Abort these lazy anti-choice arguments

‘Abortion exposes women to higher risk of depression.’ So stated a headline in The Times (London) on 27 October. In the same paper, under the headline ‘Risks of abortion’, there was a letter signed by 15 doctors raising concerns about the impact of abortion on women’s mental health, which triggered the news story.

The letter claimed that recently published research provides definitive evidence of a causal link between abortion and the development of psychiatric conditions. On this basis, argue the signatories, abortion providers should change their methods, and women seeking abortion should be informed that terminating pregnancy puts them at risk of suffering from mental ill-health.

This latest story tells us little about any real relationship between a woman’s reproductive issues and her state of mind, but a lot about the state of the abortion debate in general and the mindsets of those opposed to abortion.

The study referenced by the letter-signatories was published in the Journal of Child Psychology and Psychiatry under the title: ‘Abortion in young women and subsequent mental health.’ It concluded that, ‘[Our] findings suggest that abortion in young women may be associated with increased risks of mental health problems.’ For those who take research seriously, even this single line suggests the researchers reached very different conclusions to those presented in The Times.

The study was firstly of young women: it considered the experiences of women aged 15 to 25. The researchers make no claims about women in general; their interest lies in the experience of adolescents and young adults. (It should also be noted that the young women studied grew up in a particular area of New Zealand, which may also be significant for the relevance of the results to other societies.)

But the most important word in the researchers’ conclusion is ‘may’ – ‘abortion in young women may be associated with increased risks of mental health problems’. Where the signatories to The Times letter make strong assertions and argue for policy changes, the original journal article contains important riders. These are:

— Confounding factors that this study may not have accounted for. The authors note that their findings may not have taken into account factors other than abortion which might account for the observed association between abortion and particular states of mind;

— Under-reporting of abortion in the sample. This is a well-recognised problem with research about abortion. The authors of this latest study note there was a statistically significant difference between the rate of abortion in the sample and that among the population in general;

— Contextual factors associated with abortion-seeking to which the study could not be sensitive. For example, the authors note that, ‘It is clear the decision to seek (or not seek) an abortion following pregnancy is likely to involve a complex process’, and consequently ‘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’.

This last point, about the effects of unwanted pregnancy, is especially important. Three groups of women were compared in this study: women who said they had an abortion, against women who had not experienced a pregnancy and women who had continued a pregnancy to term. It was against this background that an association was made between abortion and poorer mental health. Yet the study was conducted in a context where abortion is legal, and relatively freely available. So it must be taken into account that, among these three groups of women, it will likely have been those whose pregnancy was truly and consistently unwanted who went on to have an abortion.

In other words, it may be the fact that their pregnancy was unwanted and possibly seen as a burden, rather than the fact they had an abortion, which contributed to certain states of mind.

The most valid comparator group to women who have an abortion is not women who have not experienced pregnancy or women who have given birth because they want to, but rather women with unwanted pregnancies who are denied abortion and who then give birth. When these two groups of women – those with unwanted pregnancies who opt for abortion and those with unwanted pregnancies who are denied abortion – are compared, we can at least be pretty certain that the context of pregnancy is similar for both, and that what is being compared is the effects of the resolution of the pregnancy (birth or abortion) on the women’s state of mind.

Yet this latest study did not include a group of women who were denied abortion, which is understandable, given the relatively free abortion laws in New Zealand. Other research has shown that lack of choice in continuing an unwanted pregnancy has a stronger association with poor mental health than abortion.

The authors of this latest study are right to be tentative in their conclusions. They are correct to conclude that ‘the issue of whether or not abortion has harmful effects on mental health remains to be fully resolved’, and to call for more research into the area.

In taking this approach they also reflect what seems to be a consensus in this area of abortion research. Academic research about the psychological effects of abortion is widely recognised as a complicated enterprise. As noted by American psychologist Henry David, a prolific writer on this subject, designing research that can make definitive statements about the psychological effects of abortion, and other reproductive events, is a complex task – far more complex than research on abortion and physical health, where it can be clearly stated that abortion is a relatively safe medical procedure.

For this reason, the British Royal College of Obstetricians and Gynaecologists (RCOG) wisely takes stock every now and then of the range of published studies on the issue, before drawing up its evidence-based guidelines for British abortion providers. In its leaflet for women considering abortion, the RCOG says: ‘How you react will depend on the circumstances of your abortion, the reasons for having it and on how comfortable you feel about your decision. You may feel relieved or sad, or a mixture of both.’ It also notes that: ‘Some studies suggest that women who have had an abortion may be more likely to have psychiatric illness or to self-harm than other women who give birth or are of a similar age. However, there is no evidence that these problems are actually caused by the abortion; they are often a continuation of problems a woman has experienced before.’

This reads as a balanced approach, taking careful account of the available evidence. It tells women and their loved ones about the general conclusions of published, peer-reviewed evidence. This is in stark contrast to the line taken by the letter-signers to The Times, who called for British medical authorities to change the way things are. On the basis of one study from New Zealand of women aged under 25, which actually makes only tentative claims and recommends further research, the signatories claim that ‘doctors [in Britain] have a duty to advise about the long-term psychological consequences of abortion’.

How did they come to this conclusion? The emphasis on the ‘risks of abortion’ and their alleged implications for abortion practice arises, not from any balanced consideration and debate about well-designed academic research, but from political attitudes to abortion.

Today, those who are hostile to abortion find it difficult to frame their arguments in moral terms. For a range of reasons, very few will agree these days that abortion is simply ‘wrong’, and so there is little support for attempts to moralise against abortion. At the same time, the language of risk increasingly provides a medicalised vocabulary in which anti-abortion arguments can be made. In effect, we have the ‘medicalisation’ of anti-abortion arguments through the use of the language of risk. Those of us who support a woman’s right to choose should challenge this new anti-abortion focus, and demand a higher standard in discussions of research and evidence.

Dr Ellie Lee is author of Abortion, Motherhood and Mental Health: Medicalising Reproduction in the US and Britain, published by AldineTransaction, and coordinator of the Pro-Choice Forum.

References:

‘Doctors’ letter sparks debate over abortion and mental health’, Abortion Review, 30 October 2006

‘The Care of Women Requesting Induced Abortion, Evidence-based Clinical Guideline Number 7’, RCOG September 2004

‘Abortion in young women and subsequent mental health’. Fergusson DM, Horwood LJ, Ridder EM. Journal of Child Psychology and Psychiatry. 2006 Jan; 47(1): 16-24.