Priscilla Coleman, Ph.D.
Bowling Green State Universi ty
Questions I’ll address today:
• Who is most at risk for psychological
harm following abortion?
• What are common negative postabortion psychological responses?
• How strong is the evidence in 2012?
• What are the obstacles to
information dissemination and what
progress that has been made?
Women at risk
I recently searched the
MEDLINE, PubMed,and
PsycINFO data bases for
articles identifying
demographic, personal,
relational, and
situational factors that
place women at risk for
experiencing postabortion mental health
problems.
Descriptors Used in the Searches:
1. Therapeutic abortion, elective abortion, and induced abortion.
2. At-risk, risk-factor, predictor, susceptibility, vulnerability.
3. Psychiatric morbidity, mental health, trauma, psychological
adjustment, psychological complications, psychological
distress, psychological disorders, psychological harm,
psychological problems, emotional adjustment, emotional
complications, emotional distress, emotional disorders,
emotional harm, emotional problems, suicide, mood disorders,
depression, anxiety, Post-traumatic Stress Disorder, substance
abuse, substance use.
Women at Risk
Search Process:
• Over 400 potentially
relevant abstracts
were identified.
• 258 full articles were
closely examined for
relevancy.
• 119 empirical articles
were summarized and
evaluated.
1972-2011
What are the most well-established risk
factors for mental health problems in
the empirical literature?
The pregnant women is pressured or
coerced by others to abort (9 studies)
She is religious or views an abortion to be
in conflict with her personal values
(10 studies)
The pregnant woman was
ambivalent about the abortion,
experienced abortion decision
difficulty, and/ or had a high degree
of decisional distress.
(21 studies)
She was committed to the pregnancy
or she preferred to carry the child to
term (7 studies)
The pregnant woman believed
that abortion terminates the
life of a human being and /or
she experienced bonding to the
fetus (6 studies)
She had pre-abortion mental health
or psychiatric problems (31 Studies)
The pregnant woman was an
adolescent or young adult (15 Studies)
She was in a conflicted, unsupportive
relationship with the father of the child
(24 studies)
The pregnant women experienced
negative relationships with others
(28 studies)
Character traits suggesting emotional
immaturity, instability, or difficulties
coping, including low self-esteem, problems
describing feelings, being withdrawn,
avoidant coping, blaming oneself for
difficulties etc. were present (42 studies)
Indicators of poor quality
abortion care (feeling
misinformed/inadequate
counseling, negative
perceptions of staff, etc.)
(10 studies)
Many of the risk factors are complexly
interconnected
For example, a woman who feels attached to her
fetus and desires to continue the pregnancy may also
be pressured from her partner to abort if the
relationship is unstable, leading to feelings of
ambivalence and stress surrounding the decision. If
she suffers from low self-esteem and has trouble
articulating her feelings, she may be particularly
prone to yielding to the pressure.
How Common are the Risk Factors?
• 44% of women
had doubts about
their decision to
abort upon
confirmation of
pregnancy
(Husfeldt et al.
1995).
How Common are the Risk Factors?
• 46% of women who abort
report a conflict of
conscience (Kero et al.,
2001).
• 25% of women who abort
view it as as terminating a
human life (Smetana &
Adler, 1979).
• 50.7% of American women
who abort feel it is morally
wrong (Rue et al., 2004).
How Common are the Risk Factors?
In a study using 5 screening
criteria (psychosocial
instability, an unstable
partner relationship, few
friends, a poor work history,
and failure to use
contraception), Belsey and
colleagues found that 68%
of the 326 abortion patients
were at high risk for
negative psychological
reactions, necessitating
counseling.
Forty years of research has shown
that when specific physical,
psychological, demographic, and
situational factors are operative in
women’s lives, they are at a
significantly increased risk of
experiencing mental health problems
following abortion.
Even Abortion Doctors Agree on Risk Factors
Two decades ago, Hern (1990) emphasized the
central role of pre-abortion counseling in
evaluating women’s mental status,
circumstances, and abortion readiness while
stressing the importance of developing a
supportive relationship between the counselor
and patient to prevent complications.
Hern also discussed the necessity of the
counselor being trained to assess whether the
abortion patient is a victim of subtle coercion.
Even Abortion Doctors Agree on Risk Factors
Baker (1995) similarly stressed
pre-abortion screening for risk
factors 17 years ago in her book
titled Abortion & Options
Counseling.
She stated: “In the cases where
women do react negatively after
an abortion, there appear to be
predisposing factors linked to
those reactions. There is enough
valid research from which we
can attempt to assess a client’s
potential for negative reactions
after an abortion…”
Even Abortion Doctors Agree on Risk Factors
Baker recommended identifying these predisposing factors prior to abortion:
• Belief that the fetus is the same as a 4-year-old
human and that abortion is murder
• Low self-esteem
• Ambivalence about the decision
• Intense guilt and shame about the abortion
• Perceived coercion to have an abortion
• Commitment to the pregnancy
APA Acknowledged Risk Factors
The APA acknowledged a number • A wanted or meaningful
of risk factors for psychological
pregnancy
distress in their Task Force
• Pressure from others
Report.
• Opposition to the abortion
from partners, family,
and/or friend
• Lack of social support
• Commitment to the
pregnancy
• Ambivalence about the
decision
• Low perceived ability to
cope
Many of the risk factors have been
known to the research community for
decades and have been recognized and
affirmed by professional organizations.
However, despite the availability of
strong research documenting risk factors
and professional awareness, abortion
providers rarely if ever routinely screen
for risk factors & counsel women at risk.
Psychological Consequences
An abundant literature comprised of methodologically
sophisticated studies from around the world now
indicates abortion significantly increases risk for the
following mental health problems:
Depression
Anxiety
Substance abuse
Suicide ideation and behavior
A minimum of
20% of
women who abort
suffer serious,
prolonged
negative
psychological
consequences.
Psychological
Consequences
Abortion is further
associated with a higher
risk for negative
psychological outcomes
when compared to
unintended
pregnancy carried
to term.
..and the data indicate that risk for longterm psychological injury is considerably
higher with abortion than with other forms
of perinatal loss.
Meta-Analysis
The strongest studies
published between 1995
and 2009 are synthesized
in my recent metaanalysis published in the
British Journal of Psychiatry
Coleman, P.K. (September,
2011). Abortion and Mental Health:
A Quantitative Synthesis and
Analysis of Research Published from
1995-2009. British Journal of
Psychiatry.
Meta-Analysis Inclusion Criteria
1. Sample size of 100 or more participants.
2. Use of a comparison group (no abortion,
pregnancy delivered, or unintended
pregnancy delivered).
3. One or more mental health outcome
variable(s): depression, anxiety, alcohol use,
marijuana use, or suicidal behaviors.
4. Controls for 3rd variables.
Meta-Analysis Results
The 1st meta-analysis, which included all 36 adjusted
odds ratios from the 22 studies identified, resulted in
a pooled odds ratio of 1.81 (95% CI: 1.57-2.09), p<.0001.
Women who have had an abortion experience an
81% higher risk for mental health problems of
various forms compared to women who have not had
an abortion.
Figure 1
Study name
Statistics f or each study
Upper
limit
Coleman 2006 [ALCO]
Coleman 2006 [MARIJ]
Coleman, Coyle, Shuping, & Rue 2009 [ALCO]
Coleman, Coyle, Shuping, & Rue 2009 [ANX]
Coleman, Coyle, Shuping, & Rue 2009 [DEP]
Coleman, Maxey, Spence, & Nixon 2008 [ALCO]
Coleman, Reardon, & Cougle 2005 [ALCO]
Coleman, Reardon, Rue, & Cougle 2002 [ALCO]
Coleman, Reardon, Rue, & Cougle 2002 [MARIJ]
Coleman, Reardon, Rue, & Cougle 2002b [ANX]
Coleman, Reardon, Rue, & Cougle 2002b [DEP]
Cougle, Reardon, & Coleman 2005 [ANX]
Cougle, Reardon, Coleman 2003 [DEP]
Dingle, Alati, Clavarino, Najman & Williams 2008 [DEP]
Dingle, Alati, Clavarino, Najman, & Williams 2008 [ALCO]
Dingle, Alati, Clavarino, Najman, & Williams 2008 [ANX]
Dingle, Alati, Clavarino, Najman, & Williams 2008 [MARIJ]
Fergusson 2008 (suicidal ideation)
Fergusson 2008 [ALCO]
Fergusson 2008 [ANX]
Fergusson 2008 [DEP]
Gilchrist 1995 (intentional self harm)
Gissler, Hemminki, & Lonnqvist 1996 [SUIC]
Pedersen 2007 [ALCO]
Pedersen 2007 [MARIJ]
Pedersen 2008 [DEP]
Reardon & Cougle 2002 [DEP]
Reardon, Coleman, & Cougle 2004 [ALCO]
Reardon, Coleman, & Cougle 2004 [MARIJ]
Reardon, Cougle, Rue et al. 2003 [DEP]
Reardon, Ney, Scheuren, et al. 2002 [SUIC]
Rees & Sabia, 2007 [DEP]
Schmiege & Russo 2005 [DEP]
Steinberg & Russo 2008 [ANX/NCS]
Steinberg & Russo, 2008 {ANX/NCFG]
Taft & Watson 2008 [DEP]
27.268
40.697
2.595
2.348
1.776
6.810
2.761
3.474
13.787
1.300
1.375
1.705
2.420
2.449
3.446
2.449
2.500
3.171
8.196
3.649
2.224
2.614
9.784
3.717
6.411
5.484
2.608
3.112
3.390
2.623
5.665
4.573
1.663
1.420
1.609
1.507
2.092
Odds
ratio
5.720
9.000
1.898
1.787
1.405
3.390
1.620
2.396
8.554
1.140
1.160
1.340
1.639
1.500
2.100
1.500
1.500
1.610
2.880
2.130
1.310
1.700
5.900
2.000
3.400
1.750
1.540
1.720
2.000
1.924
2.540
2.150
1.190
0.914
1.210
1.220
1.814
Lower
limit
1.200
1.990
1.388
1.360
1.111
1.688
0.950
1.652
5.307
1.000
0.979
1.053
1.110
0.919
1.280
0.919
0.900
0.818
1.012
1.243
0.772
1.106
3.558
1.076
1.803
0.558
0.909
0.951
1.180
1.411
1.139
1.011
0.852
0.588
0.910
0.988
1.573
Odds ratio and 95% CI
Z-Value
p-Value
2.189
2.854
4.014
4.171
2.841
3.430
1.773
4.609
8.814
1.958
1.711
2.381
2.485
1.620
2.937
1.620
1.556
1.377
1.982
2.752
1.000
2.418
6.878
2.192
3.782
0.960
1.606
1.793
2.575
4.140
2.278
1.988
1.019
-0.400
1.310
1.846
8.195
0.029
0.004
0.000
0.000
0.004
0.001
0.076
0.000
0.000
0.050
0.087
0.017
0.013
0.105
0.003
0.105
0.120
0.168
0.047
0.006
0.317
0.016
0.000
0.028
0.000
0.337
0.108
0.073
0.010
0.000
0.023
0.047
0.308
0.689
0.190
0.065
0.000
0.01
0.1
Favours no abortion
1
10
Favours abortion
100
Meta-Analysis Results
A 2nd meta-analysis was conducted with separate
effects based on the type of outcome measure.
• Marijuana: OR=3.30; 95% CI: 1.64-7.44, p=.001)
• Suicide behaviors: OR=2.55; 95% CI: 1.31-4.96,
p=.006
• Alcohol use/abuse: OR=2.10; 95% CI: 1.76-2.49, p<.0001
• Depression: OR=1.37; 95% CI: 1.22-1.53, p<.000
• Anxiety: OR=1.34; 95% CI: 1.12-1.59, p=.0001
The level of increased risk associated with abortion
varied from 34% to 230% depending on the nature of
the outcome.
Figure 2
Group by
0utcome
Study name
alcohol
alcohol
alcohol
alcohol
alcohol
alcohol
alcohol
alcohol
alcohol
alcohol
anxiety
anxiety
anxiety
anxiety
anxiety
anxiety
anxiety
anxiety
depression
depression
depression
depression
depression
depression
depression
depression
depression
depression
depression
depression
marijuana
marijuana
marijuana
marijuana
marijuana
marijuana
suicide
suicide
suicide
suicide
suicide
Coleman 2006 [ALCO]
Coleman, Coyle, Shuping, & Rue 2009 [ALCO]
Coleman, Maxey, Spence, & Nixon 2008 [ALCO]
Coleman, Reardon, & Cougle 2005 [ALCO]
Coleman, Reardon, Rue, & Cougle 2002 [ALCO]
Dingle, Alati, Clavarino, Najman, & Williams 2008 [ALCO]
Fergusson 2008 [ALCO]
Pedersen 2007 [ALCO]
Reardon, Coleman, & Cougle 2004 [ALCO]
Statistics for each study
Upper
limit
Coleman, Coyle, Shuping, & Rue 2009 [ANX]
Coleman, Reardon, Rue, & Cougle 2002b [ANX]
Cougle, Reardon, & Coleman 2005 [ANX]
Dingle, Alati, Clavarino, Najman, & Williams 2008 [ANX]
Fergusson 2008 [ANX]
Steinberg & Russo 2008 [ANX/NCS]
Steinberg & Russo, 2008 {ANX/NCFG]
Coleman, Coyle, Shuping, & Rue 2009 [DEP]
Coleman, Reardon, Rue, & Cougle 2002b [DEP]
Cougle, Reardon, Coleman 2003 [DEP]
Dingle, Alati, Clavarino, Najman & Williams 2008 [DEP]
Fergusson 2008 [DEP]
Pedersen 2008 [DEP]
Reardon & Cougle 2002 [DEP]
Reardon, Cougle, Rue et al. 2003 [DEP]
Rees & Sabia, 2007 [DEP]
Schmiege & Russo 2005 [DEP]
Taft & Watson 2008 [DEP]
Coleman 2006 [MARIJ]
Coleman, Reardon, Rue, & Cougle 2002 [MARIJ]
Dingle, Alati, Clavarino, Najman, & Williams 2008 [MARIJ]
Pedersen 2007 [MARIJ]
Reardon, Coleman, & Cougle 2004 [MARIJ]
Fergusson 2008 (suicidal ideation)
Gilchrist 1995 (intentional self harm)
Gissler, Hemminki, & Lonnqvist 1996 [SUIC]
Reardon, Ney, Scheuren, et al. 2002 [SUIC]
27.268
2.595
6.810
2.761
3.474
3.446
8.196
3.717
3.112
2.494
2.348
1.300
1.705
2.449
3.649
1.420
1.609
1.599
1.776
1.375
2.420
2.449
2.224
5.484
2.608
2.623
4.573
1.663
1.507
1.535
40.697
13.787
2.500
6.411
3.390
7.441
3.171
2.614
9.784
5.665
4.964
Odds
ratio
5.720
1.898
3.390
1.620
2.396
2.100
2.880
2.000
1.720
2.100
1.787
1.140
1.340
1.500
2.130
0.914
1.210
1.340
1.405
1.160
1.639
1.500
1.310
1.750
1.540
1.924
2.150
1.190
1.220
1.370
9.000
8.554
1.500
3.400
2.000
3.503
1.610
1.700
5.900
2.540
2.552
Lower
limit
1.200
1.388
1.688
0.950
1.652
1.280
1.012
1.076
0.951
1.768
1.360
1.000
1.053
0.919
1.243
0.588
0.910
1.123
1.111
0.979
1.110
0.919
0.772
0.558
0.909
1.411
1.011
0.852
0.988
1.223
1.990
5.307
0.900
1.803
1.180
1.649
0.818
1.106
3.558
1.139
1.312
Odds ratio and 95% CI
Z-Value
p-Value
2.189
4.014
3.430
1.773
4.609
2.937
1.982
2.192
1.793
8.464
4.171
1.958
2.381
1.620
2.752
-0.400
1.310
3.253
2.841
1.711
2.485
1.620
1.000
0.960
1.606
4.140
1.988
1.019
1.846
5.421
2.854
8.814
1.556
3.782
2.575
3.261
1.377
2.418
6.878
2.278
2.759
0.029
0.000
0.001
0.076
0.000
0.003
0.047
0.028
0.073
0.000
0.000
0.050
0.017
0.105
0.006
0.689
0.190
0.001
0.004
0.087
0.013
0.105
0.317
0.337
0.108
0.000
0.047
0.308
0.065
0.000
0.004
0.000
0.120
0.000
0.010
0.001
0.168
0.016
0.000
0.023
0.006
0.01
0.1
Favours no abortion
1
10
Favours abortion
100
Meta-Analysis Results
In a 3rd meta-analysis separate pooled odds ratios
were produced based on the type of comparison
group:
• No abortion: OR=1.59; 95% CI: 1.36-1.85, p<.0001
• Carried to term: OR=2.38; 95% CI: 1.62-3.50,
p<.0001
• Unintended pregnancy carried to term:
OR=1.55; 95% CI: 1.30-1.83,p<.0001
Regardless of the type of comparison group employed,
abortion was associated with a 55% to 138%
enhanced risk of mental health problems.
Figure 3
Group by
Control Group
Study name
delivery
delivery
delivery
delivery
delivery
delivery
delivery
delivery
delivery
delivery
delivery
no ab
no ab
no ab
no ab
no ab
no ab
no ab
no ab
no ab
no ab
no ab
no ab
no ab
no ab
unintended
unintended
unintended
unintended
unintended
unintended
unintended
unintended
unintended
unintended
unintended
unintended
unintended
unintended
Coleman, Maxey, Spence, & Nixon 2008 [ALCO]
Coleman, Reardon, Rue, & Cougle 2002 [ALCO]
Coleman, Reardon, Rue, & Cougle 2002 [MARIJ]
Coleman, Reardon, Rue, & Cougle 2002b [ANX]
Coleman, Reardon, Rue, & Cougle 2002b [DEP]
Cougle, Reardon, Coleman 2003 [DEP]
Gissler, Hemminki, & Lonnqvist 1996 [SUIC]
Pedersen 2008 [DEP]
Reardon, Cougle, Rue et al. 2003 [DEP]
Reardon, Ney, Scheuren, et al. 2002 [SUIC]
Statistics for each study
Upper
limit
Coleman, Coyle, Shuping, & Rue 2009 [ALCO]
Coleman, Coyle, Shuping, & Rue 2009 [ANX]
Coleman, Coyle, Shuping, & Rue 2009 [DEP]
Coleman, Reardon, & Cougle 2005 [ALCO]
Dingle, Alati, Clavarino, Najman & Williams 2008 [DEP]
Dingle, Alati, Clavarino, Najman, & Williams 2008 [ALCO]
Dingle, Alati, Clavarino, Najman, & Williams 2008 [ANX]
Dingle, Alati, Clavarino, Najman, & Williams 2008 [MARIJ]
Pedersen 2007 [ALCO]
Pedersen 2007 [MARIJ]
Rees & Sabia, 2007 [DEP]
Steinberg & Russo 2008 [ANX/NCS]
Taft & Watson 2008 [DEP]
Coleman 2006 [ALCO]
Coleman 2006 [MARIJ]
Cougle, Reardon, & Coleman 2005 [ANX]
Fergusson 2008 (suicidal ideation)
Fergusson 2008 [ALCO]
Fergusson 2008 [ANX]
Fergusson 2008 [DEP]
Gilchrist 1995 (intentional self harm)
Reardon & Cougle 2002 [DEP]
Reardon, Coleman, & Cougle 2004 [ALCO]
Reardon, Coleman, & Cougle 2004 [MARIJ]
Schmiege & Russo 2005 [DEP]
Steinberg & Russo, 2008 {ANX/NCFG]
6.810
3.474
13.787
1.300
1.375
2.420
9.784
5.484
2.623
5.665
3.502
2.595
2.348
1.776
2.761
2.449
3.446
2.449
2.500
3.717
6.411
4.573
1.420
1.507
1.856
27.268
40.697
1.705
3.171
8.196
3.649
2.224
2.614
2.608
3.112
3.390
1.663
1.609
1.836
Odds
ratio
3.390
2.396
8.554
1.140
1.160
1.639
5.900
1.750
1.924
2.540
2.386
1.898
1.787
1.405
1.620
1.500
2.100
1.500
1.500
2.000
3.400
2.150
0.914
1.220
1.592
5.720
9.000
1.340
1.610
2.880
2.130
1.310
1.700
1.540
1.720
2.000
1.190
1.210
1.551
Lower
limit
1.688
1.652
5.307
1.000
0.979
1.110
3.558
0.558
1.411
1.139
1.626
1.388
1.360
1.111
0.950
0.919
1.280
0.919
0.900
1.076
1.803
1.011
0.588
0.988
1.366
1.200
1.990
1.053
0.818
1.012
1.243
0.772
1.106
0.909
0.951
1.180
0.852
0.910
1.309
Odds ratio and 95% CI
Z-Value
p-Value
3.430
4.609
8.814
1.958
1.711
2.485
6.878
0.960
4.140
2.278
4.443
4.014
4.171
2.841
1.773
1.620
2.937
1.620
1.556
2.192
3.782
1.988
-0.400
1.846
5.939
2.189
2.854
2.381
1.377
1.982
2.752
1.000
2.418
1.606
1.793
2.575
1.019
1.310
5.082
0.001
0.000
0.000
0.050
0.087
0.013
0.000
0.337
0.000
0.023
0.000
0.000
0.000
0.004
0.076
0.105
0.003
0.105
0.120
0.028
0.000
0.047
0.689
0.065
0.000
0.029
0.004
0.017
0.168
0.047
0.006
0.317
0.016
0.108
0.073
0.010
0.308
0.190
0.000
0.01
0.1
1
10
100
Fav ours no abortion Fav ours abortion
Looking at Population Attributable Risk
percentages from the pooled odds ratios:
Overall: Nearly 10% of the incidence of
mental health problems was found to be
directly attributable to abortion.
Population Attributable Risk
Percentages for Specific Outcomes
Anxiety: 8.1%
Depression: 8.5%
Alcohol use: 10.7%
Marijuana use: 26.5%
All suicidal behaviors: 20.9%
Studies with different conclusions…
Beginning with the APA report in 2008, there
have been several narrative reviews on abortion
and mental health along with empirical papers
published in prestigious journals suggesting that
abortion is not associated with adverse mental
health consequences.
Both types of studies have been highly prone to
bias, and yet the very public results are actively
misleading our society.. with the eager help of
the press, of course..
Flawed Studies Promoted in the Media
By highlighting the flaws in the most
recent empirical paper and review, I’ll
demonstrate the distortions of basic
scientific methods that are behind
ideologically driven efforts to manipulate
our understanding of the potential for
psychological harm that abortion brings to
women’s lives.
Flawed Studies Promoted in the Media
Munk-Olsen, T, Laursen, TM, Pedersen, CB, Lidegaard, O,
Mortensen, PB. (2012) First-Time First-Trimester Induced
Abortion and Risk of Readmission to a Psychiatric
Hospital in Women with a History of Treated Mental
Disorder. Archives of General Psychiatry.
Munk-Olsen, T. et al. (2012)
Reported main results: Risk of psychiatric
readmission was similar before and after first
time, first trimester abortion; however risk of
readmission was higher after giving birth
compared to before birth.
Munk-Olsen, T. et al. (2012)
Serious Methodological Problems:
1) The sample was limited to women who had a first
abortion or birth between 1994 and 2007. The older
women in the population (births beginning in 1962) are
not included in the analyses, because their 1st pregnancies
were likely well before 1994. No explanation is provided for
this exclusion.
2) Out of the total sample of 8131 women, 952 (nearly
12%) were in both groups! In order to conduct clean
comparisons, these women should absolutely have been
removed prior to conducting the analyses.
Munk-Olsen, T. et al. (2012)
3) There were no controls for
variables demonstrated in
previous studies to be
associated with the choice to
abort and with post-abortion
mental illness, including
marital status, education
level, religion, income,
relationship history variables
including abuse, planning of
the pregnancy, and pressure
to abort, among others..
Munk-Olsen, T. et al. (2012)
4) Follow-up was limited to 12 months after the
pregnancies were resolved. By only measuring
readmission for one year, women who have delayed
responses, sometimes triggered by a later pregnancy,
are not included in the analyses. The data are
available in the Danish registries and there is no valid
reason for cutting off the follow-up period so early.
Munk-Olsen, T. et al. (2012)
5) The authors conducted correlational analyses and
inappropriately made inferences of causality.
For example, in the first sentence in the conclusion
section of the article they state: “In the present study,
we found that first-time first-trimester induced
abortion does not influence the risk of readmission to
psychiatric facilities.” Such a statement is not
permitted with the use of variables that cannot be
manipulated (like abortion status), particularly when
so few control variables are incorporated.
Systematic Review on Induced Abortion and Mental
Health Released by the Royal College of Psychiatrists
The Royal College of Psychiatrist’s
recently conducted review of scientific
literature published from 1990 to the present
on abortion and mental health is hauntingly
similar to the American Psychological
Association Task Force Report released in 2008.
An enormous amount of time, energy, and
expense was funneled into a work product that
was not undertaken in a scientifically
responsible manner.
Flaws in the Royal College Review:
Unjustified Dismissal of Studies
The RCP review incorporates 4 types of studies: 1) reviews;
2) studies of the prevalence of post-abortion mental health
problems; 3) studies identifying risk factors for post-abortion
mental health problems; and 4) studies comparing mental
health outcomes between women who abort or deliver.
In each category, there are studies that are ignored and large
numbers of studies that are entirely dismissed for vague
and/or inappropriate reasons .
Flaws in the Royal College Review:
Unjustified Dismissal of Studies
The most common reasons for dismissing studies were the
nebulously defined “no usable data” and “less than 90 days
follow-up.” The latter resulted in elimination of 35 studies in
the prevalence, risk factor, and comparison categories. Not
surprisingly many of the eliminated studies revealed adverse
post-abortion consequences.
Only including studies with extended follow-up minimizes the
number of cases of mental health problems identified. As time
elapses, healing may naturally occur, other events may
moderate the effects, and more confounding variables may be
introduced. Finally, this approach misses the serious and more
acute episodes that are treated soon after abortion.
Flaws in the Royal College Review:
Unjustified Dismissal of Studies
The studies included were
not representative of the
best available evidence. For
example, in the prevalence
category, only 34 studies
were retained, including 27
without controls for
previous mental health. In
contrast, in my metaanalysis, 14 out of the 22
studies had controls for
psychological history .
Flaws in the Royal College Review:
Factual Errors
As the author of the Coleman (2011) review (meta-analysis)
cited in the report, I was alarmed to see the content in the
section “Summary of Key Findings from the APA, Charles, and
Coleman Reviews”
The first 6 points are not reflective of the conclusions derived
from the meta-analysis and the 7 th and final point in this
section wrongly states, with reference to the meta-analysis
that “previous mental health problems were not controlled for
within the review.”
Flaws in the Royal College Review:
Problematic “Quality Assessments”
This review was pitched as methodologically superior
to all previously conducted reviews, largely because
of the criteria employed to critique individual studies
and to rate the overall quality of evidence.
However, the quality scales employed to rate each
individual study are not well-validated and require a
significant level of subjective interpretation, opening
the results to considerable bias.
Flaws in the Royal College Review:
Problematic “Quality Assessments”
1) The categories used to evaluate the studies are
missing key methodological features, including initial
consent to participate rates and retention of
participants over time.
2) The relative importance assigned to the criteria
employed is arbitrary, as opposed to being based on
consensus in the scientific community.
3) The specific requirements for assignment of
particular ratings are not provided.
Flaws in the Royal College Review:
Faulty Conclusions
Each section in the RCP
report includes conclusions
that are based on a very
small number of studies
that are not properly rated
for quality. The results
should, therefore, not be
trusted as a basis for
professional training
protocols or health care
policy initiatives.
Flaws in the Royal College Review:
Faulty Conclusions
To illustrate how incomplete and misleading the conclusions are, I’ll use one
example. As noted earlier, I recently identified 119 studies related to riskfactors associated with post-abortion psychological health.
The RCP conclusions relative to studies addressing risk factors for postabortion mental health problems make no mention of most of the variables
I described earlier.
Based on only 27 studies they state “The most reliable predictor of postabortion mental health problems is having a history of mental health problems
prior to abortion” and “A range of other factors produced more mixed results,
although there is some suggestion that life events, pressure from a partner to
have an abortion, and negative attitudes towards abortion in general and
towards a woman’s personal experience of the abortion, may have a negative
impact on mental health.”.
WECARE to the rescue……
When there is such an active effort by
professional organizations and
individual researchers with a political
agenda to obscure the scientifically
verified truths regarding the potential
risks associated with abortion, there is
an urgent need to counter the claims in
a timely, dispassionate fashion in order
to effect change. To this end, the World
Expert Consortium for Abortion
Research and Education, a 501 c(3), was
recently formed.
WECARE Mission…..
WECARE brings together credentialed scientists
with a research program on the physical,
psychological, and/or relational effects of abortion
on women and those closest to them. By adopting
a non-religious, non-partisan approach to
understanding the implications of abortion,
WECARE exists to enhance the quality of
information, develop strategies for effectively
transmitting research findings, and to break down
barriers to evidence-based medicine.
WECARE Affiliates:
Byron C. Calhoun, MD, FACOG, FACS, MBA, West Virginia UniversityCharleston
Patrick Carroll, Pension and Population Research Institute, London N1 2DG UK
Monique V. Chireau, MD, MPH, Duke University Medical Center
Priscilla Coleman, Ph.D., Bowling Green State University
Nicholas DiFonzo, Ph.D., Rochester Institute of Technology
Elard Koch, M.Sc., Ph.D., University of Chile
Stephen Sammut, Ph.D., Franciscan University of Steubenville
Martha W. Shuping, MD
Luis Vivanco, Ph.D., Centro de Investigación Biomédica de La Rioja, Spain
Monnica T. Williams, Ph.D., University of Louisville
WECARE SERVICES
1) Information Dissemination. WECARE provides
accurate, unbiased information in a form that is readily
accessible to diverse segments of the population
(individual women, researchers, practitioners, policymakers, students, community groups, and any other
interested parties).
2) Research Collaboration. WECARE provides a
forum for collaboration among credentialed scientists
in their efforts to conduct high quality research on yet
unexplored facets of the topic of abortion and health.
WECARE SERVICES
3) Consultation. WECARE affiliated researchers are
available to provide scientifically derived consultation to
individuals and organizations requesting information on
the mental, physical, and relational effects of abortion.
Several affiliates have extensive experience as litigation
experts.
4) Responses to Current Research Activities.
WECARE offers current news briefs related to recently
published research on abortion and health through
postings on the WECARE website and via press
releases.
WECARE SERVICES
5) Professional Development. Online tutorials and
seminars, grant-writing and publishing workshops,
and annual conferences are among our ideas for
future professional development activities.
6) Foster Dialogue and Encourage Media Coverage.
To achieve its dual goals of advancing knowledge and
disseminating high quality information derived from
rigorous experimentation, WECARE directors and
affiliates are developing strategies to encourage
public discussion and mainstream media coverage of
research on the health implications of abortion.
Please spread the word!
www.wecareexperts.org