• elective abortion;
  • emotional consequences;
  • psychosocial effects;
  • counseling strategies

Midwives are likely to encounter women seeking care before or after an elective abortion. National estimates of abortion rates suggest that 43% of women in the United States will have at least one abortion by the time they are 45 years old. By not asking women about abortion experiences, providers risk perpetuating women's guilt, shame, and silence. This article describes the emotional consequences of elective abortion, identifies women at high risk for negative reactions, and offers approaches to counseling about the psychosocial effects of abortion both before and after the procedure. Through the provision of counseling for women who have abortions, providers will be able to assist with coping, identify women who might be at greater risk for psychological sequelae, and offer referrals to those in need.