Wednesday, November 02, 2005

British Medical Journal research paper on abortion and depression should not have been represented by news outlets as conclusive proof of anything

see also: University of Oslo researchers find that abortion causes more longer term anguish than miscarriage (12th Dec)

Anyone who saw the cavalier and misleading news reports last week which made sweeping overgeneralisations that abortion is not linked to depression should read David Reardon’s comprehensive online rebuttal of Nancy Russo’s research in the rapid responses to the British Medical Journal article (see Study Fails to Address Our Previous Findings and Subject to Misleading Interpretations (Rapid response, David Reardon, 1/11/05). David Reardon has published extensively about the increased rate of depression following abortion in the BMJ in 2002 and in the Canadian Medical Association Journal in 2003, which found that 6.5 per 1000 women were admitted for the first time to a psychiatric unit within 4 years of a live birth, compared with 12.9 per 1000 women admitted within 4 years of an abortion.

Russo's research paper criticised Reardon's conclusions but also failed to note, as Reardon pointed out, how extensive the literature is on the link between on abortion and depression by concentrating only in critiquing Reardon's work and not mentioning the literature, which include a paper by Russo herself which revealed significant increases in depression, suicidal ideation, and lower life satisfaction, even though Russo hypothised that this is due to factors other than abortion. It is a pity that the mainstream media are unlikely to report Reardon's objections in full and that the misleading impression generated by Russo's paper is allowed to stick.

The immediate flaw that jumped out at me when I looked at the research by
Russo in the BMJ online first
, which was reported by BBC Newsonline as
“Abortion depression link queried” and by the Times as “First abortion 'not linked to depression'” was that these headlines were too sweeping and inaccurate given that Russo’s study explicitly stated that they had deliberately left out cases involving women who underwent abortions in which the pregnancy was wanted, even though these women are the most at risk of
suffering from depression. Far from proving that abortion in general does not cause depression, if Russo’s research was to be believed it is only applicable to pregnancies women classify as “ unwanted”, and even then the conclusions can be challenged. So far from disproving earlier findings, Russo's research simply ignored them. As David Reardon says in his rapid response "their results do not contradict ours" as they "can easily be reconciled with our own findings" - any differences in results “can primarily be explained by differences in coding of key variables and sample selection.”

Reardon's says "Ambivalence about pregnancy and abortion is common. I do not doubt that there was a group of women who
had swings in “wanting” their pregnancies, which ended in a decision against keeping the pregnancy. Indeed, ambivalent swings from wanting to unwanting a pregnancy is a well-known risk factor for emotional turmoil after an abortion.For example, research by Husfeldt and colleagues found that 44% of participants experienced doubts about a decision to abort upon
confirmation of their pregnancies, while 30% continued to have doubts on the day of their abortions. Eliminating this subset of women may significantly bias the analysis by eliminating a class of women who have abortions who may be at highest risk of post-abortion depression.


Not only does the selection of women in the abortion sample skew the findings but somewhat strangely the researchers also included women who went on to have an abortion in the control group. The control group should have consisted only of women who gave birth following unintended pregnancy in order to avoid introducing a bias, but instead it included women who had abortions too and therefore means that the depression scores for the control group could have been high due to subsequent abortions, not due, as the researchers concluded, to giving birth. Indeed, Reardon points out that there is some evidence that women who have given birth who go on to have an abortion are at a greater risk of emotional sequelae. As the time lapse under analysis is eight years after the first pregnancy, it is even more likely that the depression score may be due to the subsequent abortion and not the original pregnancy that went to term. By including women who had abortions in the control group, it lessens the chance of being able to detect any statistical difference between the delivery group and the abortion group. Reardon also notes that Russo's study does not involve any control variables for women who gave birth, and does not include any consideration of concealed abortions which is thought to be as high as 60% (compared with national averages, only 40% of the expected number of abortions are reported) which means that another confounding effect in the control group may result from the inclusion of minors who became pregnant with two years of an abortion where the abortion is not recorded. Reardon concludes that there needs to be more research not less in this area.

Proabortionists are typically dismissive of the link between abortion and depression. Nancy Russo was quoted in January 2004 by a science reporter from the Toledo Blade newspaper saying "As far as I'm concerned, whether or not an abortion creates psychological difficulties is not relevant...it means you give proper informed consent and you deal with it". Perhaps unsurprisingly, given her membership of the proabortion board of the UK Prochoice forum she also uses her research to promote abortion as a way of lowering the risk of depression, when she is quoted in The Times saying that "research should focus on how to prevent and ameliorate the effect of unwanted childbearing, particularly for younger women", a conclusion which is obviously contradictory to the vast body of research studies cited by Reardon.

Abortion agencies that carry out abortions like the British Pregnancy Advisory Service and have an ideological commitment to abortion on demand for any reason up to and including birth were quoted in the Times saying that few women return for post abortion counselling. Given that proabortionists regularly say "few" abortions are carried out past 20 weeks, even though there are over 3,000 abortions carried out on babies over 20 weeks gestation, the word "few" could really mean anything. But even if few women do go back to BPAS, is it really surprising given that this is the organisation that carried out the abortion in the first place?

7 Comments:

Blogger Liz said...

Fiona,
I saw that article in the Guardian and I already had details of other studies that contradict it. Doing research on the web I came accross more, including the Reardon study.
The trouble is that is is impossible to find studies that are conclusive as they are not wide ranging enough and fail to cover enough people over a large enough time period. But you're right, it is annoying that there is such a bias in the media about the issue. Only the Telegraph it seems ever report anything negative about abortion, the Guardian have an appalling editorial line.

8:09 AM  
Blogger Fiona said...

hi Liz thanks for your comments. It's quite interesting to see that Nancy Russo hasn't replied to the reply from David Reardon. He's very measured in his response - calling for more research etc.

I find it quite astonishing the way the pro-choice lobby shuts down debate and denies negative aspects about abortion, before even looking at the evidence. I was on a radio show where the abortion rights spokesperson was talking about women's right to choose even though the callers were talking about how they were pressurised into abortion. The line we should all be able to agree on is maximum information and support for women, although the problem with future depression is that no one can see the future and guarantee against depression.

I'd be interested in your thoughts on the Guardian and on anything else on this blog. does your blog on prolife socialism still exist?
best wishes.

12:26 PM  
Blogger Liz said...

Fiona,

What you tell me about Radio 4 doesn't surprise me in the least.
The actual feelings of women are often denied, it seems the issue of 'choice' has become a sacred cow to many. I have mentioned women who are pressured to abort and people still bring back the 'right to choose' slogan.

The Guardian has the most bias in the press on the abortion issue. I will check ut Reardon's response in full, but the way the Guardian headline ran was 'Study shows Abortion is not linked to Depression' - what a lie!

My pro life socialism blog isn't set up yet but I'll let you know when it is.

8:29 AM  
Blogger Fiona said...

thanks. I'd be interested in your blog.

It would be good if the Guardian could be persuaded to be a bit more consistent about children's rights. It really makes the paper look ridiculous to have a pro-child protection editorial on one page and a pro-abortion article on the facing page. And then there was the women's manifesto that started off with the right to abortion and then moved on to childcare! I can't be the only person who thinks that Labour is nonsensical and hypocritical when it promotes a surestart for every child but supports abortion.

It would also be nice to see the Guardian giving a little bit of column space now and again to the prolife viewpoint. Not only because it probably irritates at least a section of the Guardian's readers to read proabortion columnists given exclusive space on this subject, but also because it really makes the proabortion argument look very weak when no alternative viewpoint is allowed column space.

3:42 AM  
Blogger Liz said...

Fiona,

I've just set up my pro life socialism blog but I'm still figuring out how to use it properly, I'm quite new to it.

Take a look if you want, it is at:
http://progessiveforlife.blogspot.com/

Can I put a link on it to this blog?

5:28 PM  
Blogger Fiona said...

hi Liz

thanks for sending the link, looks excellent, and you're outblogging me!! ;o(

am very busy at the moment so haven't linked to the ones you have.

yes please link to me and I'll link back when I have a moment to add it, probably tonight.

also please can you email me on fiona at fionapinto dot com --- would like to email you one comment rather than post it.

best
Fiona

4:13 PM  
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