“Melanie Phillips” and “abortion”.

Words that really shouldn’t appear in the same sentence unless that sentence also includes the words ‘time machine”.

For the record, Mad Mel’s taken to fulminating against the Royal College of Obstetricians and Gynecologists, with all her usual lack of charm and self-awareness, over the contents of a draft paper updating RCOG’s guidance on abortion:

This guidance, intended for all doctors, nurses and counsellors advising women contemplating having an abortion, said such women should be told that terminating a pregnancy was safer than having a baby.

To which one can only ask: safer for whom, precisely? Not for the baby, certainly.

Reading Mad Mel’s article, you could easily be forgiven for thinking that this is something new, a recent innovation in the college’s thinking, but this is anything but the case. RCOG’s existing guidance, which has been in place since 2004, states clearly that:

For most women an abortion is safer than carrying a pregnancy and having a baby.

Helpfully, RCOG’s summary guidance page includes a link to its full clinical guidance, which includes a comprehensive and fully reference list of the evidence on which the college has based its guidance. Like it or not, and clearly Mad Mel counts herself amongst the ‘nots’, the clinical and statistical evidence does indicate that abortion is safer than carrying a pregnancy to term and having a baby. To women who fully intend to carry their baby to term this guidance is, of course, of no consequence whatsoever, but to women considering having an abortion it is a reasonable and necessary reassurance not least in view of the extent to which anti-abortion activists routinely resort to scaremongering and the spreading of misinformation in an effort to bully women to their way of thinking.

Somewhat further down the page, Mad Mel does get around to acknowledging the fact that RCOG’s guidance is based on empirical evidence:

Simply as a procedure, it may well be the case that having a baby is more dangerous than an abortion.

But even this admission is immediately tainted by her own prejudicial attitudes:

But to imply that having a baby is a dangerous procedure is a disreputable piece of scaremongering. It amounts to the psychological manipulation of women who are already in a vulnerable state. It is a form of bullying and a gross abuse of medical power.

In reality, the opposite is the case as RCOG’s guidance moves on from its statement on the relative safely of abortion to add:

All medical and surgical procedures have risks, but the earlier in pregnancy you have an abortion, the safer it is. Your doctor or nurse should tell you about risks and complications that relate to the specific abortion procedure(s) being offered to you. If you have special concerns about certain kinds of risk, let your healthcare team know so that they can tell you more.

One of the more pernicious fictions promoted by anti-abortion activists is the suggestion that women are routinely denied the information they need to make an informed decision as to whether to go ahead with an abortion. There is, of course, no evidence to support such an assertion which is, itself, merely a ‘trojan horse’ argument that is used to justify legislative interference in the doctor-patient relationship of a kind that serves to compel doctors to act unethically and conduct pre-abortion counselling in a manner calculated to dissuade women from going ahead with the procedure.

Taken as a whole, the clinical evidence on the risks and safety of abortion, when presented accurately, does not support the anti-abortionist’s position, a fact to which anti-abortion organisations have responded by seeking, and in some US states obtaining, legislation which forces doctors to distort and misrepresent the scientific and empirical evidence to suit the anti-abortionist’s ends.

RCOG is not, so far as I can see, updating its guidance on the physical risks associated with abortion. Rather it is voluntarily updating it guidance to take into account the findings of the House of Commons Science and Technology Committee’s (Sci-Tech) “Review of Scientific Developments relating to the Abortion Act 1967‘, specifically in relation to new evidence which appears to show that a minority of women may face an elevated risk of subsequent mental health problems following an abortion. It’s worth noting, at this point, that the committee concluded that there was no strong evidence to contradict the wording of RCOG’s existing guidelines, which state that:

…some studies suggest that rates of psychiatric illness or self-harm are higher among women who have had an abortion compared with women who give birth and to nonpregnant women of similar age. It must be borne in mind that these findings do not imply a causal association and may reflect continuation of pre-existing conditions.

RCOG have, nevertheless, taken the opportunity to firm up their view on the current evidence base for and against an association between abortion and subsequent mental health problems, although not in a manner that anti-abortionists might have been hoping for:

Recommendation 43

Women should be informed that most women who have abortions do not experience adverse psychological sequelae.

Evidence supporting recommendation 43

The great majority of women who have abortions do not experience adverse psychological sequelae. A systematic review of the evidence from 21 studies of abortion and adverse mental health outcomes did not support higher rates of a range of mental health outcomes in those who undergo abortion compared with their respective comparison groups, either women who delivered or women who had never been pregnant. Although the evidence in this area is conflicting, there are significant design flaws in many of the studies and those studies that do support a relationship between abortion and adverse mental health outcomes tend to be weaker methodologically. The evidence review by Major et al. (2009) which updates the report of the American Psychological Association Task Force on Mental Health and Abortion, 2008 confirms that the most rigorous studies support the view that any observed associations between abortion and 2179 mental health problems do not appear to be related to abortion itself but to pre-existing conditions and co-occurring risk factors. Although abortion can be associated with a range of feelings, long term feelings of sadness, guilt and regret appear to linger in only a minority of women.

Mad Mel certainly isn’t happy with this new guidance:

Nor is that all. The guidance also says that women who are deciding whether to have an abortion must be told that most do not suffer any psychological harm from the procedure.

But rates of psychiatric illness and self-harm in women are higher among those who have had an abortion. While cause and effect cannot be proved, it defies common sense to say that there is no connection.

Science regularly defies ‘common sense’ because common sense is, more often than not, nothing more than the opinion of an observer based on their own knowledge and experience – and in Mad Mel’s case there is no great shortage of past form to indicate that her own appeals to common sense are guaranteed to be worthless.

Not content with an appeal to ‘common sense’, Mad Mel continues by bring her own ‘expert’ to the party:

Indeed, according to consultant psychiatrist Professor Patricia Casey, there are more than 30 studies showing an association between abortion and psychological trauma.

Casey is Professor of Psychiatry at University College Dublin, a devout Roman Catholic and a conservative activist who opposes divorce other than in cases of spousal abuse/violence, abortion, surrogate pregnancy, anonymous donor in-vitro fertilisation, non-traditional family units and, of course, adoption by gay parents and same-sex marriage. When arguing against gay adoption and same sex marriage, Casey has form for misrepresenting research data and, in particular, a parenting study by researchers at Uppsala University, Sweden of which she wrote, in a letter to the Irish Times in 2008:

In addition, the University of Uppsala in Sweden has issued a report confirming the importance of fathers and father figures for child development.(Fathers’ involvement and children’s developmental outcomes: a systematic review of longitudinal studies. Sarkadi et al. Acta Paediatrica, 97.2, pp 153-158. February 2008).

Frances Byrne and Joan Courtney find it offensive that I should equate same-sex couples raising children with other combinations of adults raising children. I fail to see why. Perhaps it is because a lesbian couple raising a child are in a sexual relationship whereas two sisters, say, raising a child are not? We should bear in mind that the State’s interest in marriage between heterosexual couples has nothing to do with sex per se, but rather in what sex between married couples usually leads to, namely children. – Yours, etc,

The lead author on this paper, Anna Sarkadi, responded to Casey’s remarks in a letter to the same newspaper, giving a rather different interpretation of her own work:

It has come to our attention that Prof Patricia Casey has referred to our article in supporting her views on traditional marriage between biological parents being the best environment for a child to be raised in (March 5th).

Prof Casey’s conclusion that the article is one of the “compelling reasons to continue giving marriage between a man and a woman the special support of the State” is not valid based on our findings.

According to our review of longitudinal studies, there is certain evidence that cohabitation with the mother and her male partner (biological father or father figure) is associated with fewer externalising behavioural problems. There is also evidence to support the positive influence of father engagement on children’s social, behavioural, and psychological outcomes, although no specific form of engagement has been shown to yield better outcomes than another.

Please note that no comparisons were made with gay or lesbian family constellations in the studies included in the review. Therefore, there is nothing whatsoever in our review that would justify the conclusion that same-sex parents cannot raise healthy children who do well.

The fact that engaged fathers are important for their children calls for policies promoting involved fathering, if anything, such as paternal leave and the possibility to stay home with sick children, when the family constellation includes a father or father figure.

Unfortunately, traditional marriages do not automatically promote father engagement. – Yours, etc,

In the same letter to the Irish Times that drew the above response from Anna Sarkadi, Casey also claimed that UNICEF supported her position. Unfortunately (for Casey) this assertion drew a response from Michelle Verwoerd, Executive Director of UNICEF Ireland, who described Casey’s comments as ‘incorrect and unacceptable’.

Casey’s apparent propensity for misusing research evidence is, naturally enough, not just confined to her views on same-sex relationships. In 2007, she submitted a written memorandum of her own to the Sci-Tech review of abortion, one that contains a number of interesting features.

Under the heading ‘Criticism of Research’, Casey more or less accurately acknowledges the range of methodological flaws that one frequently encounters in reviewing the research literature on abortion before asserting that ‘recent studies have addressed these methodological flaws’. She then went on to outline her inclusion criteria for the studies she put forward as evidence to the committee as follows:

Only original research papers, from peer reviewed learned journals were selected.

Review papers were excluded …

The term post-abortion syndrome will not be used since this is not a recognized psychiatric term.

Only papers since 2000 will be presented since these are the most methodologically and statistically robust.

The conclusions presented at the end of each summary are those of the authors.

Three things stand out, in particular, as being of rather dubious merit.

The first is the deliberate exclusion of review papers from her evidence. A well written systematic review would, of course, provide the committee with both an overview of the totality of published evidence available at the time of the review and, critically, an evaluation of the relative methodological strengths and weaknesses of the papers included in the review. This last feature of a good quality systematic review is of particular value and importance when submitting evidence to a lay audience, such as a committee of MPs, where one cannot guarantee that members of the committee possess sufficient knowledge and understanding of research methods and methodologies to enable them to easily sift the wheat from the chaff.

In some instances, there may be very good reasons for omitting review papers from consideration. It could be the case that the only extant reviews are several years old and do not, therefore, include more recent research of a kind that has called into question or overturned the findings of earlier reviews, in which case one would expect that this would be cited, explicitly, as the reason for omitting all consideration of review papers from the submission to the committee. In the absence of any such line of reasoning one has at least a little suspicious of Casey’s motives for excluding review papers and, consequently, scrutinise her submission carefully for evidence of bias and selective use of data and exercise considerable caution when assessing the quality of the evidence included in the submission.

Fortunately, on this occasion, the presence of Dr Evan Harris and Phil Willis on the committee served to ensure that anyone attempting to pull a flanker would be quickly identified and their evidence given short-shrift.

Second, while it may be reasonable to suggest that recent research papers are more likely to be methodologically and statistically sound that earlier papers, it does not follow that one can assume that recent is automatically going to be better. Each paper included in the evidence still has to evaluated on its own individual merits, irrespective of its date of publication, as there is nothing to guarantee that an individual author has adequately or successful address any of all of the methodological shortcomings identified in earlier research. They may easily have repeated the same errors or the may even have found new and innovative ways of buggering things up and arriving at faulty conclusions. Publication date, alone, is not in any sense an adequate substitute for a systematic review of research quality.

Given these obvious shortcomings and Casey’s known personal biases one can hardly be surprised to find that a number of the papers included in her evidence had either David C Reardon or Priscilla Coleman as the lead or co-author. Regular visitors to the Ministry will have encountered both in this article, which addresses the claim that there are more than 30 studies that show an association between abortion and psychological trauma.

Reardon is basically a fraud. He has a legitimate first degree in electrical engineering but his ‘PhD’ is Bioethics was obtained from a non-accreditted correspondence ‘university’ and in his spare time he writes spectacularly offensive quasi-apocalyptic screed in which women who have abortions are likened to concentration camp Kapos and other Jewish ‘collaborators’:

Using this demonic strategy, the Nazis encouraged the empowerment of ghetto Jewish leaders who would see to the needs of the people, coordinate distribution of medicine and materials, maintain morale, etc. These same leaders were then manipulated into cooperating with the Nazi extermination program. They were confronted with the agonizing choice of cooperating with the Nazis or witnessing the slaughter of their people…

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.”

Both have been extensively criticised for poor research practices, data-mining and for making overblown claims in their research that cannot be substantiated when other researchers have attempted to replicate their findings. They are part of a small clique of ideologically-driven researchers who, according to Jillian Henderson (UCSF Bixby) and Katharine Miller, are ‘involved in building a literature to be used in efforts to restrict access to abortion.’

Finally, it must be noted that Casey asserts, quite clearly and unequivocally, that:

The conclusions presented at the end of each summary are those of the authors.

This may be true, in the sense that the conclusions are given in the form of quotations from the original papers, but it doesn’t necessarily follow that this mean that Casey has provided the committee with an accurate picture of the original authors’ findings.

Towards the end of her submission, Casey cites a qualitative study by Goodwin and Ogden as follows:

C. QUALITATIVE STUDIES

These studies are designed to evaluate feelings and emotions in greater depth. They do not measure prevalence. Their value lies in the depth of the interviews which last many hours, are taped recorded and subsequently analysed so as to identify common themes that emerge. Due to their labour intensity sample sizes are small.

Women’s reflections upon their past abortions

Goodwin and Ogden. Psychology and Health 2007.22,2. 231-248.

10 women interviewed 1 to 10 years post abortion to ascertain their reflections in the longer term:

— Some described a linear pattern of change with decreasing symptoms over time.

— Many described other patterns including.

1. persistent upset.

2. later onset distress with no distress in the immediate aftermath.

3. No distress at any time.

The reactions were related to view of foetus as human, poor social supports, a belief that society is either over judgmental or alternatively negates impact of abortion on women.

Women’s responses do not always follow the suggested reactions of grief.

Now let’s look at the actual abstract to Goodwin and Ogden’s paper, and to help things along I’ve italicised everything in the abstract that Casey omitted from her written evidence to the committee:

Previous studies have argued that women’s responses to abortion are similar to a linear grief reaction. The present study aimed to explore how women reflect upon their past abortions in the longer term. Interpretative Phenomenological Analysis (IPA) was used to analyse the transcripts of ten interviews with women who had had an abortion between 1 and 9 years ago. The results showed that although a few women reported a linear pattern of change in their emotions, many also described different patterns including persistent upset that remained ongoing many years after the event, negative re-appraisal some time after the event and a positive appraisal at the time of the event with no subsequent negative emotions. The results also provide some insights into this variability. Those who described how they had never been upset or experienced a linear recovery also tended to conceptualise the foetus as less human, reported having had more social support and described either a belief that abortions are supported by society or an ability to defend against a belief that society is judgemental. In contrast, patterns of emotional change involving persistent upset or negative appraisal were entwined with a more human view of the foetus, a lack of social support and a belief that society is either overly judgemental or negates the impact that an abortion can have on a woman. To conclude, women’s responses to their abortion do not always follow the suggested reactions of grief, but are varied and located within both the personal and social context.

Casey fails to mention that the researchers were evaluating a specific hypothesis not simply carrying out a general ‘review’ of women’s long-term reflections on their experiences. Casey refers specifically to ‘late onset distress’ where the researcher refer only to ‘negative reappraisal’ which may indicate only post-hoc regrets and these, of course, may be no than a consequence of women’s experiences some years after the abortion and not, therefore, directly related to the abortion itself – one of the obvious drawbacks of this kind of research is that women’s recollections may be coloured by post hoc rationalisation of later adverse experiences and/or their unreliable recall of events.

Most seriously, Casey omits all reference to the insights gained from women who either did not experience any distress or underwent a straightforward linear recovery and focussed only the insights gleaned from women who appear to have regretted their decision before indulging in what is as clear a piece of deliberate quote-mining as I ever see, reducing the authors’ statement that:

To conclude, women’s responses to their abortion do not always follow the suggested reactions of grief, but are varied and located within both the personal and social context.

To a bare:

Women’s responses do not always follow the suggested reactions of grief.

Casey’s presentation of this paper is not simply biased, it is manifestly dishonest, particularly in it presentation of the paper’s key findings:

Those who described how they had never been upset or experienced a linear recovery also tended to conceptualise the foetus as less human, reported having had more social support and described either a belief that abortions are supported by society or an ability to defend against a belief that society is judgemental.

In contrast, patterns of emotional change involving persistent upset or negative appraisal were entwined with a more human view of the foetus, a lack of social support and a belief that society is either overly judgemental or negates the impact that an abortion can have on a woman.

The implications of these finding are, to say the least, pretty obvious.

The very policies advocated by anti-abortionists under the spurious guise of ‘informed consent’ which, in some US states, compel women to sit through a lecture on foetal development and undergo an unnecessary and intrusive ultrasound examination prior to being permitted an abortion are likely to increase the risk of these same women experiencing an adverse psychological reaction and yet, in the diseased alternate reality that Mad Mel inhabits, its RCOG that stands accused of psychological manipulation and bullying.

Notwithstanding her professional background, Mad Mel’s ‘expert’ witness appears to be nothing more than another fully paid-up member of the Liars for Jeebus club while Mad Mel proves, yet again, that while the Dunning-Kruger effect would be a major drawback in any other walk of life, at the Daily Mail it is the primary qualification for a nice fat contract and a regular opinion column.