(The Lion)–Nearly 40% of women who suffer pregnancy loss – either a miscarriage or an abortion – report persistent grief for an average of 20 years after the incident, according to a new study.

Whether a woman chose to end a pregnancy or suffered a coerced abortion or miscarriage significantly impacts the duration and weight of her grief, researchers concluded.

Moreover, the authors of the study from the Elliot Institute argue clinics and doctors must properly screen a woman before administering an abortion to evaluate whether she is being coerced or pressured.

“Our findings confirm the importance of pre-abortion screening for any pressures to abort contrary to women’s own values and preferences,” they write. “Any such pressures are risk factors for negative mental health outcomes, including complicated grief.”

Among a 1,925-respondent pool of 41-to-45-year-old women, unaware of the survey’s topic and research, 21% reported induced abortions and nearly 30% reported a miscarriage or other natural loss.

While these numbers roughly reflect national averages, the Guttmacher Institute says 23.7% of women ages 41 to 45 report having had an abortion, according to the study.

Indeed, nearly 70% of women ages 41 to 45, report their abortions as “coerced, pressured or inconsistent with their own values and preferences,” according to a 2023 study from the Charlotte Lozier Institute.

The study divided respondents into five subcategories: pregnancy loss or miscarriage; wanted abortion; inconsistent abortion; unwanted abortion; and coerced abortion.

An inconsistent abortion means the woman chose to terminate the pregnancy despite inconsistency with her “values and preferences.”

An unwanted abortion is one in which the mother said her abortion was “unwanted and contrary to my values and preferences,” AfterAbortion.com reports.

An inconsistent abortion was the most common decision selected (35.5%), followed by Wanted (29.8%), Unwanted (22.0%) and Coerced (12.7%), according to the study.

More than half of women enduring a coerced abortion (53.8%) report “grief scores indicating a high risk of prolonged grief disorder,” according to the outlet.

“Most specifically, women who are at greater risk of feeling pressured into undergoing unwanted or coerced abortions are at greater risk of subsequent grief and other negative reactions that may persist for over twenty years,” the researchers write.

Nearly 30% of women who suffer a natural pregnancy loss (28.8%) show signs of prolonged grief disorder.

While 13.9% of women who wanted an abortion indicated prolonged grief disorder, the study found women who had “unwanted abortions” most similarly matched the grief risks of women who suffered “natural pregnancy loss” (28.8%).

A prolonged grief disorder diagnosis typically indicates the person has struggled with daily, debilitating grief from the loss of a loved one, for more than a year. Additionally, a diagnosis requires the daily experience of at least three of the following symptoms for more than a month, according to Psychiatry.org:

• Identity disruption (such as feeling as though part of oneself has died).
• Marked sense of disbelief about the death.
• Avoidance of reminders that the person is dead.
• Intense emotional pain (such as anger, bitterness, sorrow) related to the death.
• Difficulty with reintegration (such as problems engaging with friends, pursuing interests, planning for the future).
• Emotional numbness (absence or marked reduction of emotional experience).
• Feeling that life is meaningless without the deceased person.
• Intense loneliness (feeling alone or detached from others).

Many women who suffer the loss of a pregnancy endure these emotions, indicative of prolonged grief disorder, the study reports. The researchers recommend mental health workers inquire whether a woman has suffered the loss of a pregnancy – either through abortion or miscarriage – to help her address “repressed and unresolved feelings.”

“In the experience of some counselors, such a query may be necessary to ‘give permission’ to a client to share a secret they might otherwise be hesitant to disclose,” the researchers concluded.