This past semester, in a course taught by one of us (EBV) at New York University, the class spent considerable time reading women’s stories about their abortions, focusing particularly on a website called This website was founded by a pro-choice woman and on it no mention of politics, religion, or morality is allowed. The website contains thousands of women’s stories about their abortions—and about their post-abortion feelings. And many of these women are in acute pain; some are almost totally incapacitated. One writes in a post: “I am not coping at all; I feel as though the top of my head is going to fly off.” Another says: “I am just grieving like crazy!” A third: “I don’t understand why I am not getting better, but worse all the time! I am so depressed!” (Stories on this website are protected by copyright, and it is not permitted to quote directly from them. Quotations provided here are therefore faithful rewordings.)

Many of these women cannot go outside for fear of “triggers”—the sight or sound of things that will bring back the abortion experience and cause panic attacks. Triggers include the sound of a vacuum cleaner (many abortions are done by the vacuuming out of the fetus from the uterus) or the music that was playing at the abortion clinic while the abortion was being performed. The sight of pregnant women, or maternity clothes, or babies, or toddlers, or school-children, or of the place (even the neighborhood or town) where the abortion took place can all serve as triggers. Other triggers are anniversaries of all kinds, especially of the abortion and of the EBD (expected birth date), and, in particular, Mother’s Day.

What is particularly striking is that most of the women who have these powerful emotional reactions to their abortion are stunned by them. They were not opposed to abortion; many were actively pro-choice. They were blind-sided by their own reaction. One woman lamented—and thousands of others echo her mystified anguish—“If this was the right decision, why do I feel so terrible?”

Research indicates that there are various psychological or political factors that may contribute to this disconnect between the anticipated and the actual emotional outcome. Since this disturbing phenomenon is so widespread, and found among women from varied backgrounds and different parts of the world, it seems likely that the brain itself—in particular, the nature of women’s brains—may shed some particularly useful light on this unexpected negative emotional reaction.

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Women’s brains are, of course, in many fundamental ways the same as men’s. Men and women think and reason in similar ways. But recent research shows that there are some significant differences in the brain and brain-related psychology of the two sexes. And a few of these differences can make a very large difference with regard to decision-making and its emotional consequences.

The part of the brain that processes emotion, generally called the limbic system, of women functions differently than that of men. Women experience emotions largely in relation to other people: what moves women most is relationships. Females are more personal and interpersonal than men. (Differences show up as early as a day after an infant’s birth: newborn baby girls look at faces relatively more than boys, who focus more on moving robotic figures.) There is wide consensus among scientists and researchers on this fundamental issue.

Recent research has also studied the ways in which males and females cope with stress. Whereas men’s behavior under stress is generally characterized by what is called “fight or flight,” women respond to stress by turning toward nurturing behavior, nicknamed “tend and befriend.”

Men’s and women’s brains also work differently in handling memory and memories. Men are more apt to recall facts of all kinds, on the one hand, and a global picture of events, on the other. By contrast, women remember people (for example, faces), details of all kinds, and emotion-laden narratives—and they may return to them obsessively.

Women are more vulnerable to depression and anxiety than men, perhaps because they have a lower level of serotonin, an important neurotransmitter. In addition, women are twice as likely as men to suffer from post-traumatic stress disorders. Men suffer more than women from other mental pathologies, such as autism, dyslexia, and Narcissistic Personality Disorder; the two sexes suffer about equally from yet other mental problems, such as bi-polarity.

What do these differences add up to, practically speaking? Let’s walk quickly through an unplanned pregnancy and abortion. A woman may reason her way to the decision to terminate the unwanted pregnancy. Her abortion decision may seem, and may indeed be, rational in terms of her long-term goals and interests, and her chosen values. But afterwards, a woman may experience several powerful reactions, which are rooted in the structures and basic chemistry of her brain.

  • A woman may discover, emotionally, that she has (now, had) a far more powerful relationship with the fetus than she had thought. This may be particularly true if the relationship with her partner (in the interests of which she may have decided to have the abortion) should deteriorate after the abortion.
  • When responding to the stress of the abortion, she may well be drawn to nurturing, to “tending and befriending” behavior: this is, we saw, characteristic of women. But one of the key persons she might have tended and befriended—her unborn child—she has just terminated. She therefore has no ready outlet to cope with this significant stress.
  • Add to this already toxic mix the very power of the memories involved in most unwanted pregnancies and abortion experiences, such as the nausea or other physical symptoms, often exacerbated by hormonal instability and mood swings; the anxiety over the unwanted pregnancy; the drama of the pregnancy test; often, the difficulty of making the decision, then the waiting before the abortion can take place; perhaps protesters in front of the clinic; the abortion clinic waiting room, crowded perhaps with other emotional women and men; the abortion itself—the doctors and nurses, the stirrups, the vacuum or other machinery—then the recovery room; the pain and bleeding afterward. All these dramatic experiences are likely to provide her with indelible memories. A woman may return to them and relive them over and over.
  • And to cap it off, as a woman she is more vulnerable to depression and anxiety, and to post-traumatic stress disorders.

Thus, though a woman can decide rationally to have an abortion, afterwards the other shoe may drop—and it may drop very hard indeed. For the thousands of women on and similar websites, a terrible and shocking reaction sets in after their abortion. Many women have discovered that somewhere down in their psyche—deep in their limbic system—they were already in a living relationship with the fetus, their “baby” (though they may have thought they thought it was just a random clump of cells). Often what lasts is not the relief or the power of the logical arguments: these may prove very short-lived. It is, rather, the failed, betrayed relationship between the woman and her fetus—now, in her mind, her dead baby—that has staying power.

Many of these women feel “haunted” (their word) by their lost child. They cry: “I miss my baby!” “It has been three years, and I still think of my baby girl every single day!” “I want my twins back!” The babies they ******, they now desperately want to love, to hold. (Those asterisks represent one of the words—“killed”—that are so painful and triggering that their use is prohibited on A good many women on the website have named the aborted baby, which appears to promote healing.

For some women, this surprising and terrifying shift from cool logic to hot maternal feelings may be the result of particular experiences: seeing the fetal heartbeat on a sonogram, or watching a pair of twins move; or, in a medical abortion at home, recognizing that what fell into the toilet bowl was not (as they had thought it would be) undifferentiated tissue but, rather, “a tiny, pale-gray baby,” and then agonizing over the dilemma of what to do with it (flush it down the toilet? bury it—and where?).

Sometimes, however, the shift cannot be explained by any one particular memory. Their reaction seems more profound and inexplicable than that—more hard-wired. Women care about relationships—and a woman’s relationship to her baby is one of the most powerful of all.

If we look at all this in evolutionary terms, we cannot be surprised. Human mothers (unlike the females of most other species) produce few offspring. For infants to survive, they must be very carefully tended and protected, over many years. Historically, culturally, the investment of women in their young has been tremendous. Billions of mothers have lavished their time, energy, and attention—their love—on their children. And what is the reward, the reinforcement for all this maternal time and effort? What does the mother get out of it? Whatever it is, it must be a reliable, immediate, and strong reinforcement. Otherwise, infant mortality—always high in the human and primate past—would have led to our extinction. Thus, we should not be surprised that human mothers are richly rewarded—by their own feelings, their own brain responses, their own chemistry—for good mothering, and that they are emotionally punished, internally, for failure.

What to do for these wounded women? provides an impressive virtual support system: women from around the world send hugs, visualized as “(((hugs!!)))”, and loving messages of support, understanding, and affirmation to each other. Thus, women from around the world “tend and befriend” these suffering women. After a while, many who were previously beside themselves with grief write in to say that they are now feeling better; they are healing; they have stopped hating themselves; they feel once again that they have a future. This valuable sisterhood is supplemented, for many women, by psychotherapy of some form.

But can’t we work to prevent at least some women from having to experience this painful surprise? One important change would surely be for the medical and psychological professions, and the university health centers, to be more honest about the psychological impact of abortion on substantial numbers of women. Is it not like the fine print on prescriptions?: “This medication may cause internal bleeding, or blindness, or [other grave side-effects].”

Some women appear to have no regrets whatever after abortion: see Some experience modest sadness. But for many women, their abortion turns out to have been a nightmare from which they cannot wake up. Some awaken each morning to that. Women and those who advise them need to be more aware of this risk, and why it occurs. Human beings—and women in particular—are not just cortex, not just what used to be called “gray cells.” Women need to be told the truth. They need to be prepared for what may be the consequences of this major life decision.

This is what informed choice means.