The BJP Paper on Abortion

I’ve now finished reading the paper on abortion and mental health that appeared in the latest issue of the British Journal of Psychiatry. The paper is dynamite and I’ll summarise it below.

  1. This is not an individual study but rather a “quantitative synthesis and analysis” of all the research on the subject published between 1995 and 2009. What that means in real language is that the author, Priscilla K Coleman, has looked at the 22 studies in this area during the past 15 years, tried to minimise any bias in the individual studies and presented the “overall” picture that the amalgamated data from 877181 women (163831 of whom had had an abortion) tells us. In the authors own words, this exercise produces “the largest quantitative estimate of mental health risks associated with abortion available in the world literature“. The broad picture reveals that women who have an abortion have an 81% increased risk of mental health problems when compared with women who don’t. This constitutes “a moderate to highly increased risk of mental health problems after abortion“.
  2. Specifically, the pooled odds ratio for mental health issues for women who had had an abortion (compared to those who hadn’t) was 1.81. The 95% Confidence Interval was 1.57–2.09 at P <0.0001. In laymans terms that means that it is very unlikely that the real figure (81% is, coming from a sample, simple the “most likely figure”) is less than 57% (i.e. that women who had an abortion were 57% more likely to have mental health issues). The key point is this – there is PRACTICALLY NO DOUBT that women who have abortions are more likely to have mental health issues, even if the figure is not in reality exactly 81% more likely.
  3. Within this general figure of 81% more likely, there were variations in individual mental health issues. The specific figures were:
    Cannabis Use 230% Increase
    Suicide 155% Increase
    Alcohol Misuse 110% Increase
    Depression 37% Increase
    Anxiety 34% Increase
  4. Comparisons were also made between different subsets of women who had or hadn’t had pregnancies and who did or didn’t take those pregnancies full term. The figures were as follows.
    Abortion v No Abortion 59% Increase
    Abortion v Carried to Term 138% Increase
    Abortion v Carried to Term (unplanned pregnancy) 55% Increase

The paper summarises the findings with the following comment.

Based on data extracted from 22 studies, the results of this meta-analytic review of the abortion and mental health literature indicate quite consistently that abortion is associated with moderate to highly increased risks of psychological problems subsequent to the procedure. The magnitude of effects derived varied based on the comparison group (no abortion, pregnancy delivered, unintended pregnancy delivered) and the type of problem examined (alcohol use/misuse, marijuana use, anxiety, depression, suicidal behaviours). Overall, the results revealed that women who had undergone an abortion experienced an 81% increased risk of mental health problems, and nearly 10% of the incidence of mental health problems was shown to be directly attributable to abortion. The strongest effects were observed when women who had had an abortion were compared with women who had carried to term and when the outcomes measured related to substance use and suicidal behaviour.

Why is this all significant? Here is the wording of the 1967 Abortion Act (Amended):

(1) Subject to the provisions of this section, a person shall not be guilty of an offence under the law relating to abortion when a pregnancy is terminated by a registered medical practitioner if two registered medical practitioners are of the opinion, formed in good faith—

(a)that the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family; or

(b)that the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman; or

(c)that the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated; or

(d)that there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.]

(2) In determining whether the continuance of a pregnancy would involve such risk of injury to health as is mentioned in paragraph (a) or (b)] of subsection (1) of this section, account may be taken of the pregnant woman’s actual or reasonably foreseeable environment.

The number one reason given for permitting an abortion is injury to the mental health of the pregnant woman (97.7% in 2010). If the evidence proves definitively that, on average, a woman is more likely to suffer injury to her mental health by undertaking an abortion rather than carrying on with the pregnancy, how can it be justified for a doctor to sign the necessary paperwork arguing the opposite?

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