Lancet: Women should be offered post-abortion psychological care

The British medical journal, The Lancet, published an editorial in their August 23 issue regarding appropriate care for women after an abortion. Although the editorial could have taken a stronger stance on the APA report, I believe they have issued an important caution to those reviewing literature on mental health and abortion.

More than a third of American women will have an abortion by the age of 45 years, if current rates continue. A study published in The Lancet last year showed that 1·5 million abortions were done in the USA and Canada in 2003, compared with 42 million abortions worldwide.
Much attention has been given to the ethical considerations of terminating a pregnancy, but little effort has been directed at the long-term mental health effects of abortion on women. In 1989, the American Psychological Association (APA) undertook a systematic review of the literature and concluded that a single elective abortion did not result in long-term mental health problems. However, in 2006, a study published in the Journal of Youth & Adolescence concluded that abortion had a greater risk of adverse mental health outcomes compared with childbirth. This review was used in a South Dakota court to support a proposal to have abortion made illegal. The proposal failed, but doctors in the state must now inform women having a termination that they will be at risk of future mental health problems.
Recognising the need for a definitive decision on the issue, the APA commissioned the Mental Health and Abortion report, released on Aug 13. The authors systematically reviewed 50 studies, published in peer-reviewed journals since their last report in 1989, and concluded that, among adult women who have an unplanned pregnancy, the relative risk of mental health problems is no greater if they have an elective first-trimester abortion than if they deliver that pregnancy.
Although this report shows that there is no causal link between abortion and mental ill-health, the fact that some women do experience psychological problems after a termination should not be trivialised. The APA report concludes that such cases are often the result of confounding issues, such as a history of mental ill-health. Abortion is an important part of comprehensive reproductive health services. Women choosing to terminate must be offered an appropriate package of follow-up care, which includes psychological counselling when needed.

Washington Times: Is abortion a mental health risk?

This morning, the Washington Times published my article on the American Psychological Association Mental Health and Abortion Task Force.
In it, I call for the APA to start over on this topic. One study formed the essential basis for the Task Force conclusions. I do not agree that the Gilchrist study is better than the 2005 Fergusson study which did demonstrate a reason to be cautious. However, even if one concludes Gilchrist is best, that does not mean it is sufficient or adequate to make a dogmatic conclusion. By calling one study, the 1995 Gilchrist study, “the best scientific evidence,” the task force has misled the public by portraying the best evidence as being good enough evidence.

Royal College of Psychiatrists statement on abortion and mental health

Regular readers will no doubt note the number of posts on abortion, mental health and related topics. I am doing some research and writing on this topic and want to get some of the information I am finding into view. Here is one interesting statement from another mental health association regarding abortion and mental health effects. This from the Royal College of Psychiatrists in Great Britain.

Position Statement on Women’s Mental Health in Relation to Induced Abortion
14th March, 2008
In the Government Response to the Report from the House of Commons Science and Technology Committee on the Scientific Developments Relating to the Abortion Act 1967, the following request was made:
“In view of the controversy on the risk to mental health of induced abortion we recommend that the Royal College of Psychiatrists update their 1994 report on this issue”
The College has undertaken a literature review to inform the following position statement, which includes the recommendation that a full systematic review around abortion and mental health is required.
The Royal College of Psychiatrists is concerned to ensure that women’s mental health is protected whether they seek abortion or continue with a pregnancy.
Mental disorders can occur for some woman during pregnancy and after birth.
The specific issue of whether or not induced abortion has harmful effects on women’s mental health remains to be fully resolved. The current research evidence base is inconclusive – some studies indicate no evidence of harm, whilst other studies identify a range of mental disorders following abortion.
Women with pre-existing psychiatric disorders who continue with their pregnancy, as well as those with psychiatric disorders who undergo abortion, will need appropriate support and care. Liaison between services, and, where relevant, with carers and advocates, is advisable.
Healthcare professionals who assess or refer women who are requesting an abortion should assess for mental disorder and for risk factors that may be associated with its subsequent development. If a mental disorder or risk factors are identified, there should be a clearly identified care pathway whereby the mental health needs of the woman and her significant others may be met.
The Royal College of Psychiatrists recognises that good practice in relation to abortion will include informed consent. Consent cannot be informed without the provision of adequate and appropriate information regarding the possible risks and benefits to physical and mental health. This may require the updating of patient information leaflets approved by the relevant Royal Colleges, and education and training to relevant health care professionals, in order to develop a good practice pathway.
These difficult and complex issues should be addressed through additional systematic reviews led by the Royal College of Psychiatrists into the relationship between abortion and mental health. These reviews should consider whether there is evidence for psychiatric indications for abortion.

In my opinion, this is where the APA Task Force on Mental Health and Abortion should have stopped.

News coverage of the APA Mental Health and Abortion Task Force report

I have several posts about the APA task force report and will have more to come. I have been following this story since late 2005, when David Fergusson’s research finding a link between abortion and negative outcomes first hit the landscape. I have written four op-eds about the matter and will have a couple more at least. This is an intriguing study in how the APA makes policy. For myself as well as for readers who are keeping up with the issue here, I am posting links to various media reports relating to the task force report:
Study Fails to Find Link On Abortion, Mental Health – Wall Street Journal
No link between abortion and mental health – UPI
One abortion no threat to mental health: group – Reuters
One abortion no threat to mental health: panel – MSNBC
National briefing – New York Times
Lifenews
Worldnetdaily
Citizenlink
And then read this article by abortion researcher Priscilla Coleman regarding the report…

Allegations cloud APA Mental Health and Abortion report

The APA Task Force on Mental Health and Abortion was chaired by Dr. Brenda Major, psychology professor from the University of California, Santa Barbara. The same day the APA Council of Representatives approved the report, the Elliot Institute’s David Reardon released the following presse release. The release claims Dr. Major did not release data, collected with help of a federal grant, when requested. APA ethics guidelines would require the sharing of such data. This is relevant since Dr. Major’s task force called for more research and yet, she is being accused of failure to facilitate this recommendation by holding back the release of the data. Given the serious nature of these allegations, I asked Dr. Major, via email to APA spokesperson, Rhea Farberman, to confirm or deny the allegations and to provide comment in response. The APA response is at the end of this release.

For Immediate Release
August 13, 2008
Chair of APA Abortion Report Task Force Violates APA Ethics Rules
Lead Author Refuses to Release Abortion Data Collected Under Federal Grant
Springfield, IL (August 13, 2008) – The credibility of a new report on the mental health effects of abortion from the American Psychological Association is tarnished by the fact that the lead author, Dr. Brenda Major, has violated the APA’s own data sharing rules by consistently refusing to allow her own data on abortion and mental health effects to be reanalyzed by other researchers.
Major, a proponent of abortion rights, has even evaded a request from the Department of Health and Human Services (HHS) to deliver copies of data she collected under a federal grant. Because her study of emotional reactions two years after an abortion was federally funded, the data she collected is actually federal property. But in Major’s response to 2004 HHS request for a copy of the data, Major excused herself from delivering the data writing, “It would be very difficult to pull this information together.”
However, a researcher familiar with Major’s work, David Reardon of the Elliot Institute, has seen portions of Major’s unpublished findings. Reardon, who has published over a dozen studies on abortion and mental health, believes Major is withholding the data to prevent her findings supporting a link between abortion and subsequent health problems from coming to light.
“Brenda’s last published study using this data set was released in 2000, after she moved to her present facility in 1995,” said Reardon. “Immediately after that publication one of my colleagues requested a break down of details which had only been superficially summarized in one her tables. One of her grad students replied on her behalf with the additional summary statistics we had requested within 48 hours. So it clearly wasn’t at all difficult for her team to access the data. Plus, with modern electronic data bases and multiple backup procedures in place at universities like hers, it is nearly impossible to lose such data.”
According to Reardon, Major has not responded to any further requests regarding the data since early in 2000. “I know of a number of experts in the field who have requested the data, even within the last six months. But she simply doesn’t respond to their calls, emails, or letters,” said Reardon.
“This is very troubling on two counts. First, it the APA’s own ethics rule, 8.14, requires research psychologists to share their data for verification of findings. Secondly, she is the chair of the APA Abortion Task Force which is, at least in theory, supposed to bring full and clear light to this issue. But how can we trust the objectivity of a report prepared by a task force composed exclusively of pro-choice psychologists, especially when the chair and lead author has a history of withholding data and findings which may undermine her ideological preferences?”
According to Reardon the additional details from Major’s study released in 2000 actually revealed that a significant number of women interviewed by Major did attribute negative reactions to their abortions, but those findings have never been published.
“There is no doubt that she has selectively reported her findings,” said Reardon. “We have seen in the unpublished tables details about specific negative reactions which were obscured in her published report by combining them with three to eight other reactions to create watered down, composite scores.
“In my view, it is irresponsible not to report the significant findings associated with individual symptoms. For example, she found that a number of women reported that they tried to cope with negative feelings about their abortions by drinking more or taking drugs. But she has never not fully shared the details on these reactions in any of her published studies, and by refusing to share her data for reanalysis by others, she has prevented anyone else from reporting these findings either.”
Reardon believes that the newly released APA Abortion Task Force report is also flawed by a pattern of wording and reporting which tends to obscure rather than clarify what researchers have found about the mental health effects associated with abortion. The primary conclusion of the report, as highlighted in the APA news release, is that “There is no credible evidence that a single elective abortion of an unwanted pregnancy in and of itself causes mental health problems for adult women…”
According to Reardon, this nuanced statement is intended to convey a message that abortion has no mental health risks but those familiar with the literature will see that it actually admits that there is compelling evidence that there are negative effects for:
* women who have multiple abortions, which accounts for about half of all abortions);
* women who abort of a wanted pregnancy because of coercion or pressure to abort from third parties and may account for about 20-60% of all abortions;
* minors who have abortions; and
* women with preexisting mental health problems in which case abortion may not “in and of itself” be the sole cause of mental health problems but may instead trigger or aggravate preexisting problems.
“Even the modifier that there is ‘no credible evidence’ of mental health risks in the ideal case of a low risk abortion patient is an admission that there is indeed some evidence that a single abortion can pose a risk to the mental health of a emotionally stable, adult woman,” said Reardon. “In fact, the report itself identifies a whole host of studies providing such evidence, but it mutes a clear presentation of the findings of these studies by focusing on the limitations of each study’s methodology, which all studies have, in order to justify ignoring their clear implications.”
While Reardon agrees that the body of the report includes admissions that abortion does negatively impact some women, he is deeply concerned that the summary introduction and conclusion and press releases all fail to emphasize five key points which are clear in the literature and even explicitly or implicitly stated within the 91-page Task Force report. The five points he believes should be made, without room for controversy are:
1. Some women suffer emotional harm from abortion.
2. Some women feel pressured into unwanted abortions.
3. There are well established risk factors identifying the women most likely to suffer negative psychological factors to abortion, including being pressured into an abortion, and that it is incumbent on therapists treating women considering an abortion, and abortion clinics, to screen for these risk factors and to give appropriate counseling in light of any identified risk factors.
4. A nationally funded longitudinal prospective study (such as recommended by Koop in 1989) of psychological factors related to reproductive health (including abortion) is long overdue and should be undertaken as soon as possible.
5. Therapists should be alert to unresolved issues associated with a past abortion and should sensitively give women the opportunity to discuss such issues and should provide appropriate care or referrals whenever such issues are raised.
“By failing to call on therapists to be alert and sensitive to the negative emotional experiences women attribute to their abortions, the Task Force has allowed ideology to trump sensitivity,” says Reardon. “Instead, they are ignoring the reality of how and why abortions take place and are instead focused on drawing conclusions regarding the safety of abortion for an emotionally stable, pro-choice, adult woman who is freely choosing a wanted abortion without any moral qualms. But that doesn’t reflect the reality of most abortion situations.”
“The fact is that coerced abortions are more common than wanted abortions. Studies show that over 60% of American women are having abortions, often against their moral beliefs, because they feel pressured into it by third parties. These women need therapist and family members to be open to and responsive to their pain, not dismissive of it as an anomaly. Sadly, this is an ideological report that simply ignores the concerns and needs of those women for whom abortion has been a heartache rather than a triumph.”
# # #
APA’s “Ethical Principles Of Psychologists And Code Of Conduct” regarding Sharing Research Data for Verification’
Copy of HHS letter and Brenda Major’s Response
Elliot Institute
PO Box 7348
Springfield
IL 62791
United States
www.afterabortion.info

In an email, APA spokesperson, Rhea Farberman, supplied the following statement in response to the press release.

The APA’s report is a rigorous review of the best available science. It calls to light the need for more research to better understand the potential mental health effects of abortion. It is disappointing to see it met with personal attacks.

This does not seem to me to be an adequate response to the substantial allegations made by Dr. Reardon. I waited to post the release until I could get a reply from the APA. I followed up with Rhea and will post any further comments.

David Fergusson reacts to the APA Mental Health and Abortion task force report

I asked New Zealand researcher, David Fergusson, about the APA Mental Health and Abortion task force report out today. He was one of 20 reviewers who commented extensively on the draft report. I specifically asked him what he thought of this statement from Task Force chair, Brenda Major in a Reuter’s report:

“The best scientific evidence published indicates that among adult women who have an unplanned pregnancy, the relative risk of mental health problems is no greater if they have a single elective first-trimester abortion or deliver that pregnancy,”

In addition, he commented on the report as a whole:

By the admission of the report, studies in this area (including my own) have significant flaws relating to sampling, measurement and confounding. What this means is that “the best scientific evidence” to which they refer, is really not all that good. Given that this is true then it would be inappropriate to draw strong conclusions on the basis of such limited evidence. The APA report, in fact, does draw a very strong and dogmatic conclusion that cannot be defended on the basis of evidence since this evidence is lacking by the admission of the report. As I stated to the APA committee in my review [of an earlier draft], the only scientfically defensible position to take is that the evidence in the area is inconsistent and contested. Under these conditions the only scientifically defensible conclusion is to recognise the uncertainty in the evidence and propose better research and greater investments in this area. What the Committee has, in effect, said is that until there is compelling evidence to the contrary, people should act as though abortion has no harmful effects. This is not a defensible position in a situation in which there is evidence pointing in the direction of harmful effects. In this respect, the response of the APA committee to this situation appears to follow the type of logic used by the Tobacco industry to defend cigarettes: since, in our opinion, there is no conclusive evidence of harm then the product may be treated as safe. A better logic is that used by the critics of the industry: since there is suggestive evidence of harmful effects it behooves us to err on the side of caution and commission more and better research before drawing strong conclusions. History showed which side had the better arguments.
What I also think the APA committee has failed to recognise is the size of the research investment needed to pin these issues down thoroughly. The tobacco example is a clear one: there have been literally tens of thousands of studies in this area (I have in fact published over 10 papers on tobacco related topics). This amount of research is needed in an area in which there are strongly divided opinions and deeply rooted agendas. The moral of all of this is very simple: In science drawing strong conclusions on the basis of weak evidence is bad practice. The APA report on abortion and mental health falls into this error.

APA abortion and mental health report: Single abortion not a threat to women's mental health

No surprises here. This news release from the APA was distributed late this evening.

FOR IMMEDIATE RELEASE
Tuesday, Aug. 12, 2008
Contact: Kim I. Mills
(202) 336-6048
(571) 216-5596 – cell
APA TASK FORCE FINDS SINGLE ABORTION NOT A THREAT TO WOMEN’S MENTAL HEALTH
Calls for Better-Designed Future Research
BOSTON – There is no credible evidence that a single elective abortion of an unwanted pregnancy in and of itself causes mental health problems for adult women, according to a draft report released Tuesday by a task force of the American Psychological Association.
The APA Task Force on Mental Health and Abortion reached its conclusions after evaluating all of the empirical studies published in English in peer-reviewed journals since 1989 that compared the mental health of women who had an induced abortion to comparison groups of women, or that examined factors that predict mental health among women who have had an elective abortion in the United States. The task force, formed in 2006, was charged with collecting, examining and summarizing the scientific research addressing mental health factors associated with abortion, including the psychological responses following abortion.
The report was to be presented Wednesday to the association’s governing Council of Representatives at APA’s Annual Convention in Boston.
The task force observed that many of the studies published during the period reviewed suffered from serious methodological problems. Thus, it focused most closely on those found to be most methodologically sound to arrive at its conclusions. Inconsistencies in findings reported by published studies were judged to reflect differences in study quality and failures to control for potentially confounding factors.
“The best scientific evidence published indicates that among adult women who have an unplanned pregnancy, the relative risk of mental health problems is no greater if they have a single elective first-trimester abortion or deliver that pregnancy,” said Brenda Major, PhD, chair of the task force. “The evidence regarding the relative mental health risks associated with multiple abortions is more uncertain.”
The task force found that some studies indicate that some women do experience sadness, grief and feelings of loss following an abortion, and some may experience “clinically significant disorders, including depression and anxiety.” However, the task force found “no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.”
The report noted that other co-occurring risk factors, including poverty, prior exposure to violence, a history of emotional problems, a history of drug or alcohol use, and prior unwanted births predispose women to experience both unwanted pregnancies and mental health problems after a pregnancy, irrespective of how the pregnancy is resolved. Failures to control for these co-occurring risk factors, the task force noted, may lead to reports of associations between abortion history and mental health problems that are misleading.
The report noted that women have abortions for many different reasons and within different personal, social, economic and cultural circumstances, all of which could affect a woman’s mental state following abortion. “Consequently,” the task force wrote, “global statements about the psychological impact of abortion can be misleading.”
According to the report, women terminating a wanted pregnancy, who perceived pressure from others to terminate their pregnancy, or who perceived a need to keep their abortion secret from their family and friends because of stigma associated with abortion, were more likely to experience negative psychological reactions following abortion.
The task force noted that despite the importance of understanding the mental health implications of abortion compared to its alternatives – motherhood or adoption—very few studies included appropriate comparison groups for addressing this issue. One of the task force’s chief recommendations is for better-designed, rigorously conducted future research on the topic to “help disentangle confounding factors and establish relative risks of abortion compared to its alternatives.”
The task force’s conclusions are consistent with the conclusions of an APA working group that conducted a similar review of the literature published prior to 1989. Results of that review were published in Science in 1990 and in the American Psychologist in 1992.
Members of the APA Task Force on Mental Health and Abortion:
Brenda Major, PhD, chair
MarkAppelbaum, PhD
Linda Beckman, PhD
Mary Ann Dutton, PhD
Nancy Felipe Russo, PhD
Carolyn West, PhD
A full copy of the task force’s report may be accessed at www.apa.org/releases/abortion-report.pdf
The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 148,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.
# # #

I haven’t looked at the report yet, but this finding was expected. The impression I got from Rhea Farberman is the Wall Street Journal article this morning prompted the lifting of the embargo on the report. The APA Council of Representatives is slated to vote on the report tomorrow morning. It seems quite likely that the report will be approved. The headline of the news release tells the message that the task force would like the public and policy makers to take home.

Wall Street Journal previews APA Mental Health and Abortion task force report

Today’s Wall Street Journal’s Stephanie Simon has an article regarding the APA Mental Health and Abortion Task Force. Titled “New Front on the Abortion Battle,” the article previews the APA committee’s report due to be considered tomorrow (Wed. 8/13/08).
The article begins:

For decades, the cultural battle over abortion has been about what goes on inside a woman’s womb. But more and more, the focus is shifting to what goes on inside her head.
Activists on both sides are awaiting a comprehensive report reviewing two decades of published research on mental health and abortion, to be presented this week at the American Psychological Association’s annual conference in Boston.
The report comes at a pivotal time as some judges and lawmakers have begun to make decisions in part based on peer-reviewed studies suggesting women who have had abortions are at higher risk of anxiety, depression and substance abuse.

The article also refers readers to an annotated list of some studies relevant to mental health and abortion.

Norwegian study finds abortion-depression link

A relatively recent study from Norway finds a link between abortion and subsequent depression. Titled, Abortion and depression: A population-based longitudinal study of young women, the research was conducted by Willy Pedersen and published in the 2008 Scandinavian Journal of Public Health, volume 36, pages 424–428. Here is the abstract:

Induced abortion is an experience shared by a large number of women in Norway, but we know little about the likely social or mental health-related implications of undergoing induced abortion. International studies suggest an increased risk of adverse outcomes such as depression, but many studies are weakened by poor design. One particular problem is the lack of control for confounding factors likely to increase the risk of both abortion and depression. The aim of the study was to investigate whether induced abortion was a risk factor for subsequent depression.
Methods: A representative sample of women from the normal population (n5768) was monitored between the ages of 15 and 27 years. Questions covered depression, induced abortion and childbirth, as well as sociodemographic variables, family relationships and a number of individual characteristics, such as schooling and occupational history and conduct problems. Results: Young women who reported having had an abortion in their twenties were more likely to score above the cut-off point for depression (odds ratio (OR) 3.5; 95% confidence interval (CI) 2.0–6.1). Controlling for third variables reduced the association, but it remained significant (OR 2.9; 95% CI 1.7–5.6). There was no association between teenage abortion and subsequent depression.
Conclusions: Young adult women who undergo induced abortion may be at increased risk for subsequent depression.

This was a longitudinal study with very high response rates at all response times over the course of the effort (from 97% at time one to 82% at time four). The research team used questions about depression from the Symptom Checklist-90 (SCL-90), a well-accepted mental health measure.
Dr. Pedersen further describes the strengths of this study and notes other recent work which found a link between abortion and mental health.

This study is robust in several respects. The response rate is high, respondents were observed over a considerable length of time, and measures of the key variables are well validated. We have also controlled for a large number of other factors pertaining to the lives of the women that are likely to affect whether a pregnancy is brought to term or aborted, and the likelihood that depression will set in at a later date. Nonetheless, the sample’s abortion rate does indicate either underreporting or a slight non-response bias. The sample is, moreover, relatively small, making the abortion and childbirth groups small as well. The study would have benefited from a larger sample.
Studies in this area present an inconsistent picture. Most identify abortion as a mental health risk factor, but they typically have selected samples, poor response rates and/or inadequate control for
other aspects of the women’s lives that could affect future risk of depression. The most robust study was conducted in New Zealand [4,8]. This study found that abortion seemed to be a risk factor for poor mental health, including the likelihood of depression.
Reactions to abortion are, one may assume, strongly coloured by the local sociocultural climate. A sense of guilt, loss and lower self-esteem are assumed to mediate between an induced abortion and later onset of depression [21]. New Zealand’s abortion laws are much more stringent than Norway’s [8], and this in itself could possibly increase the risk of social stigmatization and negative sentiment regarding abortion. It is therefore worth noting that such reactions are also experienced by many Norwegian women following an abortion. In light of this finding, women who terminate a pregnancy would probably benefit from postabortion counselling.

Next week, the APA Mental Health and Abortion Task Force report is slated to be considered by the APA Council of Representatives. If that report adopts the findings of this and the New Zealand research reports noted in the Pedersen article, it would represent a departure from prior APA positions. Stay tuned…

Reports of adverse reactions to abortion: How should mental health professional groups respond?

In addition to my work in sexual identity issues, I am quite interested in policy relating to the psychological reactions of women who have had abortions.
I have observed over the past several years that women who associate their abortion with mental health distress have approached the American Psychological Association with their concerns and stories. I blogged about an effort like this in 2007. Briefly, the letter sent by advocacy group, Silent No More, offered to put APA researchers in touch with women who had adverse reactions and asked for a meeting with the APA to discuss means of helping women with post-abortion problems. Georgette informed me that 600 women signed the letter. However, Georgette’s group received no response from the APA.
Another group, Lumina: Hope and Healing After Abortion, led by Theresa Bonopartis, sent a letter to each member of the Mental Health and Abortion Task Force requesting the opportunity to provide information about post-abortion reactions. She also received no response.
Contrast the reaction of the APA to women who believe abortion has triggered harm with the APA reaction to clients who report harm as a result of participation in reparative therapy and/or ex-gay ministries. The APAs (both the psychiatric and psychological groups) have been quite responsive to them, crafting advisories and almost banning reparative therapy in advance of publications systematically demonstrating harm. The major study of adverse reactions by Ariel Shidlo and Michael Shroeder took 5 years to solicit nearly 200 reports of various types of harm. In addition to this study, groups representing glbt people have met with and requested assistance from the APA to oppose reparative therapies.
Before I go on, I need to say that I am in favor of the APA taking seriously client concerns regarding reparative therapy and ex-gay ministries. I have been a persistent critic of reparative approaches as a general response to same-sex attraction. Further, I have consistently acknowledged that harm has been done by various methods to attempt sexual reorientation. The APA should vigorously pursue concerns about client welfare which are presented by clients and their advocates. Due respect should be shown to those who seek such services and ministries, but nonetheless, reports of adverse reactions should be addressed and investigated.
Having noted the appropriateness of the professional groups to attend to reports of adverse psychological reactions, I ask why the APA has not responded to the reports of adverse psychological reactions to abortion? These reports are common and compelling. Many more studies have found adverse reactions associated with abortion than have found such negative reactions to reparative therapy. I recognize that abortion is a much more common procedure than is reparative therapy but this fact should prompt an energetic response. In this context and speaking about APA conclusions about abortion and adverse reactions, I want to quote again a provocative question (see letter #2) from Bill Samuel, President of Consistent Life to APA president Alan Kazdin:

Is there any other phenomenon where the conclusion is based on those who do not have problems rather than on the therapeutic needs of those who do?

I might be misinformed, and in fact have an email in to the APA to check this, but I can find no indication that the APA has met with or responded directly to groups representing women who experienced adverse psychological reactions they attribute to abortion.
Now for some discussion. Am I missing something here? Is there something so different about these adverse reactions that could explain the differential response? At this point, I am thinking out loud…