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Round and Round She Goes: More on Abortion and Mental Health

In the September 2011 issue of the British Journal of Psychiatry [1], Priscilla K. Coleman, of Bowling Green State University in Ohio, published an influential statistical analysis of the existing research on the question of abortion and mental health (reported to be the “largest quantitative estimate of mental health risks associated with abortion available in the world literature”; see my Sept. 14 Zenit article [2] ).  Her study concludes that women who have induced abortions because of unwanted pregnancies suffer an incredible 81% increased risk of mental health problems across a variety of categories.

Now, a new and improved “world’s largest” study concludes precisely the opposite.  On December 9, the London-based Royal College of Psychiatrists (RCP) published a report entitled “Induced Abortion and Mental Health: A Systematic Review of the Mental Health Outcomes of Induced Abortion, Including their Prevalence and Associated Factors [3].”  The 248 page review, purporting to be the “the world’s largest, most comprehensive and systematic review into the mental health outcomes of induced abortion,” concludes that procuring an abortion for an unwanted baby poses no more danger to a woman’s mental health than bringing an unwanted child to birth.  The real danger to women’s mental health lies not in having an abortion, but in carrying an “unwanted pregnancy.”

How can two empirically based comprehensive reviews of the literature on the same subject render such contradictory conclusions?

Earlier this week, Dr. Coleman released a short critique (copied below) of the RCP report, which she called “hauntingly similar” to other influential literature reviews on the subject, specifically a widely quoted report [4] in 2008 by the American Psychological Association.  She concludes that the RCP report was “not undertaken in a scientifically responsible manner” and sets forth several reasons why scientists and clinicians should reject its conclusions.

Perhaps the most significant reason is that the RCP study, she says, ignores “large segments” of the scientific literature on abortion and mental health.  Coleman mentions 74 studies in particular: 19 literature reviews published between 1990-2011; 35 empirical studies examining the prevalence of post-abortion mental health problems and comparing the mental health of women who abort with those who carry unplanned pregnancies to term; and 20 more empirical studies “published in highly respected peer-reviewed journals” identifying risk factors for post-abortion mental health problems.

Three dozen of these studies, she notes, were excluded simply because they did not follow their subjects for more than 90 days.  The RCP report says the studies were likely to be measuring merely “transient reactions to a stressful event” (namely, having an abortion) and not real mental health problems caused by the event.  Coleman believes this exclusion criterion is superficial.  Women who suffer reactions in the first 90 days may very well continue suffering long after the study in which they participate concludes.  Moreover, to exclude their mental health complications as “transient reactions” is completely unwarranted.  Their reactions may very well constitute “serious and more acute episodes” that are amenable to treatment soon after exposure.  She notes that the RCP report itself even states: “Women who show a negative emotional reaction immediately following an abortion are likely to have a poorer mental health outcome.” Coleman asks: “How can this ‘conclusion’ be derived if studies that only examined women in the first 3 months following abortion were eliminated?  Moreover, if this is true, why would these studies have been eliminated in the first place?  Shouldn’t the researchers be most concerned with those most likely to be adversely impacted?”

Dr. Coleman concludes her critique with the following strong words:

“This report constitutes no less than a crafty abuse of science and if the merits of this report are not seriously challenged, we will shamefully grow more distant from our ability to meet the needs of countless women.  Until there is acknowledgement than scores of women suffer from their decision to undergo an abortion, we will remain in the dark ages relative to the development of treatment protocols, training of professionals, and our ability to compassionately assist women to achieve the understanding and closure they need to resume healthy lives.”

Her entire letter is copied (with permission) here [5]