By choosing to focus of the scientific evidence relating to abortion as the central plank of its deliberations on changes to the existing abortion laws parliament has, unintentionally I’m sure, created a ready market for ill-informed and idiotic op-ed articles in the dead tree press, and with the Telegraph and Daily Mail having taken a bit of break over the summer it’s fallen to The Times to maintain the steady supply of eminently fiskable commentaries with this latest offering from Melanie McDonagh.

So let’s take this straight from the headline and work through it…

Abortion has risks, whatever the research says

THE research, in this case, is a report published last week by the American Psychological Association’s Task Force on Mental Health and Abortion which, to the surprise of no one who’s ever read [properly] any of the research literature in this field, concluded that ‘there’s no credible evidence that a single elective abortion of an unwanted pregnancy in and of itself causes mental health problems for adult women’.

What the report categorically doesn’t say – despite the misleading headline – is that abortion is without risks. Of course there are risks because life is full of risks. What matters, in the case of abortion and women’s mental health, is whether any risks associated with abortion are either unacceptably high or, at the very least, significantly greater than the risks associated with the alternatives, giving birth and either keeping the child or giving it up for adoption, and its here that there is a signal lack of credible, let alone conclusive evidence to show that, all other things being equal, terminating an unwanted pregnancy is any more of a risk than any other legal alternative.

So, we’re only seven words in and, already, McDonagh is presenting the readers of The Times with a misleading picture of the issue at hand, a situation that in no sense improves once we get to the ‘teaser’…

Even if the dangers to mental health are slight, how can anyone object to women being counselled about them?

Actually I can object to this and I will, because counselling implies giving advice or opinions with the intent of influencing a decision or directing someone towards a particular course of action, and that’s not what healthcare professionals should be doing in a pre-abortion consultation. Women should certainly be informed of the nature of any risks relating to abortion and be given an honest appraisal the scale of those risks based on the best available evidence but not counselled as a matter of course. Counselling may be appropriate in some instance, in which case it should be offered once the need for counselling has been properly identified by an appropriately qualified professional but otherwise you simply give women the facts and allow them to reach their own decision.

You may think I’m nitpicking, but actually this is an important point because what those of us who are pro-choice mean when we use the term ‘counselling’ in a lay-sense when referring to a pre-abortion consultation is fundamentally different from what anti-abortionists mean when they use the same word. If you’re pro-choice, ‘counselling’ means giving women the information they need to reach an informed decision as to whether to proceed with a termination. What McDonagh means is compelling women to sit through a ‘counselling’ session in which, in breach of all extant professional and ethical standards, a so-called ‘counsellor’ will try to talk the woman out of having an abortion.

That’s the preamble over, let’s get to the meat of McDonagh’s article:

It’s probably true to say that there is no such thing as entirely objective, unloaded research on abortion.

No, theres actually quite a lot of objective, unbiased research in this particular field, and a lot of biased and misleading ‘research’ too – that’s why academic research papers are published to a standard format and extensively peer reviewed, so that we – well those of us who are, unlike McDonagh, scientifically literate, can sift the wheat from the chaff and determine for ourselves which papers do and don’t have any credibility.

Each successive academic study (and there have been quite a few) about whether abortion carries risks to the women who have them is instantly seized on by people seeking to tighten the law or trying to liberalise it.

But that’s not a problem with the research, per se, that an problem in regards to how research is interpreted and, particularly, how its presented outside academic circles by journalists, commentators and campaigners who do operate from their own personal and political biases.

Value-free abortion research may be a nice idea, but there’s no such thing as value-free researchers, however good their methodology.

You can see where this is going already. McDonagh doesn’t like the APA conclusions because they don’t support her views on abortion but as she’s unable to produce any evidence of her own to rebut those conclusions – and almost certainly hasn’t even bother to read the full report (not that I expect she’d understand it properly if she did) – she has to resort to dropping non-specific and highly misleading hints that its all biased anyway and cannot, therefore, be given any credence.

So far, so humdrum, banal and intellectually dishonest – pretty much standard fayre from an anti-abortionist.

There are certainly no value-free interpreters of the research. We can probably take it as read, then, that the conclusions of the latest body to consider the effect of abortion on mental health, the American Psychological Association (APA), will be meat and drink to the pro-choice lobby here.

Really? Well I’m certainly pro-choice but I’m also scientifically literature and considerably better qualified to comment on the APA’s findings than McDonagh, not to mention that I’m also perfectly happen to invite you read the report for yourself if you prefer to trust your own judgement over mine, so here’s link to it.

Report of the APA Task Force on Mental Health and Abortion (pdf, 91pp)

The APA examined research published over the past 17 years on possible links between the two and concluded that most abortions of unplanned pregnancies in the first three months do not cause psychiatric problems, although it has an open mind about the effect of multiple abortions.

Well it actually says that the evidence on multiple abortions is ‘more uncertain’ – and I’ll explain why in a while, but otherwise that’s the first strictly factual statement in the whole article.

So, come October – when Parliament debates a contentious amendment to the Human Fertilisation and Embryology Bill that would require women considering an abortion to undergo compulsory counselling about the possible psychiatric risks – the pro-choice lobby will make much of this bit of research. Before then, we can expect those pundits who like to brag about their abortion experiences in print – snuff journalism – to proclaim that their own abortions did their mental health nothing but good; far more good than giving birth would have done.

‘Snuff journalism’ eh? Ooooh, that’s fighting talk even if it does nothing to advance the argument here or explain precisely why women should be required to undergo compulsory ‘counselling’ to a format proscribed by a bunch of unqualified lay people – MPs.

My chief objection to abortion isn’t the damage that it might cause the woman concerned; I mind that it kills the foetus. But if we are to take seriously the question of whether abortion may have problematic consequences, then we have to acknowledge that most of the research on mental health has not been conclusive.

That’s certainly true, the evidence as it stands is not conclusive – nor will is it ever be likely to be – but then it doesn’t actually need to be conclusive unless you’re trying to use it to justify putting up unnecessary and unhelpful barriers to abortion.

The whole mental health argument, as it being used by anti-abortionists, is founded on a fundamentally false premise, the idea that because there may be an element of risk in undergoing a termination that may be grounds for making it more difficult for women to have an abortion. Yes, it is true that some women do go to develop mental health problems after having an abortion, but even, for illustrative purposes, we both ignore all the many confounding factors that prevent us reaching a definitive conclusion as to the scale of that risk and we accept the validity of a causal hypothesis – and the usual one suggests treats abortion as a traumatic and stressful experience that give rise to problems akin to those found in Post Traumatic Stress Disorder – then we still have a major problem in validating that argument.

Why? Well simply because as much as some women may develop psychological problems after having an abortion, others develop similar problems after giving birth or after putting a baby for adoption…

…or after the failure of a relationship, or after a bereavement, or if financial problems get on top of them and become too much to cope with or because of or after a myriad of other life events and experiences few of which anyone would ever dream of trying to ban, if that were even possible in some cases – let’s see MPs try to ban people from dying because their relatives find the whole business of losing a loved one stressful and, in some cases, may develop psychological problems as a result.

The value in research of this kind is not that provides definitive answers about the risks that abortion may entail but rather that its helps us to identify the many and varied social, economic and psychological facts that may indicate that a particular woman may be at risk of later problems. Knowing that, healthcare professionals conducting pre-abortion assessments can look for the ‘warning signs’ and plan accordingly, ensuring that women who may at an elevated risk of problems are provided with appropriate access to support after they’ve reached their decision – if this is needed.

You can pick holes in almost all of the studies to date – for a good example of how this hole-picking is done, look at the report of the Commons Science and Technology Committee last year, which considered various research papers about the effect of abortion on mental health. Basically, there are so many variables in each case, so many practical difficulties about comparing like with like, so few studies that follow their subjects over years and decades that it’s difficult to declare yep, this one has cracked it.

As I’ve already noted, the very idea of ‘cracking it’ is nonsensical. Even if epidemiological studies can identify and quantify a particular risk that, in no sense, means that one can accurately relate that risk to individual cases – you simply cannot predict accurately whether a particular individual will develop psychological problems after having an abortion any more than you can predict which women will undergo post-natal depression after an otherwise normal birth. It’s just not that simple.

One often-quoted study from 2007, by a research group led by Dr M. Fergusson which suggested that people who had abortions have an increased risk of depression, suicide and substance abuse, was criticised inter alia, for not including enough about the background of the pregnancies in question.

The Fergusson study has been criticised for a number of reasons – and to be fair if you actually take the time to read that particular study then you’ll find that Fergusson makes no bones about its limitations:

An important threat to study validity comes from the lack of information on contextual factors associated with the decision to seek an abortion. It is clear that the decision to seek (or not seek) an abortion following pregnancy is likely to involve a complex process relating to: a) the extent to which the pregnancy is seen as wanted; b) the extent of family and partner support for seeking or not seeking an abortion; c) the woman’s experiences in seeking and obtaining an abortion. It is possible, therefore, that the apparent associations between abortion and mental health found in this study may not reflect the traumatic effects of abortion per se but rather other factors which are associated with the process of seeking and obtaining an abortion. For example, it could be proposed that our results reflect the effects of unwanted pregnancy on mental health rather than the effects of abortion per se on mental health. The data available in this study was not sufficient to explore these options.

The Fergusson study is one that has been leapt upon and widely misrepresented by anti-abortionists as having proved that abortion causes mental health problems when it neither claims nor demonstrates anything of the sort.

The APA report has itself been criticised by pro-life academics for bias, for selective standards in evaluating different research findings, for ignoring studies that might point to a different conclusion, for basing much of its conclusions on one problematic study in 1995 (Gilchrist et al).

Well, obviously, but the mere fact of it having been criticised by ‘pro-life academics’ for bias proves nothing – it certainly doesn’t invalidate the report’s findings, its merely reflection of the fact that anti-abortionists are unhappy that report not only fails to support their preferred ‘conclusions’ an abortion and mental health but goes to considerable lengths to note the various methodological flaws extant in the research conducted by these same academics.

To anti-abortionists the Gilchrist study is certainly ‘problematic’ for two main reasons. First, its conclusions don’t support their contention that there is a causal relationship between abortion and subsequently mental health problems experienced by women who have had an abortion. Second, the APA report notes that the Gilchrist study doesn’t exhibit the kind of obvious methodological problems found uniformly across research conducted by so-called ‘pro-life academics’…

2. Description of findings: Non-U.S. samples.

Nine studies were based exclusively on non-U.S. samples. Most were methodologically quite poor (see Table 3b). The most methodologically sound papers were based on a study conducted by Broen and colleagues in Norway (Broen, Moum, Bodtker, Ekeberg, 2004, 2005, 2006) and one conducted jointly by the Royal College of General Practitioners and the Royal College of Obstetricians and Gynecologists in the United Kingdom (Gilchrist et al., 1995).

As far the APA ‘basing much of its conclusions’ on the Gilchrist study, so what. Reading the report it is a clear that Gilchrist study has been influential, primarily because the study is methodologically far more sound than much of the other research the APA Task Force was able to review – the list of references in the report runs to 12 A4 pages. As the report states:

One study, however, stood out from the rest in terms of its methodological rigor. This study was conducted in the United Kingdom by the Royal College of General Practitioners and the Royal College of Obstetricians and Gynecologists (Gilchrist et al., 1995). It was longitudinal, based on a representative sample, measured postpregnancy/abortion psychiatric morbidity using established diagnostic categories, controlled for mental health prior to the pregnancy as well as other relevant covariates, and compared women who terminated an unplanned pregnancy to women who pursued alternative courses of action. In prospective analyses, Gilchrist et al. compared postpregnancy psychiatric morbidity (stratified by prepregnancy psychiatric status) of four groups of women, all of whom were faced with an unplanned pregnancy: women who obtained abortions, who did not seek abortion, who requested abortion but were denied, and who initially requested abortion but changed their mind. The researchers concluded that once psychiatric disorders prior to the pregnancy were taken into account, the rate of total reported psychiatric disorder was no higher after termination of an unplanned pregnancy than after childbirth.

This study provides high-quality evidence that among women faced with an unplanned pregnancy, the relative risks of psychiatric disorder among women who terminate the pregnancy are no greater than the risks among women who pursue alternative courses of action.

If you read any of my other articles on abortion over the last year or so then you’ll already be aware that one of the consistent features of arguments put forward by anti-abortionists is that they considered that bodies such as the Science and Technology Committee, the British Medical Association and, now the APA, are behaving in a biased and unfair manner by giving so much credence to the kind of well-designed and methodoligically sound research that fails to support their position rather than their own flawed, biased and sometimes even downright shoddy offerings.

One US researcher from the other side of the argument, Dr Priscilla K. Coleman, has declared that “there is consensus among most social and medical science scholars that a minimum of 10 to 30 per cent of women who abort suffer from serious negative psychological consequences”. If true, that sounds like quite a lot to me, although it still means that about eight or nine out of ten women who abort aren’t affected too badly.

The $64,000 question is ‘if its true’.

Coleman is the author or co-author of nine research papers reviewed by the APA’s Task Force, all of which are criticised for displaying obvious methodological flaws, e.g.

Problems of sampling.

First, many of the above studies cannot be generalized to the majority of women in the United States who seek abortions. Some are based on specialized data sets not representative of women in general (e.g., Coleman, Maxey, et al., 2005; Coleman, Reardon, et al 2005), some used screening criteria that eliminated a huge proportion of the larger sample (e.g., all of the Medi-Cal studies), some differentially excluded women from one outcome group but not the other (Reardon & Cougle, 2002a), and some were based on samples of women who obtained abortions under more restrictive regulations (Fergusson et al., 2006). Only one of the above studies based on survey data used sampling weights in its analyses (Coleman, 2006a). The study by Coleman (2006a), which did use sample weights, used a school-based population that did not include the most disadvantaged adolescents—those who dropped out of school to care for a child.

This last study of Coleman’s (2006a) is entitled ‘Resolution of unwanted pregnancy during adolescence through abortion versus childbirth: Individual and family predictors and psychological consequences’ and was published in the Journal of Youth and Adolescence. It is, as the title suggests, at least in part a comparison of psychological outcomes in individuals who fall unexpectedly pregnant during adolescence, one that compares the outcomes of those who choose to have an abortion with those who choose to have the baby and yet, in making that comparison – as the APA notes – it uses a sample population which explicitly excludes from consideration those adolescents who, as a result of their pregnancy, dropped out of school to care for a baby.

Omissions like this matter. For a young women to be able to return to school after having a baby they must have a pretty solid network of family and social support behind them and, in general, the presence or absence of such support and the quality of support provided is closely associated with differentials in mental health outcomes. People who have the benefit of a solid and supportive family/social environment are, across the board, less likely to experience psychological problems than those who lack that support – and the young women who have drop out of school to care for a baby rather than continue their schooling once the baby is born are those who are least likely have access to that kind of supportive environment.

It doesn’t take a genius to figure out if you’re comparing the mental health of young women who’ve had an abortion with that of young women who fell pregnant and had the baby and you exclude the latter group those young women who are most likely to experience psychological problems due to their lack of a supportive environment then you’re introducing a bias into the outcome of the study. This is a very basic methodological error, so basic in fact that its difficult not to question either the competence or the integrity of a researcher making such a basic mistake.

Coleman is one of a number of ‘researchers’ who peddle anti-abortion junk science. As this report by Pam Chamberlain of Political Research Associates explains in relation to spurious, but oft-repeated, claims of a link between abortion and breast cancer…

In the anti-abortion movement, a handful of scientists with conservative political agendas first publish articles, studies and commentaries in scientific journals, generating scientific “knowledge” about the dangers of abortion with unsubstantiated claims using problematic approaches.

In the 1980s, they tagged onto a scientific debate about abortion and breast cancer that appeared in the journals beginning in the 1950s.⁴ By repeatedly making the same claims in a variety of publications, they create the appearance of a body of scholarship that can be used to support a political goal of presenting apparently legitimate scientific evidence to influence the abortion debate. Then B.A.D. [“Biased, Agenda-Driven”] scientists create their own advocacy groups which in turn inspire new grassroots organizations with an agenda based on the scientists’ claims. Newcomers join online or at the local level, and a movement with serious policy influence is born.

This tactical trajectory mimics the path of researchers who generate their own studies to support a reproductive rights agenda. The Alan Guttmacher Institute, for instance, has generated research on reproductive and sexual health since 1968 by publishing in its own journals, supporting the activist work of many reproductive rights advocacy groups. However, these journals are refereed, meaning the articles are vetted by other scientists.

But the most important issue to consider about researchers on both sides of this polarized issue is not that scientists may have agendas. It is that the quality of the science produced by B.A.D. scientists is unmistakably shoddy. In the case of anti-abortion B.A.D. scientists, their strongly held Christian Rightist beliefs have interfered with their ability to practice reputable science. Despite this deficiency, and despite vehement challenges by mainstream researchers, the “knowledge” that abortion harms women has successfully become part of the vocabulary of anti-abortion activists.

Coleman is most closely associated with David Reardon of the anti-abortion Elliot Institute, which he set up himself after switching from electrical engineering to biomedical ethics…

Rather than trying to enter academia, he founded the Elliot Institute which specializes in generating papers on PAS (so-called ‘post-abortion syndrome’) and advocating compassion for women who are “abortion survivors.” His also calls his approach “woman-centered.” Other organizations now champion the cause of post-abortion syndrome, including the Catholic Project Rachel, the Evangelical Operation Outcry, and Christian “crisis pregnancy centers” affiliated with networks like Heartbeat International and Carenet that offer post-abortion counseling.

Reardon often is at odds with the peer review process in scientific publishing that is designed to maintain standards and further the discovery of scientific truth. The process involves a sometimes lengthy give-and-take between authors and reviewers before a study or article is accepted for publication. Then subsequent review, commentary, and new research add to a shared understanding of the topic at hand. While not perfect, peer review depends on the scrupulous critique of fellow researchers, especially ones in the same field.

…Reardon places similar material in different journals, referring back on his own previous articles or even letters to the editor, generating the conversation almost single-handedly. Most scientists are not convinced, describing his work as marred by unwarranted claims and methodological shortcomings.

In addition to peddling his pet theories about ‘post-abortion syndrome’ Reardon also extensive promotes what he calls ‘post-abortion healing‘, which is, of course, provided by explicitly religious ‘support groups’, as is obvious from the introductory statement on the Elliot Institutes ‘healing page’:

If you are in emotional or spiritual pain after abortion, this article will help you learn about different resources and options available to you in your journey to renewed emotional and spiritual well-being.

As is so often the case in the US, while the Christian right want to ban abortion outright they also have no qualms about using the fact that some women do struggle to come to terms with having had an abortion as a mean of trying to recruit them into their church for all that this is, in professional terms, a deeply unethical practice.

So the ‘if’ in ‘if it’s true’ that anything up to 30% of women ‘suffer from serious negative psychological consequences’ following abortion is looking like a very big ‘if’ indeed, particularly when one notes that that in a letter to the editor of the Journal of Anxiety Disorders, in 2004, two researchers who reviewed a paper co-authored by Reardon and Coleman, commented that…

“We believe 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,”

…before going on to add:

“All are involved in building a literature to be used in efforts to restrict access to abortion.”

Coleman is anything but a reliable source of opinion on the existence – or otherwise – of any kind of ‘consensus’ on the possible links between abortion and mental health.

Getting back to McDonagh, she now moves on to promoting a somewhat different strand of junk science…

Nor should we forget how susceptible MPs are to authoritative-sounding research with issues such as abortion. Before the recent Commons vote on whether to restrict the time limit on abortion, research was published that suggested the life chances of premature babies had not increased beyond 24 weeks, despite medical advances. This was extensively quoted in favour of keeping the limit at 24 weeks, even though babies born prematurely self-evidently have problems, or their mothers do. The study had no bearing on ordinary, healthy foetuses, yet was used to see off the attempt to change the time limit on abortion.

Note the phrase ‘even though babies born prematurely self-evidently have problems, or their mothers do’ which not only a tautology but a deeply misleading one.

Yes, in many cases where a foetus is born at a severely premature stage there is underlying problem which causes the woman to go into labour although not necessarily one that indicates either that foetus, itself, has a problem or that has a deleterious impact on the foetus’s extremely slim chances of survival.

The major problem facing a neonate born at or around the existing upper limit for elective abortions (24 weeks) is not that its ‘ill’ because of some sort of problem that caused it to be bron at that early stage but that its ‘ill’ because its seriously underdeveloped and ill-equipped for survival outside the womb, particular in terms of the development of its lungs and it capacity to breathe. That’s why the vast majority of severely premature neonates die either during the course of the birth or shortly afterwards – because they’re just not equipped ‘developmentally’ for survival outside the womb at that stage in the development and if the relative health of the foetus prior to its being born has any bearing on its survival chances then such an effect is marginal at best.

Human foetuses are simply not ‘designed’ to survive outside the womb at 22 and 23 weeks gestation and the fact that, today, some do is testement only to the advances made in medical technology over the last 30-40 years without which no foetus born at such an early stage in its development would survive beyond a matter of hours or maybe a day or two at best.

Just because doctors can save the lives of a very small number of severely premature neonates it doesn’t follow automatically that they should or that they should even try in many cases – it all depends entirely whether or not the neonate has any realistic chance of survival, what kind of quality of life its likely to have if it does survive and on the wishes of the parents who do have the right to refuse invasive treatment for the foetus or specify that it not be resuscitated in the event that the neonate dies.

The argument from viability, when looked at properly, is no more sound a basis for determining the upper time limit for elective abortions than any other and, equally, no less fraught with problems. It is, to a considerable extent, the argument we have to work with because its the one favoured by our present legislators but it still far from being definitive, merely one that many find easier to swallow than most of the others.

As regards abortion and mental health, if we are to accept that – to put it conservatively – there that remains, notwithstanding this latest research, at least a risk that having an abortion may cause depression, isn’t there a case for warning women of this?

Of course there is in, if its done properly and the information that is given in non-directional and based on the best available evidence – and that’s no more than any reputable abortion provider is currently giving women who seek an abortion.

The central fallacy here is the idea that women aren’t already given this information or that its somehow necessary to legislate in order to ensure that its given. It isn’t simply because its a matter of basic clinical ethics that women should be both appropriately advised of any risks before they decide whether to go ahead with a termination and assessed for any indications that they may be particularly at risk of complications, physical or psychological. This is all part and parcel of the basic duty of care that clinicians have towards their patients, not just those seeking an abortion but any patient seeking treatment for any medical condition.

Doctors don’t need parliament to tell them what they should and should not be telling women during the pre-abortion consultation because they have an ethical code which already dictates how that element of the procedure should be properly conducted.

There’s no saying that compulsory counselling, or indeed a cooling-off period before an abortion, will make women change their minds, but at least they should consider the possibilities. (Certainly they should be warned about the real, not illusory, association between abortion and premature delivery in subsequent pregnancies.)

All of which is true – but then, if that’s the case, why is it that anti-abortion campaigners make such a big issue of trying to introduce compulsory counselling and/or a so-called ‘cooling off’ period?

So far as ‘counselling’ is concerned, its an issue for anti-abortionist not because women don’t already receive a measure of ‘counselling’ prior to deciding to go ahead with an abortion but because they want to dictate the precise terms and content of the ‘counselling’ that women are given. They see ‘counselling’ as a means to an end, with that end being that of persuading women not to go ahead with an abortion, even though such an approach would be – as mentioned previously – in professional terms nothing short of unethical. The role of a ‘counsellor’ in a per-abortion setting is, in part, that of assessing, in the first instance, whether an individual is psychologically competent to make a decision as to whether to go ahead with a termisnation and, subsequently, whether there any indications that an individual exhibits any signs that they may have difficulty coming to terms with the decision and, therefore, be at an elevated risk of developing psychological problem, in which case, as the Royal College of Psychiatry’s guidelines indicate, the counsellor should offer and make appropriate palns for providing the individual with suitable aftercare.

Beyond that, the role of the counsellor is that of ensuring that the individual is given sufficient information about the procedure and its possible risks for them to reach an informed decision as to whether to go ahead witrh the termination and to facilitate the decision-making process without influencing it or injecting their own opinions.

Its about supporting women to make their own choice not about persuading them to make a particular decision, one that suits the preconceived opinions of the ‘counsellor’.

You don’t need to impose a statutory duty on healthcare professionals when that duty amounts only to following good clinical practice and working to professional ethical standards – you only try to do that if you have a non-clinical objective in mind, and that’s the truth that underpins all the talk of ‘counselling’ amongst anti-abortionists.

The same is true when it comes to demands for women to be given a statutory ‘cooling-off’ period. Quite what anti-abortionists think happens when women seek an abortion is anyone’s guess but if you take their rhetoric at face value you’d imagine that they simple turn at a clinic, sign the paperwork and are then ushered immediately in an operating theatre for an immediate ‘while-u-wait’ service. Now you may be able to get a service like that if you’re rich enough to afford the services of one of those ultra discreet private clinics that specialise in covertly erasing the mistakes of the rich and shameless, but for the vast majority of women, those who rely on the NHS and its contract providers or on the services of Marie Stopes, BPAS, etc. what happens is that you first have to make an appointment to see the doctors who, by law, have to sign-off on the abortion and undergo a per-abortion assessment after which – if there are no problems that would prevent the abortion going ahead – you’ve given an appointment to visit the clinic several days if not a week or two later depending on the provider.

If its a ‘cooling-off’ period you want then that’s what women already get simply because there’s a time lag between the initial consultation and the appointment to visit the clinic for the procedure to be carried out, a lag which can vary from 2-3 days to a couple of weeks depending on where you are in the UK and which provicder you’re using. The only justification for a statutory ‘cooling-off’ period would be evidence to show that women were routinely being unduly rushed in reaching a decision as to whether to proceed with an abortion and there is, so far as I’ve been able to ascertain, no such evidence, in fact what the evidence points to is not that women are being rushed into having abortions without giving it ‘proper thought’ but that many have problems gaining access to abortion services within a reasonable amount of time. The current system is not too quick to allow proper time for considering the options to but too slow in responding to women’s needs.

And the one in ten women who undergoes a later abortion – after three months – should definitely be counselled about the potential effects on mental health. Come to think of it, has anyone done any research on the effects on men when their wife or girlfriend has an abortion?

As far as conducting research on men, this is an angle that anti-abortionists like Coleman have had a bit of poke at, not in terms of abortion and male mental health but, as these two studies show, as a vehicle to attack, from a supposedly scientific direction, the idea that abortion is a primarily or exclusively female issue. The second study is, in the context of the earlier commentary on biased research, a particular amusing one as its abstract demonstates…

A survey was conducted among 1387 psychology students (429 men and 908 women) to explore correlates of perceptions of male involvement in abortion decisions by focusing on abortion attitudes on a pro-choice to pro-life continuum and on interest in the issue….

Results showed that more than half of the respondents held pro-life attitudes. The data further suggested that 14.3% of the students possessed relatively radical pro-choice attitudes, whereas 17.4% of the students expressed relatively radical pro-life attitudes…

Abortion attitudes and opinions regarding the extent to which abortion should be conceptualized as strictly female issue were found to operate as effective predictors of perceptions regarding the appropriate level of male involvement in abortion decisions. Furthermore, the tendency to view abortion as an entirely female issue was inversely related to the level of male involvement deemed appropriate in abortion decisions.

All of which should come as no great surprise when you find out the the research used student from the University of Tennessee.

In all, these two studies are pretty much meaningless other than as scene-setters for a spurious attempt to tie male mental health into the abortion debate, one that even Coleman appears not to have tried to follow-up.

As for counselling women who seek a second trimester abortion, once again they should certainly be informed of the existence of any credible evidence to show that there may be an elevated risk of later mental health problems but counselling – as a formal process – would only be appropriate if there are any indications to show that an individual may be particular at risk of such complications…

and, of course, the kind of counselling I’m talking about is very different from the kind that McDonagh favours, as her next comment demonstrates:

Of course, there is nothing magic about counselling. It depends how it’s done. The best and most brutal example of pre-abortion counselling that I can think of is in the film Alfie (the original version, with Michael Caine) when the unfortunate illegal abortionist rattles through all the downsides of the procedure before pocketing his £25, mentioning, if memory serves me correctly, “the injustice to the unborn child”.

I think that tell us pretty much everything we need to know about McDonagh’s attitude towards the provision of ‘counselling’ to women seeking an abortion – if your idea of pre-abortion counselling is a set-piece speech given by a backstreet abortionist in a film then you really have no business talking about this issue at all. If its not already obvious, McDonagh sees the purpose of ‘pre-abortion counselling’ as being that of persuading women not to have abortion not of support them to make the right choices for their own lives and their own personal circumstances.

That’s the prevailing attitude behind the attempts of anti-abortion MPs to impose mandatory ‘counselling’ and a so-called ‘cooling-off’ period on women seeking abortion and the only real positive in this whole article is that having tried carefully to stay ‘on message’ throughout – give or take the ‘snuff journalism’ jibe – McDonagh, in the end, cannot resist having another dig and, in doing so, exposing the real agenda behind the amendments that anti-abortion MPs are seeking to table.

I wonder how they’d put that now? They have compulsory counselling in Germany before abortion and women there still have them. Granted, you wouldn’t want me doing it. I wouldn’t be able to stop myself saying: “Don’t you realise the foetus is human too?” And then I’d be sacked.

I’d be deeply concerned if she even got a job in the first place…

But with all the caveats, at least informed counselling could allow women to consider the risks as well as the immediate gains of abortion. And where the potential cost is so great, that has to be worth doing.

It is worth doing, and that’s precisely why its already done – the only people who seem to think that women aren’t given the information they need to make informed decisions about abortion are anti-abortionists and that’s only because when women are given that information they do go on to choose to have abortions – which is the bit they object to.

The anti-abortion position is one in which informed consent is only valid if its informed by their opinions and results in the their preferred outcome, a decision not to have an abortion. That’s the message here – women are only intelligent enough to make up their own minds about abortion when they decide that what they really want is a baby, and if that’s not what you want then you’re basically stupid and need to be told that what you want is a baby until you accept that anti-abortionist know what you really want much better than you do.