A Tale of Two Studies: abortion and mental health
17 Dec, 08 | by Steven Reid
I came across both of these statements in the medical press last week:
- Abortion does not cause mental health problems, says large review
- Abortion is bad for your mental health
Which one to believe? The first was a news headline in the BMJ, referring to a recently-published systematic review published in Contraception, a journal dealing with matters related to…contraception. The second is the editorial summing-up of a cohort study in the current issue of the British Journal of Psychiatry. In the hotly-contested battle over abortion and choice these contradictory findings will be welcomed as further ammunition by both sides.
Have a look at the two papers though, and it’s not so clear that their findings really are in such stark opposition. The systematic review summarises 21 studies looking at elective abortion and long-term mental health outcomes. As is usually the case with observational research poor quality studies found the biggest differences. The highest quality studies (using better methods) found few, if any, differences in psychological outcomes between women who had abortions and the comparison groups. The second study is an analysis of data from a birth cohort in New Zealand – it arrived too late for inclusion in the systematic review but would clearly be considered good quality. Here some differences were found: abortion was associated with a small increase in risk. Women who had an abortion were 30% more like to have subsequent mental health problems (depression, anxiety, or drug misuse) when compared to other pregnancy outcomes.
You can try and explain this positive finding by looking at the differences in methods and comparison groups, as well as differing abortion legislation in the UK, US and New Zealand, but it’s difficult to argue with the authors’ comment that “for a minority of women abortion is a highly stressful life event which evokes distress, guilt and other negative feelings that may last for years.” That seems pretty obvious to me and raises the question of whether in this instance more research really is needed.
So do these studies inform the debate on abortion? I’m not convinced that they will add much to what are primarily moral arguments but one consistent finding is the lack of evidence that abortions reduce the risk of mental health problems for women with an unwanted pregnancy. Despite this, over 90% of abortions in the UK are undertaken on the grounds that to proceed with the pregnancy would pose a serious threat to the mental health of the woman. Isn’t it time that the law acknowledged reality: that access to abortions in the UK is largely unrestricted?
I agree with Dr Reid. I wonder how many of the doctors who sign abortion forms really believe that proceeding with the pregancy would pose a serious threat to the woman’s mental health?
Lets ditch the deception!
Jo
December 20th, 2008 at 12:12 am
Perhaps the research is needed in order to justify further support services (or sufficient implementation of existing ones) for those women who might be considered to be at risk of subsequent mental health problems? From the posting (I haven’t read the articles yet) it isn’t clear whether the 30% increased risk (of mental health problems postabortion found in one study) is a significant increase over the risk in the general population. NNT?
Julie Solomon
January 6th, 2009 at 2:49 pm
Unfortunately the incident rates are not given in the paper but the authors do provide a range for the attributable risk: 1.5 to 5.5%. That’s an estimate of the proportion of mental disorder in this study sample caused by abortion and I don’t think that number would justify additional or specialist services. My concern with repeating these studies is that they add little light but certainly generate a lot of political heat.
Steven Reid
January 6th, 2009 at 5:08 pm