It is being hailed in Britain as a major breakthrough in professional attitudes to abortion. Last weekend the Royal College of Psychiatrists issued a statement acknowledging that induced abortion may harm a woman’s mental health and advising professionals to assess and counsel women accordingly. The cautious one-page document, noting that the evidence for the association is inconclusive, may seem “anodyne” says one psychiatrist, who prefers not be named, but in reality it is “a huge step. It’s a shift from being pro-choice to being neutral.”
“Balanced and reasonable” is the verdict of the author of well-regarded New Zealand research on abortion showing its link with mental disorders. “The statement acknowledges the risks to mental health, but it also acknowledges the uncertainty. I think it’s really exemplary in its objectivity,” said David Fergusson in a telephone interview with MercatorNet. Professor Fergusson is director of the Christchurch Health and Development Study, which has followed the progress of 1265 children born in the city in 1977. Data from interviews with women in the study published two years ago showed a 50 per cent higher risk, overall, of problems including depression, anxiety, suicidal behaviours and substance abuse among those who had had an abortion.
“Our laws require that the effects should be beneficial. There is
research that shows harmful effects, or no harm — and it’s all open to
debate — but there’s nothing I can find that shows beneficial effects
on mental health.” – Prof David Fergusson
In Britain, the psychiatrists’ statement has raised the stakes in an already momentous debate about abortion. “This is the first time a royal college in the United Kingdom has acknowledged this correlation,” says Josephine Quintavalle, director of Comment on Reproductive Ethics (CORE). She expects it to have a significant effect on the Human Fertilisation and Embryology Bill due to be debated in the House of Commons next month. The highly contentious legislation would allow the production of animal-human hybrid embryos and permit lesbian partners to register as joint legal parents of a child; but it also presents the first opportunity in nearly two decades to vote on abortion and to bring the country’s law into line with new evidence about foetal development and the effects of abortion on women.
A pro-life campaign called Alive and Kicking is promoting several amendments: a substantial lowering of the 24-week upper limit for abortions; an end to the discriminatory practice of permitting abortions of disabled babies up until birth; and a charter of informed consent for women seeking abortion.
The issue of informed consent was tragically highlighted by a coroner’s hearing in the UK last month of the case of Emma Beck, a talented artist who hanged herself on the eve of her 31st birthday after the abortion of her twins when she was eight weeks pregnant. She was pleased at the pregnancy but her boyfriend was not. Her suicide note read: “I told everyone I didn’t want to do it, even at the hospital. I was frightened, now it’s too late.”
Informed consent: risks and benefits
Too late for Emma, but high time professional groups reconsidered their position. The last time the RCOP declared itself on the subject of abortion and mental health, in 1994, it was confident that “the risks to psychological health from the termination of pregnancy in the first trimester are much less than the risks of proceeding with a pregnancy which is clearly harming the mother’s mental health.” And, despite an increased risk of psychiatric disorder among women who had abortions in the second trimester — for such reasons as foetal abnormality — this risk was “still likely to be less than the risk of continuing with the pregnancy”.
Now, having reviewed the scientific literature on the subject, the psychiatrists are not so sure. They first say that pregnancy and childbirth themselves are linked with mental disorders in some women. Some studies show a similar link for induced abortion, while others do not, they continue. They next focus on women with pre-existing psychiatric disorders, saying that both those who continue with their pregnancy and those who undergo abortion will need “appropriate support and care.”
The next part of the statement is significant because it concerns all women seeking an abortion: “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.”
In addition, good professional practice 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 [note, physical also]. This may require updating of patient information leaflets …. And education and training to relevant health care professionals, in order to develop a good practice pathway.” Finally, the royal college commits itself to further systematic reviews to see whether abortion negatively impacts mental health.
Scandalously little research
Perhaps this commitment will stimulate more of the necessary research, since there is scandalously little of it for a procedure which is carried out in more than 90 per cent of cases in the UK — and New Zealand, which has a similar law — on the ground that it will actually benefit the woman’s mental health.
Professor Fergusson points out that “benefit” means more than “do no harm”.
“The debate now is whether abortion harms mental health. But the proper debate for the legislation we are talking about is whether it’s beneficial. Even if the effects were merely neutral, that would not satisfy our laws. Our laws require that the effects should be beneficial. There is research that shows harmful effects, or no harm — and it’s all open to debate — but there’s nothing I can find that shows beneficial effects on mental health.”
It is not as though researchers lack possible subjects for study. After assistance with childbirth, abortion is probably the most common surgical procedure for young women. More than 200,000 abortions were carried out in the UK in 2006 — the most recent year for which figures are available — and more than 6.6 million during the 40 years since the law was liberalised. To many of us that represents a huge social crime. In the absence of robust research, it also amounts to a massive uncontrolled experiment with women’s physical and mental health.
Professor Fergusson says the possibility that abortion has harmful effects has been dismissed too readily by practitioners and authorities. He maintains that the “ideological debate between the feminist left and the religious right” has scared researchers away from the field. If that is the case, his own example should encourage the others, since he describes himself as “pro-choice” and yet has come up with what some would call “pro-life” findings.
But the studies have to be well designed and we need a lot more of them, he warns. “Because of the intense emotions this subject arouses, any evidence must be very strong to carry the day one way or the other. In the area of abortion studies the evidence has been weak, and this has given adversaries in the ideological debate scope to dismiss it.”
Taking its cue from the royal college, he believes the British government, or indeed any government, should now “invest in some good research in this area. That is the appropriate and best route they could take.”
Carolyn Moynihan is deputy editor of MercatorNet.