Joining the Coleman et al study is a study reported by this Medical News Today news release:
Women who have an abortion face a small increase in the risk of developing common mental health problems such as depression and anxiety, according to a new study from New Zealand.
But the researchers, writing in the December issue of the British Journal of Psychiatry, say their findings point to a “middle-of-the-road” position on abortion – and do not support either the strong pro-life or pro-choice arguments.
Researchers from the University of Otago studied the pregnancy and mental health history of over 500 women born in Christchurch, a city in South Island.
The women were interviewed six times between the ages of 15 and 30. At each assessment, the women were asked whether they had been pregnant and, if so, what the outcome of that pregnancy had been. The women were asked whether the pregnancy was wanted or unwanted, and if this had caused them to be upset or distressed.
The women were also given a mental health assessment during each interview, to see if they met the diagnostic criteria for major depression, anxiety disorders, alcohol dependence and illicit drug dependence. The researchers took other confounding factors which might be associated with increased risks of various pregnancy or mental health outcomes into account.
Overall, 284 women reported a total of 686 pregnancies before the age of 30. These included: 153 abortions (occurring to 117 women), 138 pregnancy losses (including miscarriage, stillbirth and termination of ectopic pregnancy), 66 live births that resulted from an unwanted pregnancy (or one that provoked an adverse reaction), and 329 live births resulting from a wanted pregnancy (where there was no reported adverse reaction).
The study found that women who had had abortions had rates of mental health problems that were about 30% higher than other women. The conditions most associated with abortion included anxiety disorders and substance use disorders. In contrast, none of the other pregnancy outcomes were consistently related to significantly increased risks of mental health problems.
However, the overall affects of abortion on mental health were found to be small. The researchers estimated that exposure to abortion accounted for between 1.5% and 5.5% of the overall rate of mental disorders in this group of women.
Professor David Fergusson, John Horwood and Dr Joseph Boden said their study had “important implications for the ongoing debates between pro-life and pro-choice advocates about the mental health effects of abortion”.
Writing in the British Journal of Psychiatry they said: “Specifically, the results do not support strong pro-life positions that claim that abortion has large and devastating effects on the mental health of women. Neither do the results support any strong pro-choice positions that imply that abortion is without any mental health effects.
“In general, the results lead to a middle-of-the-road position that, for some women, abortion is likely to be a stressful and traumatic life event which places those exposed to it at a modestly increased risk of a range of common mental health problems.”
“Abortion and mental health disorders: evidence from a 30-year longitudinal study.” Fergusson D, Horwood LJ and Boden JM (2008). British Journal of Psychiatry, 193: 444-451
I am still reviewing the study but it looks like the APA should have waited to bring out their report on abortion and mental health.
I posted extensively on the APA Task Force on Mental Health and Abortion in August, including comments from New Zealand researcher David Fergusson. This month, the Psychiatric Bulletin published an editorial by Dr. Fergusson.
The editorial supports the recent Royal College of Psychiatrists’ statement regarding abortion and mental health.
Fergusson’s editorial notes the contrast between a RCP statements in 1994 and 2008. The 1994 view was that no relationship existed between abortion and mental health. Currently, the RCP cautions about the possible effects and suggests post-abortion counseling.
Fergusson notes that such debates are important, especially in the UK since mental health concerns are offered as the major reason a woman is granted an abortion. If mental health status is not improved, or may be worsened, the effects of abortion have major relevance to policy.
It is unlikely that these problems of evidence, uncertainty and the law will be resolved by further medicolegal debates between pro-life and pro-choice advocates. What is required is a well-designed, well-funded and, above all, impartial programme of research into the mental health risks, benefits and consequences of abortion. The recent Royal College of Psychiatrists’ statement makes an important contribution to this process by highlighting the real uncertainties that exist in the current evidence on abortion and mental health.
It is hard for me to read this in any other way but as a critical contrast to the recent APA 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.