Read through the
Tree Trimming Project
case in chapter 13 of the textbook. This case refers to the earned value (EV) of the owner, Will Fence’s Tree Trimming business. Will briefly describes his techniques for EV. Based on the description provided in the case, is Will using EV?
Answer the corresponding question provided at the end of the case (300-500 words). Use references from the reading materials to support your response.
APA format is not required, but solid academic writing is expected.
Tree Trimming Project
Wil Fence is a large timber and Christmas tree farmer who is attending a project man-agement class in the spring, his off season. When the class topic came to earned value, he was perplexed. Isn’t he using EV? Each summer Wil hires crews to shear fields of Christmas trees for the coming Holiday season. Shearing entails having a worker use a large machete to shear the branches of the tree into a nice, cone-shaped tree. Wil describes his business as follows:A. I count the number of Douglas Fir Christmas trees in the field (24,000).B. Next, I agree on a contract lump sum for shearing with a crew boss for the whole field ($30,000).C. When partial payment for work completed arrives (5 days later), I count or estimate the actual number sheared (6,000 trees). I take the actual as a percent of the total to be sheared, multiply the percent complete by total contract amount for the partial payment [(6,000/$30,000 = 25%), (.25 × $30,000 = $7500)].1. Is Wil over, on, or below cost and schedule? Is Wil using earned value?2. How can Wil set up a scheduling variance?
.
This document discusses contemporary ethical dilemmas faced by healthcare administrators, including abortion, sterilization, artificial insemination, surrogacy, and organ transplantation. It also covers end-of-life dilemmas like euthanasia, physician-assisted suicide, and advance directives. A case study is presented involving a patient who received radiation treatment as a child and later developed tumors, suing the hospital for failing to properly warn him of risks.
Running Head: ABORTION PRO-CHOICE 1
ABORTION PRO CHOICE 7
Abortion Pro-Choice
Rosie M. Rivera
Columbia Southern University
30 January 2019
Abortion Pro-Choice
Literature review
Extensive research has been conducted on abortion pro-choice , as it has been a topic of debate since way back. This chapter offers, through selective references to some of the literature, a comprehensible description of abortion and the perspectives on safe abortion. The chapter will also give a thumbnail sketch on previous research findings on abortion and abortion pro-choice, what justifies it and the dangers associated with abortion pro-choice, according to different scholars and researchers.
Ruibal (2014) defines abortion as the termination of a pregnancy by getting rid of an embryo or a fetus so that the fetus does not survive outside the uterus. At times, abortion can occur spontaneously, and when this happens, it is referred to as a miscarriage. Abortion pro-choice is a woman’s right to decide whether to keep a pregnancy or cut it short. Abortion has been carried out for thousands of years. Back in the 1800s, surgical procedures such as abortion were deemed as highly risky. Hospitals and other healthcare facilities were not so popular and antiseptics were not well known. Women were procuring abortions from illegal practitioners which was extremely dangerous and deadly. As time progressed, especially with the advancement and domination of scientific technologies in medical practices, abortion started being advertised openly and abortion became a norm. Thereafter, states started passing laws which illegalized abortion.
Making abortion illegal, however, did not impede women from seeking abortion services. A vast number of women suffered from severe health complications from self-induced abortions. According to Boyle et al (2015), The drive to illegalize abortion was linked to doctors who wanted to create for themselves full rights to practice medicine. They wanted to stop unqualified practitioners from competing with them for customers, in this case, patients. These doctors were also doing so to stop the untrained doctors from competing with them for patients fees and charges. As a result, abortion stopped being criminalized and was successfully changed into a procedure meant for qualified physicians only. A historical survey on abortion pro-choice reveals that it was highly scrutinized because a woman who decided to cut short the life of their unborn baby was said to be no different from a murderer. Moreso, staunch Christians opposed abortion in any circumstance, which meant that a lot of condemnation was thrown at women who felt the need to terminate their pregnancy. Weitz and Weitz (2015) State that an unborn baby is like property and the mother is the prop.
Medical Ethics Case Study Essay
Medical Ethics Essay
Essay on What is Medical Ethics?
Essay on Religion and Medical Ethics
Medical Ethical Principles
Patient-Physician Contract
Medical Ethicism
Medical Ethics
Read What is the Object of this Exercise A Meandering Exploratio.docxhoward651
Read “
What is the Object of this Exercise? A Meandering Exploration of the Many Meanings of Objects in Museums
Actions
” by Elaine Heumann Gurian,
Daedalus
, Vol. 128, No. 3, America’s Museums (Summer, 1999) and “
How Objects Speak
Actions
” by Peter N. Miller,
The Chronicle of Higher Education Chronicle Review
, August 11, 2014 and write a 4- page essay which compares and contrasts the authors’ respective views. Conclude your essay by applying the argument(s) to your experience(s) during your most memorable visit(s) to a museum exhibition.
.
Read Voices for food methodologies for implementing a multi-st.docxhoward651
Read “Voices for food: methodologies for implementing a multi-state communitybased intervention in rural, high poverty communities"
Discuss:
a) how the findings were analyzed
, b) what were those procedures
c) what types of statistical analysis was used
d) were any qualitative methods used
e) what are the implications for the social work education, practice, research, and policy
and f) were the limitations described? If so, discuss in detail
Previous
Next
.
Read W.K. Clifford’s Ethics of Belief” (please use the link I p.docxhoward651
Read W.K. Clifford’s “
Ethics of Belief
” (please use the link I provided as the common source for our class) and write an analysis paper addressing the following issues:
1.)What is Clifford’s main argument?
2)What examples does Clifford use in support of his argument?
3)What do you think about each of the arguments that he gives? Are his arguments valid? Sound? Convincing?
4) What is your personal opinion of the article as a whole?
.
Read Trifles” and View the Film Adaptation (due TONIGHT) Pick on.docxhoward651
Read: “Trifles” and View the Film Adaptation (due TONIGHT) Pick one group
https://youtu.be/zGJTHi0rliA
7.0. A Jury of Her Peers by Susan K. Glaspell (Director: Sally Heckel)
Group A: What sort of relationship forms between Mrs. Hale and Mrs. Peters? What impact does the never-glimpsed Mrs. Wright have on this relationship? Explain the use of narrative structure in "Trifles," focusing particularly on the notion of "resolution." How does the plot resolve itself? How does this resolution differ from the expected outcome of the story expressed by the townsmen looking for evidence of the crime?
Group B: The question of ethics arises in regards to the way the men and the women approach the crime. Compare the approach of the townsmen to Minnie Wright to that of the townswomen who accompany the men on their search for evidence of the crime. What drives the women to make the choice they make?
Group C: Minnie Wright never appears in the story, but we learn much about her motives and traits from the other characters. What are the motives that possibly compelled Minnie Write to kill her husband? How do we come to know them during the course of the story?
Group D: What causes the men to overlook the evidence found by the women in the play? Why would Glaspell set up the story in this way? In other words, what is her point for having the men fail in their task where the women succeed? What is the relationship of the characters involved in the action of the play to the Wright family? What do they reveal to us about the Wrights?
Group E: Although "Trifles" was written almost one hundred years ago, it possesses contemporary attitudes about women that has led many people to refer to it as a feminist or pro-woman story. What elements or occurrences in the play would produce this response in a reader?
Story of an Hour Assignment (due tomorrow at 10pm)
After reading the chapter titled "Fiction As Genre," in a 150-200 word response, address the following questions. Make sure to support your points with a secondary source from the library databases.
1 . How is Mrs. Mallard ' s character developed? Do you see examples of exposition, where the narrator simply tells us information about the protagonist? In addition, does Chopin portray particular emotional responses, thoughts, and actions to reveal Mrs. Mallard ' s character? If so, how so? How does she employ point of view in this story?
2. What is your impression of Brently Mallard? What elements of the story generate this impression?
3. How is setting (both the historical period and the physical atmosphere of the story) used to contribute to the story ' s meaning?
4 . What is Mrs. Mallard ' s social class? What clues lead you to this conclusion?
5. What is the story ' s central conflict? Does Mrs. Mallard change, as we might expect a protagonist to do?
6. What are the important themes of this story?
Kate Chopin
The Story of an Hour
Knowing that Mrs. Mallard was afflicted with.
Read Traditions and Encounters, pp. 793-797 - ATTACHEDa.Wh.docxhoward651
Read Traditions and Encounters, pp. 793-797 -
ATTACHED
a.
What are the alterations in social structures (religion, government, etc.) after the First World War?
b.
How did the developments in science and psychology relate to the altered “sense of the world”?
c.
Describe the cultural shift (literature, art, and architecture). Why is this significant?
Personalities:
Oswald Spengler, Albert Einstein, Sigmund Freud
.
This document discusses contemporary ethical dilemmas faced by healthcare administrators, including abortion, sterilization, artificial insemination, surrogacy, and organ transplantation. It also covers end-of-life dilemmas like euthanasia, physician-assisted suicide, and advance directives. A case study is presented involving a patient who received radiation treatment as a child and later developed tumors, suing the hospital for failing to properly warn him of risks.
Running Head: ABORTION PRO-CHOICE 1
ABORTION PRO CHOICE 7
Abortion Pro-Choice
Rosie M. Rivera
Columbia Southern University
30 January 2019
Abortion Pro-Choice
Literature review
Extensive research has been conducted on abortion pro-choice , as it has been a topic of debate since way back. This chapter offers, through selective references to some of the literature, a comprehensible description of abortion and the perspectives on safe abortion. The chapter will also give a thumbnail sketch on previous research findings on abortion and abortion pro-choice, what justifies it and the dangers associated with abortion pro-choice, according to different scholars and researchers.
Ruibal (2014) defines abortion as the termination of a pregnancy by getting rid of an embryo or a fetus so that the fetus does not survive outside the uterus. At times, abortion can occur spontaneously, and when this happens, it is referred to as a miscarriage. Abortion pro-choice is a woman’s right to decide whether to keep a pregnancy or cut it short. Abortion has been carried out for thousands of years. Back in the 1800s, surgical procedures such as abortion were deemed as highly risky. Hospitals and other healthcare facilities were not so popular and antiseptics were not well known. Women were procuring abortions from illegal practitioners which was extremely dangerous and deadly. As time progressed, especially with the advancement and domination of scientific technologies in medical practices, abortion started being advertised openly and abortion became a norm. Thereafter, states started passing laws which illegalized abortion.
Making abortion illegal, however, did not impede women from seeking abortion services. A vast number of women suffered from severe health complications from self-induced abortions. According to Boyle et al (2015), The drive to illegalize abortion was linked to doctors who wanted to create for themselves full rights to practice medicine. They wanted to stop unqualified practitioners from competing with them for customers, in this case, patients. These doctors were also doing so to stop the untrained doctors from competing with them for patients fees and charges. As a result, abortion stopped being criminalized and was successfully changed into a procedure meant for qualified physicians only. A historical survey on abortion pro-choice reveals that it was highly scrutinized because a woman who decided to cut short the life of their unborn baby was said to be no different from a murderer. Moreso, staunch Christians opposed abortion in any circumstance, which meant that a lot of condemnation was thrown at women who felt the need to terminate their pregnancy. Weitz and Weitz (2015) State that an unborn baby is like property and the mother is the prop.
Medical Ethics Case Study Essay
Medical Ethics Essay
Essay on What is Medical Ethics?
Essay on Religion and Medical Ethics
Medical Ethical Principles
Patient-Physician Contract
Medical Ethicism
Medical Ethics
Read What is the Object of this Exercise A Meandering Exploratio.docxhoward651
Read “
What is the Object of this Exercise? A Meandering Exploration of the Many Meanings of Objects in Museums
Actions
” by Elaine Heumann Gurian,
Daedalus
, Vol. 128, No. 3, America’s Museums (Summer, 1999) and “
How Objects Speak
Actions
” by Peter N. Miller,
The Chronicle of Higher Education Chronicle Review
, August 11, 2014 and write a 4- page essay which compares and contrasts the authors’ respective views. Conclude your essay by applying the argument(s) to your experience(s) during your most memorable visit(s) to a museum exhibition.
.
Read Voices for food methodologies for implementing a multi-st.docxhoward651
Read “Voices for food: methodologies for implementing a multi-state communitybased intervention in rural, high poverty communities"
Discuss:
a) how the findings were analyzed
, b) what were those procedures
c) what types of statistical analysis was used
d) were any qualitative methods used
e) what are the implications for the social work education, practice, research, and policy
and f) were the limitations described? If so, discuss in detail
Previous
Next
.
Read W.K. Clifford’s Ethics of Belief” (please use the link I p.docxhoward651
Read W.K. Clifford’s “
Ethics of Belief
” (please use the link I provided as the common source for our class) and write an analysis paper addressing the following issues:
1.)What is Clifford’s main argument?
2)What examples does Clifford use in support of his argument?
3)What do you think about each of the arguments that he gives? Are his arguments valid? Sound? Convincing?
4) What is your personal opinion of the article as a whole?
.
Read Trifles” and View the Film Adaptation (due TONIGHT) Pick on.docxhoward651
Read: “Trifles” and View the Film Adaptation (due TONIGHT) Pick one group
https://youtu.be/zGJTHi0rliA
7.0. A Jury of Her Peers by Susan K. Glaspell (Director: Sally Heckel)
Group A: What sort of relationship forms between Mrs. Hale and Mrs. Peters? What impact does the never-glimpsed Mrs. Wright have on this relationship? Explain the use of narrative structure in "Trifles," focusing particularly on the notion of "resolution." How does the plot resolve itself? How does this resolution differ from the expected outcome of the story expressed by the townsmen looking for evidence of the crime?
Group B: The question of ethics arises in regards to the way the men and the women approach the crime. Compare the approach of the townsmen to Minnie Wright to that of the townswomen who accompany the men on their search for evidence of the crime. What drives the women to make the choice they make?
Group C: Minnie Wright never appears in the story, but we learn much about her motives and traits from the other characters. What are the motives that possibly compelled Minnie Write to kill her husband? How do we come to know them during the course of the story?
Group D: What causes the men to overlook the evidence found by the women in the play? Why would Glaspell set up the story in this way? In other words, what is her point for having the men fail in their task where the women succeed? What is the relationship of the characters involved in the action of the play to the Wright family? What do they reveal to us about the Wrights?
Group E: Although "Trifles" was written almost one hundred years ago, it possesses contemporary attitudes about women that has led many people to refer to it as a feminist or pro-woman story. What elements or occurrences in the play would produce this response in a reader?
Story of an Hour Assignment (due tomorrow at 10pm)
After reading the chapter titled "Fiction As Genre," in a 150-200 word response, address the following questions. Make sure to support your points with a secondary source from the library databases.
1 . How is Mrs. Mallard ' s character developed? Do you see examples of exposition, where the narrator simply tells us information about the protagonist? In addition, does Chopin portray particular emotional responses, thoughts, and actions to reveal Mrs. Mallard ' s character? If so, how so? How does she employ point of view in this story?
2. What is your impression of Brently Mallard? What elements of the story generate this impression?
3. How is setting (both the historical period and the physical atmosphere of the story) used to contribute to the story ' s meaning?
4 . What is Mrs. Mallard ' s social class? What clues lead you to this conclusion?
5. What is the story ' s central conflict? Does Mrs. Mallard change, as we might expect a protagonist to do?
6. What are the important themes of this story?
Kate Chopin
The Story of an Hour
Knowing that Mrs. Mallard was afflicted with.
Read Traditions and Encounters, pp. 793-797 - ATTACHEDa.Wh.docxhoward651
Read Traditions and Encounters, pp. 793-797 -
ATTACHED
a.
What are the alterations in social structures (religion, government, etc.) after the First World War?
b.
How did the developments in science and psychology relate to the altered “sense of the world”?
c.
Describe the cultural shift (literature, art, and architecture). Why is this significant?
Personalities:
Oswald Spengler, Albert Einstein, Sigmund Freud
.
Read through the Tree Trimming Project case in chapter 13 of the.docxhoward651
Read through the Tree Trimming Project case in chapter 13 of the textbook. This case refers to the earned value (EV) of the owner, Will Fence’s Tree Trimming business. Will briefly describes his techniques for EV. Based on the description provided in the case, is Will using EV?
Answer the corresponding question provided at the end of the case (300-500 words). Use references from the reading materials to support your response.
⏐ PUBLIC HEALTH THEN AND NOW ⏐
Joffe | Peer Reviewed | Public Health Then and Now | 57January 2013, Vol 103, No. 1 | American Journal of Public Health
| Carole Joffe, PhD
WHAT SHOULD STAFF IN
abortion-providing facilities say
to abortion patients prior to the
procedure? This seemingly sim-
ple question is of course not sim-
ple at all, in light of the deep
social and political divide over
abortion that continues to char-
acterize the contemporary United
States, some 40 years after legal-
ization. This conflict has inevita-
bly had consequences for how
abortion is organized as a ser-
vice. Beyond their efforts to over-
turn Roe v Wade,2 opponents
have sought in numerous ways to
regulate the delivery of abortion,
The field of abortion counseling originated in the abortion rights movement of the 1970s. During its
evolution to the present day, it has faced significant challenges, primarily arising from the increasing
politicization and stigmatization of abortion since legalization. Abortion counseling has been affected
not only by the imposition of antiabortion statutes, but also by the changing needs of patients who
have come of age in a very different era than when this occupation was first developed. One major
innovation—head and heart counseling—departs in significant ways from previous conventions of the
field and illustrates the complex and changing political meanings of abortion and therefore the chal-
lenges to abortion providers in the years following Roe v Wade. (Am J Public Health. 2013;103:57–65.
doi:10.2105/AJPH.2012.301063)
including staff interactions with
patients. State legislatures, for
example, have passed laws that
mandate that patients be forced
to view their ultrasounds and
hear detailed descriptions of
their fetus’s development; numer-
ous states have also dictated
scripts—often containing untrue
statements—that clinic staff must
deliver to patients.3
Abortion rights supporters, and
particularly those who work in
abortion-providing facilities, vehe-
mently reject opponents’ argu-
ments that such regulations are in
abortion patients’ interest; rather,
they argue, these requirements
exist to make access to abortion
more difficult and the experience
more upsetting. Although they
reject what they see as politically
driven restrictions, however,
those involved in abortion provi-
sion are not in complete agree-
ment about what precisely the
abortion experience should be for
patients. In particular, opinions
differ about what the nonmedical
com.
Read through the case study, and answer the questions following the .docxhoward651
Read through the case study, and answer the questions following the case study. You do not need to follow APA guidelines in your discussion posts; however, you MUST still provide attribution for your outside sources. The use of at least two scholarly/academic sources is required.
Practicing Organizational Culture Without a Leader
Dea Robinson
Small Feet OB/GYN was at one time a robust practice with five physicians, a midwife, and two PAs. The practice had a strong following in the community, was trusted by the many women it had served, and recently began delivering “legacy” babies of patients. Dr. Smith was the founder of the practice and had been the lead physician for many years.
Two competing systems with hospitals only one mile apart had vied for the affiliation with the Small Feet practice. Dr. Smith decided to change her affiliation to the other hospital. As a result, the practice experienced a move that seemed to only strengthen the patient base, and the new space (which was twice as large as the previous office) seemed to suit the new practice well.
The medical staff and CEO of the new hospital supported Dr. Smith’s move for several reasons. First, Dr. Smith, as mentioned, was delivering legacy babies and in the OB/GYN field this speaks to the trust the provider has been able to create and sustain throughout the years. This resulted in lots of community goodwill; that intangible quality is highly sought after in the medical community, yet is so difficult to quantify. Second, the new affiliation of Dr. Smith and her patients would bring positive revenues to the hospital through the move. Finally, the new hospital had a Level 1 trauma center, known for neurological cases, but not for delivering babies. The expansion of labor and delivery with the addition of a seasoned, legacy-delivering physician was a real coup for the hospital to attain.
Dr. Smith became ill and had to go on medical leave for almost a year. During that time the cohesiveness among the other providers suffered. When Dr. Smith came back things were very different. Dr. Smith became suspicious of everyone and had feelings that the staff and other providers were conspiring against her. Her suspicious attitude toward the physicians and staff in her practice led to dysfunctional problems throughout the practice. When Dr. Smith was confronted by the manager, Amy, she became distrustful and suspicious that Amy was conspiring with the other providers in the group against her.
The practice had also gone through some growing pains from a one-physician practice to five. Though originally the physicians worked well together, they now seemed to be less willing to collaborate. The practice also suffered as a result of a manager who had not kept up with the managerial requirements needed to run a midsize practice. For example, staff and provider performance reviews had never been done, the physicians had not established policies and procedures for the practice, there was no.
Read Thomas Paine Calls for American Independence, 1776 and .docxhoward651
Read
Thomas Paine Calls for American Independence, 1776
and the
Declaration of Independence, 1776
under VIII in the Primary Sources at the end of Chapter 5. You may also use Chapter 5 as background material on Thomas Paine and Thomas Jefferson. Once all reading is complete, respond to the following items:
Compare the backgrounds of Jefferson and Paine; did Paine have an advantage or disadvantage by not being born in the colonies? Explain.
Examine the language used in both documents; who is the audience for each writer?
Why does Jefferson not discuss slavery in the Declaration?
What did Paine and Jefferson say about the monarchy in their respective documents?
Why does Jefferson focus more on the king than parliament?
You are required to submit an initial posting (200 words minimum) that addresses the items above.
.
Read this essay then respond to the question down bellowThe .docxhoward651
Read this essay then respond to the question down bellow
The Bearded Seal My Son May Never Hunt
Global warming is real and is affecting many parts of our lives. For Laureli Ivanoff, the author of the article The Bearded Seal My Son May Never Hunt has majorly affected her and her communities' culture. She describes through facts, and her stories ice that usually always forms in Unalakleet Alaska and across the globe is little is nonexistent. The decrease in ice, many traditions and their way of life have been taken from her and her indigenous community. She highlights the practice of hunting for Bearded Seal and is distraught that it is something her son will never experience. In her article, she uses ethos and pathos's rhetorical skills to engage and provoke the reader to care; the logos tool is less apparent in the article. In using ethos and pathos, the reads' knowledge is evident, and their experiences develop the argument that the world is changing tragically fast, and with that, so are the traditions of indigenous people.
Ivanoff relies heavily on pathos throughout his speech, as without it, she would be unable to connect and engage the reader in a relatable way. She describes her experiences while hunting for Bearded Seal as apart of their culture. As she does this, she intertwines saddening facts about the lack of ice. In the text, she emotionally appeals to the audience, "grateful to share the moments on the ocean with these quiet, confident and beautiful creatures." Describing the animals as beautiful creatures, humanizing them. Doing this helps you see the animals in a positive light and helps convince you that they are worthy of saving. They rely on Breaded Seal and many other marine animals to survive. She describes how their ways of life are slowly becoming lost, "Because the indigenous experience is one of loss. My community, like others around the world, has lost a lot… We lost ways of nourishing ourselves." She puts into perspective how much the indigenous people have already suffered. They take care of their land and have high respect for the animals. As around the world, others do not, and it had affected their survival. She ends the article on a positive and optimistic note, not mad at the world, but in hopes the world will be able to adapt, such as her people will. By using pathos, she humanized the issue and helped the reader to care.
As pathos was the primary rhetorical tool used throughout the article, the ethos was used as well. Ivanoff has a consistent logical viewpoint throughout the text. There is a small undertone of manipulative when she describes the ocean changing so rapidly, she brings in the guilt of her son, "I hurt for him. And for my family and our stomachs and spirits. My son, not yet crawling, may never harvest an ugruk for his family. His experience is already one of loss." She targeted the emotions to get the reader engaged. In the article, she does appear very knowledgeable. She grew up learni.
Read this carefully please Research Question Review· Backg.docxhoward651
Read this carefully please:
Research Question Review
· Background Paper / Literature review
Research Question
· What skills identified in the literature as being critical in an education curriculum of forensic accounting are presently absent or given little emphasis Saudis Universities?)
·
· What do industry and academic experts perceive to be the highest priority forensic accounting education and training content for practicing CPAs in Saudi Arabia?)
Subsections (e.g., Introduction, Review of Literature, Method, Results, Conclusions)
Article 1 Reference List / Article 1 Appendices (if applicable)
My Adviser Feedback About this Question: (This would be much easier to research, since you acquire a list of skills in the accounting literature and then compare it to published or archival documents relating to Saudi programs.)
What you have described looks like a plausible topic for an interesting paper. At the moment, you have not given me enough to provide detailed comments--when the paper is more developed, I will gladly do so. I will therefore limit my comments to some general thoughts:
1) In your introduction, you do not specifically reference any of the citations you provide at the end. It is a good idea to do this as you proceed with writing, otherwise you may have trouble remembering them when it comes time to finish the paper. You will need these citations to back up your assertions.
2) You need some existing work to anchor your study. There are a couple of ways you might go. First, you could focus on some general theory regarding fraud (which seems to be the direction your introduction is taking), such as the fraud triangle. You could then build a case for analyzing a curriculum based on its mapping to the theory. Second, what may be a better alternative, you could take a model forensic accounting curriculum--perhaps from the U.S. or Europe (or both)--and build your analysis around comparing it to what you find in Saudi Arabia.
3) Because this paper is specifically focused on Saudi Arabia, you need to provide some context regarding ways in which the Saudi experience is likely to be similar or unique when compared with the western experience, your background sections provide the basis for your discussion section after you have presented your findings. You need to have some material in your background section that you can use for the purpose of the analysis you present in the discussion section.
Template for (Muma Business Review) Research Question Review (RQR) Submission
Overview
An MBR RQR article is expected to:
· Identify a research question of practical importance to managers
· Present a summary of the results of a systematic search of the research literature related to the question; this will normally be done in tabular form
· List the key takeaways of the search
· Identify strengths and weaknesses of the literature in terms of addressing the question being asked
Such an article would normally be around 20 pages.
Acce.
Read these below responses for the question and provide an answer- a.docxhoward651
Read these below responses for the question and provide an answer- address each student as if you were talking to them directly and give them your opinion on their response to the question- three separate answers for these three students.
Topic 1 DQ 1
What are the strengths and weakness of the scientific and the critical cultural approach to media studies? Which one is most desirable for studying the media? Explain why. What key concepts and terms help you understand the media better?
Zackery
As I see it, Mass media uses, almost instinctly, the scientific approach. But, " cultural behaviour and mass media are unique in themselves because they influence each other. (2020)" The scientific approach seems to be more desirable for studying the media. The simple answer is because of the more wide usage of the approach. To be fair, before I began any research, I expected the critical cultural approach to be my preferred method. Whenever I think of anything that uses the a scientific approach, I think about creating a hypothesis, doing the research (or experiment) and drawing a conclusion based on the findings of the research or experimentation. But, for this question, this isn't quite the case. The fact that mass media relies on scientific approach is significant. Advertising, for me, is the biggest use as they use scientific approach to survey their audiences. Using something, such as demographics, to target advertising shows scientific method use over critical cultural approach. Examples such as this are used through the use of Nielson ratings, targeted advertising, and other ventures where mass media is utilized. The scientific approach in advertising, TV, movies, and other uses of mass media help ensure the targeted audience is receiving the communication stardards it expects, or in some cases, the entertainment is desires.
Dorothy P.
The scientific and critical cultural approach of media studies involves the way we can use the approach of the many aspects of the world around us. We sometimes might not even learn things directly from the different sources of media; however, we can learn from other people’s ideas that they get from the media. Cultural approaches are a way that others use media to mainly get them through the structure of everyday life living. “Cultural studies are less concerned with the long-term consequences of media for social order and more concerned with looking how media affect individual lives” (Naveed, 2019). There are many strengths and weaknesses, such as the Media is politically based, action-oriented. Media uses theory to research and change in the real world. The weakness is Media is too political; the call to action is too subjective, typically lacks scientific verification; based on subjective observation. Whenever it is subjected to scientific verification, often employs innovative but controversial research methods.
What helps me to understand the key concepts and terms of understanding media, is .
Read these articles from Week 2· Introduction to Global Issu.docxhoward651
Read these articles from Week 2:
·
Introduction to Global Issues
·
A Global Ethics for a Globalized World
·
Virtue Ethics and Modern Society
·
Classical Stoicism and the Birth of a Global Ethics: Cosmopolitan Duties in a World of Local Loyalties
Reflect
: The change of our world from a local economy to a national economy to a global, international economy means that increasingly diverse populations will have to work together to achieve common goals. However, as the economy becomes increasingly global, local economies and people may suffer economic disadvantage or may find themselves marginalized from the rest of the world. Globalization creates ethical dilemmas for which we will need to find solutions.
Write
: For this discussion, address all the prompts:
1) Explain the implications of globalization.
2) Identify at least two ethical issues that go along with the global societal topic you have chosen for your final essay.
3) Explain how globalization contributes to or affects these ethical dilemmas.
4) Propose solutions to these ethical dilemmas that are feasible financially, socially, and culturally.
Your initial post should be at least 250 words in length.
Due 4/8/20 @9am EASTERN
.
Read the Wikipedia article on Eloise (httpsen.wikipedia.orgwik.docxhoward651
Read the Wikipedia article on Eloise (https://en.wikipedia.org/wiki/H%C3%A9lo%C3%AFse) OR Abedlard (https://en.wikipedia.org/wiki/Peter_Abelard). Then, read the first section of this one on Pope’s poem (https://en.wikipedia.org/wiki/Eloisa_to_Abelard).
I highly recommend that you listen to the poem. I like Kristin Hughes’ librivox version on (https://ia801409.us.archive.org/28/items/long_poems_003_librivox/eloisa_to_abelard_pope_klh.mp3) but there are lots of youtube versions as well.
Print the poem, make notes and bring to class.
Eloise to Abelard
by Alexander Pope (1717)
IN these deep solitudes and awful cells,
Where heav’nly-pensive Contemplation dwells,
And ever-musing Melancholy reigns,
What means this tumult in a vestal’s veins?
Why rove my thoughts beyond this last retreat?
5
Why feels my heart its long-forgotten heat?
Yet, yet I love!—From Abelard it came,
And Eloisa yet must kiss the name.
Dear fatal name! rest ever unreveal’d,
Nor pass these lips, in holy silence seal’d:
10
Hide it, my heart, within that close disguise,
Where, mix’d with God’s, his lov’d idea lies:
O write it not, my hand—the name appears
Already written—wash it out, my tears!
In vain lost Eloisa weeps and prays,
15
Her heart still dictates, and her hand obeys.
Relentless walls! whose darksome round contains
Repentant sighs, and voluntary pains:
Ye rugged rocks, which holy knees have worn;
Ye grots and caverns shagg’d with horrid thorn!
20
Shrines! where their vigils pale-eyed virgins keep,
And pitying saints, whose statues learn to weep!
Tho’ cold like you, unmov’d and silent grown,
I have not yet forgot myself to stone.
All is not Heav’n’s while Abelard has part,
25
Still rebel Nature holds out half my heart;
Nor prayers nor fasts its stubborn pulse restrain,
Nor tears, for ages taught to flow in vain.
Soon as thy letters trembling I unclose,
That well-known name awakens all my woes.
30
Oh name for ever sad! for ever dear!
Still breathed in sighs, still usher’d with a tear.
I tremble too, where’er my own I find,
Some dire misfortune follows close behind.
Line after line my gushing eyes o’erflow,
35
Led thro’a safe variety of woe:
Now warm in love, now with’ring in my bloom,
Lost in a convent’s solitary gloom!
There stern religion quench’d th’ unwilling flame,
There died the best of passions, Love and Fame.
40
Yet write, O write me all, that I may join
Griefs to thy griefs, and echo sighs to thine.
Nor foes nor fortune take this power away;
And is my Abelard less kind than they?
Tears still are mine, and those I need not spare;
45
Love but demands what else were shed in prayer.
No happier task these faded eyes pursue;
To read and weep is all they now can do.
Then share thy pain, allow that sad relief;
Ah, more than share it, give me all thy grief.
50
Heav’n first taught letters for some wretch’s aid,
Some banish’d lover, or some cap.
Read the two post below and answer the following questions for e.docxhoward651
Read the two post below and answer the following questions for each post.
· Identify one element that you would recommend including in the S. health care system.
· Discuss why this element would benefit the S. health care system.
1. Jamaica Healthcare System
The country healthcare system I chose to write about is Jamaica. There are twenty-four public hospitals and estimates of three hundred and forty healthcare center, and ten private hospitals (Commonwealth Health Online, 2019). In Jamaica, there is public healthcare that is free to all citizens and legal residents that is subsidized by the government. But if the person is working, then they pay a share cost for public healthcare. This also includes prescription drugs. Which a third of the pharmaceutical are imported in from the USA (Commonwealth Health Online, 2019). There is a longer wait time to see a physician at the public hospital or clinic. If a person lives in a remote part of the island, they are limited to quality emergency care. You would have to travel to the larger cities like Kingston Jamaica. According to InterNations.org they stated that the public hospital is “often unreliable, frequently overcrowded, and have low funding from the government “(InterNations 2018). They also said that pharmacies usually have a shortage of free medication and offer overpaid medicines to the patient. So, this means many people go without prescribed medication. But in Jamaica, they do have private healthcare institutions. Private health insurance is offered by some employer or those who can afford to pay cash for their care. Private healthcare provides a higher standard of care to their patients. It is said that people get a better quality of care in private hospitals vs. the public health facility.
Many of the island hospitals that offers state-of-the-art medical technology are a private hospital that accepts private insurance. They offer state of the art three-dimensional ultrasound scan, x-rays, CT scans, mammograms, fluoroscopy, etc. These hospitals are in located in larger parts of Kingston, Jamaica.
One pro for Jamaica healthcare is that they have free healthcare for their citizen. But a con to their healthcare system would be the shortage of free medication. This means many people are still suffering from their injuries or sick because they do not have access to the prescribed medication by the doctor.
Both Jamaica and the U.S offer free healthcare to their citizen. Jamaica state-of-the-art medical technology is similarities the United States. In the United States, if you live in a rural area, you must travel to get medical care just like in Jamaica. One significant difference between the two countries healthcare system is there is not a shortage of prescribing medication for people who have free healthcare in the U.S. But in Jamaica, they are faced with a shortage of medicines because they do not have the same regulation as the United States for healthcare.
2. Switzerland HealthCare S.
Read the two documents attached in this quiz (Washington-DuBois de.docxhoward651
Read the two documents attached in this quiz (Washington-DuBois debate) and use them to answer the questions below.
1. Identify the ethical choices offered by the two speakers.
2. Discuss both sides of the ethical choices offered by the speakers.
3. Offer a personal evaluation of the ethical choices to be made.
4. Identified the pros and cons of both sides of the ethical choices to be made.
5. Indicate how the student’s own cultural background relates to the ethical choices proposed by the speakers.
6. Identify how the speaker’s point of view might be affected by the speaker’s cultural backgrounds.
7. Discuss how reading these two speeches allows them to relate to other cultures and helps them to understand and react to other cultures.
8. Indicate how reading these two speeches promotes their ideas of civic involvement in relation to the issues raised by these two speeches.
· Opinion
· Commentary
Jussie Smollett and the Hazards of Moral Sentimentality
Narratives about ‘racism’ and ‘homophobia,’ stoked by news and social media, stir self-affirming rage.
By
Lance Morrow
March 1, 2019 6:29 p.m. ET
Harriet Beecher Stowe‘s 1852 novel, “Uncle Tom's Cabin.” Photo: Fine Art Images/Heritage Images/Getty Images
A well-known story says that when President Lincoln met Harriet Beecher Stowe, he remarked, “So you are the little woman who wrote the book that started this great war.”
Stowe’s 1852 novel, “Uncle Tom’s Cabin”—with its melodrama of Eliza’s flight across the ice, of Simon Legree’s cruelty, of Uncle Tom’s martyrdom—had so roused American feelings on the subject of slavery that nothing less than a great civil war could have done justice to either the crime or the novel.
“Uncle Tom’s Cabin” was a supreme work of moral sentimentality—of feelings stirred to noble and lethal purposes. The story tore sentimental 19th-century America apart. It ended not with Uncle Tom’s crucifixion but with Appomattox.
Sentimentality may enlist in the cause of justice. Beware: It serves just as often in the ranks of evil. Hitler and Joseph Goebbels deployed sentimental storylines of the Volk, of Aryan purity and blood and soil. Righteousness sometimes waxes sentimental, but so do monsters. Anyone who ever organized a lynch mob in Alabama knew how to sentimentalize white womanhood.
Newsletter Sign-up
Today’s media storytelling has perfected a genre of intensely sentimental and spontaneously generated folk tales, especially stories dealing with race and sexuality. Social media and cable news pour forth vividly moralized tales that are sometimes true and sometimes not. The stories dramatize wrongs in order to amuse and polarize what has become the Republic of Maury Povich. They boost TV ratings, ignite apoplexy in our iPhones, and organize Americans along angry ideological lines.
Sentimentality, the regime of feelings, tempts people to exaggerate facts in ways that awaken grievances and encourage hatreds. Social media and cable news move faster than the speed of t.
Read the story on page 131 concerning a moral dilemma. Is the man wh.docxhoward651
Read the story on page 131 concerning a moral dilemma. Is the man who stole the medicine quilty of a crime? Which is more likely to say yes, a Classical School believer or a Positive School believer?
ALL FROM BOOK Book "Criminoloy Second Edition
"
Read Chapter 6. Please submit your responses to the following questions via the drop box:
1. What is
social disorganization
? How does it contribute to crime? What were Shaw and McKay's findings with regards to the
Concentric Zone
model?
2. Define
anomie. How does this "cause" crime.
3. Briefly explain Robert K. Merton's
Mean/Ends Theory (Modes of Adaptation).
4. According to Robert Agnew, what are the 3 major types of
negative relationships
which cause
strain
?
5. What would
Albert Cohen
say caused crime? What are
middle-class measuring rods
?
6. How do
Sykes and Matza
differ from Cohen in their belief of crime causation?
7. Briefly explain the
violent subculture theory
of Marvin Wolfgang.
.
Read the story timeline of Flint MI water crisis httpswww.cnn..docxhoward651
Read the story timeline of Flint MI water crisis:
https://www.cnn.com/2016/03/04/us/flint-water-crisis-fast-facts/index.html
(Links to an external site.)
Flint Update:
https://www.nytimes.com/2021/01/14/us/rick-snyder-flint-water-charges.html?action=click&module=Top%20Stories&pgtype=Homepage (Links to an external site.)
(Links to an external site.)
The CNN timeline chronicles the Flint MI water crisis with lead, bacterial contamination, and cases of Legionnaires disease after the city of Flint made a water source change.
Discussion:
The CNN timeline chronicles the Flint MI water crisis with lead, bacterial contamination, and cases of Legionnaires disease after the city of Flint made a water source change.
A. Discuss the topic addressed in the timeline and video. Do you agree or disagree with the points made in the documentaries and why? How did you perceive the information presented- be specific? Could different points have been covered in an alternative manner and how? Does the FSW College community have an obligation to address issues like water quality or issues in healthcare? Discuss any current water related issues that have health implications here in SWFL. Support your position.
B. Consider whether SWFL water systems have similar issues related to quality – not just lead. Consider that not all water sources are city/ county provided.
What would you do to become active in discussing the facts with your local FL state legislator? What points would you make related to public/ community healthcare on this topic in SWFL.
What five (5) factual points will you make as a practicing PHN related to the outbreak of Legionnaires’’ disease or another water borne illness.
Why would you make these five? Provide supportive data and references for your facts
Search entries or author
.
Read the short story, How Much land Does a Man Need written by.docxhoward651
Read the short story, "How Much land Does a Man Need" written by Leo Tolstoy in Modules on Canvas.
Look up the following elements of analysis:
1. Biography of writer
2. define: allegory, parable, paradox
3. what is the theme of the story and how did the writer develop/convey the theme in the story.
.
Read the speech posted below, then answer the following questions.docxhoward651
Read the speech posted below, then answer the following questions. Click on Submit Assignment to submit your answers. You may copy and paste your answers. The last two questions may require that you actually write the statements rather than copy and paste.
1. Copy the attention-getter for the speech.
2. Copy the sentence where the speaker establishes her own credibility.
3. Copy the sentence that is a preview of the main points from the introduction.
4. Copy the three main points of the speech.
5. Copy the three transition sentences.
a. (Transition from introduction to body)
b. (Transition between main point 1 and main point 2)
c. (Transition between main point 2 and main point 3)
6. Copy the summary sentence from the conclusion.
7. Copy the speaker's closing sentence.
8. Copy two sentences from the speech that contain citations.
9. Find an example in the speech of each of the following:
a. statistic
b. testimony (direct quote or person's opinion)
10. Write a specific purpose statement for this speech. “To inform my audience about . . .
11. Write a thesis statement (also known as central idea) for this speech.
Exploring the Titanic
An American writer named Morgan Robertson once wrote a book called The Wreck of the Titan. The book was about an “unsinkable” ship called the Titan that set sail from England to New York with many rich and famous passengers on board. On its journey, the Titan hit an iceberg in the North Atlantic and sunk. Many lives were lost because there were not enough lifeboats. So, what is so strange about this? Well, The Wreck of the Titan was written 14 years before the Titanic sank. I have been fascinated by the history of the Titanic for as long as I can remember, and I have read and studied my collection of books about the Titanic many times, and have done research on the Internet. First, I will discuss the Titanic itself; second, I will discuss the sinking of the ship; and finally, I will discuss the movie that was made about the Titanic.
From the disaster to the movie, the sinking of the Titanic remains one of the most famous tragedies in history. The Titanic was thought to be the largest, safest, most luxurious ship ever built. At the time of her launch, she was the biggest existing ship and the largest moveable object ever built. According to Geoff Tibbals, in his 1997 book The Titanic: The extraordinary story of the “unsinkable” ship, the Titanic was 882 feet long and weighed about 46,000 tons. This was 100 feet longer and 15,000 tons heavier than the world’s current largest ships. Thresh stated in Titanic: The truth behind the disaster, published in 1992, that the Titanic accommodated around 2,345 passengers and 860 crew-members.
The beautiful accommodations of the Titanic were decorated and furnished with only the finest items. According to a quotation from Shipbuilders magazine that is included in Peter Thresh’s 1992 book Titanic, “Everything has been done in regard to the.
Read the sentence and answer the question that followsHistorical .docxhoward651
Read the sentence and answer the question that follows:
Historical buildings in the small Kansas town were completely destroyed by the unexpected storm.
Which word may be eliminated to remove redundancy?
[removed] Historical
[removed] Small
[removed] Completely
[removed] Unexpected
.
How to Setup Default Value for a Field in Odoo 17Celine George
In Odoo, we can set a default value for a field during the creation of a record for a model. We have many methods in odoo for setting a default value to the field.
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
Read through the Tree Trimming Project case in chapter 13 of the.docxhoward651
Read through the Tree Trimming Project case in chapter 13 of the textbook. This case refers to the earned value (EV) of the owner, Will Fence’s Tree Trimming business. Will briefly describes his techniques for EV. Based on the description provided in the case, is Will using EV?
Answer the corresponding question provided at the end of the case (300-500 words). Use references from the reading materials to support your response.
⏐ PUBLIC HEALTH THEN AND NOW ⏐
Joffe | Peer Reviewed | Public Health Then and Now | 57January 2013, Vol 103, No. 1 | American Journal of Public Health
| Carole Joffe, PhD
WHAT SHOULD STAFF IN
abortion-providing facilities say
to abortion patients prior to the
procedure? This seemingly sim-
ple question is of course not sim-
ple at all, in light of the deep
social and political divide over
abortion that continues to char-
acterize the contemporary United
States, some 40 years after legal-
ization. This conflict has inevita-
bly had consequences for how
abortion is organized as a ser-
vice. Beyond their efforts to over-
turn Roe v Wade,2 opponents
have sought in numerous ways to
regulate the delivery of abortion,
The field of abortion counseling originated in the abortion rights movement of the 1970s. During its
evolution to the present day, it has faced significant challenges, primarily arising from the increasing
politicization and stigmatization of abortion since legalization. Abortion counseling has been affected
not only by the imposition of antiabortion statutes, but also by the changing needs of patients who
have come of age in a very different era than when this occupation was first developed. One major
innovation—head and heart counseling—departs in significant ways from previous conventions of the
field and illustrates the complex and changing political meanings of abortion and therefore the chal-
lenges to abortion providers in the years following Roe v Wade. (Am J Public Health. 2013;103:57–65.
doi:10.2105/AJPH.2012.301063)
including staff interactions with
patients. State legislatures, for
example, have passed laws that
mandate that patients be forced
to view their ultrasounds and
hear detailed descriptions of
their fetus’s development; numer-
ous states have also dictated
scripts—often containing untrue
statements—that clinic staff must
deliver to patients.3
Abortion rights supporters, and
particularly those who work in
abortion-providing facilities, vehe-
mently reject opponents’ argu-
ments that such regulations are in
abortion patients’ interest; rather,
they argue, these requirements
exist to make access to abortion
more difficult and the experience
more upsetting. Although they
reject what they see as politically
driven restrictions, however,
those involved in abortion provi-
sion are not in complete agree-
ment about what precisely the
abortion experience should be for
patients. In particular, opinions
differ about what the nonmedical
com.
Read through the case study, and answer the questions following the .docxhoward651
Read through the case study, and answer the questions following the case study. You do not need to follow APA guidelines in your discussion posts; however, you MUST still provide attribution for your outside sources. The use of at least two scholarly/academic sources is required.
Practicing Organizational Culture Without a Leader
Dea Robinson
Small Feet OB/GYN was at one time a robust practice with five physicians, a midwife, and two PAs. The practice had a strong following in the community, was trusted by the many women it had served, and recently began delivering “legacy” babies of patients. Dr. Smith was the founder of the practice and had been the lead physician for many years.
Two competing systems with hospitals only one mile apart had vied for the affiliation with the Small Feet practice. Dr. Smith decided to change her affiliation to the other hospital. As a result, the practice experienced a move that seemed to only strengthen the patient base, and the new space (which was twice as large as the previous office) seemed to suit the new practice well.
The medical staff and CEO of the new hospital supported Dr. Smith’s move for several reasons. First, Dr. Smith, as mentioned, was delivering legacy babies and in the OB/GYN field this speaks to the trust the provider has been able to create and sustain throughout the years. This resulted in lots of community goodwill; that intangible quality is highly sought after in the medical community, yet is so difficult to quantify. Second, the new affiliation of Dr. Smith and her patients would bring positive revenues to the hospital through the move. Finally, the new hospital had a Level 1 trauma center, known for neurological cases, but not for delivering babies. The expansion of labor and delivery with the addition of a seasoned, legacy-delivering physician was a real coup for the hospital to attain.
Dr. Smith became ill and had to go on medical leave for almost a year. During that time the cohesiveness among the other providers suffered. When Dr. Smith came back things were very different. Dr. Smith became suspicious of everyone and had feelings that the staff and other providers were conspiring against her. Her suspicious attitude toward the physicians and staff in her practice led to dysfunctional problems throughout the practice. When Dr. Smith was confronted by the manager, Amy, she became distrustful and suspicious that Amy was conspiring with the other providers in the group against her.
The practice had also gone through some growing pains from a one-physician practice to five. Though originally the physicians worked well together, they now seemed to be less willing to collaborate. The practice also suffered as a result of a manager who had not kept up with the managerial requirements needed to run a midsize practice. For example, staff and provider performance reviews had never been done, the physicians had not established policies and procedures for the practice, there was no.
Read Thomas Paine Calls for American Independence, 1776 and .docxhoward651
Read
Thomas Paine Calls for American Independence, 1776
and the
Declaration of Independence, 1776
under VIII in the Primary Sources at the end of Chapter 5. You may also use Chapter 5 as background material on Thomas Paine and Thomas Jefferson. Once all reading is complete, respond to the following items:
Compare the backgrounds of Jefferson and Paine; did Paine have an advantage or disadvantage by not being born in the colonies? Explain.
Examine the language used in both documents; who is the audience for each writer?
Why does Jefferson not discuss slavery in the Declaration?
What did Paine and Jefferson say about the monarchy in their respective documents?
Why does Jefferson focus more on the king than parliament?
You are required to submit an initial posting (200 words minimum) that addresses the items above.
.
Read this essay then respond to the question down bellowThe .docxhoward651
Read this essay then respond to the question down bellow
The Bearded Seal My Son May Never Hunt
Global warming is real and is affecting many parts of our lives. For Laureli Ivanoff, the author of the article The Bearded Seal My Son May Never Hunt has majorly affected her and her communities' culture. She describes through facts, and her stories ice that usually always forms in Unalakleet Alaska and across the globe is little is nonexistent. The decrease in ice, many traditions and their way of life have been taken from her and her indigenous community. She highlights the practice of hunting for Bearded Seal and is distraught that it is something her son will never experience. In her article, she uses ethos and pathos's rhetorical skills to engage and provoke the reader to care; the logos tool is less apparent in the article. In using ethos and pathos, the reads' knowledge is evident, and their experiences develop the argument that the world is changing tragically fast, and with that, so are the traditions of indigenous people.
Ivanoff relies heavily on pathos throughout his speech, as without it, she would be unable to connect and engage the reader in a relatable way. She describes her experiences while hunting for Bearded Seal as apart of their culture. As she does this, she intertwines saddening facts about the lack of ice. In the text, she emotionally appeals to the audience, "grateful to share the moments on the ocean with these quiet, confident and beautiful creatures." Describing the animals as beautiful creatures, humanizing them. Doing this helps you see the animals in a positive light and helps convince you that they are worthy of saving. They rely on Breaded Seal and many other marine animals to survive. She describes how their ways of life are slowly becoming lost, "Because the indigenous experience is one of loss. My community, like others around the world, has lost a lot… We lost ways of nourishing ourselves." She puts into perspective how much the indigenous people have already suffered. They take care of their land and have high respect for the animals. As around the world, others do not, and it had affected their survival. She ends the article on a positive and optimistic note, not mad at the world, but in hopes the world will be able to adapt, such as her people will. By using pathos, she humanized the issue and helped the reader to care.
As pathos was the primary rhetorical tool used throughout the article, the ethos was used as well. Ivanoff has a consistent logical viewpoint throughout the text. There is a small undertone of manipulative when she describes the ocean changing so rapidly, she brings in the guilt of her son, "I hurt for him. And for my family and our stomachs and spirits. My son, not yet crawling, may never harvest an ugruk for his family. His experience is already one of loss." She targeted the emotions to get the reader engaged. In the article, she does appear very knowledgeable. She grew up learni.
Read this carefully please Research Question Review· Backg.docxhoward651
Read this carefully please:
Research Question Review
· Background Paper / Literature review
Research Question
· What skills identified in the literature as being critical in an education curriculum of forensic accounting are presently absent or given little emphasis Saudis Universities?)
·
· What do industry and academic experts perceive to be the highest priority forensic accounting education and training content for practicing CPAs in Saudi Arabia?)
Subsections (e.g., Introduction, Review of Literature, Method, Results, Conclusions)
Article 1 Reference List / Article 1 Appendices (if applicable)
My Adviser Feedback About this Question: (This would be much easier to research, since you acquire a list of skills in the accounting literature and then compare it to published or archival documents relating to Saudi programs.)
What you have described looks like a plausible topic for an interesting paper. At the moment, you have not given me enough to provide detailed comments--when the paper is more developed, I will gladly do so. I will therefore limit my comments to some general thoughts:
1) In your introduction, you do not specifically reference any of the citations you provide at the end. It is a good idea to do this as you proceed with writing, otherwise you may have trouble remembering them when it comes time to finish the paper. You will need these citations to back up your assertions.
2) You need some existing work to anchor your study. There are a couple of ways you might go. First, you could focus on some general theory regarding fraud (which seems to be the direction your introduction is taking), such as the fraud triangle. You could then build a case for analyzing a curriculum based on its mapping to the theory. Second, what may be a better alternative, you could take a model forensic accounting curriculum--perhaps from the U.S. or Europe (or both)--and build your analysis around comparing it to what you find in Saudi Arabia.
3) Because this paper is specifically focused on Saudi Arabia, you need to provide some context regarding ways in which the Saudi experience is likely to be similar or unique when compared with the western experience, your background sections provide the basis for your discussion section after you have presented your findings. You need to have some material in your background section that you can use for the purpose of the analysis you present in the discussion section.
Template for (Muma Business Review) Research Question Review (RQR) Submission
Overview
An MBR RQR article is expected to:
· Identify a research question of practical importance to managers
· Present a summary of the results of a systematic search of the research literature related to the question; this will normally be done in tabular form
· List the key takeaways of the search
· Identify strengths and weaknesses of the literature in terms of addressing the question being asked
Such an article would normally be around 20 pages.
Acce.
Read these below responses for the question and provide an answer- a.docxhoward651
Read these below responses for the question and provide an answer- address each student as if you were talking to them directly and give them your opinion on their response to the question- three separate answers for these three students.
Topic 1 DQ 1
What are the strengths and weakness of the scientific and the critical cultural approach to media studies? Which one is most desirable for studying the media? Explain why. What key concepts and terms help you understand the media better?
Zackery
As I see it, Mass media uses, almost instinctly, the scientific approach. But, " cultural behaviour and mass media are unique in themselves because they influence each other. (2020)" The scientific approach seems to be more desirable for studying the media. The simple answer is because of the more wide usage of the approach. To be fair, before I began any research, I expected the critical cultural approach to be my preferred method. Whenever I think of anything that uses the a scientific approach, I think about creating a hypothesis, doing the research (or experiment) and drawing a conclusion based on the findings of the research or experimentation. But, for this question, this isn't quite the case. The fact that mass media relies on scientific approach is significant. Advertising, for me, is the biggest use as they use scientific approach to survey their audiences. Using something, such as demographics, to target advertising shows scientific method use over critical cultural approach. Examples such as this are used through the use of Nielson ratings, targeted advertising, and other ventures where mass media is utilized. The scientific approach in advertising, TV, movies, and other uses of mass media help ensure the targeted audience is receiving the communication stardards it expects, or in some cases, the entertainment is desires.
Dorothy P.
The scientific and critical cultural approach of media studies involves the way we can use the approach of the many aspects of the world around us. We sometimes might not even learn things directly from the different sources of media; however, we can learn from other people’s ideas that they get from the media. Cultural approaches are a way that others use media to mainly get them through the structure of everyday life living. “Cultural studies are less concerned with the long-term consequences of media for social order and more concerned with looking how media affect individual lives” (Naveed, 2019). There are many strengths and weaknesses, such as the Media is politically based, action-oriented. Media uses theory to research and change in the real world. The weakness is Media is too political; the call to action is too subjective, typically lacks scientific verification; based on subjective observation. Whenever it is subjected to scientific verification, often employs innovative but controversial research methods.
What helps me to understand the key concepts and terms of understanding media, is .
Read these articles from Week 2· Introduction to Global Issu.docxhoward651
Read these articles from Week 2:
·
Introduction to Global Issues
·
A Global Ethics for a Globalized World
·
Virtue Ethics and Modern Society
·
Classical Stoicism and the Birth of a Global Ethics: Cosmopolitan Duties in a World of Local Loyalties
Reflect
: The change of our world from a local economy to a national economy to a global, international economy means that increasingly diverse populations will have to work together to achieve common goals. However, as the economy becomes increasingly global, local economies and people may suffer economic disadvantage or may find themselves marginalized from the rest of the world. Globalization creates ethical dilemmas for which we will need to find solutions.
Write
: For this discussion, address all the prompts:
1) Explain the implications of globalization.
2) Identify at least two ethical issues that go along with the global societal topic you have chosen for your final essay.
3) Explain how globalization contributes to or affects these ethical dilemmas.
4) Propose solutions to these ethical dilemmas that are feasible financially, socially, and culturally.
Your initial post should be at least 250 words in length.
Due 4/8/20 @9am EASTERN
.
Read the Wikipedia article on Eloise (httpsen.wikipedia.orgwik.docxhoward651
Read the Wikipedia article on Eloise (https://en.wikipedia.org/wiki/H%C3%A9lo%C3%AFse) OR Abedlard (https://en.wikipedia.org/wiki/Peter_Abelard). Then, read the first section of this one on Pope’s poem (https://en.wikipedia.org/wiki/Eloisa_to_Abelard).
I highly recommend that you listen to the poem. I like Kristin Hughes’ librivox version on (https://ia801409.us.archive.org/28/items/long_poems_003_librivox/eloisa_to_abelard_pope_klh.mp3) but there are lots of youtube versions as well.
Print the poem, make notes and bring to class.
Eloise to Abelard
by Alexander Pope (1717)
IN these deep solitudes and awful cells,
Where heav’nly-pensive Contemplation dwells,
And ever-musing Melancholy reigns,
What means this tumult in a vestal’s veins?
Why rove my thoughts beyond this last retreat?
5
Why feels my heart its long-forgotten heat?
Yet, yet I love!—From Abelard it came,
And Eloisa yet must kiss the name.
Dear fatal name! rest ever unreveal’d,
Nor pass these lips, in holy silence seal’d:
10
Hide it, my heart, within that close disguise,
Where, mix’d with God’s, his lov’d idea lies:
O write it not, my hand—the name appears
Already written—wash it out, my tears!
In vain lost Eloisa weeps and prays,
15
Her heart still dictates, and her hand obeys.
Relentless walls! whose darksome round contains
Repentant sighs, and voluntary pains:
Ye rugged rocks, which holy knees have worn;
Ye grots and caverns shagg’d with horrid thorn!
20
Shrines! where their vigils pale-eyed virgins keep,
And pitying saints, whose statues learn to weep!
Tho’ cold like you, unmov’d and silent grown,
I have not yet forgot myself to stone.
All is not Heav’n’s while Abelard has part,
25
Still rebel Nature holds out half my heart;
Nor prayers nor fasts its stubborn pulse restrain,
Nor tears, for ages taught to flow in vain.
Soon as thy letters trembling I unclose,
That well-known name awakens all my woes.
30
Oh name for ever sad! for ever dear!
Still breathed in sighs, still usher’d with a tear.
I tremble too, where’er my own I find,
Some dire misfortune follows close behind.
Line after line my gushing eyes o’erflow,
35
Led thro’a safe variety of woe:
Now warm in love, now with’ring in my bloom,
Lost in a convent’s solitary gloom!
There stern religion quench’d th’ unwilling flame,
There died the best of passions, Love and Fame.
40
Yet write, O write me all, that I may join
Griefs to thy griefs, and echo sighs to thine.
Nor foes nor fortune take this power away;
And is my Abelard less kind than they?
Tears still are mine, and those I need not spare;
45
Love but demands what else were shed in prayer.
No happier task these faded eyes pursue;
To read and weep is all they now can do.
Then share thy pain, allow that sad relief;
Ah, more than share it, give me all thy grief.
50
Heav’n first taught letters for some wretch’s aid,
Some banish’d lover, or some cap.
Read the two post below and answer the following questions for e.docxhoward651
Read the two post below and answer the following questions for each post.
· Identify one element that you would recommend including in the S. health care system.
· Discuss why this element would benefit the S. health care system.
1. Jamaica Healthcare System
The country healthcare system I chose to write about is Jamaica. There are twenty-four public hospitals and estimates of three hundred and forty healthcare center, and ten private hospitals (Commonwealth Health Online, 2019). In Jamaica, there is public healthcare that is free to all citizens and legal residents that is subsidized by the government. But if the person is working, then they pay a share cost for public healthcare. This also includes prescription drugs. Which a third of the pharmaceutical are imported in from the USA (Commonwealth Health Online, 2019). There is a longer wait time to see a physician at the public hospital or clinic. If a person lives in a remote part of the island, they are limited to quality emergency care. You would have to travel to the larger cities like Kingston Jamaica. According to InterNations.org they stated that the public hospital is “often unreliable, frequently overcrowded, and have low funding from the government “(InterNations 2018). They also said that pharmacies usually have a shortage of free medication and offer overpaid medicines to the patient. So, this means many people go without prescribed medication. But in Jamaica, they do have private healthcare institutions. Private health insurance is offered by some employer or those who can afford to pay cash for their care. Private healthcare provides a higher standard of care to their patients. It is said that people get a better quality of care in private hospitals vs. the public health facility.
Many of the island hospitals that offers state-of-the-art medical technology are a private hospital that accepts private insurance. They offer state of the art three-dimensional ultrasound scan, x-rays, CT scans, mammograms, fluoroscopy, etc. These hospitals are in located in larger parts of Kingston, Jamaica.
One pro for Jamaica healthcare is that they have free healthcare for their citizen. But a con to their healthcare system would be the shortage of free medication. This means many people are still suffering from their injuries or sick because they do not have access to the prescribed medication by the doctor.
Both Jamaica and the U.S offer free healthcare to their citizen. Jamaica state-of-the-art medical technology is similarities the United States. In the United States, if you live in a rural area, you must travel to get medical care just like in Jamaica. One significant difference between the two countries healthcare system is there is not a shortage of prescribing medication for people who have free healthcare in the U.S. But in Jamaica, they are faced with a shortage of medicines because they do not have the same regulation as the United States for healthcare.
2. Switzerland HealthCare S.
Read the two documents attached in this quiz (Washington-DuBois de.docxhoward651
Read the two documents attached in this quiz (Washington-DuBois debate) and use them to answer the questions below.
1. Identify the ethical choices offered by the two speakers.
2. Discuss both sides of the ethical choices offered by the speakers.
3. Offer a personal evaluation of the ethical choices to be made.
4. Identified the pros and cons of both sides of the ethical choices to be made.
5. Indicate how the student’s own cultural background relates to the ethical choices proposed by the speakers.
6. Identify how the speaker’s point of view might be affected by the speaker’s cultural backgrounds.
7. Discuss how reading these two speeches allows them to relate to other cultures and helps them to understand and react to other cultures.
8. Indicate how reading these two speeches promotes their ideas of civic involvement in relation to the issues raised by these two speeches.
· Opinion
· Commentary
Jussie Smollett and the Hazards of Moral Sentimentality
Narratives about ‘racism’ and ‘homophobia,’ stoked by news and social media, stir self-affirming rage.
By
Lance Morrow
March 1, 2019 6:29 p.m. ET
Harriet Beecher Stowe‘s 1852 novel, “Uncle Tom's Cabin.” Photo: Fine Art Images/Heritage Images/Getty Images
A well-known story says that when President Lincoln met Harriet Beecher Stowe, he remarked, “So you are the little woman who wrote the book that started this great war.”
Stowe’s 1852 novel, “Uncle Tom’s Cabin”—with its melodrama of Eliza’s flight across the ice, of Simon Legree’s cruelty, of Uncle Tom’s martyrdom—had so roused American feelings on the subject of slavery that nothing less than a great civil war could have done justice to either the crime or the novel.
“Uncle Tom’s Cabin” was a supreme work of moral sentimentality—of feelings stirred to noble and lethal purposes. The story tore sentimental 19th-century America apart. It ended not with Uncle Tom’s crucifixion but with Appomattox.
Sentimentality may enlist in the cause of justice. Beware: It serves just as often in the ranks of evil. Hitler and Joseph Goebbels deployed sentimental storylines of the Volk, of Aryan purity and blood and soil. Righteousness sometimes waxes sentimental, but so do monsters. Anyone who ever organized a lynch mob in Alabama knew how to sentimentalize white womanhood.
Newsletter Sign-up
Today’s media storytelling has perfected a genre of intensely sentimental and spontaneously generated folk tales, especially stories dealing with race and sexuality. Social media and cable news pour forth vividly moralized tales that are sometimes true and sometimes not. The stories dramatize wrongs in order to amuse and polarize what has become the Republic of Maury Povich. They boost TV ratings, ignite apoplexy in our iPhones, and organize Americans along angry ideological lines.
Sentimentality, the regime of feelings, tempts people to exaggerate facts in ways that awaken grievances and encourage hatreds. Social media and cable news move faster than the speed of t.
Read the story on page 131 concerning a moral dilemma. Is the man wh.docxhoward651
Read the story on page 131 concerning a moral dilemma. Is the man who stole the medicine quilty of a crime? Which is more likely to say yes, a Classical School believer or a Positive School believer?
ALL FROM BOOK Book "Criminoloy Second Edition
"
Read Chapter 6. Please submit your responses to the following questions via the drop box:
1. What is
social disorganization
? How does it contribute to crime? What were Shaw and McKay's findings with regards to the
Concentric Zone
model?
2. Define
anomie. How does this "cause" crime.
3. Briefly explain Robert K. Merton's
Mean/Ends Theory (Modes of Adaptation).
4. According to Robert Agnew, what are the 3 major types of
negative relationships
which cause
strain
?
5. What would
Albert Cohen
say caused crime? What are
middle-class measuring rods
?
6. How do
Sykes and Matza
differ from Cohen in their belief of crime causation?
7. Briefly explain the
violent subculture theory
of Marvin Wolfgang.
.
Read the story timeline of Flint MI water crisis httpswww.cnn..docxhoward651
Read the story timeline of Flint MI water crisis:
https://www.cnn.com/2016/03/04/us/flint-water-crisis-fast-facts/index.html
(Links to an external site.)
Flint Update:
https://www.nytimes.com/2021/01/14/us/rick-snyder-flint-water-charges.html?action=click&module=Top%20Stories&pgtype=Homepage (Links to an external site.)
(Links to an external site.)
The CNN timeline chronicles the Flint MI water crisis with lead, bacterial contamination, and cases of Legionnaires disease after the city of Flint made a water source change.
Discussion:
The CNN timeline chronicles the Flint MI water crisis with lead, bacterial contamination, and cases of Legionnaires disease after the city of Flint made a water source change.
A. Discuss the topic addressed in the timeline and video. Do you agree or disagree with the points made in the documentaries and why? How did you perceive the information presented- be specific? Could different points have been covered in an alternative manner and how? Does the FSW College community have an obligation to address issues like water quality or issues in healthcare? Discuss any current water related issues that have health implications here in SWFL. Support your position.
B. Consider whether SWFL water systems have similar issues related to quality – not just lead. Consider that not all water sources are city/ county provided.
What would you do to become active in discussing the facts with your local FL state legislator? What points would you make related to public/ community healthcare on this topic in SWFL.
What five (5) factual points will you make as a practicing PHN related to the outbreak of Legionnaires’’ disease or another water borne illness.
Why would you make these five? Provide supportive data and references for your facts
Search entries or author
.
Read the short story, How Much land Does a Man Need written by.docxhoward651
Read the short story, "How Much land Does a Man Need" written by Leo Tolstoy in Modules on Canvas.
Look up the following elements of analysis:
1. Biography of writer
2. define: allegory, parable, paradox
3. what is the theme of the story and how did the writer develop/convey the theme in the story.
.
Read the speech posted below, then answer the following questions.docxhoward651
Read the speech posted below, then answer the following questions. Click on Submit Assignment to submit your answers. You may copy and paste your answers. The last two questions may require that you actually write the statements rather than copy and paste.
1. Copy the attention-getter for the speech.
2. Copy the sentence where the speaker establishes her own credibility.
3. Copy the sentence that is a preview of the main points from the introduction.
4. Copy the three main points of the speech.
5. Copy the three transition sentences.
a. (Transition from introduction to body)
b. (Transition between main point 1 and main point 2)
c. (Transition between main point 2 and main point 3)
6. Copy the summary sentence from the conclusion.
7. Copy the speaker's closing sentence.
8. Copy two sentences from the speech that contain citations.
9. Find an example in the speech of each of the following:
a. statistic
b. testimony (direct quote or person's opinion)
10. Write a specific purpose statement for this speech. “To inform my audience about . . .
11. Write a thesis statement (also known as central idea) for this speech.
Exploring the Titanic
An American writer named Morgan Robertson once wrote a book called The Wreck of the Titan. The book was about an “unsinkable” ship called the Titan that set sail from England to New York with many rich and famous passengers on board. On its journey, the Titan hit an iceberg in the North Atlantic and sunk. Many lives were lost because there were not enough lifeboats. So, what is so strange about this? Well, The Wreck of the Titan was written 14 years before the Titanic sank. I have been fascinated by the history of the Titanic for as long as I can remember, and I have read and studied my collection of books about the Titanic many times, and have done research on the Internet. First, I will discuss the Titanic itself; second, I will discuss the sinking of the ship; and finally, I will discuss the movie that was made about the Titanic.
From the disaster to the movie, the sinking of the Titanic remains one of the most famous tragedies in history. The Titanic was thought to be the largest, safest, most luxurious ship ever built. At the time of her launch, she was the biggest existing ship and the largest moveable object ever built. According to Geoff Tibbals, in his 1997 book The Titanic: The extraordinary story of the “unsinkable” ship, the Titanic was 882 feet long and weighed about 46,000 tons. This was 100 feet longer and 15,000 tons heavier than the world’s current largest ships. Thresh stated in Titanic: The truth behind the disaster, published in 1992, that the Titanic accommodated around 2,345 passengers and 860 crew-members.
The beautiful accommodations of the Titanic were decorated and furnished with only the finest items. According to a quotation from Shipbuilders magazine that is included in Peter Thresh’s 1992 book Titanic, “Everything has been done in regard to the.
Read the sentence and answer the question that followsHistorical .docxhoward651
Read the sentence and answer the question that follows:
Historical buildings in the small Kansas town were completely destroyed by the unexpected storm.
Which word may be eliminated to remove redundancy?
[removed] Historical
[removed] Small
[removed] Completely
[removed] Unexpected
.
How to Setup Default Value for a Field in Odoo 17Celine George
In Odoo, we can set a default value for a field during the creation of a record for a model. We have many methods in odoo for setting a default value to the field.
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
Andreas Schleicher presents PISA 2022 Volume III - Creative Thinking - 18 Jun...EduSkills OECD
Andreas Schleicher, Director of Education and Skills at the OECD presents at the launch of PISA 2022 Volume III - Creative Minds, Creative Schools on 18 June 2024.
Elevate Your Nonprofit's Online Presence_ A Guide to Effective SEO Strategies...TechSoup
Whether you're new to SEO or looking to refine your existing strategies, this webinar will provide you with actionable insights and practical tips to elevate your nonprofit's online presence.
Elevate Your Nonprofit's Online Presence_ A Guide to Effective SEO Strategies...
Read through the Tree Trimming Project case in chapter 13 of the.docx
1. Read through the Tree Trimming Project case in chapter 13 of
the textbook. This case refers to the earned value (EV) of the
owner, Will Fence’s Tree Trimming business. Will briefly
describes his techniques for EV. Based on the description
provided in the case, is Will using EV?
Answer the corresponding question provided at the end of the
case (300-500 words). Use references from the reading
materials to support your response.
⏐ PUBLIC HEALTH THEN AND NOW ⏐
Joffe | Peer Reviewed | Public Health Then and Now | 57January
2013, Vol 103, No. 1 | American Journal of Public Health
| Carole Joffe, PhD
WHAT SHOULD STAFF IN
abortion-providing facilities say
to abortion patients prior to the
procedure? This seemingly sim-
ple question is of course not sim-
ple at all, in light of the deep
social and political divide over
2. abortion that continues to char-
acterize the contemporary United
States, some 40 years after legal-
ization. This conflict has inevita-
bly had consequences for how
abortion is organized as a ser-
vice. Beyond their efforts to over-
turn Roe v Wade,2 opponents
have sought in numerous ways to
regulate the delivery of abortion,
The field of abortion counseling originated in the abortion
rights movement of the 1970s. During its
evolution to the present day, it has faced significant challenges,
primarily arising from the increasing
politicization and stigmatization of abortion since legalization.
Abortion counseling has been affected
not only by the imposition of antiabortion statutes, but also by
the changing needs of patients who
have come of age in a very different era than when this
occupation was first developed. One major
innovation—head and heart counseling—departs in significant
ways from previous conventions of the
field and illustrates the complex and changing political
meanings of abortion and therefore the chal-
lenges to abortion providers in the years following Roe v Wade.
(Am J Public Health. 2013;103:57–65.
doi:10.2105/AJPH.2012.301063)
3. including staff interactions with
patients. State legislatures, for
example, have passed laws that
mandate that patients be forced
to view their ultrasounds and
hear detailed descriptions of
their fetus’s development; numer-
ous states have also dictated
scripts—often containing untrue
statements—that clinic staff must
deliver to patients.3
Abortion rights supporters, and
particularly those who work in
abortion-providing facilities, vehe-
mently reject opponents’ argu-
ments that such regulations are in
abortion patients’ interest; rather,
they argue, these requirements
exist to make access to abortion
more difficult and the experience
more upsetting. Although they
reject what they see as politically
driven restrictions, however,
those involved in abortion provi-
sion are not in complete agree-
ment about what precisely the
abortion experience should be for
patients. In particular, opinions
differ about what the nonmedical
component of abortion should be,
that is, the talking, or counseling,
portion of the abortion visit.
Alissa Perrucci, author of a recent
4. highly regarded book on abortion
counseling, has commented on
the “lack of consensus on the
breadth and depth of responsibil-
ity that abortion providers have
toward working with patients’
emotions.”4
What is commonly referred to
as counseling in the abortion set-
ting actually involves three sepa-
rate functions: obtaining informed
consent, which includes ruling
out coercion; patient education,
which involves explaining the
actual technical aspects of the
procedure and possible complica-
tions; and counseling, which
and the Evolution of
Abortion Counseling
Politicization
ofAbortion
The
“Our patients are not coming to ‘exercise their constitutional
rights.’
They want to talk about prayer and forgiveness.”
—Claire Keyes, Daily Beast1
⏐ PUBLIC HEALTH THEN AND NOW ⏐
5. American Journal of Public Health | January 2013, Vol 103, No.
158 | Public Health Then and Now | Peer Reviewed | Joffe
involves addressing the patient’s
feelings about her forthcoming
procedure.5 The first two func-
tions are fairly straightforward
(albeit often compromised by leg-
islative mandates), but counseling
practices have varied consider-
ably among different abortion-
providing settings and have
changed over time.
The field of abortion counsel-
ing has evolved considerably
from its origins in the abortion
rights movement of the 1970s.
The field has faced significant
challenges, primarily from the
increasing politicization and stig-
matization of abortion since legal-
ization. Abortion counseling has
been affected not only by the
imposition of antiabortion stat-
utes, but also by the changing
needs of patients who have come
of age in a very different era than
when this occupation was first
developed. One major innovation,
head and heart counseling,
departs in significant ways from
previous conventions of the field
and illustrates the complex and
changing political meanings of
6. abortion—and therefore the chal-
lenges to abortion providers—in
the years following Roe.
Abortion counseling can be
viewed as a case study of a new
occupation, created by one social
movement—the abortion rights
movement of the 1970s—but
sharply affected by another, the
antiabortion movement that
shortly followed. Abortion coun-
seling can be understood as a
movement-affiliated occupation
that ultimately found itself torn
between the political needs of the
larger abortion rights movement
and the emotional needs of many
of the individuals served by the
provider wing of that movement.
To understand the history of
abortion counseling and its cur-
rent challenges, I conducted
interviews with 25 veteran abor-
tion counselors who have worked
in this field since the years sur-
rounding the Roe v Wade deci-
sion in 1973.6
ORIGINS OF ABORTION
COUNSELING
Abortion counseling as a dis-
tinct component of the abortion
visit had its roots in the early
7. 1970s, before Roe, in the first
freestanding clinics established in
New York City and Washington,
DC, both of which had by then
legalized abortion. The motiva-
tion of the clinic founders
(mainly physicians) to incorpo-
rate a specific counseling func-
tion into abortion care stemmed
from the dearth of knowledge
about delivering this procedure
to large numbers of healthy
women. Before the early 1970s,
legal abortions had been largely
confined to a few women, typi-
cally very ill or carrying severely
compromised fetuses, who went
before therapeutic abortion com-
mittees in hospitals and had their
abortions performed under gen-
eral anesthesia.7 Abortion legal-
ization in New York and
Washington coincided with two
medical developments: the intro-
duction of the vacuum suction
machine to US physicians and
localized anesthesia methods that
increased the safety of abortion
and made it feasible to offer out-
patient procedures in freestand-
ing clinics.8 At a landmark
medical meeting on abortion in
1968, doctors sympathetic to
abortion expressed concerns
about what it would be like to
provide outpatient abortions to
8. large numbers of women who
would be coming from all over
the country and shortly thereaf-
ter returning to their home
communities.
These physicians realized,
often to their discomfort, that
legal abortion was unique as a
medical procedure, in that other-
wise healthy women were them-
selves diagnosing their condition
and its solution, rendering the
physician a mere “technician.”
Some of those at the meeting
bristled at the idea of acting as a
“rubber stamp,” in the words of
the famed obstetrician–gynecolo-
gist Alan Guttmacher,9 and
expressed confusion as to
whether it was an appropriate
role for the physician to discuss
the social, psychological, and
”
“Abortion counseling has been affected not only by the
imposition of antiabortion statutes, but also by the changing
needs of patients who
have come of age in a very different era than
when this occupation was first developed.
⏐ PUBLIC HEALTH THEN AND NOW ⏐
9. January 2013, Vol 103, No. 1 | American Journal of Public
Health Joffe | Peer Reviewed | Public Health Then and Now | 59
advocacy-oriented counselors
brought with them to their work
also led to skepticism about, if
not aversion to, more conven-
tional forms of therapy in the
clinic. As Barbara, who opened a
clinic on the West Coast with a
friend shortly after Roe, put it,
From the very beginning, we
used the word “counseling” only
because we didn’t have another
word for it, and it came out of
our mouths only every once a
while. But mostly we used the
word “advocate.” . . . We were
women’s advocates, we did in-
formation sharing, we did in-
formed consent. . . . We thought
counseling was patronizing. We
always thought that women
should come to us as they are
and our role wasn’t to fix them.
. . . They didn’t need fixing!
They needed tools, they needed
information, they needed to
take control over their lives.
Yet during this same period a
more professionalized concept of
the role of abortion counselor
was being developed, one that
focused more sharply on counsel-
10. ing techniques and that put the
patient’s feelings at the center of
the abortion experience. This
model was most strongly associ-
ated with Washington, DC’s Pre-
term Clinic (one of several
Preterm Clinics operating in that
period) which quickly became
known as a major training center
for abortion workers from all
over the country. As a 1976 Pre-
term manual stated,
The new element [in freestand-
ing abortion clinics] is the intro-
duction of a counselor in full
partnership with the medical
team that is concerned with
emotional and physical aspects
of patient care. Counselors are
trained to work as co-profes-
sionals with the physician and
other medical staff.
14
Terry Beresford, author of sev-
eral influential works on abortion
moral aspects of abortion with the
patient, along with the medical
ones. The response by Robert
Hall—another leading physician
advocate for legal abortion of
that era—is one that seems to
have carried the day: “She [the
11. patient] should receive some
guidance (but) not necessarily
from a doctor.”10As the first free-
standing abortion clinics were
established, the founders drew
on allies from the feminist health
community to work as counsel-
ors. These were typically women
in their 20s, who had been a
crucial part of the political coali-
tion to legalize abortion and
who, often, had themselves
undergone an abortion.11
ADVOCACY VS
PROFESSIONALISM
In this formative period, two
different, if overlapping, models
arose regarding what this new
occupation of abortion counseling
should comprise. Many of the
feminist activists who were
among the first counselors to be
hired, particularly in New York,
understood their job as primarily
political. They saw their task as
advocacy for the abortion patient:
that is, to protect her from facili-
ties that the counselors perceived
as unsafe or overpriced. Inside
the clinic, the counselor’s role
was to guide the patient through-
out the abortion process, attend-
ing to both her emotional and
her physical needs.
12. Counselors adhering to this
advocacy model would meet out-
of-town patients at the airport,
accompany them to the clinic,
inform them of all that would be
occurring, and answer any ques-
tions. During the abortion itself,
the counselor would continue
this advocacy by speaking on a
patient’s behalf to the doctor,
and sometimes to clinic manage-
ment, about any distress she
might experience. As a counselor
from that period recounted, some
years later, to a researcher,
It blows my mind, thinking
about it now, about how much
power we [counselors] had. . . .
The doctors were just terribly
nervous about the whole thing
and were willing to listen to
us—about what kind of counsel-
ing services there should be,
about all kinds of things. If one
of the doctors they hired was
causing too much pain or say-
ing disgusting things to patients,
we’d run into the director’s of-
fice and get him fired.12
Indeed, the chapter on abor-
tion in the 1973 edition (though
not later editions) of the feminist
13. health classic Our Bodies, Our-
selves states, “Probably the most
important person you would
come in contact with during an
abortion would be the abortion
counselor.”13
The atmosphere surrounding
this form of advocacy counseling
in the early 1970s was overtly
political, with the victory of legal
abortion viewed by the newly
hired counselors as inseparable
from the women’s liberation
movement of that era. As Cathy,
who worked in one of the first
legal abortion clinics in a major
northeastern city, described in an
interview the culture of her clinic
and its first generation of
counselors,
We were jubilant when Roe
became the law of the land.
And the fervor and joy that
we brought to our work was
very evident. . . . There was al-
most a giddiness about women’s
rights and women’s bodies. . . .
Women’s liberation was very
much part of the whole group
of us.
The feminist politics that
many of this first generation of
14. ⏐ PUBLIC HEALTH THEN AND NOW ⏐
American Journal of Public Health | January 2013, Vol 103, No.
160 | Public Health Then and Now | Peer Reviewed | Joffe
were provided, and that would
increase referrals, Baker said in
an interview. She described her
early days in the clinic as a time
of discovery. She and two other
newly hired counselors learned
on the fly:
It was trial by error. There was
nothing written about abortion
counseling. We would just go in
and talk to the woman, and
we’d come out, and at the end
of the day we’d get together
and we’d discuss the women we
saw, what they said, what we
said to them.
Despite being given consider-
able freedom by the clinic man-
ager to devise their own
protocols for counseling, Baker
and her colleagues quickly
became frustrated by the time
pressures they felt—in particular,
not to keep the clinic doctor
waiting, if a particular counseling
session was taking up too much
time—a tension that exists in
15. many clinics to this day.
And when I went to the first
three-day workshop that Terry
Beresford gave for all of us
fledglings across the country,
we all had the same complaints:
we were being rushed, and we
wanted to be able to have more
time with the patients, because
things would come up. They
would start talking about guilt,
they would start crying, they
would start talking about killing
the baby—we couldn’t say to
them, “’scuse me, I have 10
minutes for this [counseling
session].”
Attendance at Beresford’s train-
ing sessions was a transformative
experience for Baker and facili-
tated her own professional devel-
opment as an eventual leader in
the field. Recalling the “empower-
ing experience” of the Baltimore
workshops, she described a boost
in confidence in her professional
abilities as a counselor, especially
in possessing the skills to deal
budget, would not be kept wait-
ing. As security and other costs
began to rise, the hiring of ade-
quate numbers of counselors
became one of the easiest items in
16. the clinic budget to cut. Beresford
explained,
So the goal of counseling
changed. . . . At Preterm, the
goal had been to make this ex-
perience life changing for the
woman. Later, the goal became,
“don’t let anybody get through
who’s really disturbed or
doesn’t know what they’re
doing.16
Beresford expressed both wist-
fulness that the original Preterm
model was lost—“We used to get
letters from people that would
make you weep about what the
experience had meant to them, it
changed their lives”—and recog-
nized that such a model, where
patients were offered up to an
hour of individual counseling,
and sometimes more, could not
be replicated elsewhere or
indeed, continued even at the
several Preterm Clinics
themselves.
Beresford, after her Preterm
experience, worked at Planned
Parenthood of Baltimore, Mary-
land. In the late 1970s, she inau-
gurated the first training sessions
for abortion counselors that drew
participants from across the
17. country. These workshops,
beyond the practical skills they
developed, helped to forge an
occupational identity and sense
of community for counselors in
both independent clinics and
Planned Parenthood facilities.
One attendee at a Beresford
workshop was Anne Baker. She
started work in a newly opened
midwestern abortion facility in
1976 after graduating college.
The physician-owner of the clinic
thought his facility would be
more reputable if counseling
counseling15 and a leading trainer
until her recent retirement,
became involved in abortion work
while at the DC Preterm Clinic,
where she ultimately became
director of staff development.
Beresford and the clinic’s first
medical director, a fervent cham-
pion of in-depth counseling, devel-
oped their own approach, as
Beresford recalled in an interview:
You would help the person de-
cide if they were clear about
their decision, you’d help to
weed out people who were
being coerced and you would
be preparing the patient to be
relaxed and comfortable for an
18. outpatient procedure. . . . So
every women would be seen for
at least up to an hour, as
needed. . . . The model was to
help the patient do some self-ex-
ploration so she reaches under-
standing of herself, her feelings,
and her options, and can then
take an action, and is assisted in
taking that action. . . . Your job
as a counselor is to affirm her
competency and her sense of
self-worth, and her ability to act
on her understanding.
In short, the model of counsel-
ing initially developed at Preterm
was not just about abortion per
se. The model also used the
experience of the abortion deci-
sion—“often the first important
decision a woman may have had
to make in her life,” as Beresford
and other counselors frequently
put it—as a vehicle to lead the
woman to confront other impor-
tant issues in her life.
Beresford acknowledged that as
the abortion field grew, the very
expansive view of counseling that
had been developed at Preterm
became difficult, if not impossible,
to sustain, for several reasons.
One was clinic flow—that is,
patients needed to be moved pre-
19. dictably and smoothly through the
abortion process, so doctors,
whose salaries were the most
expensive element in the clinic
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contrast between those she saw
in a New York State clinic in the
early 1970s and those she was
seeing in her midwestern state by
the late 1980s:
When I started, we didn’t see
patients who were “ambivalent.”
They would drive through a
snowstorm to show up in an-
other state—or they were going
to have a baby. It was really
crystal clear!
But counselors were now see-
ing some patients with no mem-
ory of, or affinity with, the
feminist and pro-choice sensibili-
ties of the 1970s that had ani-
mated both clinic staff and many
of the first generation of patients.
Patients were now more apt to be
apolitical, if not politically conser-
vative; religious; poor; and,
20. increasingly, women of color—in
short, quite different from the
mostly White, college-educated,
strongly feminist-identified, mainly
secular group of counselors (simi-
lar to many of the patients they
had seen in an earlier era) that
gathered in Dallas in 1989.
In transition were not only the
types of patients coming to the
clinics, but also the society-wide
“feeling rules” governing abor-
tion, to use the formulation of the
sociologist Arlie Hochschild.19
Numerous forces in American
society during the 1980s—the
presidency of Ronald Reagan,20
the increasing strength of the
National Right to Life Committee
and similar organizations, and the
widely distributed film The Silent
Scream, which purported to show
a late abortion—were driving a
change in the dominant feeling
rules regarding abortion from a
woman’s right to a shameful,
immoral, and selfish act.21
The impact of these changes
at the clinic level, revealed in
November Gang discussions, was
that noticeably more patients
with challenging patient issues:
“Now when they [patients]
21. brought up guilt, we weren’t so
afraid of it, we could go into it.”
Baker compiled a list of counsel-
ing techniques that seemed to
work particularly well and even-
tually wrote several influential
works on counseling.17
Baker also innovated a system
of second evaluations, in which
patients whom counselors per-
ceived to need extra attention
would be seen again by either
Baker herself or another senior
counselor. This move to second
evaluations was an early version
of the triage that would be
expanded on by the head and
heart model of counseling.
THE NOVEMBER GANG
In 1989, a group of about 30
women who worked as counsel-
ors or clinic managers in inde-
pendent clinics (as opposed to
Planned Parenthood or hospital-
based clinics) began meeting
informally to discuss their work
and to offer one another personal
support. This group (which meets
to this day) became known as the
November Gang because of the
date of its first meeting, which
was convened by Charlotte Taft,
a longtime counselor and then a
22. clinic director in Texas, and
another counselor from Utah.
The immediate precipitant for
the first meeting was the
Supreme Court decision in Web-
ster v. Reproductive Health Ser-
vices, handed down in July
1989.18 Webster, which allowed
extensive new abortion restric-
tions, also led many to fear an
eventual overturning of Roe. The
original members of the Novem-
ber Gang were alarmed by the
possible implications of this rul-
ing and were dismayed that the
national pro-choice organizations
seemed helpless to respond.
However, what drew them to
gather in an airport hotel in Dal-
las, Texas, was not only national
abortion politics. The increasing
strength of the antiabortion
movement, culturally as well as
politically, in the 15 years since
legalization also deeply con-
cerned them. Meeting partici-
pants were increasingly aware of
how the antiabortion move-
ment’s success in stigmatizing
abortion was shaping the
responses of their patients, more
of whom were now coming to
the clinics visibly conflicted.
23. Robin, a midwestern coun-
selor, colorfully captured the
hunger that many of the counsel-
ors then felt, both for community
building and for confronting the
impact of larger abortion politics
on their work. As she recalled in
an interview, when she heard
about that first November Gang
meeting,
It was the first time I was going
to leave my two young kids
at home. . . . I said I would
crawl on my belly over broken
glass. . . . I just knew I had to
get there.
At these first meetings, those
who had been involved in abor-
tion since Roe, or in some cases
before, acknowledged the chal-
lenges presented by some con-
temporary patients. Robin, for
example, remembered drawing a
”
“Baker also innovated a system of second evaluations, in which
patients whom counselors perceived to need
extra attention would be seen again
by either Baker herself or another
senior counselor.
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Although checking with the
patient on the second item, coer-
cion, had long been part of coun-
seling practice, the other issues
had not been as systematically
addressed by counselors. In Taft’s
clinic, and in the others that
adapted her model, patients
whose responses to the state-
ments raised concern not only
were given more counseling, but
also were asked to do more reflec-
tion on their own, with the help
of materials supplied by the clinic.
Over time, the most widely used
of these supplementary materials
have become a workbook, devel-
oped by a longtime counselor and
clinic manager, Margaret John-
ston.23 In this workbook, origi-
nally published in 1998, the
prospective patient is led through
exercises that explore her feelings
about abortion, her assumptions
about her support system’s reac-
tion if she has the abortion or
continues her pregnancy, her
anticipated emotional reactions
about adoption, and so on.
25. To implement this mode of
counseling, many early Novem-
ber Gang attendees had to relin-
quish their previous commitment
to a more unobtrusive approach.
As Arlene put it,
It involved really getting women
to talk about where they are in
their process, to step away from
this, “Her feelings are not my
business, if she made it through
the door, it’s all okay.” We had
to acknowledge that women
were coming in with ambiva-
lence, that some women come
into clinics who shouldn’t be
there, that being able to say no
to someone who’s not in a good
place in their decision is the
right thing to do, and we’ve got
to learn the skills to do it.
Clearly, head and heart coun-
seling implied changing several
long-standing clinic conventions;
the most striking change, rarely
done, was sending an ambivalent
A woman comes in, and in her
head she says “I know that an
abortion is the right decision for
me,” but her heart is breaking.
So she wants an abortion and
then she changes her mind,
or she’s sobbing, or she says,
26. “I think an abortion is killing my
baby, but I have to have one
anyway.” So it became an easy
way for us to describe what we
were trying to do when we said,
“If we can get the woman to
connect her head and heart
before her abortion, how
much healthier will she be
afterwards.”
CHANGES IN COUNSELING
PRACTICE
The core of Taft’s argument,
which formed the basis of this
new approach, is that “just as
there may be medical contraindica-
tions to providing an abortion . . .
there are attitudinal contraindi-
cations to providing an abortion
as well.” These attitudinal contra-
indications can in most cases,
Taft believes, be resolved
through counseling, but if they
are unresolved, the patient is not
an appropriate candidate for an
abortion. Taft’s staff used a
checklist of statements during the
patient’s first contact to deter-
mine whether the woman
needed more extensive counsel-
ing before an abortion could take
place:
1. I’m against abortion but I have
27. no other choice.
2. I don’t want an abortion but
someone else is forcing me or
pressuring me.
3. I believe that having an abor-
tion is the same as murdering
a born person.
4. I believe if I have an abortion
I will never be forgiven and I
will be separated forever from
God or my Higher Power.
5. I believe I will regret having
an abortion.22
were showing signs of difficulty
with their abortion decision.
Arlene, an interviewee who
worked in Florida at that time,
recalled in stark terms her grow-
ing realization of such changes:
“Every so often you’d walk
through the recovery room and
you’d see a woman just falling
apart.”
It was admittedly difficult for
some of the counselors to
acknowledge the ambivalence, if
not anguish, of some patients. As
one early Gang participant said,
I think we fought so hard to
28. protect abortion rights that
there was a real hesitation on
anybody’s part to address that
[for] some women, abortion
might be hurting them. They
shouldn’t be a candidate for an
abortion, or at least they
weren’t ready to have it on the
day they came in.
Similarly, Meg, an East Coast
counselor recollected,
We would talk at great length
about “if we are doing such
great work, why are we losing
politically?” And we realized that
we were doing work that was all
about access and not about the
quality of the experience.
Some at those first meetings
even gave grudging credit to
antiabortion forces for being
more attuned to patients’ con-
flicted feelings. As Meg said,
They tapped into things that pa-
tients were concerned with. . . .
I . . . felt bad that they were
doing a better job at listening to
women than we were . . . and
we weren’t doing anything. In
fact, we were quite adamantly
denying that reality.
29. At these early November Gang
meetings, Taft introduced her
colleagues to a new model she
had developed with her staff:
head and heart counseling. As she
later explained in an interview,
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written widely, and controver-
sially, on the alleged psychologi-
cal damage suffered by abortion
recipients.29 WEBA, a group now
apparently defunct (although sim-
ilar groups are active), was very
effective in staging opportunities
for its members to speak about
their regretted abortions.
Several of the women I inter-
viewed specifically mentioned
their concern about creating
recruits for WEBA as an addi-
tional motive for identifying
ambivalent clients. Anne Baker
was forthright about her con-
cerns about WEBA, regarding
both the psychological manipula-
tion vulnerable abortion patients
might be subjected to and poten-
tial harm to the abortion-provid-
30. ing community. Explaining her
realization that some clients
should not have an abortion the
day of the appointment, or per-
haps ever, Baker said,
We felt like we had an obliga-
tion also to protect ourselves. . . .
We decided early on we are not
going to provide fuel for the fire
of WEBA So if a woman is cry-
ing and distressed and [saying],
“Everyone else is trashy but me
out in that waiting room and I
know I’m going to feel horrible,
I’m going to regret it but this is
what I need to do,” well, we
could say, “No, not here, not
now. We are going to send you
home, here are some things you
can read, here are some coun-
seling referrals. You can come
back, but we want to be able to
see some kind of change in
your acceptance, in your ability
to cope.”
Robin gave an example of a
patient who raised enough red
flags that her abortion was
delayed (although eventually it
took place). “This patient said to
us, ‘You have to do my abortion,
because you guys are baby kill-
ers and you all are going to go to
hell anyway.’”
31. patient home for further consid-
eration of her decision.24 In such
cases, most patients returned
later, more comfortable with or,
in Taft’s terminology, more
“resolved” about the decision to
abort. In some cases, such
patients did not return, and
counselors acknowledged that it
was not known whether they
went to another clinic or ulti-
mately decided against an abor-
tion. In some cases, women who
had been urged to delay later
wrote to the clinic, enclosing pic-
tures of their child and thanking
the counselors for helping lead
them to this outcome.
Yet another change brought
about by this new approach con-
cerned the delicate issue of the
language used in counseling,
which had long vexed the abor-
tion-providing community.25 As
Cathy, one of the original
November Gang attendees,
reflected in an interview on her
realization at an early meeting,
All of a sudden it occurred to
me, why am I not using her lan-
guage? You know, we were told,
you never, never say “baby.”
And if a patient says “baby,” you
32. correct her. You tell her, “It’s not
a baby, it’s cells, it’s a fetus,”
whatever. And after a point, it
felt offensive to be denying this
woman her own experience,
using her own language. And so
once that hit me, I remember
[realizing] if you can hear that,
then you can hear everything
else that she’s saying.
Similarly, Robin described her
decision to take on the potentially
explosive issue of patients’ occa-
sional use of the word “killing.”26
After her exposure to discussions
of head and heart counseling, she
changed her previous practice of
avoiding such language when
brought up by the patient. “If the
patient used that language, we
didn’t correct her. We took the
language she used and we talked
to her. And what we found was
that patients were opening up to
us in ways they had not before—
because they weren’t being cor-
rected, which they might have
seen as a criticism.”
Meg recalled the difficulties
but ultimately the importance of
hearing the patients’ concerns
about killing:
33. A woman says, “I feel like I’m
killing my baby” . . . we were
like, “OK, let’s just stick with
whatever her reality is and ask
how that is for her.” . . . We
would have conversations about
killing, and “Is killing the same
as murdering? Is there ever a
time when killing is justified?” . .
. We could go from there to
“Well, you’re trying to protect
the lives of the three kids you’ve
got.” . . . To explore those issues
with them in a safe place—you
had the feeling you might be the
only person they’ve ever had
that conversation with.
Several interviewees acknowl-
edged that these changes in lan-
guage were difficult to accept
for those in the pro-choice
movement, even among their
own clinic peers. Cathy recol-
lected colleagues’ jeers at a
national conference when she
shared her changed language
practices. “There were real fears
at that point that we were play-
ing into the hands of antiabor-
tion people, of allowing patients
to use that language.” Meg simi-
larly recalled her own staff writ-
ing to a feminist journal to
object to an article she had writ-
ten urging these language
34. innovations.27
Yet another change came with
the acknowledgment that many
more patients now than in the
immediate post-Roe period were
raising spiritual concerns. Cathy
related in an interview,
That was another thing that
was a no-no when I went to
school [graduate work in coun-
seling]. You know, “the spiritual
or religious stuff had no place
in counseling.” But that isn’t
how it was for our patients. . . .
They would say everything
from “Am I going to burn in
hell?” to . . . “What if God de-
cides to punish one of my other
children?” It was a major theme
for a small percentage of
women. In fact it was in some
cases the only thing that they
were worried about.
Anne Baker, though not for-
mally part of the November
Gang, was very influential,
through informal contacts with
many group members, in estab-
lishing the rationale of addressing
spiritual issues with abortion
patients. Starting in the early
1980s, after hearing so many
35. patients raise religious issues, she
invited local clergy to help her
largely secular staff deal with
such concerns.
An Episcopal priest came and
talked to us. And he was just
amazed at what we had to deal
with in our counseling sessions.
He said, “You are having an in-
credible opportunity. . . . You’re
working with these people in
the moment of their greatest
need for pastoral counseling.”28
RESPONSE TO CLAIMS OF
ABORTION DAMAGE
The development of head and
heart counseling was primarily
driven by the desire to attend to
the emotional well-being of abor-
tion patients. However, another
impetus was the growth of sev-
eral antiabortion organizations
that specifically targeted women
who regretted their abortions.
The best known of these organi-
zations at the time of the Novem-
ber Gang’s founding was WEBA
(Women Exploited by Abortion),
a group started in 1982 by David
Reardon, a psychologist who has
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and suicide. Often the time allocated to
counseling must be spent undoing the
fright caused by such state-mandated in-
formation.
4. A. Perrucci, Decision Assessment and
Counseling in Abortion Care: Philosophy
and Practice (Boulder, CO: Rowan and
Littlefield Publishers, 2012), 6.
5. A. Baker and T. Beresford, “Informed
Consent, Patient Education and Coun-
seling,” in Management of Unintended
and Abnormal Pregnancy: Comprehensive
Abortion Care, ed. M. Paul, S. Lichten-
ber, L. Borgatta, D. A. Grimes, P. G.
Stubblefield, and M. D. Creinin (Oxford,
UK: Wiley–Blackwell, 2009), 48–53.
6. I used the real and full names of in-
terviewees who have written about
abortion counseling. For other inter-
viewees, I used only a pseudonymous
first name. I selected interviewees from
a pool of counselors I know to have
been involved in abortion from the pe-
riod around Roe. I obtained other in-
terviewees via the snowball method;
that is, initial interviewees suggested
others who had similarly worked in the
field for a very long period. All inter-
37. viewees worked at (or were retired
from) independent freestanding abor-
tion clinics.
7. The therapeutic abortion committees,
and their often unfair practices, such as
developing informal quotas and favor-
ing private patients over ward patients,
are discussed at length in L. Reagan,
When Abortion Was a Crime: Women,
Medicine and the Law, 1867–1973
(Berkeley, CA: University of California
Press, 1997). See also C. Joffe, Doctors
of Conscience: The Struggle to Provide
Abortion Before and After Roe v. Wade
(Boston, MA: Beacon Press, 1995),
119–127.
8. Joffe, Doctors of Conscience, 135–
138.
9. R. Hall, ed., Abortion in a Changing
World (New York, NY: Columbia Uni-
versity Press, 1970), 2:108.
10. Ibid., 109.
11. C. Joffe, T Weitz, and C. Stacey,
“Uneasy Allies: Pro-Choice Physicians,
Feminist Health Activists and the Strug-
gle for Abortion Rights,” in Social Move-
ments in Health, ed. P. Brown and S. Za-
vestoski (Oxford, UK: Blackwell
Publishing, 2005), 94–115.
12. C. Joffe, The Regulation of Sexuality:
38. Experiences of Family Planning Workers
(Philadelphia, PA: Temple University
Press, 1986), 36.
13. Boston Women’s Health Book Col-
lective. Our Bodies, Ourselves: A Book By
and For Women (New York, NY: Simon
and Schuster, 1973), 147.
that their own political commit-
ment to the larger abortion rights
movement was interfering with
another deeply held political and
occupational commitment —to
best meet the diverse needs of
their patients. Acting on this real-
ization, they broke, not without
controversy, with previous coun-
seling conventions.
About the Author
Carole Joffe is with the Bixby Center for
Global Reproductive Health, Department
of Obstetrics, Gynecology, and Reproduc-
tive Sciences, University of California, San
Francisco.
Correspondence should be sent to Car-
ole Joffe, ANSIRH, 1330 Broadway, Suite
1100, Oakland, CA 94612 (e-mail: jof-
[email protected]). Reprints can be or-
dered at http://www.ajph.org by clicking
the “Reprints” link.
This article was accepted September 2,
2012.
39. Acknowledgments
The author gratefully acknowledges sup-
port from the Society of Family Planning
to conduct this research.
I thank Heather Gould, Katrina Kim-
port, Steph Herold, and Leslie Reagan
for their comments on an earlier draft of
this article and Elisette Weiss for her ex-
cellent research assistance.
Human Participant Protection
This research received approval from
the institutional review board of the
University of California, San Francisco.
Endnotes
1. E. Thomas, “Reality Check for ‘Roe,’”
Daily Beast, http://www.thedailybeast.
com/newsweek/2006/03/05/reality-
check-for-roe.html (accessed June 28,
2012).
2. Roe v. Wade, 410 US 113 (1973).
3. In a rigorous review conducted sev-
eral years ago by the Guttmacher Insti-
tute, researchers found that 23 of the
33 states that had specific requirements
for information to be imparted to pa-
tients included “information not in keep-
ing with the fundamental tenets of in-
formed consent.” R. Gold and E. Nash,
“State Abortion Counseling Policies and
the Fundamental Principles of Informed
40. Consent,” Guttmacher Policy Review 10,
no. 4 (2007): 6–13. Such counseling
mandates include information that is
misleading, or, in some cases, blatantly
untrue, such as the alleged link between
abortion and breast cancer, infertility,
SIGNIFICANCE OF HEAD
AND HEART COUNSELING
It is not possible to say with
any precision how many of the
approximately 1790 abortion-
providing facilities in the United
States30 employ the head and
heart counseling approach, nor
more generally what their coun-
seling practices are. The many
pressures facing beleaguered pro-
viders—the huge security costs,
which cut into the resources
available for hiring and training
counselors; the necessity to
devote limited counseling time to
state-imposed counseling man-
dates, as well as to calming down
rattled patients confronted by
screaming picketers as they
approach the clinic—have made
it difficult for many to offer more
than cursory counseling of any
kind. The facilities most likely to
incorporate aspects of the head
and heart approach are affiliated
with the Abortion Care Network,
an association of independent
41. clinics.31 Seemingly, the most
adopted aspect of this approach
is emotional triage. The concepts
and techniques of this form of
counseling continue to be shared
at network conferences, as well
as at meetings of the National
Abortion Federation, an umbrella
group of abortion providers.
The development of head and
heart counseling is a moving
story of clinic workers whose
political identities were forged in
the Roe era, who gradually came
to perceive a gap between them-
selves and many of their patients
and to realize that these patients
had quite different understand-
ings of the abortion issue and
therefore different needs as abor-
tion recipients than had previ-
ously been the norm in abortion
care. In simplest terms, these
counselors came to understand
14. A Guide for Training Abortion Coun-
selors (Newton, MA: Preterm Institute,
1976), 1.
15. T. Beresford, Short Term Relationship
Counseling (Baltimore, MD: Planned
Parenthood of Maryland, 1977); How to
Be a Trainer: A Self-Instructional Manual
for Training in Sexual and Reproductive
Health Care (Baltimore, MD: Planned
42. Parenthood of Maryland, 1980); and
A. Baker and T. Beresford, “Informed
Consent, Patient Education and Coun-
seling,” in Paul et al., Management of
Unintended and Abnormal Pregnancy,
48–53.
16. To be sure, this expansive notion of
what the abortion experience might be
has not entirely disappeared. Amy Hag-
strom Miller, who runs several clinics in
Texas, Minnesota, and Maryland, has re-
cently written about abortion in terms
quite similar to those used by Beresford
to describe the original Preterm model:
“An unplanned pregnancy experience
shines a bright light on a woman’s life.
The experience challenges her to look
at everything—her hopes and her
dreams, her relationship choices, her
ideas about family and career, her plans
for the future, her intentions. For many
women, abortion can be a transforma-
tional experience—one where she ac-
tively chooses what she wants for her
life, one where she is in charge.” A. H.
Miller, “Work to End the Stigma,” (St.
Paul, MN: Minnesota Women’s Press)
http://www.womenspress.com/main.asp
?FromHome=1&TypeID=1&ArticleID=
4099&SectionID=124&SubSectio
nID=684 (accessed July 3, 2012).
17. A. Baker, Abortion and Options
Counseling: A Comprehensive Reference
(Granite City, IL: Hope Clinic for
43. Women, 1995); and A. Baker, Coping
Well After an Abortion (Granite City, IL:
Hope Clinic for Women, 2007).
18. Webster v. Reproductive Health Ser-
vices, 492 US 490 (1989). The deci-
sion upheld a Missouri law that imposed
restrictions on the use of state funds, fa-
cilities, and employees in performing,
assisting with, or counseling on abor-
tions. The Supreme Court in this deci-
sion allowed for states to legislate in an
area that had previously been thought
to be forbidden under Roe v. Wade and
confirmed some abortion providers’
fears that some of the justices were
ready to overturn Roe altogether or, at
the very least, that more regulations on
abortion provision were certain to
come.
19. As Hochschild argues, emotions
have a social as well as a psychological
component, and different groups in society
struggle to assert the legitimacy of their
favored frames of how one is “supposed
to feel” about certain phenomena,
⏐ PUBLIC HEALTH THEN AND NOW ⏐
January 2013, Vol 103, No. 1 | American Journal of Public
Health Joffe | Peer Reviewed | Public Health Then and Now | 65
especially contested ones. A. Hochs-
44. child, “Emotion Work, Feeling Rules,
and Social Structure,” American Journal
of Sociology 85, no. 3 (1979), 551–
575.
20. The antiabortion movement had
been growing in size and influence ever
since the 1973 Roe decision; however,
the election of Ronald Reagan in
1980—an effort to which the movement
had contributed many resources—
marked a turning point in the move-
ment’s influence in political circles, in-
cluding Reagan’s Cabinet picks,
selection of Supreme Court nominees,
and so on. This political coming of age
of the antiabortion movement is well
documented in M. McKeegan, Abortion
Politics: Mutiny in the Ranks of the Right
(New York, NY: Free Press, 1992).
21. Of course, as a perceptive anony-
mous reviewer for this journal pointed
out, the feeling rules surrounding abor-
tion may well have changed for the
counselors as well as for their patients.
This is an intriguing question for which
my interviews do not contain a direct an-
swer. In the most general terms, it is fair
to say that the abortion-providing com-
munity—counselors as well as clinicians—
has always had a diversity of views
about abortion (e.g., some see abortion
as sad but necessary and others reject
that formulation, viewing the abortion
decision as often the first decision a
45. woman has made for herself and the
first step in taking control of her life).
However, I speculate that the counselors
I interviewed had less change in their
own views about abortion than did the
general public, including patients, be-
cause so much of their professional and
political identity revolved around the
protection of legal abortion. The various
admissions made by interviewees of their
regrets about not “hearing” their patients
sooner suggest this.
22. C. Taft, “Abortion Counseling—the
Full Head and Heart Process” (unpub-
lished paper), 2010. This paper was cir-
culated by Taft to fellow members of
the Abortion Care Network, to help
them make best use of the Pregnancy
Options Workbook (see note 23). One
of the earliest compilations of head and
heart counseling principles was Abortion
Resolution Workbook: Ways to Connect
the Head and Heart, a 1991 booklet pre-
pared by the staff of the Routh Street
Women’s Clinic, in Dallas, where Taft
then served as clinic director. Eventu-
ally, portions of this approach were in-
corporated into a two-page precounsel-
ing needs assessment form written by
Anne Baker for use in her Illinois clinic
and reprinted in the leading textbook
on abortion provision in the United
States: Paul et al., Management of Unin-
tended and Abnormal Pregnancy, 52–53.
46. Carhart, stated, “While we find no reli-
able data to measure the phenomenon, it
seems unexceptionable to conclude some
women come to regret their choice to
abort the infant life they once created
and sustained. Severe depression and
loss of esteem can follow.” Gonzales v.
Carhart, 127 S.CT. (2007), 1610.
30. The figure of 1790 abortion-provid-
ing facilities in the United States comes
from the Guttmacher Institute, http://
www.guttmacher.org/media/
nr/2011/01/11/index.html (accessed
June 28, 2012). In one of the few stud-
ies of clinic counseling practices, a re-
search team from the University of Cali-
fornia, San Francisco surveyed 27
clinics and found that 96% of them re-
ported providing information about the
abortion procedure; nearly as many
stated that they checked on the “cer-
tainty of patients’ decisions.” Some 74%
reported that they “assess the patients’
feelings and provide emotional support.”
H. Gould, A. Perrucci, R. Barar, D. Sink-
ford, and D. G. Foster, “Patient Educa-
tion and Emotional Support Practices in
Abortion Care Facilities in the United
States,” Women’s Health Issues 22, no. 4
(2012): e359–e364. No reliable studies
of counseling effectiveness nor of the
superiority of one model of counseling
over another have been published.
31. Planned Parenthood clinics that pro-
47. vide abortions have taken a more stan-
dardized approach to abortion counsel-
ing, have not used the head and heart
model, and, in general, have done less
in-depth counseling. However, the
Planned Parenthood Federation an-
nounced a new approach to meeting
the emotional needs of its abortion pa-
tients and developed a training program
for all staff who interact with abortion
patients. Its new training manual states,
“Addressing emotional issues is similar
to addressing physical ones. So, just as
we provide antibiotic prophylaxis to pre-
vent infection, this training supports giv-
ing clients ‘emotional prophylaxis.’” Not
unlike head and heart efforts, this man-
ual also stipulates that patients should
be screened for potential risk of poor
coping after an abortion, such as
“stigma and social disapproval of oth-
ers,” “coercion or history of abuse,” and
so on. Talking About Abortion (New
York, NY: Planned Parenthood Federa-
tion of America, 2008), 1,2.
23. Johnston M, ed., Pregnancy Options
Workbook: A Resource for Women Mak-
ing a Difficult Decision (Binghamton,
NY: Ferre Institute, 2006); and John-
ston M, ed., A Guide to Emotional and
Spiritual Resolution After an Abortion
(Binghampton, NY: Ferre Institute,
2008). These publications are also
available at http://www.pregnancyo-
ptions.info (accessed June 28, 2012).
48. 24. The counselors I interviewed esti-
mated that the number of patients
whose initial screening led to their
being sent home or, if they lived too far
from the clinic, their abortions being
delayed for a few hours of further re-
flection and work with clinic-provided
materials such as the Pregnancy Options
Workbook, was 1% to 5% of the total
patient load. A somewhat larger group,
approximately 10% according to some
interviewees, proceeded with their abor-
tions as scheduled, but only after more
extensive counseling than was received
by other patients. These figures are con-
sistent with a large study recently com-
pleted by researchers at the University
of California, San Francisco, which ex-
amined data from the precounseling
needs assessment forms and clinic in-
take forms of more than 5000 patients
at one US clinic and concluded that
87% of women seeking abortions had
“high confidence in their decision” be-
fore receiving counseling. D. Foster, H.
Gould, J. Taylor, and T. Weitz, “Attitudes
and Decision Making among Women
Seeking Abortion at One U.S. Clinic,”
Perspectives on Sexual and Reproductive
Health 44, no. 2 (2012): 117–124.
25. Joffe, Regulation of Sexuality, 94.
26. Alissa Perrucci offers an extended
and sensitive discussion of how to coun-
49. sel patients who believe abortion is
murder, yet wish to have an abortion:
Decision Assessment and Counseling in
Abortion Care, 87–115.
27. It is impossible to answer the ques-
tion of whether the practices of those
using the head and heart approach—that
is, acknowledging the emotional difficul-
ties some women have with abortion,
and incorporating into the counseling
session such previously taboo language
as “killing” and “baby”—have hurt either
the larger abortion rights movement or
others in the abortion-providing commu-
nity who do not use these practices.
However, the fears earlier expressed by
some have not come to pass. In 2003,
Glamour magazine published an article
on the November Gang, and this gener-
ated predictably negative attention from
several antiabortion groups: “Are you
ready to understand abortion?” Glamour,
September 2003, 264–267, 294–295,
299. Since then, however, the denuncia-
tions of abortion and its alleged harm
to women by abortion opponents have
ignored both the November Gang and
its counseling approach. It is possible
that abortions that are denied or delayed
for the most conflicted women, as urged
by head and heart adherents, in fact
have reduced the number of women
who come to regret their abortion, but
no evidence exists to verify this.
50. 28. Liberal clergy from a variety of de-
nominations were active in abortion
referrals in the pre-Roe era. For an ac-
count by its founders of the Clergy Con-
sultation Service, see A. Carmen and H.
Moody, Abortion Counseling and Social
Change: From Illegal Act to Medical Prac-
tice (New York, NY: Judson Press, 1973).
After legalization, direct clergy partici-
pation dropped off, although a notable
exception, besides Baker, was the late
George Tiller, who was assassinated by
an anti-abortion extremist in May
2009. Tiller, who provided post–24-
week abortions to women who were
carrying fetuses with anomalies or who
had serious health conditions of their
own, hired a chaplain to minister to
these grieving patients and devoted a
special space in his clinic to meditation
and prayer. See C. Joffe, “Working with
Dr. Tiller: Staff Recollections of Wom-
en’s Health Services of Wichita,” Per-
spectives on Sexual and Reproductive
Health 43, no. 3 (2011): 199–204.
More recently, there has been an up-
surge of interest in bringing spiritual el-
ements into the clinic for those patients
who wish this, and two groups in partic-
ular, the Religious Coalition for Repro-
ductive Choice and Faith Aloud, have
been prominent in these efforts.
29. Reardon, who holds a BA degree in
electrical engineering, subsequently re-
51. ceived a PhD degree in biomedical eth-
ics from Pacific Western University, an
unaccredited correspondence school of-
fering no classroom instruction. His
claim, made in numerous books and arti-
cles, that abortion causes mental illness,
has been repeatedly challenged by lead-
ing psychologists, such as Brenda Majors
of the University of California, Santa Bar-
bara; Nancy Russo of the University of
Arizona; and Julia Steinberg of the Uni-
versity of California, San Francisco. A
task force of the American Psychological
Association has on several occasions
challenged the existence of “postabortion
syndrome.” B. Major, M. Appelbaum, L.
Beckman, M. A. Dutton, N. F. Russo, and
C. West, “Abortion and Mental Health:
Evaluating the Evidence,” American Psy-
chologist 64, no. 9 (2009): 863–890.
Nevertheless, to the dismay of many in
the abortion-providing community, the
notion of postabortion syndrome re-
ceived a substantial boost in legitimacy
in 2007, when Justice Anthony Ken-
nedy, writing for the majority in the
Supreme Court’s decision in Gonzales v.
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53. for posttraumatic stress disorder (PTSD) with controls for
demographic and personal/situational variables used. For men,
perceptions of inadequate counseling predicted relationship
problems and symptoms of intrusion and avoidance with the
same controls used. Incongruence in the decision to abort
predicted intrusion and meeting diagnostic criteria for PTSD
among
women with controls used, whereas for men, decision
incongruence predicted intrusion, hyperarousal, meeting
diagnostic
criteria for PTSD, and relationship problems. Findings suggest
that both perceptions of inadequate preabortion counseling
and incongruence in the abortion decision with one’s partner are
related to adverse personal and interpersonal outcomes.
Keywords
elective abortion, abortion counseling, abortion decision,
relationship problems, psychological stress, PTSD
Introduction
Few contemporary social issues have evoked more contro-
versy than elective abortion. The continuing debate over
abortion and mental health has focused on the nature and
frequency of adverse postabortion psychological sequelae.
There is now consensus, however, that a significant percent-
age of women experience negative psychological reactions
following abortion (Bradshaw & Slade, 2003; Coleman,
Reardon, Strahan, & Cougle, 2005; Wilmoth, deAlteriis, &
Bussell, 1992). This study was designed to identify poten-
tially key factors predictive of postabortion relationship
problems and psychological stress in both women and men.
Women and Abortion
Recent studies have corrected methodological weaknesses of
54. earlier studies and have revealed increased mental health
risks associated with the experience of abortion. The most
thoroughly researched adverse consequences include anxiety,
depression, substance abuse, suicidal ideation, and suicide
(Broen, Moum, Bodtker, & Ekeberg, 2004; Coleman et al.,
2005; Cougle, Reardon, & Coleman, 2003; Cougle, Reardon,
Coleman, & Rue, 2005; Coleman, Reardon, Rue, & Cougle,
2002; Fergusson, Horwood, & Ridder, 2006; Gissler, Berg,
Bouvier-Colle, & Buekens, 2005; Gissler, Hemminki, &
Lonnqvist, 1996; Pedersen, 2007, 2008; Reardon & Cougle,
2002; Reardon, Coleman, & Cougle, 2004; Reardon et al.,
2003; Rees & Sabia, 2007; Soderberg, Janzon, & Sojberg,
1998; Thorp, Hartman, & Shadigan, 2003).
An estimated 43% of U.S. women will experience at least
one anxiety disorder in their lifetime (Breslau, Schultz, &
Peterson, 1995). Posttraumatic stress disorder (PTSD) is a rela-
tively common and particularly disabling anxiety disorder
that may be caused by one or more profound stressors. Exten-
sive research has documented how traumatic stress can signi-
ficantly alter the quality of individuals’ lives (Kapfhammer,
Rothenhausler, Krauseneck, Stoll, & Schelling, 2004; Marshall
1APART Inc., Madison, WI, USA
2Bowling Green State University, Bowling Green, OH, USA
3Institute for Pregnancy Loss, Jacksonville, FL, USA
Corresponding Author:
Catherine T. Coyle, APART, Inc., Madison, WI 53711, USA
Email: [email protected]
Coyle et al. 17
55. et al., 2001; Schnurr, Hayes, Lunney, McFall, & Uddo, 2006;
Warshaw et al., 1993). In the United States, an estimated
13% of women develop PTSD in their lifetime (Butterfield,
Becker, & Marx, 2002). Systematic exploration of the role of
elective abortion as a traumatic stressor associated with
symptoms of PTSD has grown substantially in recent years
(American Psychological Association, 2008; Bradshaw &
Slade, 2003). Various clinicians have identified abortion as
potentially traumagenic (Bagarozzi, 1993, 1994; Burke &
Reardon, 2002; De Puy & Dovitch, 1997; Speckhard, 1987;
Speckhard & Rue, 1993; Torre-Bueno, 1996). Moreover,
recent research has provided empirical evidence of this link
between abortion and PTSD symptomatology (Kubany, Hill,
& Owens, 2003; Mufel, Speckhard, & Sivuha, 2002; Rue,
Coleman, Rue, & Reardon, 2004; Steinberg & Russo, 2008;
Suliman et al., 2007). Rue et al. (2004) and Suliman et al.
(2007) reported that 12% to 18% of women met the full diag-
nostic criteria for PTSD after an abortion. An even greater
number of women in these studies experienced subthreshold
or partial PTSD symptoms following abortion (Barnard, 1990;
Rue et al., 2004). The higher the number of these subthreshold
symptoms present, the greater the risk of impairment, comor-
bidity, and suicidal ideation (Marshall et al., 2001).
Informed consent and preprocedure counseling can bene-
fit the patient’s decision making and postprocedure emotional
and physical adjustment (Baker, Beresford, Halvorson-Boyd,
& Garrity, 1999). The perceived adequacy of preabortion
counseling may also play an important role in mitigating or
increasing the amount of stress women feel following abor-
tion. Preabortion counseling has been criticized as being too
time limited, inadequate to address the ambivalence and the
complexity inherent in the abortion decision, lacking in discus-
sion of alternatives to abortion, deficient in assessing coercion
or pressure to abort, provided by nonprofessionals who are
biased, and not tailored to the needs of the individual patient
56. (Singer, 2004; Steinberg, 1989; Stites, 1982). The National
Abortion Federation (2007) advises that “there should be an
opportunity for discussion of the patient’s feelings about the
abortion decision” (p. 3). However, there is no current stan-
dard of care in abortion clinics requiring individualized
and thorough counseling regarding the patient’s feelings
and decision making. In a cross-cultural study, Rue et al.
(2004) reported that only 29% of women in the U.S. sample
received preabortion counseling, and 84% stated that it was
inadequate.
Individual psychological responses to abortion have also
been found to be related to the quality of preabortion deci-
sion making and, particularly, lack of partner support for the
decision (Bradshaw & Slade, 2003; Coleman et al., 2005).
Research has consistently identified ambivalence and absence
of partner support as predictive of negative abortion out-
comes (Bracken, 1978; Coleman et al., 2005; Major &
Cozzarelli, 1992; Major et al., 1990; Osofsky & Osofsky,
1972). Payne, Kravitz, Notman, and Anderson (1976) found
that women electing abortion were significantly more angry
and depressed afterward, if they were in conflict with their
husband or lover over the abortion. Rue et al. (2004)
reported that most women were unsure about their decision
at the time of the abortion, and only 24% perceived their
partners as supportive. Thus, the degree of perceived partner
support and perceived quality of preabortion counseling
are seemingly central factors in possible adverse psycho-
logical outcomes following elective abortion and they are
addressed in this investigation.
Men and Abortion
Although few studies have addressed men’s psychological
responses to elective abortion (Coyle, 2007), there are iden-
tifiable, recurring themes within the scientific literature. A
57. number of reports have noted men’s need and/or desire for
counseling (Gordon, 1978; Lauzon, Roger-Achim, Achim,
& Boyer, 2000; Myburgh, Gmeiner, & van Wyk, 2001a;
Rothstein, 1977a; Shostak & McLouth, 1984). Most men
who experience a partner’s abortion do not perceive it to be
a benign experience (Blumberg, Golbus, & Hanson, 1975;
Gordon & Kilpatrick, 1977; Poggenpoel & Myburgh, 2002;
Shostak, 1979, 1983; White van-Mourik, Connor, &
Ferguson-Smith, 1992) and specific emotions identified
among men include anger, anxiety, guilt, grief, and powerless-
ness (Gordon & Kilpatrick, 1977; Holmes, 2004; Mattinson,
1985; Speckhard & Rue, 1993). In studies of men dealing
with therapeutic abortion following amniocentesis, 82%
(Blumberg et al., 1975), 50% (Jones et al. 1984) and 47%
(White van-Mourik et al. 1992) of men have reported depres-
sion. Furthermore, clinicians have observed symptoms among
postabortion men that are consistent with delayed or compli-
cated grief reactions and PTSD (Mattinson, 1985; Robson,
2002; Speckhard & Rue, 1993). These clinical reports
involved small numbers of men and, to date, no quantitative
studies have looked at the potential for PTSD among men
following a partner’s abortion. In light of established comor-
bidity of PTSD with depression and other forms of anxiety
(Shalev, 2001), further investigation is warranted to deter-
mine the extent of risk of psychological trauma among men
whose partners undergo elective abortion.
Men tend to defer the abortion decision to their partners
and suppress their own emotions and desires as they attempt
to support their partners (Gordon & Kilpatrick, 1977;
Robson, 2002; Shostak & McLouth, 1984), and men who
disagree with their partners’ abortion decisions may be more
susceptible to intense anger (Naziri, 2007; Reich & Brindis,
2006). Even men who agree with the abortion decision may
suffer from ambivalence (Kero & Lalos, 2000, 2004; Kero,
Lalos, Hogberg, & Jacobsson, 1999) and their relationships,
58. both social and sexual, with their partners may be strained
or come to an end (Berger, 1994; Coleman, Rue, Spence &
Coyle, 2008; Myburgh, Gmeiner, & van Wyk, 2001b;
Naziri, 2007; Rothstein, 1977b; White van-Mourik et al.,
1992).
18 Traumatology 16(1)
Although little is known about the long-term effects on
men, M. Buchanan and Robbins (1990) provided evidence
that adolescent pregnancy resolution may have effects that
last into adulthood. These authors found that adult men who
experienced abortion during adolescence were more psycho-
logically distressed than adult men who became fathers
during adolescence.
Although men are involved with conception and abortion,
they are not routinely offered abortion counseling. Despite
the call for greater inclusion of and attention to males in
abortion clinics (Shostak, 2007), little has changed. Most
men who accompany women for abortion do not receive
counseling and are left alone to wait.
Given that abortion is a highly personal and sensitive
issue, an online investigation seems ideally suited to this
topic. Participants may remain anonymous thereby increas-
ing their comfort with self-disclosure. The very existence of
an online survey concerning the emotional and relational
aspects of abortion may serve to normalize respondents’
experiences and encourage them to seek help if needed.
Web-Based Research
This investigation represents one of the first online studies
pertaining to the topic of abortion and, in this section, estab-
59. lished advantages and disadvantages of this contemporary
data collection mode are examined. Use of the Internet to
engage in data collection is time- and cost-efficient (Duffy,
2000; Wilson, 2003), effective in accessing difficult-to-reach
populations (Mangan & Reips, 2007; Yeaworth, 2001), and
enhances respondents’ comfort with the process and motiva-
tion to participate (Adler & Zarchin, 2002; Gosling, Vazire,
Srivastava, & John, 2004). A review of Web-based studies
published in the American Psychological Association journals
between 2003 and 2004 (Skitka & Sargis, 2006) revealed that
21% of those journals had published at least one such study.
Gosling et al. (2004) compared a large Internet sample with
510 traditional samples and found that Internet samples “are
generally more diverse than samples published in a highly
selective psychology journal” (p. 99). Similarly, Mathy,
Schillace, Coleman, and Berquist (2002) reported their Inter-
net sample as being more representative in terms of
education, income, and ethnic diversity than that of a large
sample obtained through random digit dialing. Still others
have argued that Internet samples are at least as representa-
tive as the ubiquitous college-student samples (Gosling
et al., 2004; Smith & Leigh, 1997).
Because data collected through Web-based surveys are
often obtained from self-selected, convenience samples,
generalization must be approached with caution. However,
the voluntary nature of such samples offers considerable
benefits (Buchanan & Smith, 1999; Reips, 2000) such as
superior responses in terms of clarity and completeness
(Petit, 2002; Walsh, Kiesler, Sproull, & Hesse, 1992), and
responses that are less likely to be contaminated by social
desirability (Richman, Kiesler, Weisb, & Drasgow, 1999).
Furthermore, research indicates that data collected online
appears to be equivalent to that collected via more traditional
60. methods (Ballard & Prine, 2002; Hewson & Charlton, 2005;
Knapp & Kirk, 2003; Robie & Brown, 2006) and Meyerson
and Tryon (2003) concluded that “data collection on the
Web is (1) reliable, (2) valid, (3) reasonably representative,
(4) cost effective, and (5) efficient” (p. 614).
Potential risks of online survey administration such as
inaccurate responses, failure to respond, and the influence of
phrasing and ordering of questions are applicable to tradi-
tional survey administration methods as well. The risks of
multiple survey submissions and nonserious responses
(Buchanan & Smith, 1999; Schmidt 1997) may be avoided by
using Internet protocol numbers to identify surveys coming
from the same respondent (Birnbaum, 2004; Gosling et al.,
2004). Furthermore, the anonymity afforded by the Internet
facilitates honest disclosure (Levine, Ancill, & Roberts, 1989;
Locke & Gilbert, 1995; Mangan & Reips, 2007).
Ethical considerations in Web-based research are the same
as those for other research forms. Consent to participate may
be defined as and verified by submission of an online survey.
The risk of psychological harm in online surveys has been
deemed to be no greater than that of offline surveys (Kraut
et al., 2004) if initial instructions include a clear statement
respecting the participant’s freedom to withdraw from the
study at any time. For studies involving sensitive subjects,
information concerning referrals for counseling or support
may be provided.
Objectives and Hypotheses
Based on the literature reviewed here, it appears that pre-
abortion counseling for women may be limited, whereas for
men, it is nonexistent. In addition, men and women may be
arriving at abortion decisions that are made without adequate
communication and candor between them thus resulting in
decisions that are less than satisfactory to one or both parties.
61. Consequent to both the crisis of pregnancy resolution and
insufficient communication, relationships may be strained
(Rue et al., 2004; Speckhard & Rue, 1993) and psychologi-
cal stress increased (Bagarozzi, 1994; Coleman & Nelson,
1998; Fergusson et al., 2006).
Both inadequate preabortion counseling and the incon-
gruence of partner abortion decision making may therefore
predict postabortion relationship difficulties and/or psycho-
logical trauma. Given that some studies on women have
found factors such as prior mental health (Major et al., 2000),
religious beliefs (Adler et al., 1990; Major, Richards, Cooper,
Cozzarelli, & Zubek, 1998), opinions or attitudes about
abortion (Soderberg et al., 1998; Zolese & Blacker, 1992),
number of abortions (Rue et al., 2004), and various sociode-
mographic characteristics (Zavodny, 2001) are likely to
influence the decision to abort and/or postabortion adjust-
ment, these factors were used as control variables in this
Coyle et al. 19
study. In addition, history of physical or sexual abuse during
childhood or adulthood may be a confounding variable in
terms of postabortion mental health given the evidence
that such abuse may contribute to emotional problems
(Fergusson, Horwood, & Lynskey, 1996; Schilling, Aseltine,
& Gore, 2007). Therefore, controls were also implemented
for various forms of childhood and adulthood victimization.
The primary objective of this study was to investigate the
extent to which perceived inadequacy of preabortion coun-
seling and partner incongruence in abortion decision making
predicted postabortion relationship problems and psycho-
logical stress. The following hypotheses were tested:
62. Hypothesis 1: Men and women who do not perceive
preabortion counseling as having been adequate
will be at significantly greater risk for abortion-
related anger, relationship problems, and sexual
problems after controlling for sociodemographic
and personal history variables.
Hypothesis 2: Men and women who do not perceive
preabortion counseling as adequate will report
significantly higher abortion-related stress as evi-
denced by symptoms of intrusion, avoidance, and
hyperarousal, and they will be at significantly
greater risk of meeting the Diagnostic and Statis-
tical Manual of Mental Disorders, fourth edition
(DSM-IV) diagnostic criteria for PTSD after con-
trolling for sociodemographic and personal history
variables.
Hypothesis 3: Men and women who were not in agree-
ment with their partners regarding the decision to
abort will be at significantly greater risk for abor-
tion-related anger, relationship problems, and sexu-
al problems after controlling for sociodemographic
and personal history variables.
Hypothesis 4: Men and women who were not in
agreement with their partners regarding the deci-
sion to abort will report significantly higher abor-
tion-related stress as evidenced by symptoms of
intrusion, avoidance, and hyperarousal, and they
will be at significantly greater risk of meeting the
DSM-IV diagnostic criteria for PTSD after con-
trolling for sociodemographic and personal his-
tory variables.
63. Method
Procedure
Surveys were posted at www.abortionresearch.net from
April, 2005 through August, 2008. The surveys consisted of
questions concerning sociodemographics, meaningfulness
of religious affiliation, abortion history, reasons for abortion,
perceived adequacy of preabortion counseling, agreement in
abortion decision making, opinion regarding abortion at time
of procedure, relationship status with partner postabortion,
mental health history, abuse history, trauma symptoms related
to abortion, abortion-related anger, relationship problems,
sexual problems, and general stress attributed to abortion.
The introduction to the survey clarified that submission of
the survey would qualify as consent to participate and that
respondents could withdraw from participation at any time.
Links were provided for those respondents who desired sup-
port or counseling. Participants were recruited through
e-mail requests to crisis pregnancy centers across the United
States and to a few other organizations that offer postabor-
tion counseling. Potential participants could also find the
survey via search engines using phrases such as “men and
abortion,” “women and abortion,” or “abortion research.”
Sample
Surveys were completed by 374 women and 198 men. U.S.
citizens comprised 81% of the female sample and 78% of the
male sample. Citizens from England (6.5% male and 4%
female surveys), Canada (4.5% male and 6.4% female
surveys), and Australia (2.5% male and 2.7% female sur-
veys) contributed the next largest number of surveys.
Respondents also identified the following as country of citi-
zenship: France, Ireland, Norway, Romania, Czechoslovakia,
Germany, Sweden, New Zealand, South Africa, Kenya,
Mexico, Nicaragua, Brazil, Nepal, and South Korea. The
64. average age of both male and female respondents was 38
years (SD = 12.8 for males and 11.1 for females). Religious
affiliation of women was as follows: 81.6% Christian, 0.3%
Jewish, 9.5% Other, and 8.6% None. Religious affiliation of
males was 82% Christian, 0.5% Jewish, 0.5% Islam, 7.2%
Other, and 9.8% None. Females reported an average of 15
years (SD = 11.8) had elapsed since abortion and males
reported a mean of 14.7 years (SD = 12) had passed since
abortion occurred. Approximately half of the respondents
endorsed liberal views prior to abortion with 21% of males
and 24% of females agreeing that abortion “should be legal
for any reason at any time during pregnancy” and 27% of
males and 36% of females agreeing that abortion “should be
legal for any reason during the first trimester of pregnancy.”
Additional demographic information can be found in Table 1.
Measures
Perceived adequacy of preabortion counseling was assessed
via a single item question, “Do you think the counseling you
received at the abortion clinic was adequate?” to which
respondents indicated “yes” or “no.” Agreement regarding
abortion decision making was determined by respondents’
endorsement of agreement or disagreement with their part-
ners about the decision to abort.
Relationship quality was assessed with single item
variables indicating the presence or absence of abortion-
related relationship problems, abortion-related anger, and
20 Traumatology 16(1)
Table 1. Descriptive Statistics for Primary Study Variables and
Control Variables
65. Percentage
Variables Women Men
Independent variables
Inadequate preabortion counseling
Endorsed 85.8 86.6
Not endorsed 14.2 13.4
Respondent and partner did not agree
on abortion decision
Endorsed 50.7 52.9
Not endorsed 49.3 47.1
Control variables
Race
White 85.4 85.2
Black 3.0 7.7
Hispanic 5.7 2.0
Asian 0.5 1.0
Other 5.4 4.1
Education
Less than 12 years 2.7 4.1
High school diploma 21.4 19.4
Technical/associates degree 29.2 26.5
Bachelor degree 28.7 29.6
Graduate degree 18.0 20.4
Employment
Full-time 49.0 74.5
Part-time 24.3 10.7
Unemployed 26.7 14.8
66. Marital status
Married 48.0 37.8
Remarried 10.5 6.1
Single (never married) 26.4 39.3
Single (divorced) 12.1 14.8
Separated 2.2 2.0
Number of children
None 42.0 55.1
One 12.8 11.1
Two 23.0 17.7
Three 13.9 9.6
Four or more 8.2 6.5
Number of abortions
One 73.4 81.8
Two or more 26.6 18.2
Meaningfulness of respondent’s religion
Not at all 8.2 10.3
Not very 4.4 8.8
Somewhat 10.7 17.5
Important 12.1 14.4
Very important 64.6 49.0
Abortion position at time of procedure
Legal for any reason at anytime 24.2 20.9
in pregnancy
Legal for any reason in first trimester 36.3 27.0
Legal only in rape, incest, 9.2 11.7
genetic disorders, and to
preserve health of mothers
Legal only in rape, incest, and to 6.7 16.6
preserve mother’s health
67. (continued)
Table 1. (continued)
Percentage
Variables Women Men
Legal only if mother’s 7.6 8.6
health is threatened
Never legal 15.9 15.3
Mental health counseling
prior to abortion
Yes 27.5 13.5
No 72.5 86.5
Hospitalized for emotional
reasons prior to abortion
Yes 3.8 4.2
No 96.2 95.8
Told needed counseling
before abortion but did not go
Yes 22.7 20.2
No 77.3 79.8
Felt needed counseling before
abortion but did not go
Yes 23.6 17.2
No 76.4 82.8
68. Victim of child abuse
Yes 24.1 15.6
No 75.9 84.4
Victim of child neglect
Yes 18.9 17.8
No 81.1 82.2
Victim of sexual abuse in
childhood or adolescence
Yes 36.7 19.4
No 63.3 80.6
Victim of physical abuse
during adulthood
Yes 26.3 6.5
No 73.7 93.5
Victim of sexual abuse
during adulthood
Yes 32.5 5.5
No 67.5 94.5
Dependent variables
Abortion-related anger
Yes 86.6 79.8
No 13.4 30.2
Abortion-related relationship problems
Yes 82.6 81.8
No 17.4 18.2
69. Abortion-related sexual problems
Yes 69.5 55.6
No 30.5 44.4
Met DSM-IV criteria for intrusion
Yes 83.5 77.6
No 16.5 22.4
Met DSM-IV criteria for avoidance
Yes 74.1 59.4
No 25.9 40.6
Met DSM-IV criteria for hyperarousal
Yes 61.6 54.2
No 38.4 45.8
(continued)
Coyle et al. 21
abortion-related sexual problems. These items had dichoto-
mous (yes/no) responses.
Psychological stress was assessed using the PTSD
Checklist–Civilian Version (PCL-C). The entire PCL-C was
contained within the online survey. The PCL is composed of
17 items that measure the severity of PTSD symptoms. The
PCL yields a total score of 17 to 85 and assesses three symp-
tom clusters: arousal, avoidance of, and re-experiencing of the
traumatic event. The response format of the PCL is a 5-point
Likert-type scale with higher scores indicative of greater trau-
matic stress. The diagnosis of PTSD was determined using
DSM-IV criteria: (a) one or more endorsements of
re-experience symptoms; (b) three or more endorsements of
70. avoidance symptoms; and (c) two or more endorsements
of hyperarousal symptoms not present prior to the abortion.
Reliability and validity of the PCL have been established
(Weathers, Litz, Herman, Huska, & Keane, 1993). With the
current sample, internal consistency reliability estimates for the
full scale and for the arousal, avoidance, and re-experiencing
subscales were equal to .89, .77, .78, .80, and .92, .82, .80, .82
using the women’s and men’s data, respectively.
Results
Table 1 provides frequency data for the independent variables,
sociodemographic and personal history control variables, and
dependent variables separately for men and women. To test
the first and third hypotheses, which predicted that percep-
tions of inadequate preabortion counseling and disagreement
with one’s partner regarding the decision to abort would be
associated with increased risk for abortion-related anger,
relationship, and sexual problems after employing various
controls, three sets of logistic regression analyses were con-
ducted separately for males and females in the sample. In the
first set, perceptions of counseling inadequacy and partner
disagreement operated as the independent variables with
abortion-related anger problems functioning as the depen-
dent variable. A similar logistic regression analysis was then
conducted incorporating the control variables listed in Table 1.
In the second set of two logistic regression analyses, the
analyses were structured similarly to the first set except rela-
tionship problems functioned as the dependent variable.
Finally, in the third set of logistic regressions employing a
similar structure to the preceding analyses, sexual problems
operated as the dependent variable.
The results of these tests are provided in Table 2 for the
female respondents and in Table 3 for the male respondents.
As indicated by the data presented in Table 2, prior to inclusion
71. of the control variables, both independent variables (disagree-
ment regarding the abortion decision and perceptions of
preabortion counseling as inadequate) were significant predic-
tors of abortion-related anger, relationship, and sexual
problems.
However, once the controls were entered into the analyses,
only the inadequate preabortion counseling variable signifi-
cantly predicted postabortion-related anger, relationship, and
sexual problems in the women sampled. More specifically, the
inadequate counseling variable was associated with a 592%,
831%, and 340% increased risk for anger, relationship, and
sexual problems, respectively, among the females.
A different pattern of results emerged with the male data.
As indicated in Table 3, both independent variables were sig-
nificant predictors of postabortion-related anger, relationship,
and sexual problems after statistically controlling for the
wide range of sociodemographic and personal situational
variables. Inadequate counseling was specifically associated
with a 1,797% increased risk of postabortion anger, a 1,421%
increased risk of postabortion relationship problems, and a
407% increased risk of postabortion-related sexual prob-
lems. In addition, disagreement with one’s partner regarding
the abortion decision was associated with a 4,248%, 469%,
and a 331% increased risk of postabortion-related anger,
relationship problems, and sexual problems, respectively.
To test the first part of the second and fourth hypotheses,
two sets (one for males and one for females) of analyses of
variance were conducted. In each test, the independent vari-
ables of partner disagreement on the decision and preabortion
counseling inadequacy served as the independent variables
with scores on the single item measure of abortion-related
stress serving as the dependent variable. Higher scores on the
stress measure are indicative of greater stress. One analysis
in each set incorporated controls and one did not. Using the
72. female data, without controls employed, the main effect for
counseling inadequacy was significant, F(1, 334) = 71.92,
p < .0001, as was the main effect for partner disagreement,
F(1, 334) = 71.92, p < .0001, and the interaction was signifi-
cant as well, F(1, 334) = 20.58, p < .0001. Then, with the
controls instituted, the results were similar—counseling
inadequacy: F(1, 218) = 36.31, p < .0001; partner disagree-
ment: F(1, 218) = 12.23, p < .0001; interaction: F(1, 334) =
5.45, p < .0001. Means were as follows—no agreement,
counseling inadequate: 8.80 (SE = .21); no agreement,
Table 1. (continued)
Percentage
Variables Women Men
Met DSM-IV diagnostic
criteria for PTSD
Yes 54.9 43.4
No 45.1 56.6
Stress associated with the abortion
(0 = no stress; 4 = moderate stress; 7
= high stress; 10 = overwhelming stress)
0-2 5.7 6.2
3-4 7.9 14.4
5-6 8.2 8.3
7-8 22.1 29.9
9-10 56.3 41.2
Note: DSM-IV = Diagnostic and Statistical Manual of Mental
Disorders, fourth
edition; PTSD = posttraumatic stress disorder.
73. 22 Traumatology 16(1)
counseling adequate: 8.26 (SE = .23); agreement, counseling
inadequate: 6.78 (SE = .77); agreement, counseling adequate:
3.96 (SE = .56).
Using the male data, without controls employed, only the
main effect for partner disagreement was significant, F(1,
152) = 10.99, p < .001. Then, with the controls instituted,
partner disagreement remained significant, F(1, 95) = 8.24,
p = .005, and the interaction effect was likewise significant,
F(1, 95) = 4.00, p = .048. Adjusted means were as follows—
no agreement, counseling inadequate: 7.81 (SE = .36); no
Table 2. Results of Logistic Regression Analyses With
Relationship-Based Dependent Variables for Females
Dependent Variable Independent Variable B SE Exp(B) 95% CI
for Exp(B) Significance
Abortion- Respondent and partner not in 1.45 0.42 4.25 1.85-
9.74 .001
related anger agreement on abortion
Inadequate preabortion counseling 2.69 0.38 14.68 6.95-30.98
.0001
Abortion-related angera Respondent and partner 0.56 0.55 1.75
0.60-5.13 .309
not in agreement on abortion
Inadequate preabortion counseling 1.93 0.64 6.92 1.97-24.34
.003
74. Abortion-related Respondent and partner not 1.08 0.35 2.94
1.474-5.89 .002
relationship problems in agreement on abortion
Inadequate preabortion counseling 2.54 0.36 12.69 6.26-25.66
.0001
Abortion-related Respondent and partner 0.73 0.48 2.08 0.813-
5.33 .126
relationship problemsa not in agreement on abortion
Inadequate preabortion counseling 2.23 0.61 9.31 2.805-30.91
.0001
Abortion-related Respondent and partner 0.52 0.25 1.68 1.03-
2.76 .039
sexual problems not in agreement on abortion
Inadequate preabortion counseling 1.66 0.33 5.26 2.74-10.10
.0001
Abortion-related Respondent and partner not 0.44 0.34 1.55
0.80-3.03 .196
sexual problemsa in agreement on abortion
Inadequate preabortion counseling 1.48 0.53 4.40 1.56-12.38
.005
Note: aControlled for race, education, marital status,
employment, number of children, number of abortions, the
meaningfulness of the respondent’s
religion, the respondent’s view on the legality of abortion prior
to the abortion, mental health counseling before the abortion,
hospitalized for emotional
reasons before the abortion, told he or she needed counseling
before the abortion, respondent felt he or she needed counseling
before the abortion,
victim of child abuse, child neglect, sexual abuse in childhood
or adolescence, physical abuse in adulthood, or sexual abuse in
75. adulthood.
Table 3. Results of Logistic Regression Analyses With
Relationship-Based Dependent Variables for Males
Dependent Variable Independent Variable B SE Exp(B) 95% CI
for Exp(B) Significance
Abortion-related anger Respondent and partner 2.78 0.64 16.10
4.58-56.62 .0001
not in agreement on abortion
Inadequate preabortion counseling 1.46 0.56 4.30 1.42-13.01
.010
Abortion-related angera Respondent and partner not 3.77 1.08
43.48 5.24-360.43 .0001
in agreement on abortion
Inadequate preabortion counseling 2.94 1.01 18.97 2.63-136.69
.003
Abortion-related Respondent and partner 1.55 0.56 4.70 1.57-
14.05 .006
relationship problems not in agreement on abortion
Inadequate preabortion counseling 2.67 0.60 14.47 4.43-47.29
.0001
Abortion-related Respondent and partner 1.74 0.81 5.69 1.15-
28.02 .033
relationship problemsa not in agreement on abortion
Inadequate preabortion counseling 2.72 0.91 15.21 2.57-89.95
.003
Abortion-related Respondent and partner 0.89 0.34 2.43 1.23-
4.78 .010
sexual problems not in agreement on abortion
Inadequate preabortion counseling 1.37 0.61 3.95 1.20-12.97
.023
Abortion-related Respondent and partner not 1.46 0.51 4.31
1.58-11.74 .004
sexual problemsa in agreement on abortion
76. Inadequate preabortion counseling 1.62 0.83 5.07 1.00-25.77
.050
Note: aControlled for race, education, marital status,
employment, number of children, number of abortions, the
meaningfulness of the respondent’s
religion, the respondent’s view on the legality of abortion prior
to the abortion, mental health counseling before the abortion,
hospitalized for emotional
reasons before the abortion, told he or she needed counseling
before the abortion, respondent felt he or she needed counseling
before the abortion,
victim of child abuse, child neglect, sexual abuse in childhood
or adolescence, physical abuse in adulthood, or sexual abuse in
adulthood.
Coyle et al. 23
agreement, counseling adequate: 8.28 (SE = 1.77); agreement,
counseling inadequate: 6.94 (SE = .38); agreement, counsel-
ing adequate: 3.49 (SE = .73).
To test the second part of the second and fourth hypotheses,
which predicted that inadequate preabortion counseling and
partner disagreement on the abortion decision would be asso-
ciated with higher risk for experiencing intrusion, avoidance,
hyperarousal, and with meeting diagnostic criteria for PTSD
after employing controls, four sets of logistic regression
analyses were conducted separately for males and females in
the sample. The dependent variable in each of the four sets
of two analyses was different (intrusion criteria, avoidance
criteria, hyperarousal criteria, and general PTSD criteria
met) and as in the previous set of logistic regressions per-
formed to test the first and third hypotheses, there were
77. separate tests conducted with and without the controls.
Table 4 provides these results for women, and Table 5 pro-
vides these results for men.
With the female data, both independent variables were
associated with increased risk for meeting the DSM-IV crite-
ria for intrusion (202% and 2,383% for the partner
disagreement and inadequate counseling variables, respec-
tively) and full PTSD diagnostic criteria after the controls
were applied (89% and 283% for the partner disagreement
and inadequate counseling variables, respectively.) How-
ever, only the inadequate counseling variable was a
significant predictor after the controls were included on the
avoidance subscale (559% increased risk) and on the hyper-
arousal subscale (425% increased risk). Using the male data,
both independent variables were associated with increased
risk of meeting the DSM-IV criteria on the intrusion subscale
(925% and 1,737% for the partner disagreement and inade-
quate counseling variables, respectively). However, only the
inadequate counseling variable was associated with increased
risk for meeting the DSM-IV criteria for the avoidance sub-
scale (1,005%) after controls were applied. Only partner
disagreement over the abortion decision increased risk for
experiencing hyperarousal symptoms (384%) and for meet-
ing the full diagnostic criteria for PTSD (210%).
Discussion
The purpose of this study was to explore associations bet-
ween two independent variables (perceptions of preabortion
counseling adequacy and partner abortion decision congru-
ence) and two sets of dependent variables (postabortion
relationship problems and psychological stress). Perceptions of
inadequate preabortion counseling significantly predicted
all the dependent relationship variables for both men and
women with utilization of control variables. Although other
research has found abortion in itself to be associated with
78. abortion-related anger (Kero, Hogberg, & Lalos, 2004; Naziri,
2007), relationship difficulties (Barnett, Freudenberg, &
Wille, 1992; Lauzon et al., 2000; Rue et al., 2004), and
sexual dysfunction (Bradshaw & Slade, 2003; Rue et al.,
2004), no studies had previously investigated the association
between preabortion counseling and postabortion relation-
ship challenges. The inclusion of participants’ perceptions of
counseling adequacy is therefore an important contribution
of the current study.
For women, perceived inadequate counseling also pre-
dicted all trauma subscale scores (i.e., intrusion, avoidance,
hyperarousal) and predicted meeting diagnostic criteria for
PTSD. For men, only intrusion and avoidance scores were
predicted by perceptions of inadequate counseling. Simi-
larly, Peters, Issakidis, Slade, and Andrews (2006) observed
that whereas women were significantly more likely to report
arousal symptoms, men were significantly more likely to
report avoidance symptoms particularly the symptom of
detachment. Both biological (Bryant & Harvey, 2003) and
sociocultural (Gavranidou & Rosner, 2003) explanations
have been proposed to explain these observed differences
between men’s and women’s endorsement of specific PTSD
symptoms. From a biological perspective, males and females
may have innate predispositions that differentiate their res-
ponses to trauma. Alternatively, culturally prescribed gender
roles may influence which trauma symptoms men and women
are likely to endorse depending on whether symptoms are per-
ceived as being gender appropriate.
Sex differences in the association between perceived cou-
nseling inadequacy and meeting full diagnostic criteria for
PTSD may be related to women’s direct participation in the
abortion procedure, which could predispose them to greater
trauma and an increased likelihood of developing PTSD
79. regardless of the quality of counseling. Nonetheless, a large
majority of both women and men (85.8% and 86.6%, respec-
tively) in this study indicated that they did not perceive
preabortion counseling to be adequate. Because abortion is
the legal right of females in the United States and continues
to be viewed as an exclusively women’s issue, there are no
requirements or incentives to offer counseling to male part-
ners. If men receive any counseling at all, it is likely to occur
informally if and when they accompany their partners for
preabortion clinic visits.
When unplanned pregnancy is experienced as a crisis situ-
ation for one or both partners, the individuals tend to use more
primitive coping skills and to be psychologically vulnerable as
they struggle to solve the problem and regain equilibrium
(Caplan, 1961). The emotional strain of the crisis and the lack
of effectiveness of one’s usual coping mechanisms may result
in anxiety and an inability to function (Caplan, 1961). Thus,
men and women facing a crisis pregnancy may need consider-
ably more counseling than is currently being offered.
With control variables applied, incongruence of abortion
decision significantly predicted trauma symptoms of intru-
sion and meeting diagnostic criteria for PTSD for both men
and women. Contrary to the findings concerning counseling
adequacy, disagreement about the abortion decision predicted
24 Traumatology 16(1)
Table 4. Results of Logistic Regression Analyses With
Posttraumatic Stress Disorder (PTSD) Subscales and Total Scale
Criteria Met for
Females
80. Dependent Variable Independent Variable B SE Exp(B) 95% CI
for Exp(B) Significance
Intrusion subscale Respondent and partner 1.00 0.37 2.73 1.33-
5.59 .006
not in agreement on abortion
Inadequate preabortion counseling 2.88 0.38 17.74 8.51-37.00
.0001
Intrusion subscalea Respondent and partner 1.11 0.51 3.02 1.11-
8.21 .030
not in agreement on abortion
Inadequate preabortion counseling 3.21 0.74 24.83 5.80-106.37
.0001
Avoidance subscale Respondent and partner 0.86 0.29 2.35
1.33-4.17 .003
not in agreement on abortion
Inadequate preabortion counseling 2.54 0.39 12.72 5.98-27.04
.0001
Avoidance subscalea Respondent and partner 0.67 0.39 1.95
0.92-4.15 .083
not in agreement on abortion
Inadequate preabortion counseling 1.89 0.57 6.59 2.16-20.11
.001
Hyperarousal subscale Respondent and partner 0.38 0.24 1.47
0.91-2.35 .114
not in agreement on abortion
Inadequate preabortion counseling 1.66 0.35 5.25 2.63-10.47
.0001
Hyperarousal subscalea Respondent and partner 0.31 0.31 1.36
0.74-2.52 .325
not in agreement on abortion
Inadequate preabortion counseling 1.48 0.54 4.39 1.53-12.61
.006
PTSD total scale Respondent and partner 0.64 0.24 1.89 1.17-
3.05 .009
not in agreement on abortion
81. Inadequate preabortion counseling 1.80 0.41 6.06 2.69-13.66
.0001
PTSD total scalea Respondent and partner 0.64 0.32 1.89 1.01-
3.55 .046
not in agreement on abortion
Inadequate pre-abortion counseling 1.34 0.57 3.83 1.25-11.74
.019
Note: aControlled for race, education, marital status,
employment, number of children, number of abortions, the
meaningfulness of the respondent’s
religion, the respondent’s view on the legality of abortion prior
to the abortion, mental health counseling before the abortion,
hospitalized for emotional
reasons before the abortion, told he or she needed counseling
before the abortion, respondent felt he or she needed counseling
before the abortion,
victim of child abuse, child neglect, sexual abuse in childhood
or adolescence, physical abuse in adulthood, or sexual abuse in
adulthood.
hyperarousal in men but not in women. Furthermore, decision
incongruence predicted abortion-related anger, relationship
problems, and sexual difficulties for men only. The inherent
inequality of abortion decisions may explain these differen-
tial associations.
Numerous studies (Bracken, Hachamovitch, & Grossman,
1974; Major, Zubek, Cooper, Cozzarelli, & Richards, 1997;
Moseley, Follingstad, Harley, & Heckel, 1981; Payne et al.,
1976) have identified conflict with one’s partner and lack of
partner support for abortion as predictors of women’s posta-
bortion distress. In contrast, very few studies, with the
exception of work by Shostak and McLouth (1984) and Naziri
(2007), have examined the male’s reaction to an abortion that
occurs against his wishes. Our findings suggest that disagree-