Category: abortion

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.
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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…

Handicapping the APA abortion and mental health task force report

Last week, I reported the concerns of peace advocates, Consistent Life, about the upcoming American Psychological Association report regarding potential mental health consequences of abortion. In one of their letters to APA President Alan Kazdin, CL Executive Director, Bill Samuel, wrote:

It is accordingly with great concern we note APA has not taken sufficient care with a highly volatile issue, that of abortion. APA has held a position of abortion as being a civil right for women since 1969, and therefore has a clear political stand. Yet the Task Force on Mental Health and Abortion had no call for nominations; it was formed by Division 35, whose position is stronger and more focused than that of the national organization; and the final make-up of the task force had half the members as strong public advocates of the pro-choice view. Advocates of the view that abortion is violence to both unborn children and to women, which could balance such biases, are ominously absent. There are several well-qualified researchers who would have been pleased to serve on the panel, had the panel been selected with balance in mind.
Consider also that the report of this task force is scheduled to come out during an election year, 2008. The APA position is in accord with that of one of the major political parties, and in opposition to that of the other. When a prestigious organization puts out a report on a politically volatile issue at a time when political passions run particularly high, any imbalance on the task force will not pass unnoticed. Surely critics and observers will highlight the fact that members of such a task force were unbalanced in favor of those whose views matched the political position of the organization. The absence of those who could best challenge assumptions, provide alternative explanations, and offer differing interpretations of the same data will not be overlooked. We hope you will pause to reflect upon how partisan this will appear.

Dr. Kazdin wrote back to say that the APA report “must be grounded in the strongest, peer-reviewed science available…” This is of course the correct answer but I maintain that the Consistent Life people have raised valid points of concern. The task force report is to be released in August at the APA convention if approved by the Council of Representatives.
Beyond the appearance of bias, there is a more obvious indication of how the APA will report the research on abortion and mental health consequences. In the June 2008, APA Monitor, Rebecca Clay wrote an article on how the right wing misuses scientific research. In her article titled, “Science vs. ideology: Psychologists fight back against the misuse of research,” Clay interviews abortion researcher Nancy Adler regarding how anti-abortion psychologists are seeking legitimacy for their perspective by, shudder, doing research and reporting in peer-reviewed journals. Do you think the task force will see things much differently than Dr. Adler?

In other issue areas, special-interest groups have assumed the trappings of science to bolster ideology-driven claims. One example is so-called “post-abortion syndrome,” a scientific-sounding name for something most researchers say doesn’t exist. Nancy E. Adler, PhD, a professor of medical psychology at the University of California, San Francisco, is one of them. She has found that the rate of distress among women who’ve had abortions is the same as that of women who’ve given birth. Adler and other experts reviewed the literature in the late 1980s as part of an APA panel and found no evidence of a post-abortion syndrome. Even the anti-abortion Surgeon General C. Everett Koop, MD, refused to issue a report on abortion’s supposed psychological impact when President Ronald Reagan asked him to, citing the lack of evidence of harm.
Since then, says Adler, anti-abortion advocates have become more world-wise.
“They’re using scientific terminology,” she points out. They’re also gaining credibility by getting published in mainstream journals.
But such research often has methodological problems, Adler claims.
“Women are not randomly assigned to have abortions,” she points out. “Women who are having abortions are having them in the context of an unwanted pregnancy, which usually has some other very stressful aspects. Their partners may have left them. They may have been raped.”
In addition, says Adler, proponents of the syndrome don’t mention the base rate of depression and other psychological problems in society as a whole. And they always attribute such problems to abortion rather than any other possible causes.
A new APA Task Force on Mental Health and Abortion will examine such issues in a report later this year.

I think this is probably signals how the APA’s task force report will turn out. The good guys use good methods and the bad guys use the “trappings of science” and are being sneaky by “getting published in mainstream journals.” I guess the way to tell the good research from the bad is not the quality of peer-reviewed work but the ideology of the researcher. What I get from Clay’s article is this: When an APA-approved policy position is supported, it is science; otherwise, it is ideology.