The latest piece of anti-abortion trash that’s being bandied around by Nadine Dorries purports to be a list of thirty studies, published in the last five years, which allegedly show that abortion ‘hurts women’s mental health’.

It’s a veritable plethora of evidence, and anyone who’s familar with the events surrounding the British Chiropractic Associations failed attempt to sue Simon Singh for libel will already have guessed what’s coming next.

The list, itself, has been compiled by Priscilla K Coleman, a Professor of Human Development and Family Studies at Bowling Green State University, Ohio. Coleman is an anti-abortion advocate with close links to David C Reardon, founder of the anti-abortion Elliot Institute, Jesse Cougle, and Vincent Rue of the Institute for Pregnancy Loss, which he runs from his home in Jacksonville, Florida. Rue credits himself with coining the term ‘Post Abortion Syndrome’, a manufactured afflication that was recently given the full bum’s rush by Dadlez and Andrews in a paper published in the journal Bioethics. (abstract only, full paper req. subscription).

Coleman is listed as either primary author or co-author on fifteen of the thirty studies on the list, which is a considerable time-saver as this means that fully half of this particular plethora can be readily dismissed as ideologically driven, biased and methodologically flawed. Coleman and her associated, the most notable of which being Reardon, have been roundly criticised for their research methods, which are based solely on data-mining national surveys and state records in which unplanned pregnancy is not the focus of the data collection.Their work has been described, by a panel convened by the American Psychological Association to revue the evidence base on abortion and mental health, as having ‘inadequate and inapproriate’ controls and as failing to control adequately ‘for women’s mental health prior to the pregnancy and abortion’.

Other researchers in the field have been similarly critical of their methods.

Jillian Henderson (UCSF Bixby Centre for Global Reproductive Health) and Katharine Millar wrote to the Journal of Anxiety Disorders, stating their view that Cougle, et al., operate with strong political views regarding abortion, and unfortunately their biases appear to have resulted in serious methodological flaws in the analysis published in your journal. [Reardon, Coleman and Cougle] are involved in building a literature to be used in efforts to restrict access to abortion.”

In 2005, Nancy Russo (Regents Professor, Dept. of Psychology Arizona State University) re-evaluated the evidence used in two papers (Reardon & Cougle, 2002 & Reardon 2005) and found serious flaws in the coding of the data used in the studies, specifically the misidentification of unwanted first pregnancies and exclusion of women at highest risk of depression associated with early childbearing. On correcting for these serious errors, Russo found that the association between abortion and clinical depression that Reardon claimed to have uncovered, disappeared completely.

Reardon, it should be noted, has also been accused of misrepresenting his academic credentials by Chris Mooney, author of The Republican War on Science. Reardon, a graduate of the University of Illinois Dept. of Electrical Engineering, lays claim to a PhD. in biomedical ethics awarded by Pacific Western University, but PWU turns out to be have been an unaccredited correspondence college which, at the time it made the award to Reardon, offered no classroom instruction. PWU has since relocated, in 2005, from Los Angeles to San Diego, changed its name to the California Miramar University and started to offer classroom instruction, becoming a properly accredited institution in 2009.

Reardon’s actual views on abortion, when not dressed up in pseudoscience and poor quality research, are best summed up by a self-published text entitled ‘The Devil’s Bargain’ in which he asserts that abortion is a sin, pushed on by women by the Devil before going to add that once a woman chooses an abortion, “Satan turns on her…he charges her with the crime of an unforgivable murder, a secret shame of which she can never be free.”

Fans of Godwin’s Law may also appreciate this gem of an argument from the same text:

The similarity between Nazi manipulations of the Jews and the abortionists’ manipulation of women faced with crisis pregnancies is striking. Just as the victim-Jews were forced to choose between losing everything, or just a little, so abortion counselors encourage the victim-woman to view “this pregnancy” as a threat to everything she has, her relationships, her family, her career, her entire future. She is assured that by sacrificing this one thing (a tiny unborn child), she can save the rest. During this process, the victim-woman is urged to view the abortion decision not as a moral choice, but as a rational choice of “saving what you can.”

Seriously, Reardon explicitly equates the position of women considering an abortion to that faced by Jews, and other prisoners, in Nazi concentration camps when offered the ‘opportunity’ to become a Kapo.

Moving on from Coleman and Reardon, the rest of the list consists of genuine research and this might, at first sight, seem to give some credence to claims of a link between abortion and subsequent mental health problems experience by women – providing you don’t take the time to run down these papers and look at what they actually say.

So, taking the list on in alphabetical order by lead author’s surname:

• Bradshaw, Z., & Slade, P. (2005). The relationship between induced abortion, attitudes toward sexuality, and sexual problems. Sexual and Relationship Therapy, 20, 390-406.

The paper looks at sexual problems and attitudes to sex in women who fall pregnant and go on to have an abortion.

What it actually finds is that women initially ‘go off’ sex on discovering that they are pregnant but, for those who have an abortion, everything returns to normal within a couple of months.

• Brockington, I.F. (2005). Post-abortion psychosis, Archives of Women’s Mental Health 8: 53–54.

Review paper which defines abortion as referring to ‘miscarriage, termination, criminal abortion and even (in the old literature) foetal death in utero. The paper does not deal exclusively with elective abortion (termination)

• Broen, A. N., Moum, T., Bodtker, A. S., & Ekeberg, O. (2006). Predictors of anxiety and depression following pregnancy termination: A longitudinal five-year follow-up study. Acta Obstetricia et Gynecologica Scandinavica 85: 317-23.

Comparison of incidence of anxiety and depression in women who’ve had a miscarriage with women who’ve undergone and elective abortion. Abstract contains the following comments:

In both groups, important predictors of anxiety and depression at T2 (6 month after event) and T4 (five years after event) were recent life events and poor former psychiatric health. [not abortion or miscarriage]

For women with induced abortion, doubt about the decision to abort was related to depression at T2, while a negative attitude towards induced abortion was associated with anxiety at T2  and T4

A number of studies, including Fergusson et al (2009 – listed below) show that between 1% and 3% of women have significant dount/regrets about their decision to have an abortion.

•       Broen, A. N., Moum, T., Bodtker, A. S., & Ekeberg, O. (2005). Reasons for induced abortion and their relation to women’s emotional distress: A prospective, two-year follow-up study. General Hospital Psychiatry 27: 36-43.

Small study (n=80) which looked at why women choose to have an abortion. ‘Pressure from male partner’ came 11th on the list of reasons, far behind reasons relating to job, education and finances, and was found to have a significant negative impact on women’s psychological responses at 2 years after event.

Women who gave ‘have enough children’ as a reason for an abortion reported slightly better psychological outcomes at two years.

•       Broen, A. N., Moum, T., Bodtker, A. S., & Ekeberg, O. (2005). The course of mental health after miscarriage and induced abortion: a longitudinal, five-year follow-up study. BMC Medicine 3(18).

Small study comparing post-event recovery between women who miscarried (n=40) and women who had an elective abortion (n-80).

Study found that distress was greatest in women who miscarried close to the event while those who underwent an abortion showed higher score on some outcomes over the whole follow-up period of five years. Authors hypothesise that the difference in the courses of responses may partly result from the different characteristics of the two pregnancy termination events.

•       Dingle, K., et al. (2008). Pregnancy loss and psychiatric disorders in young women: An Australian birth cohort study. The British Journal of Psychiatry, 193, 455-460.

Findings:

The findings suggest that the poor outcomes reported for women who had an induced abortion may be associated with pregnancy loss rather than simply the experience of abortion. Induced abortion and miscarriage are both stressful life events that have been shown to lead to anxiety, sadness and grief and, for some women, serious depression and substance use disorders. Although we were not able to fully explain the mechanisms behind these associations, a number of possible pathways were explored in sensitivity analyses. Early heavy alcohol, illicit drug use and depression have been linked to risky sexual activity, unwanted pregnancies and pregnancy complications and could be on the causal pathway leading to both pregnancy loss and adverse psychiatric outcomes. After taking these factors into account and removing early onset disorders our findings remained robust. This suggests that our results were unlikely to be explained by reverse causality. Pregnancy loss and substance misuse may have shared risk factors.

Study is inconclusive on key questions of causality but suggests that depression in young women, post abortion, and substance abuse are likely to symptomatic of wider multiple personal and social problems. Limitations include:

Contextual information related to circumstances of the pregnancy loss were not collected, so we could not account for associated factors such as reasons to abort, support received and gestational age at the time of the pregnancy loss. We had no access to medical records to investigate whether specific circumstances surrounding the termination, the timing of termination or other pregnancy-related events would confound associations between pregnancy loss and psychiatric disorders.

As the study focusses on young women only, its findings cannot be generalised to all women who choose to have a termination.

•       Fergusson, D. M., Horwood, L. J., & Boden, J.M. (2009). Reactions to abortion and subsequent mental health. The British Journal of Psychiatry, 195, 420-426.
•       Fergusson, D. M., Horwood, L. J., & Ridder, E. M. (2006). Abortion in young women and subsequent mental health. Journal of Child Psychology and Psychiatry, 47, 16-24.

Fergusson’s papers are widely cited by anti-abortion organisations as ‘conclusive’ evidence of an elevated risk of psychiatric problems/disorders after having an abortion without citing Fergusson’s acknowlegdement of the possible limitations of his work and the careful qualifications he applies to his own findings in both papers, e.g.

Notwithstanding the reservations and limitations above, the present research raises the possibility that for some young women, exposure to abortion is a traumatic life event which increases longer-term susceptibility to common mental disorders.

Fergusson’s stated position is that his work neither support a strong ‘pro-life’ (abortion is harmful) or pro-choice (there are no risks) position, one that Fergusson goes to considerable length to clarify in his 2009 paper:

Abortion was associated with both positive and negative emotional reactions. The extent of negative emotional reactions appeared to modify the links between abortion and subsequent mental health problems…

…As we have noted previously, these findings are not consistent with strong pro-life positions that depict unwanted pregnancy terminated by abortion as having devastating consequences for women’s mental health. Equally, however, the findings do not support strong pro-choice positions that claim unwanted pregnancy terminated by abortion is without mental health risks. Rather, the accumulated evidence suggests that unwanted pregnancy terminated by abortion is an event that leads to significant distress in some women, with this distress being associated with a modest increase in risk of common mental health problems.

•       Gissler, M., et al. (2005). Injury deaths, suicides and homicides associated with pregnancy, Finland 1987-2000. European Journal of Public Health, 15, 459-463.

In the year after undergoing an abortion, a woman’s mortality rate for unintentional injuries, suicide and homicide was substantially higher than among non-pregnant women in all age groups combined. While these findings were not statistically significant for deaths resulting from unintentional injuries among women younger than 25 years old and for homicides among women aged 35 years or older, the increased risk was observed for unintentional injuries at all ages. It is unlikely that induced abortion itself causes death due to injury; instead, it is more likely that induced abortions and deaths due to injury share common risk factors. Our register-based data were incomprehensive on these kind of variables, and more detailed background information for example on mental health, social well-being, substance abuse and socio-economic circumstances among the deceased would be necessary for further analysis.

•       Hemmerling, F., Siedentoff, F., & Kentenich, H. (2005). Emotional impact and acceptability of medical abortion with mifepristone: A German experience. Journal of Psychosomatic Obstetrics & Gynecology, 26, 23-31.

Our study supports the consensus view that termination of an unwanted pregnancy is a positive first solution to the conflict, regardless of the chosen method. The positive outcome and high satisfaction levels among the participants illustrate the importance of an ongoing and improved accessibility of medical abortion for women in Germany.

•       Mota, N.P. et al (2010). Associations between abortion, mental disorders, and suicidal behaviors in a nationally representative sample. The Canadian Journal of Psychiatry, 55(4), 239-246.

Study finds corrrelation between abortion and mental illness but does not provide any clear evidence in relation to causality:

There are several possible mechanisms that may explain the association between abortion and mental illness. First, there could be a direct causal relation where the abortion increases the likelihood of a mental disorder, or a mental disorder increases the likelihood of abortion. Second, there could be an indirect mechanism. For example, mental disorder may be associated with poor social support or impulsivity that might lead to an increased likelihood of unplanned pregnancy and a decision to have an abortion. Finally, there could be shared vulnerability factors (for example, environmental factors and personality pathology) that might be associated both with abortion and with mental illness. Future work needs to explore these and other possible mechanisms.

•       Pedersen, W. (2008). Abortion and depression: A population-based longitudinal study of young women. Scandinavian Journal of Public Health, 36, No. 4, 424-428.

•       Pedersen, W. (2007). Childbirth, abortion and subsequent substance use in young women: a population-based longitudinal study. Addiction, 102 (12), 1971-78.

Its impossible to fully evaluate either study on the basis of their published abstracts. Both cite increased risks of depression and substance use associated with abortion but, in abstract, provide no information or discussion on causality, limitations and potential confounding factors.

In short, both are perfect examples of why simply listing studies is not enough to support claims made for this particular list.

•       Rees, D. I. & Sabia, J. J. (2007). The Relationship between Abortion and Depression: New Evidence from the Fragile Families and Child Wellbeing Study. Medical Science Monitor. 13(10): 430-436.

Concludes that:

The results suggest that the positive association between abortion and depressive symptoms cannot be explained by pre-pregnancy depression. Women who have an abortion are not at higher risk of MD [major depression] than those who give birth.

Whoops! That’s not an outcome that will please anti-abortion activists.

•       Suliman et al. (2007) Comparison of pain, cortisol levels, and psychological distress in women undergoing surgical termination of pregnancy under local anaesthesia versus intravenous sedation. BMC Psychiatry, 7 (24), p.1-9.

Concludes that…

High rates of PTSD characterise women who have undergone surgical abortions (almost one fifth of the sample meet criteria for PTSD), with women who receive local anaesthetic experiencing more severe acute reactions. The choice of anesthetic, however, does not appear to impact on longer-term psychiatric outcomes or functional status.

So, surgical abortions are pretty stressful – but then so is surgery, generally – and its a bit more stressful when conducted under a local rather than a general anaesthetic (No shit, Sherlock!) but there is no evidence that any of this has an impact on long-term psychiatric outcomes.

So that’s fifteen papers cited as providing evidence that abortion is harmful to women’s mental health and wellbeing, none of which have established either a clear causal relationship or produced results/conclusions that can be readily and legimately generalised to all women seeking an abortion.

Critically, there is one confounding factor that very few of these studies successfully take into account, particularly in the case of those which report a clear correlation between abortion and a elevated risk of mental health problems and/or susbstance abuse.

That factor is choice – or to put it a little more specifically, the central question of whether or not a woman who asks for an abortion is doing so fully of her own free will and voilition, i.e. making a positive choice, as opposed to feeling that she has been propelled unwillingly into such a decision by circumstances over which she has no control or due to pressure from a male partners or from family members or, indeed, for fear of the social stigma attached to abortion in the immediate social environment.

Abortion is not entirely risk free, but nor does the evidence in any sense support the contention that it presents any significant risks to the vast majority of women who elect to undergo a termination.

What the evidence does indicate is that there is a very small subgroup of women for whom going ahead with a termination will put them at a greater risk of subsequent mental health problems than might otherwise have been the case.

Credible scientific research, including some of the papers cited (and misrepresented) in this list has gone some considerable to way towards identifying some of the contributory factors and indicators that may help to identify those for whom the apparent risks associated with abortion are a genuine concern. A prior history of depression, anxiety and/or other mental illness is one such factor. A history of abuse and domestic violence, particularly with the father of the foetus that the women is seeking to abort is also a factor as is, unsurprisingly, being pressured into an abortion by a male partner or by family members – thankfully, the evidence suggests that this is relatively uncommon today but it, nevertheless, deserves careful consideration.

Possession of conservative/religious attitudes towards abortion has also unsurprisingly, but still somewhat ironically in the circumstances, been clearly identified as a risk factor.

The truth, as revealed by the evidence rather than by god, the Bible or by the ideological prejudices of anti-abortion campaigners, is that there is a small minority of women, every year, who undergo a termination in circumstances where, deep down, the really, really, would have rather continued with the pregnancy and had a baby, and it is these women who are, unfortunately, at risk of developing subsequent mental health problems.