to make use of psychotherapy. In my approach to my work, I avoid pathologising and I see clients as people who wish to undertake a form of self-development.

One of my objectives is to empower clients and one of the ways of empowering people is to give them options in how to address their problems.  Feeling forced into important decisions or feeling stuck without a choice in matters of huge importance is disempowering.  For example, a woman in a situation who feels forced to terminate a pregnancy is obviously more likely to feel upset than one who does so with the full conviction that an abortion is the best option for her.

The most difficult situations for a caring therapist are when a pregnancy occurs and there is a desire to have a baby but circumstances do not allow. Common examples are; lack of support from the would-be father, an abusive relationship, or the lack of socio-economic circumstances to bring up a child in the way deemed to be good enough.  A UK trained psychotherapist’s role is to support the client to meet their needs without interference of their own personal beliefs.

Support in our community

As well as working with individuals, I have in the past run support groups for post natal depression. Due to demand I will be organising a new group for mothers this month and if a need is identified, I am also happy to run a support group for women who would like a safe space to talk about their experiences of abortion.


Trainee Psychotherapist & Executive Coach
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