Lies, damn lies, and statistics

I’ve been following the MTR debate with some interest.  I had planned to write a blog post about how she’s not my kind of feminist, and I may yet do, but a statistic she quoted today in an article with Mamamia caught my eye.

6. How do you resolve the apparent divide between being pro-life and a feminist?

A growing number of feminists are questioning abortion as safe, simple and risk free. Research is also indicating that women have significant negative mental health outcomes after abortions. The UK Royal College of Psychiatrists has published a meta-analysis in the British Journal of Psychiatry finding that women who undergo abortions are 81% more likely to experience subsequent mental health problems. (Substance abuse increased 340%, suicidal behaviour by 155%).

I looked at those statistics and boggled, because when I last looked at Wikipedia regarding mental health and abortion the information suggested that there was no correlation between negative health outcomes and abortion.  I went and tracked down what I could find of the British Journal of Psychiatry article.  Sadly I found it was behind a paywall, so I went and looked at what other people had said regarding the article, the methods used, and the author of the piece.  It was an interesting read.  To start off, I’ll quote the Results section of the abstract:

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* (my own asterisk) was shown to be attributable to abortion. The strongest subgroup estimates of increased risk occurred when abortion was compared with term pregnancy and when the outcomes pertained to substance use and suicidal behaviour.

The first commentary I found was an interview with the author, Dr Priscilla Coleman, and Elizabeth Moncher from the Culture of Life Foundation.  The questions asked by the interviewer were quite leading and it was hard to tell what Coleman’s actual opinions regarding the study, whether she had approached the study with one opinion and came out with a different finding, or whether she had always believed that there were negative mental health outcomes for women who had had abortions.  I won’t quote any of the interview here because it’s likely to make you go “grrrr”.  Though in summary, those who are likely to have negative mental health outcomes are those who are from religious backgrounds, those who felt that they had to have an abortion, and who do not have support in their family or community and as a result suffer in silence.

So I dug a bit further and found a blog called, “Philosopical Comment” written by a Professor of Practical Philosophy at the University of Gothenburg, Sweden (Christian Munthe).  He has written several pieces on this study (all detailed in this post) and had written a letter to the British Journal of Psychiatry, the letters are freely available on the interwebs (Yay!).  Munthe did not, as some authors have, critique the methodology behind the meta-analysis, but he argued against the conclusions, which are stated in the abstract as:

This review offers the largest quantitative estimate of mental health risks associated with abortion available in the world literature. Calling into question the conclusions from traditional reviews, the results revealed a moderate to highly increased risk of mental health problems after abortion. Consistent with the tenets of evidence-based medicine, this information should inform the delivery of abortion services.

Munth argues that there are mental health issues with many medical procedures and life events, and perhaps the focus should not be on restricting access to said medical procedures but instead focusing on providing mental health services to people:

The debate on Coleman’s study has moved into ethics, as commentators claim it to support conclusions about the organisation of abortion services (AS). In her reply, Coleman sides with these voices. However, closer scrutiny puts these suggestion into question.

Puccetti argue that, regadless of Coleman’s study, AS should include “in-depth analysis of the various factors known to interfere with the psychological outcomes” as a pre-procedure. The basis for this is that abortion has not been shown to benefit mental health. No ethical principle is presented to back up this argument, but one may generalize the suggestion into one: If a health care practice has not been proven to be beneficial to mental health, it should not be allowed unless preceded by an in depth analysis of the various factors known to interfere with the psychological outcomes. This principle has far-reaching implications, since risk factors for mental health problems all across health care, while there is normally no proven mental health benefits. The principle also rules out the original suggestion: the suggested analysis should not be made before another analysis has been made and the same holds with respect to that additional analysis, and so on.

These proposals and Coleman’s own response rest on the notion of the most important task being to discourage women from having abortions. If the ethical baseline is to be care for mental health, however, the proper conclusion should rather be about access to mental health care. If Coleman is wrong, anyone may be burdened by mental health problems independently of whetheher [sic] or not they contemplate abortion. If she is right, there should be a special readiness to attend to mental health needs in AS. If feasible, harmless pre-abortion identification of high-risk cases may be added to this. Neither Coleman nor her supporters have considered anything in this vein and this adds to suspiscions [sic] of an undisclosed ideological conflicts of interest.  (citations at link)

The letters page at the British Journal of Psychology also contains strong criticisms from Epidemiologists, Professors of Medicine, and others.  I’ll quote Gregory L Kinney and Ben Goldacre, the rest can be viewed at your own pleasure/interest.  Kinney details that the meta-analysis is flawed as:

An author should be commended for defending the work that they have done when that work is questioned by peers. Coleman however does not address a specific analytical observation made by authors that have commented (Coyne, Polis, Littel and Thygesen among others). Coleman included multiple analyses performed within multiple studies that represent the same study populations (Table 1, citation 10, 20, 21, 22, 24, 27, 29, 30, 32, 39 where each of these citations represents a study population being counted more than once in the meta-analysis). Doing so inappropriately increases the sample size and reduces the variance in the pooled measure. This causes the pooled estimate to be biased as the analytical technique was not applied in an appropriate manner and represents an inflated N. In her response the author addresses that observation by discussing random verses fixed effects and weighting but this is not the issue at hand

Kinney also pointed out that the Coleman included much of her own research in the study (11 of the 22 articles).

Acre wrote that there were significant omissions in Coleman’s paper:

Professor Coleman’s systematic review and meta-analysis of the literature on termination of pregnancy and mental health featured several significant omissions: an undislosed [sic] conflict of interest; no assessment of publication bias; and no assessment of the quality of studies included. The search strategy was also inadequately reported, and the meta-analytic technique was faulty.

Most of the comments in the letters page request that the article be retracted due to flawed methodology, bias, and undisclosed conflict of interest.

Based on my research tonight, I am not satisfied that this paper genuinely reflects the true picture of mental health outcomes for women who have abortions.  I’d want to see another meta-analysis done by another group before accepting that this results is true.  And even if it is true, as argued by Munth, surely we should be prioritising mental health care for people and not taking away medical procedures and choice from them.


* If “nearly 10% of the incidence of mental health problems” stem from abortion, then over 90% of mental health problems stem from other causes.  I don’t know, and with Wikipedia shut down for the SOPA protest can’t find out, how many mental health problems are diagnosed each year.  If approximately 9% of mental health problems are caused by abortion, and 91% are caused by everything else that happens to people, is that really a good argument to call for abortion to be restricted or banned?  Surely a better argument would be to ban all the other things that are causing mental health problems.
Further reading: More on Review Claiming Abortion Hurts Women’s Mental Health, James C. Coyne PhD

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8 thoughts on “Lies, damn lies, and statistics”

  1. First of all: Of *course* there will be some mental health related consequences of having an abortion. I mean, it’s not an easy decision that one makes lightly (in most cases, at any rate). I fail to see how that information is even relevant except to offer better services to women before and after they have an abortion.

    Second of all: What are the mental health related consequences of being forced to carry an unwanted pregnancy? Is carrying a pregnancy to term and then giving the resulting baby up for adoption any less traumatic? Is carrying a pregnancy to term and then attempting to raise the resulting child one’s self with no support, possible abusive relationships, no money, when not in a good mental place to begin with, or all the other multiple reasons one might otherwise have chosen abortion any less traumatic?

    Third of all, if people like Tankard Reist are so concerned with the mental health of women with unwanted pregnancies then why are they not concentrating more on helping women prevent the pregnancies & mental health issues to begin with? Why not support women at risk? Why not help educate on and provide birth control to women at risk? How in the hell is banning abortion &, thus, forcing women with unwanted pregnancies to carry to term going to help women’s mental health?

    Seriously, these people make me sick. If they were so concerned about women, they’d be helping women, not cutting off their options. Abortion is not easy but it’s an option that women must have available to them. In fact, there are MORE mental health (and physical health) consequences for women if abortion is made illegal. I don’t think I would have an abortion myself but I sure as hell won’t tell someone else that they can’t/shouldn’t if that’s what they feel is right for them.

  2. What Kareena said, AND, for 487 bazilionth time, correlation is not causation. Even if those statistics were not as clearly dodgy as they are (my rudimentary stats understanding tells me fixed effects and weighting have nothing to do with sample size, and that sample size is critical), just because women who have abortions have a higher rate of mental health issues does not mean that abortions cause them. It’s really not hard to imagine situations in which mental health (and substance abuse etc) problems result in a higher risk of unwanted pregnancy.

    Can we have a few more people shouting at each other in agreement? 🙂

  3. With Kareena’s comment and my own thoughts this morning on the issue, how exactly do you have a control group of people who have given birth to a child that they either wanted or were indifferent to, and compare it to a group of people who had an abortion? Its not like you’re measuring the same thing here really.


    Joking aside … Good point, Rebecca. It’s not something that can be measured. It’s simply a bullshit premise to try and legitimize the desire of a bunch of simplistic, controlling people to make decisions for people they’ve never even met let alone fully understand every nuance of what it is to live their lives. Theory and grand, sweeping arguments are all well and good but they need to be tempered by the lived experience of the people in the situation about which one is theorizing. *wonders off grumbling about radfems & arrogance*

  5. Following on from Kareena, we’ve now had a lot of comment and analysis on the news (well Radio National, which I listen to when driving, and the print media) about the recent report on relinquishing mothers. If MTR wants to claim that women who have abortions have a higher rate of depression or other consequences, surely she should compare them directly with women who have relinquished. It seems to me that the consequences of that are dire and having read the blogger Fugitivus, who writes about this issue, these news reports/stories didn’t surprise me in the least. As recently as two weeks ago I read one of the inevitable forced-birther comments on an internet thread saying “why not just adopt! Adoption is an under-utilised solution!”

    But probably the forced-birthers wouldn’t accept that as most of them still cling to the idea that abstinence is 1) possible and 2)desirable for all unmarried young people.

  6. Perhaps reading the research yourself would be a better place to start. The methodology is very sound and has been well accepted by the majority of the scientific world. Perhaps the bias of those who have been critical of the study should be scrutinized. The research also clearly controls for mental health issues prior to abortion, and includes studies which compared women having abortion compared to women who considered abortion but continued to term, the closest control you can get retrospectively.

    The purpose of highlighting the potential harm of abortion to women is to ensure that women are fully informed of all the possible risks they are exposing themselves to especially when you consider that abortion is an elective procedure generally undertaken by an otherwise healthy woman.

    The majority of research undertaken by scientists on both ‘sides’ of the abortion ideology agrees that between 10-30% of women suffer serious, prolonged psychological trauma following abortion. If we only accept the lower figure, this equates to a conservative estimate of 9,000 women every year which is a highly significant burden on women, their families and communities.

    The facts should not be lost in the political and ideological arguments surrounding abortion. If this accepted figure of adverse reaction were found in women undertaking a particular kind of cosmetic procedure for example we would be jumping up and down about the need for greater informed consent protocols and protections.

    1. Hi Debbie,

      Thank you for coming to my blog, reading my post and commenting on it. I’d’ve appreciated it if you’d also disclosed your agenda, as I strongly suspect that your site would be funded by a Christian anti-abortion lobby group.

      I had a quick look through your site, and I wasn’t surprised to find no reference to any source of funding for providing the service, nor links with any organisations – though you had a testimonial from a random “Trevor” who was also from a mysteriously unnamed community you presented to.

      I fully support all women having all the information available to them when making a decision regarding the termination of a pregnancy, I do not support misinformation, emotional blackmail, and lies, as many “pro-life” organisations and individuals tend to employ when attempting to dissuade women from choosing abortion as the most feasible choice for themselves. I also think it smacks of paternalism to suggest that women who choose abortion are not fully informed, ethical, and rational individuals who cannot make such a decision.

      Like all medical procedures, abortion carries with it some risk. I have found and read through your page that details the risks of abortion, and note that you don’t draw any comparison to the risk of carrying to term or any other equivalent surgery – which would paint a far fairer picture of the risks of abortion. Carrying to term can kill women, it is incredibly rare that a legal abortion would result in the death of a woman.

      You talk about providing support to pregnant women, both emotional, psychological and financial support I am guessing, but for how long will that emotional, psychological and financial support last? A child remains (generally) the responsibility of their parents for 18 years, I don’t see many “pro-life” organisations suggesting additional financial support for children beyond what the government already provides. If a woman cannot afford to support a (another) child, who is going to provide sufficient food, clothing, education, etc for that child?

      I find it astounding that so many “pro-life” groups are often only interested in preserving the life of a foetus, and not the life of the child once it is born.

      The facts should not be lost in the political and ideological arguments surrounding abortion. If this accepted figure of adverse reaction were found in women undertaking a particular kind of cosmetic procedure for example we would be jumping up and down about the need for greater informed consent protocols and protections.

      You’re right that facts should not be lost in the discussions around abortion. Adverse reactions are found in women undertaking comestic procedures and very few people are jumping up and down, because women can choose to undertake cosmetic surgery, just as they can choose to have an abortion if they believe that it is the right decision for themselves. By all means provide information to women regarding all the options, but make sure that information does not contain mistruths such as abortion leading to breast cancer, or it being more risky than any other form of surgery, or even carrying to term.

      Let’s just trust that women are completely able to make informed decisions, that they can do their own research, and can ask appropriate questions. Let’s talk about what support can be provided to women post-abortion (if required) and not assume that all (or even the majority) of those who have abortions suffer terribly.

      And let’s also talk about why people object to abortion, and on what basis their moral/ethical code is based, and whether or not any faith based leanings they may or may not have is relevant to the discussion – because that’s one I find really interesting.

      More reading can be done here (particularly Chrys’ responses in the comments).

  7. Really? Cosmetic surgery? That’s your analogy? I can’t even begin to imagine a way in which that is valid. However, as many people have already pointed out, the rate of trauma is genuinely a problem and deserves further investigation. But it deserves a broad investigation – what exactly is causing the trauma? The abortion itself or the condemnation of other people afterwards? Would better access to contraception and better support for single parents be the best way to reduce the trauma? This is as much a social problem as a medical one, if not more so. Treating the consequences of abortion as an “adverse reaction” is limiting and misleading.

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