Our culture is in a worrisome state when major medical journals ignore the foundation and methods of science in service to a political end. Equipped for decades with billions in grant revenue, ideological control of the academy, and agenda-driven professional organizations, scores of scientists have suspended personal and professional ethics to safeguard women’s right to end the lives of their children and suffer the concomitant effects. Dr Antonia Biggs and colleagues are just the latest to march down this path with their JAMA Psychiatry article titled “Women’s Mental Health and Well-Being 5 Years after Being Denied an Abortion: A Prospective, Longitudinal Cohort Study.”
What once appeared to be a subtle mainstream journal bias in favor of publishing results, suggesting abortion poses no threat to women’s psyches, has morphed into a peer-review process, blind to scientific deficiencies as long as the results further leftist abortion rights initiatives. These are desperate times for the pro-choice community, as they seek to block women-centered abortion laws rooted in strong empirical evidence and the voices of brave women standing up to share their post-abortion struggles. What better way than to grab bullet points from a JAMA article and flood the popular media with them? Women deserve better and here is why the latest study results have absolutely no merit and will not hold up in any court.
Study results and their obvious bias
The authors compared women who received abortions just under legal gestational limits with women who wanted an abortion but were denied, because they were just over the facility gestational limit (Turnaway Group) relative to psychological outcomes. The Turnaway Group was subdivided into those who gave birth and those who obtained an abortion subsequently or miscarried. The authors summarized the results by stating “Women who were denied an abortion, in particular those who later miscarried or had an abortion elsewhere (Turnaway no-birth group), had the most elevated levels of anxiety and lowest self-esteem and life satisfaction 1 week after being denied an abortion, which quickly improved and approached levels similar to those in the other groups by 6 to 12 months.”
The authors’ objective for publishing the study is introduced in the opening line: “The idea that abortion leads to adverse psychological outcomes has been the basis for legislation mandating counseling before obtaining an abortion and other policies restricting abortion” and it is nailed down at the end of the article when they state “…there is no evidence to justify laws that require women seeking abortion to be forewarned about negative psychological responses.” As scientists we never make such sweeping conclusions based on a single study, particularly when there is an abundant literature comprised of sophisticated studies with discrepant conclusions. Courts throughout the US have concluded that women should be appraised of the risks before consenting to abortion; it is absurd that these researchers have attempted to shift the tide based on this one study. Funding was predictably secured from the David and Lucille Packard Foundation among other sources with a political agenda. As described on their website, “Our work in the United States seeks to advance reproductive health and rights for women and young people by improving access to quality comprehensive sexuality education, family planning and safe abortion care.”
Results are inconsistent with the current state of knowledge
The results of hundreds of studies published worldwide over the past three decades indicate that abortion is a substantial contributing factor to women’s mental health problems. I published a meta-analysis on the association between abortion and mental health in the British Journal of Psychiatry (BJP) in 2011. In a meta-analysis, the contribution of any particular study to the final result is based on objective scientific criteria (sample size and strength of effect). The BJP sample consisted of 22 studies and 877,297 participants. Results revealed that women who aborted experienced an 81% increased risk for mental health problems. When compared exclusively to unintended pregnancy delivered, women were found to have a 55% increased risk of experiencing mental health problems. This review offers the largest quantitative estimate of mental health risks associated with abortion currently available. Evidence of this nature has influenced informed consent legislation in many states. For example, upholding the South Dakota law in 2012, the US Court of Appeals relied upon the emerging body of data.
The authors suggest that later abortions are healthier for women than childbirth when women seek abortions, obscuring the well-documented risks of late abortions to women’s physical well-being in addition to the elevated psychological risks. For example, using national data, Bartlett and colleagues reported in 2004 that the relative risk of abortion-related mortality was 14.7 at 13–15 weeks of gestation, 29.5 at 16-20 weeks, and 76.6 at or after 21 weeks. This compares to a 12.1 rate for childbirth. Bartlett reported that the causes of death during the second trimester included hemorrhage, infection, embolism, anesthesia complications, and cardiac and cerebrovascular events.
Many women who make the decision to abort do so without a thorough understanding of the procedure. A number of studies have revealed that feeling misinformed or being denied relevant information often precipitates post-abortion difficulties. There is also considerable evidence that a high percentage of women walking into abortion clinics are conflicted about the choice. In a 2006 study I published with colleagues in the Journal of Medical Ethics, we found that 95% of a socio-demographically diverse group of women wished to be informed of all possible complications associated with drugs, surgery, and/or other forms of elective treatments, including abortion. Fortunately state-level legislation has responded to the needs of women, respecting the gravity of an abortion decision by mandating dissemination of accurate information on the procedure and risks involved, time to reflect on the decision, and sensitive pre-abortion counseling.
This latest study in JAMA will be aptly tossed on the dusty stack with other similarly compromised studies that have yielded results palatable to a culture fighting to normalize a procedure that will never feel natural or right to countless women. The studies will be unattended to by the average person, clinicians, and the science-savvy alike, because the results simply do not align with the lived experiences of women.
Priscilla Coleman PhD is Professor of Human Development and Family Studies at Bowling Green State University in the US).