Misc ResearchNotes

Little if any material below was not in the supplments. Most after 2002 Please start the process of moving this material to the proper subcategories of the main Index

Effectiveness of Post-Abortion Counseling Programs

SD Layer, C Roberts, K Wild, J Walters. Postabortion Grief: Evaluating the Possible Efficacy of a Spiritual Group Intervention. Research on Social Work Practice, Vol. 14, No. 5, 344-350 (2004)

Objective: Although not every woman is negatively affected by an abortion, researchers have identified a subgroup of women susceptible to grief and trauma. The primary providers for postabortion grief (PAG) groups are community faith-based agencies. Principle features of PAG are shame and post-traumatic stress disorder (PTSD) symptoms. Method: This study measured the efficacy of a spiritually based grief group intervention for women grieving an abortion. Thirty-five women completed the Impact of Event Scale-Revised(IES-R) and the Internalized Shame Scale (ISS) pre- and postintervention along with posttest open-ended questions. Results: Postintervention measures indicated significant decrease in shame (p < .000) and PTSD symptoms (p < .002). More than 80% reported their religious beliefs and the spiritual intervention played a strong to very strong role in the group. Conclusion: Social workers need to screen for PAG with a postabortive woman and when appropriate refer her to agencies offering such groups.

Support program for women suffering grief after termination of pregnancy: A pilot study. Sriarporn P, Turale S, Lordee N, Liamtrirat S, Hanpra W, Kanthino A. Nurs Health Sci. 2017 Mar;19(1):75-80. doi: 10.1111/nhs.12307. Epub 2016 Sep 12.

In this study, we preliminarily examined the effects of the Informational and Emotional Support Program for Women after Pregnancy Termination in 30 Thai women. A literature review and House's theory of social support informed the program content, which consisted of the following elements: (i) an evaluation of grief; (ii) an analysis of the problems and needs of each woman; (iii) informational and emotional support tailored to individual problems and needs; (iv) telephone support; and (v) an exit phone interview. The Grief Questionnaire for Women after Pregnancy Termination was used to measure changes in the grief levels of participants. The data were analyzed using descriptive statistics and the contingency coefficient. At the completion of the study, the participants' average grief score had decreased from the prior grief score and was in the moderate to low range. These preliminary findings indicate that the support program can be effective in real-life situations in Thailand to assist women who are grieving after the termination of pregnancy. Our findings highlight the need for nursing and emotional support to be provided to help Thai women after the TOP.

The impact of supportive intervention after second trimester termination of pregnancy for fetal abnormality. Elder SH, Laurence KM. Prenat Diagn. 1991 Jan;11(1):47-54.

The reactions of women who had had a termination of pregnancy for fetal abnormality in the second trimester have been studied retrospectively using a semi-structured questionnaire. The severity of the grief reaction was measured and the outcome at 6 months was compared with the findings from a previous study in South Wales which had led to the introduction of skilled support from genetic fieldworkers and formal genetic counselling after the termination. Of the 69 women interviewed, 55 (80 per cent) experienced an acute grief reaction and 17 (25 per cent) had not resolved their grief 6 months after the termination, compared with 37 (77 per cent) and 22 (46 per cent) out of 48 respectively in the previous study. Fifty-seven (83 per cent) women had found the fieldworker's intervention useful or very useful, some describing her support as essential. An association between poor resolution of the grief reaction with increasing maternal age and with poor perceived support from partners was noted. Improved follow-up support and counselling have lessened the adverse emotional consequences and support should therefore be offered to all women undergoing termination for fetal malformation.

PIP: The reactions of women who had undergone a termination of pregnancy for fetal abnormality in the 2nd trimester have been studied retrospectively using a semistructured questionnaire. The severity of the grief reaction was measured and the outcome at 6 months compared with the findings from a previous study in South Wales which had led to the introduction of skilled support from genetic fieldworkers and formal genetic counseling after the termination. Of the 69 women interviewed, 55 (80%) experienced an acute grief reaction and 17 (25%) had not resolved their grief 6 months after the termination, compared with 37 (77%) and 22 (46%) of 48, respectively, in the previous study. 57 (83%) women has found the fieldworker's intervention useful or very useful, some describing the support received as essential. An association between poor resolution of the grief reaction with increasing maternal age and with poor perceived support from partners was noted. Improved followup support and counseling have reduced the adverse emotional consequences, and support should thus be offered to all women undergoing pregnancy termination for fetal malformations.

Morning After Abortion Pill & Higher Abortion Rates

See Sweden Abortions Increase Despite Much Higher Sales of Morning After Pill and lookup sources to add to index.

Medical Abortion

"Immediate complications after medical compared with surgical termination of pregnancy.Niinimäki M, Pouta A, Bloigu A, Gissler M, Hemminki E, Suhonen S, Heikinheimo O. Obstet Gynecol. 2009 Oct;114(4):795-804."

OBJECTIVE: To estimate the immediate adverse events and safety of medical compared with surgical abortion using high-quality registry data.

METHODS: All women in Finland undergoing induced abortion from 2000-2006 with a gestational duration of 63 days or less (n=42,619) were followed up until 42 days postabortion using national health registries. The incidence and risk factors of adverse events after medical (n=22,368) and surgical (n=20,251) abortion were compared. Univariable and multivariable association models were used to analyze the risk of the three main complications (hemorrhage, infection, and incomplete abortion) and surgical (re)evacuation.

RESULTS: The overall incidence of adverse events was fourfold higher in the medical compared with surgical abortion cohort (20.0% compared with 5.6%, P<.001). Hemorrhage (15.6% compared with 2.1%, P<.001) and incomplete abortion (6.7% compared with 1.6%, P<.001) were more common after medical abortion. The rate of surgical (re)evacuation was 5.9% after medical abortion and 1.8% after surgical abortion (P<.001). Although rare, injuries requiring operative treatment or operative complications occurred more often with surgical termination of pregnancy (0.6% compared with 0.03%, P<.001). No differences were noted in the incidence of infections (1.7% compared with 1.7%, P=.85), thromboembolic disease, psychiatric morbidity, or death.

CONCLUSION: Both methods of abortion are generally safe, but medical termination is associated with a higher incidence of adverse events. These observations are relevant when counseling women seeking early abortion.

Rue

Rue VM, Coleman PK, Rue JJ, Reardon DC. Induced abortion and traumatic stress: A preliminary comparison of American and Russian women. Med Sci Monit, 2004 10(10): SR5-16.

BACKGROUND: Individual and situational risk factors associated with negative postabortion psychological sequelae have been identified, but the degree of posttraumatic stress reactions and the effects of culture are largely unknown.

MATERIAL/METHODS: Retrospective data were collected using the Institute for Pregnancy Loss Questionnaire (IPLQ) and the Traumatic Stress Institute's (TSI) Belief Scale administered at health care facilities to 548 women (331 Russian and 217 American) who had experienced one or more abortions, but no other pregnancy losses.

RESULTS: Overall, the findings here indicated that American women were more negatively influenced by their abortion experiences than Russian women. While 65% of American women and 13.1% of Russian women experienced multiple symptoms of increased arousal, re-experiencing and avoidance associated with posttraumatic stress disorder (PTSD), 14.3% of American and 0.9% of Russian women met the full diagnostic criteria for PTSD. Russian women had significantly higher scores on the TSI Belief Scale than American women, indicating more disruption of cognitive schemas. In this sample, American women were considerably more likely to have experienced childhood and adult traumatic experiences than Russian women. Predictors of positive and negative outcomes associated with abortion differed across the two cultures.

CONCLUSIONS: Posttraumatic stress reactions were found to be associated with abortion. Consistent with previous research, the data here suggest abortion can increase stress and decrease coping abilities, particularly for those women who have a history of adverse childhood events and prior traumata. Study limitations preclude drawing definitive conclusions, but the findings do suggest additional cross-cultural research is warranted.

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Autopsy after termination of pregnancy for fetal anomaly: retrospective cohort study P A Boyd, F Tondi, N R Hicks, and P F Chamberlain BMJ (December 8, 2003)

Objective To study trends in termination of pregnancy for fetal anomaly over 10 years and to assess the contribution of autopsy to the final diagnosis and counselling after termination. Design Retrospective study with cases from a congenital anomaly register and a defined unselected population. Data sources Pregnancies resulting in termination for fetal anomaly identified from the Oxford congenital anomaly register. Details about the prenatal diagnosis and autopsy findings were retrieved from case notes. Results Of the 57 258 deliveries, 309 (0.5%) were terminated because of prenatally diagnosed abnormality. There were 129/29 086 (0.4%) terminations for fetal anomaly carried out in 1991-5 and 180/28 172 (0.6%) in 1996-2000. The percentage of fetuses that underwent autopsy fell from 84% to 67%. Autopsy was performed in 132 cases identified by ultrasound scan, with no evidence for abnormal karyotype. In 95 (72%) the autopsy confirmed the suspected diagnosis and did not add important further information, two cases were not classified, and in 35 (27%) the autopsy added information that led to a refinement of the risk of recurrence (reduced in 17, increased in 18); in 11 of these 18 cases it was increased to a one in four risk. Conclusions Though there has been an increase in the rate of terminations of pregnancy for fetal anomaly, there has been a decline in the autopsy rate. When a prenatal diagnosis was based on the results of a scan only, the addition of information from an autopsy by a specialist paediatric pathologist provided important information that changed the estimated risk of recurrence in 27% of cases and in 8% this was to a higher (one in four) risk. ABOUT one-Fifth of abortions were done on healthy babies. From Calhoun: That may be the case[that one fifth were healthy babies] . .there is also, as noted in this article a significant number of cases that the autopsy changes the diagnosis as well as the risk counseling. . .this information as noted in the article "and in 35 (27%) the autopsy added information that led to a refinement of the risk of recurrence (reduced in 17, increased in 18); in 11 of these 18 cases it was increased to a one in four risk," really is the crux of the matter.

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Peggy Reynolds, Susan Hurley, Debbie E. Goldberg, Hoda Anton-Culver, Leslie Bernstein, Dennis Deapen, Pamela L. Horn-Ross, David Peel, Richard Pinder, Ronald K. Ross, Dee West, William E. Wright, and Argyrios Ziogas Active Smoking, Household Passive Smoking, and Breast Cancer: Evidence From the California Teachers Study J Natl Cancer Inst 2004; 96: 29-37. Background: There is great interest in whether exposure to tobacco smoke, a substance containing human carcinogens, may contribute to a woman’s risk of developing breast cancer. To date, literature addressing this question has been mixed, and the question has seldom been examined in large prospective study designs. Methods: In a 1995 baseline survey, 116 544 members of the California Teachers Study (CTS) cohort, with no previous breast cancer diagnosis and living in the state at initial contact, reported their smoking status. From entry into the cohort through 2000, 2005 study participants were newly diagnosed with invasive breast cancer. We estimated hazard ratios (HRs) for breast cancer associated with several active smoking and household passive smoking variables using Cox proportional hazards models. Results: Irrespective of whether we included passive smokers in the reference category, the incidence of breast cancer among current smokers was higher than that among never smokers (HR = 1.32, 95% confidence interval [CI] = 1.10 to 1.57 relative to all never smokers; HR = 1.25, 95% CI = 1.02 to 1.53 relative to only those never smokers who were unexposed to household passive smoking). Among active smokers, breast cancer risks were statistically significantly increased, compared with all never smokers, among women who started smoking at a younger age, who began smoking at least 5 years before their first full-term pregnancy, or who had longer duration or greater intensity of smoking. Current smoking was associated with increased breast cancer risk relative to all nonsmokers in women without a family history of breast cancer but not among women with such a family history. Breast cancer risks among never smokers reporting household passive smoking exposure were not greater than those among never smokers reporting no such exposure. Conclusion: Our study provides evidence that active smoking may play a role in breast cancer etiology and suggests that further research into the connection is warranted, especially with respect to genetic susceptibilities.

Healing After Pregnacy Loss -- Reenactment

Van P. Breaking the silence of African American women: healing after pregnancy loss. Health Care Women Int. 2001 Apr-May;22(3):229-43. African American women experience pregnancy and infant losses at rates twice those of European American women and women of other recognized ethnic and racial groups. Health professionals, families, and friends tend to avoid discussions of these losses because grief following pregnancy or infant loss is frequently considered insignificant. Bereaved mothers whose grief is unrecognized are likely to have grief responses that are exaggerated in intensity and duration. In this article I reflect part of a larger qualitative study in which I explored the pregnancy-related experiences of 10 African American women. The purpose of this article is to describe the perceived strategies these women used to heal after pregnancy or infant loss. Individual interviews were conducted using open-ended questions. Grounded theory methodology was used to analyze the data. The healing strategies used by the participants reflect predominately inner and instinctive processes, resources, and remedies. Culturally appropriate strategies for health care interventions and research activities are offered.

V. Comments: Came across this study and wonder if the reason black women have abortions almost double that of white women is due to the fact that black women have so much more pregnancy loss in general compared to white women? Could this be some sort of reenactment strategy or attempt to unconsciously resolve disenfranchised grief? To my knowledge, this whole area has never been addressed.

Reenactment

Q: Are women whose mother's have a history of abortion more likely to abort A: (Martha) What I see in actual practice is this happens all the time… when the mom has had an abortion, the daughter’s pregnancy seems to bring back all the original trauma, anxiety, stress… and these women seem driven to get their daughters an abortion. We had a lady in my practice who had acknowledged that the abortion had caused her distress, and she said she wanted to go through an abortion recovery program. Before we could get her into one, the daughter who was a young adolescent got pregnant. The girl never said she wanted an abortion, actually seemed favorable to having the baby… but her mom took care of getting the abortion for her daughter, even though she recognized it had been a huge mistake when she had done this herself in the past. I think it is a very typical pattern, but no actual data that I know of. In women who come to retreats, we’ve seen where this happens also, but the one case was sort of dramatic because the whole thing was unfolding before our eyes and we couldn’t do anything about it… at retreats it is all after the fact, but in that case, the girl got pregnant while the mom was in treatment, and she just had to get her an abortion.

Racisms and Weathering

Racism's Hidden Toll by Ryan Blitstein discusses the research of Arline Geronimus which examines the lower levels of health among black Americans and attributes a portion of the problem to the "weathering" caused by racism. Part of this weathering may be the exposure to a much higher rate of abortion.

"Geronimus hypothesized that the black infants' poor health wasn't because their mothers were too young; it was due to their mothers' social disadvantages. If she could take into account factors like income and race, she might show that teen mothers were no worse off than moms in their 20s. Unlike most studies, which separated mothers into the broad categories of teen and not-teen, Geronimus broke down maternal ages by year. The results among white women were expected: higher infant mortality rates among teen mothers. Yet the numbers for blacks astounded even Geronimus. Black teenage mothers had lower infant death rates than black mothers in their 20s. Because infant health is a decent predictor of maternal health, Geronimus' data meant the average black woman might be less healthy at 25 than she was at 15. Perhaps the population of pregnant teens in Trenton was onto something. Consciously or not, the black teen mothers might be doing what was best for their infants' health."

..."Together with earlier studies, Geronimus was presenting new data showing that teen mothers' socioeconomic outcomes were as good as or better than those of older moms. In many cases, pregnancy made the teens eligible for social programs like Medicaid, or they formed alliances with the families of the fathers of their children, improving their economic positions. Geronimus hoped to explain why these girls were making these choices and to show that efforts to prevent teen pregnancy wouldn't solve anything. Her goal was to convince people to focus on larger underlying causes of poverty and poor health. After all, even the young mothers who were slightly better off still had it very rough."

.."Slowly, she and the graduate students she advised built up evidence of accelerating, lifelong decline in health among minorities — first among mothers, then across a variety of illnesses and unhealthy behaviors like smoking. While it was well known that blacks are more likely than whites to be hypertensive, no one had looked at the age patterns of that risk. Geronimus found that black and white hypertension rates are virtually identical for people in their 20s, but the differences increase sharply during middle age. Similar patterns appeared in almost every health condition."

Abortion Does Not Reduce Number of Children Born with Disabilities

vad Der Veen, WJ., "The small epidemiologic transition: further decrease in infant mortality due to medical intervention during pregnancy and childbirth, yet no decrease in child disabilities," Ned Tijdshr Geneeskd. 2003. Mar 1;147(9):378-81 (article in Dutch) Selective abortion has failed to reduce the incidence of child disabilities. This may be due to improved neo-natal care allowing disabled children to survive and (which may not be noted by the author) by increased risk of neo-natal problems associated with increased rates of induced abortion.

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Vikhlayeva EM, Nikolaeva E. Epidemiology of abortions in Russia. Entre Nous Cph Den. 1996 Dec; (34-35): 18. Abstract: In Russia, the fact that many women consider abortion their main or only effective means of fertility regulation has led to prevailing high rates of abortion. A pilot study was undertaken, therefore, to determine why this situation exists and how to decrease the incidence of abortion. Physicians gathered data using a standardized questionnaire administered during interviews with 352 women (221 from Moscow and 131 from rural areas) who had just had an abortion. Most women were employed in the labor force as were most husbands (partners) and parents of the women. Most of the women reported early first coitus, and 49% were married before age 20. More than 80% of the women had children, but only a third of all previous pregnancies had been carried to term. Most abortions occurred because women were worried about their ability to afford another child or about their health status or that of their husband. In fact, approximately 40% of the women presented with inflammatory diseases and infections of the vulva, vagina, uterus, or adnexes. Most women received their first contraceptive counseling after their first delivery or abortion, but only 30% of urban women and 18% of the rural women were using modern contraceptives (condoms) at the time of the unwanted conception. Most women received their information about contraceptives from the mass media, from medical personnel, or from friends although they indicated they would have preferred to have received sex education in school. Most women decided on their own to have an abortion, and 76% experienced psychological pain in conjunction with the procedure. However, 42.3% indicated they would resort to abortion in the future. This study concluded that the Ministry of Health should make provision of information on contraception a priority.

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Bradshaw Z, Slade P. The effects of induced abortion on emotional experiences and relationships: a critical review of the literature. Clin Psychol Rev. 2003 Dec; 23(7): 929-58. This paper reviews post-1990 literature concerning psychological experiences and sexual relationships prior to and following induced abortion. It assesses whether conclusions drawn from earlier reviews are still supported and evaluates the extent to which previous methodological problems have been addressed. Following discovery of pregnancy and prior to abortion, 40-45% of women experience significant levels of anxiety and around 20% experience significant levels of depressive symptoms. Distress reduces following abortion, but up to around 30% of women are still experiencing emotional problems after a month. Women due to have an abortion are more anxious and distressed than other pregnant women or women whose pregnancy is threatened by miscarriage, but in the long term they do no worse psychologically than women who give birth. Self-esteem appears unaffected by the process. Less research has considered impact on the quality of relationships and sexual functioning, but negative effects were reported by up to 20% of women. Conclusions were generally concordant with previous reviews. However, anxiety symptoms are now clearly identified as the most common adverse response. There has been increasing understanding of abortion as a potential trauma, and studies less commonly explore guilt. The quality of studies has improved, although there are still some methodological weaknesses.

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Northern KS. Procreative torts: enhancing the common-law protection for reproductive autonomy. Univ Ill Law Rev. 1998; 1998(2): 489-546. Roe v. Wade's twenty-fifth anniversary is likely to herald widespread scholarly commentary on the decision's continued vitality and the future of abortion in the United States. However, if such commentary focuses solely upon the constitutional dimensions and political aspects of a woman's right to privacy, an important dimension of this right will be overlooked. Few commentators have considered the extent to which tort law safeguards a woman's interest in reproductive autonomy. In this article, Professor Northern argues that the interest in reproductive autonomy has not yet received the full protection to which it is entitled and that tort law is poised to evolve distinct causes of action for the interference with procreative autonomy interests. Professor Northern begins with an overview of the medical and psychological literature on abortion-related risks. She goes on to discuss current trends in abortion malpractice litigation. The author then reviews the three basic types of malpractice causes of action--battery, negligence, and lack of informed consent--and explores their application to abortion malpractice claims. The focus of the article then shifts to the development of specialized procreative torts, and Professor Northern contends that courts should go beyond previous decisions to redress any substantial interference with procreative autonomy. Finally, the author asserts that legislative alternatives to the common-law development of procreative torts, such as right-to-know statutes, are less protective of women's interests. Professor Northern concludes that tort law could and should be used to more fully protect women's interests in procreative autonomy.

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Avalos L.Hindsight and the abortion experience: what abortion means to women years later. Gender Issues. 1999 Spring; 17(2): 35-57. This article provides views on abortion by demonstrating women's retrospective accounts of their abortion experiences. Women's accounts of their abortion experiences are socially constructed both at the time of the abortion and in subsequent years in their lives. Some women reflect on their past abortion as the right decision; however, some also feel varying degrees of pain, grief, and loss. Many view their abortions as mistakes. Profiles of four women are presented in this article to provide several critical points on a continuum pertaining to study participants' retrospective satisfaction with an abortion experience. Based on the profiles, various emotional reactions are possible to occur after abortion and those retrospective interpretations of the experience change as personal growth and circumstances prompt women to reflect about the original experience. It was also documented that the satisfied group in the study was the one composed of women still involved with the partner with whom they became pregnant. With an open conversation on the emotional effects of abortion, women will be able to help inform and transform politicized abortion debates.

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THE FOLLOWING DATA SET IS AVAILABLE FOR ANALYSIS AND INCLUDES ABORTION DATA http://www.nhlbi.nih.gov/resources/deca/directry.htm Depression and Cardiovascular Sequelae in Postmenopausal Women The Women's Health Initiative (WHI) Arch Intern Med. 2004;164:289-298. Sylvia Wassertheil-Smoller, PhD; Sally Shumaker, PhD; Judith Ockene, PhD; Greg A. Talavera, MD, MPH; Philip Greenland, MD; Barbara Cochrane, RN, PhD; John Robbins, MD; Aaron Aragaki, MS; Jacqueline Dunbar-Jacob, PhD, RN Background Subclinical depression, often clinically unrecognized, may pose increased risk of cardiovascular disease. Few studies have prospectively investigated cardiovascular events related to depression in older women. We describe prevalence, cardiovascular correlates, and relationship to subsequent cardiovascular events of depressive symptoms among generally healthy postmenopausal women. Methods The Women's Health Initiative Observational Study followed up 93 676 women for an average of 4.1 years. Depression was measured at baseline with a short form of the Center for Epidemiological Studies Depression Scale. Risks of cardiovascular disease (CVD) events were estimated from Cox proportional hazards models adjusting for multiple demographic, clinical, and risk factor covariates. Results Current depressive symptoms above the screening cutoff point were reported by 15.8% of women. Depression was significantly related to CVD risk and comorbidity (odds ratios ranging from 1.12 for hypertension to 1.60 for history of stroke or angina). Among women with no history of CVD, depression was an independent predictor of CVD death (relative risk, 1.50) and all-cause mortality (relative risk, 1.32) after adjustment for age, race, education, income, diabetes, hypertension, smoking, high cholesterol level requiring medication, body mass index, and physical activity. Taking antidepressant medications did not alter the depression-associated risks associated. Conclusions A large proportion of older women report levels of depressive symptoms that are significantly related to increased risk of CVD death and all-cause mortality, even after controlling for established CVD risk factors. Whether early recognition and treatment of subclinical depression will lower CVD risk remains to be determined in clinical trials.

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• The ‘morning-after’ pill causes an increase in the incidence of ectopic pregnancies (lodgement of the human embryo in the Fallopian tube rather than in the womb.) [6] In one of these cases the affected Fallopian tube had to be surgically removed. As a result these women have a greatly reduced possibility of a future pregnancy. [6] Sheffer-Mimouni G, Pauzer D, Maslovitch S et al. Ectopic pregnancies following levonorgestrel contraception. Contraception. 2003;67:267-269

• The ‘morning-after’ pill can also have serious interactions with prescribed medications. The British Medical Journal has reported that the ‘morning-after’ pill can interfere with warfarin medications. [7] [8]

[7] Ellison J, Thomson AJ, Greer IA. Apparent interaction between warfarin and levonorgestrel used for emergency contraception. BMJ. 2000;321:1382 [8] Richards D. An Important drug interaction – an alternate mechanism. BMJ Rapid responses. 22 December 2000

• Dr. Ellen Grant, writing in the Lancet (2001) has expressed the concern that “… 5% of women have a genetic susceptibility to thromboembolic disease (blood clots).” When these women take the ‘morning-after’ pill – which is equal in strength to taking 50 regular birth control tablets – a blood clot might form. [9] [9] Grant E. Adverse reactions and emergency contraception. Lancet. 2001;357:1201

• There is concern that the very high dose of hormone taken in the ‘morning-after’ pill might ‘kick-start’ cervical cancer if a woman is already infected with human papilloma virus. [10] [10] Chen Y-H, Huang L-H, Chen T-M. Differential effects of progestins and estrogens on long control regions of human papillomavirus types 16 and 18.

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http://www.obgynworld.com/international/news/2003/week_50/6-12_december_2003.asp Weekly Archives of 6-12 December 2003 Childbirth protects against stroke Further reinforcing the link between cardiovascular parameters and pregnancy, researchers from Denmark have found that childbirth may lower the risk of stroke. David Gaist (Aarhus and Aalborg University Hospital) and colleagues showed that the odds ratio for experiencing subarachnoid hemorrhage declined with increasing parity in their study of 887 women. Commenting in a related Editorial, Aaron Dumont and Neal Kassel, from the University of Virginia School of Medicine in Charlottesville, USA, say that, while future study may reveal a "biological basis for this association.... consideration of behavioral changes associated with pregnancy and the puerperium may be important." Childbirth lowers stroke risk Source: Stroke 2004: Early online publication Examining the relationship between parity and the risk of subarachnoid hemorrhage in women. Childbirth may provide moderate, cumulative protection against subarachnoid hemorrhage (SAH) in women, say researchers. "SAH is the only type of stroke with female predominance, suggesting that reproductive factors may play a role in the etiology," write David Gaist (Aarhus and Aalborg University Hospital, Denmark) and co-authors. To examine this relationship, the researchers obtained data on 9399 Swedish women who last gave birth between 1973 and 1997. A total of 887 (9 percent) women experienced SAH during the study period, 70 percent of whom developed the condition 5 years or more after giving birth to their last child. The risk of SAH declined with increasing parity. Compared with women with only one child, those with two children had an odds ratio for SAH of 0.83, which gradually fell to 0.67 for those with five or more children.

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E. Abdel-Aziz , I. Hassan and H. M. Al-Taher Assessment of pain associated with medical abortion International Journal of Gynecology & Obstetrics, Volume 84, Issue 3, March 2004, Pages 264-265 http://www.sciencedirect.com/science/journal/00207292 No abstract available

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Gissler M, Berg C, Bouvier-Colle MH, Buekens P. Pregnancy-associated mortality after birth, spontaneous abortion or induced abortion in Finland, 1987-2000. Am J Ob Gyn 2004; 190:422-427.

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McMahon JM, Ananth CV, Litson RL Gestational Diabetes Mellitus: Risk Factors, Obstetric Complications and Infant Outcomes, J Reprod Med 1998 43:372-378. Prior abortion is significantly associated with a higher risk of GDM (RR=1.41, 95% CI= 1.18-1.68)

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Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83 000 women with breast cancer from 16 countries. Lancet 2004; 363: 1007-16. 27 March 2004 When studies using only prospective data sources are used, there is no association between abortion and breast cancer.

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Lung Cancer in US Women: A Contemporary Epidemic Jyoti D. Patel, MD; Peter B. Bach, MD; Mark G. Kris, MD JAMA. 2004;291:1763-1768.

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Linda A. Bartlett, Cynthia J. Berg, Holly B. Shulman, Suzanne B. Zane, Clarice A. Green, Sara Whitehead, Hani K. Atrash Risk Factors for Legal Induced Abortion–Related Mortality in the United States Obstet Gynecol 2004 103: 729-737.

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A.Kero,U.H .ogberg,A.Lalos. Wellbeing and mental growth —long-term effects of legal abortion. Social Science &Medicine 58 (2004)2559 –2569. The study comprises interviews focusing on the experiences and effects of abortion in 58 women,4 and 12 months after the abortion. 12 had had severe emotional distress directly post-abortion. Furthermore,almost all described the abortion as a relief or a form of taking responsibility and more than half reported only positive experiences such as mental growth and maturity of the abortion process.Those without any emotional distress post-abortion stated clearly before the abortion that they did not want to give birth since they prioritised work,studies and/or existing children. Several negative effects increased with time.

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ECONOMIC COSTS OF ABORTION COMPLICATIONS -smoking -drug abuse -suicide -pre-term delivery -miscarriage -psychiatric treatments -lost productivity -divorce -reduced life span (estimates)

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Kenneth E. Thorpe, Curtis S. Florence, Peter Joski. Which Medical Conditions Account For The Rise In Health Care Spending? Health Affairs, 10.1377/hlthaff.w4.437 Researchers wrote in their report, published in this week's issue of the journal Health Affairs and available on the Internet at http://www.healthaffairs.org. Between 1987 and 2000, the 15 costliest medical conditions were heart disease, mental disorders, lung disease, cancer, trauma, high blood pressure, diabetes, back problems, arthritis, stroke and other brain blockages, skin disorders, pneumonia, infectious disease, hormone disorders, and kidney disease. For their study, Thorpe and colleagues used two U.S. government surveys -- the 1987 National Medical Expenditure Survey of 34,000 people and the 2000 Medical Expenditure Panel Survey of 25,000 people New patients accounted for 59 percent of the rise in spending on mental disorders, the report found. While mental disorders did not become more common, twice as many people sought treatment for them between 1987 and 2000, Thorpe's team found.

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USE THE EXCELLENT RESOURCE BELOW (INCLUDING CITATIONS) TO CALCULATE COSTS OF DEPRESSION Employers can now see how many of their workers are likely to be depressed, and as one new Web site emphasizes, how much it will cost.

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Two health care companies recently launched www.depressioncalculator.org. Employers can punch in a set of statistics such as a company's location or workers' age and gender, and the end result is a group of online charts detailing the business' work force and productivity.

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1) Adenomyosis: symptoms, histology, and pregnancy terminations.

Obstet Gynecol. 2000 May;95(5):688-91.

Levgur M, Abadi MA, Tucker A.

Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York 11219, USA. michaellevgur@pol.net

OBJECTIVE: To correlate symptoms of uterine adenomyosis with histopathologic features. METHODS: One hundred eleven specimens of uteri and cervices that weighed under 280 g were reevaluated. When adenomyosis was identified, assessment included depth of adenomyotic foci, graded as deep (above 80%), intermediate (40-80%), and superficial (under 40%), and number of adenomyotic foci. Clinical data were collected from patient records. RESULTS: Specimens were categorized in four groups, 17 with adenomyosis alone, 19 with adenomyosis with leiomyomas, 39 with leiomyomas alone, and 36 with neither. Among women with adenomyosis alone, 58.8% had pregnancy terminations and 47.4% of women with adenomyosis and leiomyomas had terminations, compared with 20.5% of women with leiomyomas alone (P <.01) and 22.2% in those with neither (P <.01). The number of foci correlated significantly with depth within the myometrium in specimens with adenomyosis alone (r =.46, P =.05) or combined with leiomyomas (r =.66, P <.001). The median number of foci associated with dysmenorrhea was 10 compared with 4.5 without it (P <.003); in menorrhagia the respective median numbers were 7 and 7 (P =.25). Menorrhagia and dysmenorrhea presented in 36.8% and 77.8% of deep, compared with 13.3% (P <.001) and 12.5% (P <.001) of intermediate depths, respectively. Superficial depth was not associated with menorrhagia or dysmenorrhea. CONCLUSION: Pregnancy termination might affect the pathogenesis of adenomyosis. The number of foci and their myometrial depths correlated to each other and to dysmenorrhea, but only myometrial depth correlated to menorrhagia.

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2) Disruption of the endometrial-myometrial border during pregnancy as a risk factor for adenomyosis

Am J Obstet Gynecol. 2002 Sep;187(3):543-4.

Curtis KM, Hillis SD, Marchbanks PA, Peterson HB. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga., USA.

We assessed surgical disruption of the endometrial-myometrial border during pregnancy as a risk factor for adenomyosis in a cohort of 1850 women undergoing hysterectomy during 1978 to 1981. Women who had 3 or more abortions when sharp curettage was common were at increased risk for adenomyosis; women who had curettage procedures or cesarean deliveries were not.

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3) Adenomyosis at hysterectomy: prevalence and relationship to operative findings and reproductive and menstrual factors. Clin Exp Obstet Gynecol. 1997;24(1):36-8

Vavilis D, Agorastos T, Tzafetas J, Loufopoulos A, Vakiani M, Constantinidis T, Patsiaoura K, Bontis J.

2nd Department of Obstetrics and Gynaecology, Aristotelian University of Thessaloniki, Greece.

In order to estimate the frequency and risk factors for adenomyosis, the clinical records of 594 women undergoing hysterectomy were retrieved. Data were collected on indications for the intervention, age at surgery, age at menarche, parity, abortions, mode of delivery, abnormal uterine bleeding, dysmenorrhea, and menopausal status at surgery. Adenomyosis was found in 116 of the 594 patients (19.5%). A pathologic condition was present in 63 patients with fibroids (20.5%), 11 with genital prolapse (25.6%), 11 with benign ovarian tumors (17.8%), six with endometrial hyperplasia (13.6%), two with cervical cancer (18.2%), ten with endometrial cancer (16.1%), and 13 with ovarian cancer (21.3%). No relationship was found between adenomyosis and endometriosis. On the contrary, a strong relationship was found between adenomyosis and parity, cesarean section, induced abortions, dysmenorrhea, abnormal uterine bleeding, and late age at menarche. These results show that adenomyosis is a common pathologic finding, significantly related to reproductive and menstrual characteristics of the patients.

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4) Adenomyosis: analysis of 35 cases Tunis Med. 2001 Aug-Sep;79(8-9):447-51. [Article in French]

Ben Aissia N, Berriri H, Gara F.

Service de gynecologie-obstetrique, CHU Mongi Slim La Marsa.

The authors suggest an analytic study of 35 cases of a adenomyosis discovered on operatory pieces of hysterectomy. The incidence over 28%. The pick of frequency is situated between 40 and 50 years old. The history of voluntary interruption of pregnancy and early abortion are found in 60% of cases. 8 patients have scary uterus post cesarean section or myomectomy. The symptoms and signs are dominated by vaginal bleeding which is found in 71% of cases. Pelvic pain is present in 34% of cases. The adenomyosis is rarely isolated. It is associated to uterine fibroma in 62% of cases. Their symptoms and signs are often the same. Hysterographie can head the diagnosis in 7% of cases. The endovaginal ultrasound and the IRM may help in the diagnosis.

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5) Adenomyosis as a social problem

Cesk Gynekol. 1990 Dec;55(10):732-40.[Article in Czech]

Nesit V, Petros J, Micanik B. Gynek.-porod. oddeleni ZUNZ, Vitkovice.

In a retrospective investigation of 149 patients from 1979-1988 with histologically confirmed adenomyosis the authors proved by comparison with a regional population sample (n = 198) that it is a disease of above average fertile women (3.7 pregnancies per woman). The operated women had in their case-history 1.3 times more deliveries, 1.9 times more spontaneous abortions, twice as many induced abortions and 5.3 times as many extrauterine pregnancies. The group comprises 1.4 times more women using intrauterine contraception in the past and only 2.7% were sterile. The authors were unable to prove a relationship of some causes of relative hyperoestrogenism (early menarche, postponed first childbirth) and this disease. The higher rate of pregnancies terminated by curettage (spontaneous and induced abortions) and the greater preference of IUD in this group of women support the hypothesis that intrauterine manipulations are the main predisposing factor of endometrial cells into the myometrium. The inhibiting effect of pregnancies terminated by lactation on this disease. similarly as hormonal contraception, are of little importance, as apparent from our material.

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The Ancel et al, 2004 article from the EUROPOP study did calculate OR's and see below. . .showed a minimum of increase of VLBW (< 32 weeks) by 30% with 1 abortion and up to 80+% with > 2 abortions. The data is consistent. . .

(Ancel PV, Lelong N, Papiernik E, Saurel-Cubizolles MJ, Kaminski M. History of induced abortion as a risk factor for preterm birth in European countries: results of EUROPOP survey. Human Repro 2004; 19(3): 734-740) "The extent of association with previous induced abortion varied according to the cause of preterm delivery. Previous induced abortions significantly increased the risk of preterm delivery after idiopathic preterm labour, preterm premature rupture of membranes and ante-partum haemorrhage, but not preterm delivery after maternal hypertension. The strength of the association increased with decreasing gestational age at birth." The countries included in this study: Germany, Finland, Scotland, Sweden, Italy, Czech Republic, Slovenia, Romania, Russia, and Hungary. This study is in effect a 'meta-analysis' (since 10 countries supplied data). More important is that a co-author is the most respected PTB expert on planet earth, Dr. Emile Papiernik of France; he was, as you know, head of a French program that cut that country's PTB rate in half, a spectacular achievement.

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Soderberg H, Janzon L, Sjoberg NO: Emotional distress following induced abortion: A study of its incidence and determinants among adoptees in Malmo, Sweden. Eur J Obstetr Gyn Reprod Biol, 1998; 79: 173-178

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E Mittendorfer-Rutz, F Rasmussen, D Wasserman. Restricted fetal growth and adverse maternal psychosocial and socioeconomic conditions as risk factors for suicidal behaviour of offspring: a cohort study. Lancet 2004; 364: 1135-40 Interpretation Multiparity and low maternal education predicted suicide attempt, whereas restricted fetal growth and teenage motherhood were associated with both suicide completion and attempt in offspring.

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Cougle JR, Reardon DC, Coleman PK. Generalized anxiety following unintended pregnancies resolved through childbirth and abortion: a cohort study of the 1995 National Survey of Family Growth. J Anxiety Disord. 2005;19(1):137-42.

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K Hofberg and M R Ward Fear of pregnancy and childbirth. Postgraduate Medical Journal 2003;79:505-510 http://pgmj.bmjjournals.com/cgi/content/full/79/935/505#R16

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Evans J, Francomb H, Oke S, et al. Cohort study of depressed mood during pregnancy and after childbirth. BMJ 2001;323:257–60. Evans et al suggest that the proportion of women rating themselves as severely depressed was similar before and after childbirth. They suggest that postnatal depression is not a distinct syndrome. Their data suggest that childbirth is less likely than the events of pregnancy to be followed by depression in women who are not depressed. Furthermore, depressed women are more likely to improve after childbirth.

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Soderberg, H, Anderssson C, Janzon L, Sjoberg NO. Continued pregnancy among abortion applicants: a study of women having a change of mind. Acta Obstet Gynecol Scand. 1997; 76: 942-947.

Effectiveness of Post-Abortion Counseling Programs

SD Layer, C Roberts, K Wild, J Walters. Postabortion Grief: Evaluating the Possible Efficacy of a Spiritual Group Intervention. Research on Social Work Practice, Vol. 14, No. 5, 344-350 (2004)

Objective: Although not every woman is negatively affected by an abortion, researchers have identified a subgroup of women susceptible to grief and trauma. The primary providers for postabortion grief (PAG) groups are community faith-based agencies. Principle features of PAG are shame and post-traumatic stress disorder (PTSD) symptoms. Method: This study measured the efficacy of a spiritually based grief group intervention for women grieving an abortion. Thirty-five women completed the Impact of Event Scale-Revised(IES-R) and the Internalized Shame Scale (ISS) pre- and postintervention along with posttest open-ended questions. Results: Postintervention measures indicated significant decrease in shame (p < .000) and PTSD symptoms (p < .002). More than 80% reported their religious beliefs and the spiritual intervention played a strong to very strong role in the group. Conclusion: Social workers need to screen for PAG with a postabortive woman and when appropriate refer her to agencies offering such groups.

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JE Tedstone, N Tarrier. Posttraumatic stress disorder following medical illness and treatment. Clin Psychol Rev. 2003 May;23(3):409-48. Studies describing posttraumatic stress disorder (PTSD) as a result of physical illness and its treatment were reviewed. PTSD was described in studies investigating myocardial infarction (MI), cardiac surgery, haemorrhage and stroke, childbirth, miscarriage, abortion and gynaecological procedures, intensive care treatment, human immunodeficiency virus (HIV) infection, awareness under anaesthesia, and in a group of miscellaneous conditions. Cancer medicine was not included as it had been the subject of a recent review in this journal. Studies were reviewed in terms of the prevalence rates for PTSD, intrusive and avoidance symptoms, predictive and associated factors and the consequences of PTSD on healthcare utilization and outcome.

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BYRNE, DENNIS M. MYERS, STEVEN C. KING, RANDALL H. Short Term Labour Market Consequences of Teenage Pregnancy Applied Economics 23,12 (December 1991): 1819-1827

NLSY79 Cohort Study

To determine the impact that teenage pregnancy followed by a birth or an abortion has on labor market success, the relationship between teenage pregnancy and education and the effect of pregnancy on wages are examined. The data are from the NLSY, using 1984 and 1985 survey interview data. The results indicate that a live birth has a negative impact on years of education completed, wages, and labor supply. Young women who undergo abortions complete less schooling, on average, than a similarly aged never-pregnant group, leading to lower wages and less attachment to the labor market. While the greatest educational penalty - 1.8 years - is borne by a teenager who has a baby, the 0.53 year penalty faced by the teenager who aborts is also substantial. These women carry a career penalty into their early 20s in the form of lower education, lower wages, and higher wage elasticities.

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Sir Liam Donaldson. Levonelle/Levonelle-2 emergency contraception: new advice, CMO 's Update 35, Department of Health, Jan., 03, page 9. http://www.dh.gov.uk/PublicationsAndStatistics/LettersAndCirculars/CMOUpdate/CMOUpdateArticle/fs/en?CONTENT_ID=4003844&chk=2uZJEX Of 201 EC failures, there were 12 ectopic pregnancies, 6%, which is three times the expected rate.

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K Edgardh. Adolescent sexual health in Sweden. Sex Transm Inf 2002;78:352-356 http://sti.bmjjournals.com/cgi/content/full/78/5/352 Teen abortions increased 31% during the 5 years following introduction of "emergency contraception" "Teenage abortion rates have gone up, from 17/1000 in 1995 to 22.5/1000 in 2001. Genital chlamydial infections have increased from 14 000 cases in 1994 to 22 263 cases in 2001, 60% occurring among young people, and with the steepest increase among teenagers."

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Sexually Transmitted Disease Morbidity Report, http://www.doh.wa.gov/cfh/STD/morbidity.htm Chlamydia infections increased 30% from 1999 to 2001 following over the counter access to EC.

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Toledano, Levana. Assessing traumatic reactions of abortion with the emotional stroop. Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 64(9-B), 2004. pp. 4639. (see email from Jesse in Research Folder) Two groups of women were included in this study: 59 women who had undergone an abortion and a control group of 28 women who had comparable surgical procedures. The mean age of the participants was 29.82, with ages ranging from 18 to 50 years. Symptoms of PTSD were assessed using the Posttraumatic Diagnostic Scale (PDS), the Impact of Event Scale (IES), and the Emotional Stroop paradigm. The Emotional Stroop procedure utilized was a color-naming task comprised of abortion-relevant words (i.e., sex, pregnant, fetus), positive words, neutral words, and obsessive-compulsive disorder (OCD) words. Levels of depression and anxiety were assessed with the Beck Depression Inventory-II (BDI-II), and the State-Trait Anxiety Inventory (STAI). The role of social support at the time of abortion was measured via the Multidimensional Scale of Perceived Social Support (MSPSS). Background variables such as religiosity, the presence or absence of coercion, marital status, gestational length, number of children, and age were also explored as possible risk factors mediating responses to abortion. Multivariate tests indicated the presence of PTSD in both groups of women, but to a greater extent in the post-abortion group. The two groups reported similarly elevated scores for anxiety. Post-abortion women exhibited significantly longer response latencies on the Stroop for abortion/trauma-relevant stimuli as compared to the control group. There were no significant differences found between groups on measures of depression. Significant risk factors included low levels of perceived social support, younger age, and the presence of coercion. Implications for community and clinical psychology are outlined.Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 64(9-B), 2004. pp. 4639.

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Anna Glasier, Karen Fairhurst, Sally Wyke, Sue Ziebland, Peter Seaman, Jeremy Walker, and Fatim Lakha Advanced provision of emergency contraception does not reduce abortion rates. Contraception. 2004; 69(5): 361-366. All women aged between 16 and 29 years living in Lothian, Scotland, were offered, through health services, five courses of EC without cost to keep at home. Of a population of around 85,000 women in this age group, the study showed that an estimated 17,800 women took a supply of EC home and over 4500 of them gave at least one course to a friend. It was found that nearly half (45%) of women who had a supply used at least one course during the 28 months that the study lasted. In total, an estimated 8081 courses of EC were used. EC was used within 24 h after intercourse on 75% of occasions. Abortion rates in Lothian were compared with those from three other health board areas of Scotland. No effect on abortion rates was demonstrated with advanced provision of EC. The results of this study suggest that widespread distribution of advanced supplies of EC through health services may not be an effective way to reduce the incidence of unintended pregnancy in the UK.

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Tina R. Raine, Cynthia C. Harper, Corinne H. Rocca, Richard Fischer, Nancy Padian, Jeffrey D. Klausner, and Philip D. Darney Direct Access to Emergency Contraception Through Pharmacies and Effect on Unintended Pregnancy and STIs: A Randomized Controlled Trial JAMA. 2005;293:54-62. A randomized, single-blind, controlled trial (July 2001-June 2003) of 2117 women, ages 15 to 24 years, attending 4 California clinics providing family planning services, who were not desiring pregnancy, using long-term hormonal contraception or requesting EC. Participants were assigned to 1 of the following groups: (1) pharmacy access to EC; (2) advance provision of 3 packs of levonorgestrel EC; or (3) clinic access (control). Main Outcome Measures Primary outcomes were use of EC, pregnancies, and sexually transmitted infections (STIs) assessed at 6 months; secondary outcomes were changes in contraceptive and condom use and sexual behavior. Results Women in the pharmacy access group were no more likely to use EC (24.2%) than controls (21.0%) (P = .25). Women in the advance provision group (37.4%) were almost twice as likely to use EC than controls (21.0%) (P<.001) even though the frequency of unprotected intercourse was similar (39.8% vs 41.0%, respectively, P = .46). Only half (46.7%) of study participants who had unprotected intercourse used EC over the study period. Eight percent of participants became pregnant and 12% acquired an STI; compared with controls, women in the pharmacy access and advance provision groups did not experience a significant reduction in pregnancy rate (pharmacy access group: adjusted odds ratio [OR], 0.98; 95% confidence interval [CI], 0.58-1.64; P = .93; advance provision group: OR, 1.10; 95% CI, 0.66-1.84, P = .71) or increase in STIs (pharmacy access group: adjusted OR, 1.08, 95% CI, 0.71-1.63, P = .73; advance provision group: OR, 0.94, 95% CI, 0.62-1.44, P = .79). There were no differences in patterns of contraceptive or condom use or sexual behaviors by study group.

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B. Reime, B.A. Schuecking and P. Wenzlaff. Perinatal outcomes of teenage pregnancies according to gravidity and obstetric history. Annals of Epidemiology, Volume 14, Issue 8, September 2004, Pages 619-619 B. Reime, B.A. Schuecking and P. Wenzlaff After exclusion of girls with multiple births, two or more previous pregnancies, a previous spontaneous abortion, or a previous stillbirth, the remaining 8669 subjects were stratified into primigravidae (n = 7695) and secundigravidae one previous live-birth (n = 767) or one previous induced abortion (n = 207). Bivariate and multivariable logistic regression analyses (adjusted for smoking status, nationality, partner status, and maternal height and weight at first and last antenatal visit) were conducted to calculate odds ratios (OR) with 95% confidence intervals (CI). Compared with primigravidae (referent group), teenagers with a second live-birth had higher risks of perinatal mortality (OR = 2.11, 95% CI = 1.13, 3.95) and of neonatal mortality (OR = 4.30, 95% CI = 1.77, 10.49) and teens with a previous induced abortion had higher risk of stillbirth (OR = 3.41, 95% CI = 1.04, 11.19) and preterm birth (OR = 2.21, 95% CI = 1.07, 4.58) in crude analyses. Adjusted for all confounders, teens with a second live-birth were more likely to experience perinatal mortality (OR = 2.32, 95% CI = 1.12, 4.81) and neonatal mortality (OR = 4.67, 95% CI = 1.60, 13.66), and teenagers with a previous induced abortion had a higher risk of VLBW (OR = 2.90, 95% CI = 1.10, 7.69).

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Fisher WA, Singh SS, Shuper PA, Carey M, Otchet F, MacLean-Brine D, et al. Characteristics of women undergoing repeat induced abortion. CMAJ 2005;172(5):637-41

Phillips SP. Violence and abortions: What's a doctor to do? CMAJ 2005; 172 (5):653

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Li J, Laursen TM, Precht DH, Olsen J, Mortensen PB. Hospitalization for mental illness among parents after the death of a child. N Engl J Med. 2005 Mar 24;352(12):1190-6. BACKGROUND: The loss of a child is considered one of the most stressful events in the life of a parent. We hypothesized that parental bereavement increases the risk of hospital admission for a psychiatric disorder, especially for affective disorders. METHODS: We studied a cohort of 1,082,503 persons identified from national registers in Denmark who were born between 1952 and 1999 and had at least one child under 18 years of age during the follow-up period, from 1970 to 1999. Parents who lost a child during follow-up were categorized as "bereaved" from the date of death of the child. RESULTS: As compared with parents who did not lose a child, parents who lost a child had an overall relative risk of a first psychiatric hospitalization for any disorder of 1.67 (95 percent confidence interval, 1.53 to 1.83). Bereaved mothers had a higher relative risk of being hospitalized for any psychiatric disorder than bereaved fathers (relative risks, 1.78 [95 percent confidence interval, 1.60 to 1.98] and 1.38 [95 percent confidence interval, 1.17 to 1.63], respectively; P value for interaction, 0.01). The relative risks of hospitalization specifically for affective disorders were 1.91 (95 percent confidence interval, 1.59 to 2.30) and 1.61 (95 percent confidence interval, 1.15 to 2.27) for bereaved mothers and fathers, respectively. Among mothers, the relative risk of being hospitalized for any psychiatric disorder was highest during the first year after the death of the child but remained significantly elevated five years or more after the death. CONCLUSIONS: The risk of psychiatric hospitalization was increased among parents, especially mothers, who lost a child.

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Li J, Precht DH, Mortensen PB, Olsen J. Mortality in parents after death of a child in Denmark: a nationwide follow-up study. Lancet. 2003 Feb 1;361(9355):363-7.

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Li J, Hansen D, Mortensen PB, Olsen J.Myocardial infarction in parents who lost a child: a nationwide prospective cohort study in Denmark. Circulation. 2002 Sep 24;106(13):1634-9. The average RRs for a fatal MI and any first MI among the exposed were 1.36 (95% CI, 0.98 to 1.88) and 1.28 (95% CI, 1.08 to 1.51), respectively. The two cohorts had similar MI risk during the first 6 years of follow-up. From the 7th to the 17th year of follow-up, the exposed cohort had a RR of 1.58 (95% CI, 1.08 to 2.30) for fatal MI and a RR of 1.31 (95% CI, 1.09 to 1.57) for first MI. Parents who lost a child unexpectedly, especially from sudden infant death syndrome, experienced higher RRs. CONCLUSIONS: The death of a child was associated with an increased risk of MI in bereaved parents.

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J. Li, C. Johansen, H. Bronnum-Hansen, E. Stenager, N. Koch-Henriksen, and J. Olsen. The risk of multiple sclerosis in bereaved parents: A nationwide cohort study in Denmark. Neurology, March 9, 2004; 62(5): 726 - 729.

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Allanson S, Astbury J. The aboriton decision: fantasy processes. J Psychsom Obstet Gynecol 1996; 17:158-167. The significant number of abortion patients have positive fantasies regarding having the child. 40 percent have talked to their baby and 30 percent imagined a monetary windfall that would allow them to keep theri baby. Half imagined being a mother and whether their baby would be a boy or girl. One-fourth made plans in their heads for keeping the baby.

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Skotko BG. Prenatally diagnosed Down syndrome: Mothers who continued their pregnancies evaluate their health care providers. Am J Obstet Gynecol. 2005 Mar;192(3):670-7. Of 1126 surveys received, 141 (12.5%) were from mothers who had received a prenatal diagnosis. Though satisfied with the care that they had received, the majority of respondents expressed frustration with the process. The most common suggestions were that the diagnosis be conveyed in person, that up-to-date printed materials on Down syndrome (DS) be provided, and that mothers be referred to local DS support groups.

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Moreau C, Kaminski M, Ancel PY, Bouyer J, Escande B, Thiriez G, Boulot P, Fresson J, Arnaud C, Subtil D, Marpeau L, Roze JC, Maillard F, Larroque B; EPIPAGE Group. Previous induced abortions and the risk of very preterm delivery: results of the EPIPAGE study. BJOG. 2005 Apr;112(4):430-7. Women with a history of induced abortion were at higher risk of very preterm delivery than those with no such history (OR + 1.5, 95% CI 1.1-2.0); the risk was even higher for extremely preterm deliveries (< 28 weeks). The association between previous induced abortion and very preterm delivery varied according to the main complications leading to very preterm delivery. A history of induced abortion was associated with an increased risk of premature rupture of the membranes, antepartum haemorrhage (not in association with hypertension) and idiopathic spontaneous preterm labour that occur at very small gestational ages (< 28 weeks). Conversely, no association was found between induced abortion and very preterm delivery due to hypertension.

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B. Reime, B.A. Schuecking and P. Wenzlaff. Perinatal outcomes of teenage pregnancies according to gravidity and obstetric history Annals of Epidemiology. 2004; 14(8): 619-619 Bivariate and multivariable logistic regression analyses (adjusted for smoking status, nationality, partner status, and maternal height and weight at first and last antenatal visit). Compared with primigravidae (referent group), teenagers with a second live-birth had higher risks of perinatal mortality (OR = 2.11, 95% CI = 1.13, 3.95) and of neonatal mortality (OR = 4.30, 95% CI = 1.77, 10.49) and teens with a previous induced abortion had higher risk of stillbirth (OR = 3.41, 95% CI = 1.04, 11.19) and preterm birth (OR = 2.21, 95% CI = 1.07, 4.58) in crude analyses. Adjusted for all confounders, teens with a second live-birth were more likely to experience perinatal mortality (OR = 2.32, 95% CI = 1.12, 4.81) and neonatal mortality (OR = 4.67, 95% CI = 1.60, 13.66), and teenagers with a previous induced abortion had a higher risk of VLBW (OR = 2.90, 95% CI = 1.10, 7.69). Conclusion: Among teens, the second pregnancy bears greater risks than the first one. The prevention of the second pregnancy during adolescence should be paramount.

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Woo J, Fine P, Goetz L Abortion Disclosure and the Association With Domestic Violence Obstet Gynecol 2005 105: 1329-1334 OBJECTIVE: To estimate the rate at which women disclose abortion to their partners and examine the association between domestic violence and partner disclosure. METHODS: A cross-sectional cohort study was performed on women presenting for elective termination of pregnancy to a single clinic in Houston, Texas. Subjects were offered an anonymous, self-administered questionnaire. The 15-question survey addressed disclosure of abortion to the partner, reasons for nondisclosure if applicable, and physical and sexual abuse using a modified Abuse Assessment Screen. RESULTS: Of 960 patients, 85.2% completed the survey, for a final sample size of 818. Overall, 139 (17.2%) of subjects chose not to disclose the abortions to their partners, and 14% of patients reported abuse within the past year. Physical or sexual abuse or both was twice as common among nondisclosers (23.7% compared with 12.0%, P = .001). Among nondisclosers, 63 (45.3%) said the relationship with the partner had no future, 52 (37.4%) did not feel obliged to notify their partners, 29 (20.9%) said the partner would oppose the abortion, and 11 (7.9%) said disclosure would result in physical harm. CONCLUSION: In this urban, racially and socioeconomically diverse population, 17.2% of women concealed pregnancy terminations from their partners. Although relationship instability and personal choice were cited as the most frequent reasons for nondisclosure, the rate of domestic abuse was twice as high in this group and may have adversely affected open communication. Of greatest concern, a subset of nondisclosers reported the direct fear of personal harm as the primary reason for nondisclosure. 0.7 percent reported that they were subjected to physical or sexual abuse to compel them to abort.

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Jody Steinauer, Eleanor A. Drey, Rebekah Lewis, Uta Landy, Lee A. Learman. Prenatal Risk Factors for Cerebral Palsy in Very Preterm Singletons and Twins. Obstet Gynecol 2005 105: 1335-1340. In very preterm singletons, spontaneous preterm labor and preterm premature rupture of membranes increased the risk of cerebral palsy compared with hypertension.

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Hope, Trina L.; Wilder, Esther I.; Watt, Toni Terling The Relationships among Adolescent Pregnancy, Pregnancy Resolution, and Juvenile Delinquency The Sociological Quarterly. 2003, 44(4): 555-576. Abstract: We apply criminological theories of social control to explore the relationships among adolescent pregnancy, pregnancy resolution, & juvenile delinquency. While most ever-pregnant girls have especially high rates of delinquent behavior, adolescent mothers exhibit delinquency levels no higher than those of their never-pregnant peers. Unlike adolescent females who end their pregnancies through abortion, those who keep their babies experience a dramatic reduction in both smoking & marijuana use. Our results suggest that among adolescent girls, the birth of a child has a strong trajectory-modifying effect. It serves as a mechanism of social control & substantially reduces the likelihood of delinquent behavior. 7 Tables, 1 Appendix, 67 References.

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Neale RE, Darlington S, Murphy MF, Silcocks PB, Purdie DM, Talback M. The effects of twins, parity and age at first birth on cancer risk in Swedish women. Twin Res Hum Genet. 2005 Apr;8(2):156-62. We found positive associations between a later age at first birth and breast cancer and melanoma, while there were inverse associations with cervix, ovarian, uterine and colorectal cancers. “The more children you have, the more protective it gets,” said medical statistician Steven Darlington, a member of a group at the Queensland Institute of Medical Research (QIMR) who conducted the research, according to a news.com.au report. “It seems that an increase in the hormones produced during pregnancy are protecting against cancer, but we're not quite sure exactly how or why that happens.”

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Gissler M, Berg C, Bouvier-Colle MH, Buekens P. Methods for identifying pregnancy-associated deaths: population-based data from Finland 1987-2000. Paediatr Perinat Epidemiol. 2004 Nov;18(6):448-55. Horon IL. Underreporting of maternal deaths on death certificates and the magnitude of the problem of maternal mortality.Am J Public Health. 2005 Mar;95(3):478-82. Both Gissler and Horon show that the CDC statistics on pregnancy associated death are virtually meaningless.

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IVF has negative health impact on children. Gissler M, Malin Silverio M, Hemminki E. In-vitro fertilization pregnancies and perinatal health in Finland 1991-1993.Hum Reprod. 1995 Jul;10(7):1856-61 In 1993, in Finland at least 0.7% of all pregnancies ending in birth were assisted by in-vitro fertilization (IVF). The purpose of this study was to compare IVF mothers with other mothers, and the perinatal health and health care costs of IVF infants to those of other infants. The main source of information was the Medical Birth Register for 1991-1993 (n = 19,1712 pregnancies, of which 1015 were started by IVF). IVF mothers were more often older, married and primiparas. They started antenatal care earlier, had more visits than other mothers and more than 50% were hospitalized during their pregnancy. Every fourth IVF pregnancy was a multiple one. Both IVF singletons and multiples had poorer health than other infants. The new practice of implanting fewer embryos than before was introduced in 1992-1993, and a 50% decrease in triplet rate was found. At the same time, a somewhat better outcome for IVF newborns was found. However, every fourth child was still preterm or weighed < 2500 g. The health care costs for one IVF newborn from induction of pregnancy until the age of 7 days was 5.4-fold compared to other newborns. The subsequent health of IVF children has to be further studied to more fully assess the health impact of IVF.

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Ericson A, Nygren KG, Olausson PO, Kallen B. Hospital care utilization of infants born after IVF. Hum Reprod. 2002 Apr;17(4):929-32. BACKGROUND: Infants born after IVF are often twins, and singleton IVF babies have an increased risk for preterm birth. Both conditions are likely to increase morbidity. We examined the frequency and duration of hospitalization required by babies born after IVF, and compared this information with all infants born in Sweden during the same time period. METHODS: We used a nationwide registration of IVF pregnancies from 1984 to 1997 and a nationwide register of all in-patient care up to the end of 1998. We identified 9056 live born infants after IVF treatment and compared them with 1 417 166 non-IVF live born infants. RESULTS: The highest odds ratio (OR approximately 3) was seen for neonatal hospitalization, but an increased OR (1.2-1.3) was noted for children up to 6 years of age. The OR for being hospitalized after IVF was 1.8, but when the analysis was restricted to term infants it was 1.3 and this excess was then explainable by maternal subfertility. Statistically significant increased ORs were seen for hospitalization for cerebral palsy (1.7), epilepsy (1.5), congenital malformation (1.8) or tumour (1.6), but also for asthma (1.4) or any infection (1.4). When information from the Swedish Cancer Registry was used, no excess risk for childhood cancer was found. The average number of days spent in hospital by IVF and non-IVF children was 9.5 and 3.6 respectively. CONCLUSIONS: The increased hospitalization of IVF children is, to a large extent, due to the increased incidence of multiple births. Therefore, the increased costs associated with this may be reduced by the use of single embryo transfers, with the savings in health care costs being offset against the increased number of embryo transfer cycles required to maintain the pregnancy rate.

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http://www.agi-usa.org/presentations/ab_slides.html "An Overview of Abortion in the United States" The Guttmacher Institute's research indicates that 53 percent of women who have unintended pregnancies used a contraceptive method during the month they got pregnant. Continues to hide deaths associated with abortion.

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Miech RP. Pathophysiology of Mifepristone-Induced Septic Shock Due to Clostridium sordellii. Ann Pharmacother. 2005 Jul 26; [Epub ahead of print] It appears that the mechanisms of mifepristone abortion treatments favor the development of infection that leads to septic shock and intensifies the actions of multiple inflammatory cytokines, resulting in fulminant, lethal septic shock.

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http://www.iarc.fr/ENG/Press_Releases/pr167a.html International Agency for Research on Cancer of the World Health Organization, Press Release No 167, 29 July 2005 "An IARC Monographs Working Group has concluded that combined estrogen-progestogen oral contraceptives and combined estrogen-progestogen menopausal therapy are carcinogenic to humans (Group 1), after a thorough review of the published scientific evidence." "Use of OC's increases risk of breast, cervix and liver cancer… There is a small increase in the risk of breast cancer in current and recent users of oral contraceptives. However, ten years after cessation of use, the risk appears to be similar to that in never-users. The risk of cervical cancer increases with duration of use of combined oral contraceptives. The risk of hepatocellular carcinoma is increased in long-term users of combined oral contraceptives in populations with low prevalences of hepatitis B infection and chronic liver disease – two major causes of human liver cancer. "… but decreases risk of endometrial and ovarian cancer In contrast, the risks of endometrial and ovarian cancer are consistently decreased in women who used combined oral contraceptives. The reduction is generally greater with longer duration of use, and some reduction persists at least 15 years after cessation of use."

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Negative Health Effects of Non-Marital Intercourse Ebrahim SH, McKenna MT, Marks JS. Sexual behaviour: related adverse health burden in the United States. Sex Transm Infect 2005;81:38-40. CDC study shows that sexual behaviour accounted for around 20 million adverse health consequences - equivalent to over 7,500 per 100,000 people - in 1998. These included infections, infertility, and abortions. And it accounted for almost 30,000 deaths - just over 1% of the total for that year. They compiled data from the U.S. Burden of Disease Study for 1996 to estimate mortality and disability adjusted life years (DALYs) due to sexual behavior. The authors calculated that over 2 million DALYs were attributable to sexual behaviour. This equals over 6% of the national total and adds up to three times the levels of other wealthy nations. Almost two thirds (62%) of the adverse health consequences were borne by women, who were also most affected by disability (57%). Proportionately more men than women died (66%), but the authors point out that if HIV/AIDS is taken out of the equation, then 80% of the deaths attributed to sexual behaviour would have been among women. Cervical cancer and HIV infection were the leading causes of death among women; HIV was the single most important cause of death among men. CDC

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Hallfors DD, Waller MW, Bauer D, Ford CA, Halpern CT. Which comes first in adolescence--sex and drugs or depression? Am J Prev Med. 2005 Oct;29(3):163-70.

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Data are from the National Longitudinal Study of Adolescent Health, weighted to produce population estimates. The sample includes 13,491 youth, grades 7 to 11, interviewed in 1995 and again 1 year later. Multivariate logistic regression analyses, conducted in 2004, tested temporal ordering, controlling for covariates. The main outcome measures were depression, as measured by a modified Center for Epidemiological Studies–Depression Scale (CES-D), and three behavior patterns: (1) abstaining from sexual intercourse and drug use, (2) experimental behavior patterns, and (3) high-risk behavior patterns. Overall, sex and drug behavior predicted an increased likelihood of depression, but depression did not predict behavior. Among girls, both experimental and high-risk behavior patterns predicted depression. Among boys, only high-risk behavior patterns increased the odds of later depression. Depression did not predict behavior in boys, or experimental behavior in girls; but it decreased the odds of high-risk behavior among abstaining girls (RRR=0.14) and increased the odds of high-risk behavior (RRR=2.68) among girls already experimenting with substance use.Conclusions: Engaging in sex and drug behaviors places adolescents, and especially girls, at risk for future depression.

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Coleman PK, Maxey CD, Rue VM, Coyle CT. Associations between voluntary and involuntary forms of perinatal loss and child maltreatment among low-income mothers. Acta Pædiatrica, 2005; 94: Compared to women with no history of perinatal loss, those with one loss (voluntary or involuntary) had a 99% higher risk for child physical abuse, and women with multiple losses were 189% more likely to physically abuse their children. Compared to women with no history of induced abortion, those with one prior abortion had a 144% higher risk for child physical abuse. Finally, maternal history of multiple miscarriages and/or stillbirths compared to no history was associated with a 1237% increased risk of physical abuse and a 605% increased risk of neglect. Perinatal loss may be a marker for elevated risk of child physical abuse, and this information is potentially useful to child maltreatment prevention and intervention efforts. http://journalsonline.tandf.co.uk/link.asp?id=xr05355225rk21wk

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Whitehead A, Fanslow J. Prevalence of family violence amongst women attending an abortion clinic in New Zealand. Aust N Z J Obstet Gynaecol. 2005 Aug;45(4):321-4. AIMS: To measure the prevalence of family violence reported by women seeking a termination of pregnancy (TOP). METHODS: A cross sectional survey involving consecutive women at one Health Waikato abortion clinic. Participants completed a self-administered questionnaire in private counselling rooms. RESULTS: Sixty-two of the 125 women invited to participate did so (response rate: 49.6%). The reported lifetime prevalence of physical or sexual abuse was 50.8%. The reported lifetime prevalence of physical abuse was 43.3% and that of sexual abuse was 32.2%. The reported prevalence of physical abuse within the last year was 13.3%, and of sexual abuse within the last year was 8.5%. Of women reporting a lifetime history of physical abuse, 69% reported that her partner was the perpetrator/one of the perpetrators of abuse. CONCLUSIONS: The study demonstrated a high prevalence of family violence amongst women attending an abortion clinic. Consideration should be given to screening for family violence in abortion clinics in New Zealand. Screening should be accompanied by the provision of appropriate information and support for women with family violence issues

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Gissler M, Berg C, Bouvier-Colle MH, Buekens P. Injury deaths, suicides and homicides associated with pregnancy, Finland 1987-2000. Eur J Public Health. 2005 Oct;15(5):459-63. http://eurpub.oxfordjournals.org/cgi/content/abstract/15/5/459

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Coleman PK. Induced Abortion and Increased Risk of Substance Abuse: A Review of the Evidence, Current Women’s Health Reviews, 2005, 1, 21-34. http://www.bentham-direct.org/ben18/cwhr1-1/cwhr.htm http://www.bentham-direct.org/ben18/cwhr1-1/coleman.pdf

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Husfeldt C, Hansen SK, Lyngberg A, Noddebo M, Pettersson B. Ambivalence among women applying for abortion. Acta Obstetricia et Gynecologia Scandinavica, 1995; 74, 813-817. 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.

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There is a lower risk of mortality during pregnancy and until one year after birth compared to women without a recent pregnancy. (See Ronsmans C, et al. "Mortality in pregnant and nonpregnant women in England and Wales 1997–2002: are pregnant women healthier?" in Lewis G, editor. Why Mothers Die 2000-2002. The Sixth Report of the Confidential Enquiries into Maternal Death in the United Kingdom. London: RCOG Press;2004) "All-cause mortality in women aged 15–44 years was 58.4 deaths per 100,000 women per year.... Surprisingly, however, mortality during pregnancy or within 1 year after birth was between four and five times lower than mortality in women without a recent pregnancy. The rate ratios comparing the pregnancy–42 day and the 43–365 postpartum periods with nonpregnant women were 0.21 and 0.22, respectively." This study fails to distinguish between pregnancy outcomes, but does also report the following citations.... "In the USA, women who had delivered a live or stillborn infant in the previous year were half as likely to die as women who had not recently delivered." citing Jocums SB, Berg CJ, Entman SS, Mitchell EF. Postdelivery mortality in Tennessee, 1989–1991. Obstet Gynecol 1998; 91: 766–70. "In Canada, mortality rates during pregnancy or within 42 days of its termination and between 43 and 225 days postpartum were about half those of nonpregnant women."citing Turner LA, Kramer MS, Liu S. Cause-specific mortality during and after pregnancy and the definition of maternal death. Chronic Dis Can 2002; 23: 1–8. "In Finland, the age-adjusted risk of a natural death within a year after birth or a miscarriage was half that of women without a pregnancy." citing Gissler M, Berg C, Bouvier-Colle MH, Buekens P. Pregnancy-associated mortality after birth, spontaneous abortion or induced abortion in Finland, 1987-2000. Am J Ob Gyn 2004; 190:422-427. NOT MENTIONED: Results: The age-adjusted mortality rate for women during pregnancy and within one year of pregnancy termination was 36.7 deaths per 100,000 pregnancies, which was significantly lower than the mortality rate among nonpregnant women 57.0 per 100,000 person-years (RR=0.64, 95% CI 0.58-0.71). The mortality was lower *after a birth (28.2/100,000)* than after a spontaneous (51.9/100,000) or *induced abortion (83.1/100,000).* We observed a significant increase in the risk of death from cerebrovascular diseases after delivery among women aged 15-24 years (RR=4.08, 95% CI 1.58-10.55).

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COMPLICATIONS OF IVF Klemetti R, Sevon T, Gissler M, Hemminki E. Complications of IVF and ovulation induction. Hum Reprod. 2005 Dec;20(12):3293-300. Epub 2005 Aug 26 BACKGROUND: The frequency and importance of complications of IVF and other ovulation induction (OI) are poorly known. We examined the occurrence of serious complications and miscarriages leading to hospitalization or operation after IVF (including microinjections and frozen embryo transfers) and OI treatment (with or without insemination). METHODS: Women who received IVF (n = 9175) or OI treatment (n = 10 254) 1996-1998 in Finland were followed by a register linkage study until 2000. RESULTS: After the first IVF treatment cycle, 14 per 1000 women had a serious case of OHSS (ovarian hyperstimulation syndrome), with 23 per 1000 throughout the study period (mean of 3.3 treatments). The corresponding values after OI were very low. The rates of registered ectopic pregnancies and miscarriages after IVF were nine and 42 respectively per 1000 women, with corresponding rates after OI of eight and 42. Infections and bleeding were not common after IVF and even rarer after OI. Overall, 15% of IVF and 8% of OI women had at least one hospital episode during the study period. CONCLUSIONS: Though there was a low risk of complications after each IVF treatment cycle, repeated attempts resulted in serious complications for many women, and these occurred much more often than after ovulation induction alone.

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Klemetti R, Gissler M, Sevon T, Koivurova S, Ritvanen A, Hemminki E. Increasing evidence of major congenital anomalies in children born with assisted reproduction technology: what should be done? Fertil Steril. 2005 Nov;84(5):1327.

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Schieve LA, Rasmussen SA, Reefhuis J. Risk of birth defects among children conceived with assisted reproductive technology: providing an epidemiologic context to the data. Fertil Steril. 2005 Nov;84(5):1320-4; discussion 1327.

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Klemetti R, Gissler M, Sevon T, Koivurova S, Ritvanen A, Hemminki E. Children born after assisted fertilization have an increased rate of major congenital anomalies. Fertil Steril. 2005 Nov;84(5):1300-7.

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Koivurova S, Hartikainen AL, Gissler M, Hemminki E, Klemetti R, Jarvelin MR. Health care costs resulting from IVF: prenatal and neonatal periods. Hum Reprod. 2004 Dec;19(12):2798-805.

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Negative Effects of Hostility and Stress on Health Smith TW, Gallo LC. Hostility and cardiovascular reactivity during marital interaction. Psychosom Med. 1999 Jul-Aug;61(4):436-45.

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Kiecolt-Glaser JK et al., Hostile Marital Interactions, Proinflammatory Cytokine Production, and Wound Healing. Arch Gen Psychiatry. 2005;62:1377-1384.

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Kiecolt-Glaser JK, Glaser R, Cacioppo JT, Malarkey WB.Marital stress: immunologic, neuroendocrine, and autonomic correlates. Ann N Y Acad Sci. 1998 May 1;840:656-63. Ninety newlywed couples (mean age = 25), selected on the basis of extremely stringent mental and physical health criteria, were admitted to a hospital research unit for 24 hours to provide a detailed assessment of conflict-resolution behaviors and changes in autonomic, endocrine, and immune function. Among these newlyweds, negative or hostile behaviors during marital conflict (coded from videotaped interactions) were associated with increased levels of epinephrine, norepinephrine, growth hormone, and ACTH as well as greater immunological change over the subsequent 24 hours. Wives demonstrated greater and more persistent physiological changes related to marital conflict than husbands. To assess the generalizability of these physiological changes, a similar laboratory paradigm was used with 31 older couples (mean age = 67) who had been married an average of 42 years. Consistent with the data from newlyweds, both endocrinological and immunological data showed significant relationships to negative behavior during marital conflict in these older couples. These findings suggest that abrasive marital interactions have important endocrinological and immunological correlates.

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Fergusson DM, John Horwood L, Ridder EM. Abortion in young women and subsequent mental health. J Child Psychol Psychiatry. 2006 Jan;47(1):16-24. Background: The extent to which abortion has harmful consequences for mental health remains controversial. We aimed to examine the linkages between having an abortion and mental health outcomes over the interval from age 15-25 years. Methods: Data were gathered as part of the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of New Zealand children. Information was obtained on: a) the history of pregnancy/abortion for female participants over the interval from 15-25 years; b) measures of DSM-IV mental disorders and suicidal behaviour over the intervals 15-18, 18-21 and 21-25 years; and c) childhood, family and related confounding factors. Results: Forty-one percent of women had become pregnant on at least one occasion prior to age 25, with 14.6% having an abortion. Those having an abortion had elevated rates of subsequent mental health problems including depression, anxiety, suicidal behaviours and substance use disorders. This association persisted after adjustment for confounding factors. Conclusions: The findings suggest that abortion in young women may be associated with increased risks of mental health problems.

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World Mortality Report: 2005 , United Nations Populations Division, According to the Catholic Family and Human Rights Institute, a pro-life group that lobbies at the UN, the report reveals that Russia, where abortion has long been considered a form of birth control, a maternal mortality rate of 67 deaths for every 100,000 births. The rate is 17 deaths for every 100,000 births in the United States, which also has very permissive abortion laws. On the other hand, Ireland and Poland have lower rates. Ireland has the lowest maternal mortality rate of Poland, the U.S. and Russia with just 5 deaths for every 100,000 births. Poland's is also lower with 13 deaths for every 100,000 births. Pro-abortion laws also do not decrease infant mortality, even when the number of abortions is subtracted from the number of infant deaths. Ireland has the lowest rate at 6 deaths for every 1,000 live births, both Poland and the U.S. are at 7 deaths for every 1,000 live babies born, and pro-abrotion Russia has the highest at 12 deaths per 1,000 babies born.

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Vinson DC, Arell V. State Anger and the Risk of Injury: A Case-Control and Case-Crossover Study Ann Fam Med 2006 4: 63-68. High levels of self-reported state anger increase the risk of injury, especially among men, and specifically the risk of intentional injury in both sexes. This may be an excellent citation for increased risk of injury following abortion.

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Kersting A, et al. Trauma and grief 2-7 years after termination of pregnancy because of fetal anomalies-a pilot study. J of Psychosomatic Obstetrics & Gynecology 2005; 26(1): 9-14. The aim of the study was to obtain information on the long-term posttraumatic stress response and grief several years after termination of pregnancy due to fetal malformation. We investigated 83 women who had undergone termination of pregnancy between 1995 and 1999 and compared them with 60 women 14 days after termination of pregnancy and 65 women after the spontaneous delivery of a full-term healthy child. Women 2-7 years after termination of pregnancy were expected to show a significantly lower degree of traumatic experience and grief than women 14 days after termination of pregnancy. Contrary to the hypothesis, however, the results showed no significant intergroup differences with respect to the degree of traumatic experience. With the exception of one subscale (fear of loss), this also applied to the grief reported by the women. However, both groups differed significantly in their posttraumatic stress response from women who had given spontaneous birth to a full-term healthy child. The results indicate that termination of pregnancy is to be seen as an emotionally traumatic major life event which leads to severe posttraumatic stress response and intense grief reactions that are still detectable some years later.

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Kersting A, Reutemann M, Ohrmann P, Baez E, Klockenbusch W, Lanczik M, Arolt V. Grief after termination of pregnancy due to fetal malformation. J Psychosom Obstet Gynaecol. 2004 Jun;25(2):163-9. Three case studies presented

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Taft AJ, Watson LF, Lee C. Violence against young Australian women and association with reproductive events: a cross-sectional analysis of a national population sample. Aust N Z J Public Health. 2004 Aug;28(4):324-9. RESULTS: 23.8% of 14,784 women aged 18 to 23 years reported violence; 12.6% reported non-partner violence in the previous year; and 11.2% reported ever having had a violent relationship with a partner. Of the latter group, 43% (4.8% overall) also reported violence in the past year. Compared with women reporting no violence, women reporting partner but not recent violence (OR 2.55, 95% CI 2.10-3.09) or partner and recent violence (OR 3.96, 95% CI 3.18-4.93) were significantly more likely to have had one or more pregnancies. Conversely, having had a pregnancy (2561) was associated with an 80% increase in prevalence of any violence and a 230% increase in partner violence. Among women who had a pregnancy, having had a miscarriage or termination was associated with violence. Partner and recent violence is strongly associated with having had a miscarriage, whether alone (OR = 2.85, 95% CI 1.74-4.66), with a termination (OR = 4.60, 2.26-9.35), or with birth, miscarriage and a termination (OR = 4.12, 1.89-9.00). DO THEY ALSO HAVE A 2007 Study? see http://www.lifenews.com/int239.html http://www.phaa.net.au/anzjph/anzjph.htm

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"Comparison of pain, cortisol levels, and psychological distress in women undergoing surgical termination of pregnancy under local anaesthesia versus intravenous sedation." Suliman S, Ericksen T, Labuschgne P, de Wit R, Stein DJ, Seedat S. BMC Psychiatry June 20; 7:24, High rates of PTSD characterise women who have undergone surgical abortions (almost one fifth of the sample meet criteria for PTSD),

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Calhoun B, Shadigian E, Rooney B. "Cost consequences of induced abortion as an attributable risk for preterm birth and its impact on informed consent" Journal of Reproductive Medicine Oct. 2007 article (Volume 52, pp. 929-937): RESULTS: IA increased the early preterm delivery rate by 31.5%, with an increase in initial neonatal hospital costs related to IA of >$1.2 billion. The yearly human cost includes 22,917 excess early preterm bIrths (EPB) (<32 wees) and 1,rrr excess CP cases in very-low-birth-weight newborns, <1,500 g. CONCLUSION: IA contributes to significantly increased neonatal health costs by causing 31.5% of EPB. Providers of obstetrical care should be aware of the risk of preterm birth attributable to induced abortion with its significant increase in initial neontal hospital costs and CP cases.

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Suliman S, Ericksen T, Labuschgne P, de Wit R, Stein DJ, Seedat S. Comparison of pain, cortisol levels, and psychological distress in women undergoing surgical termination of pregnancy under local anaesthesia versus intravenous sedation. BMC Psychiatry. 2007 Jun 12;7:24. Examining symptom domains preabortion, and 1 and 3 months later, the authors evaluated 155 women who had abortions in South Africa. They reported: 1. "High rates of PTSD characterize women who have undergone voluntary pregnancy termination." p. 8 (almost one fifth of the sample met criteria for PTSD) 2. The percent of women who met PTSD criteria increased by 61% from pre-abortion baseline to 3 months post-abortion (11.3 to 18.2) 3. Women who met PTSD criteria pre-abortion experienced significantly more physical pain post-abortion 4. "Thus it would follow that screening women pre-termination for PTSD and disability and post-termination for high levels of dissociation is important in order to help identify women at risk of PTSD and to provide follow-up care." p. 6

Depression scores and associated factors in pregnant and non-pregnant women

Deniz Caliskan; Bedriye Oncu; Kenan Kose; Mine Esin Ocaktan; Oya Ozdemir Journal of Psychosomatic Obstetrics and Gynecology; Dec 2007; 28, 4; pg. 195 Among pregnant women, a history of abortion was significantly correlated to higher rates of depression.

Induced abortion and anxiety, mood, and substance abuse disorders: Isolating the effects of abortion in the national comorbidity survey

Priscilla K. Coleman, Catherine T. Coyle, Martha Shuping, Vincent M. Rue. J Psychiatr Res. 2008 Nov 27

The purpose of this study was to examine associations between abortion history and a wide range of anxiety (panic disorder, panic attacks, PTSD, Agoraphobia), mood (bipolar disorder, mania, major depression), and substance abuse disorders (alcohol and drug abuse and dependence) using a nationally representative US sample, the national comorbidity survey. Abortion was found to be related to an increased risk for a variety of mental health problems (panic attacks, panic disorder, agoraphobia, PTSD, bipolar disorder, major depression with and without hierarchy), and substance abuse disorders after statistical controls were instituted for a wide range of personal, situational, and demographic variables. Calculation of population attributable risks indicated that abortion was implicated in between 4.3% and 16.6% of the incidence of these disorders. Future research is needed to identify mediating mechanisms linking abortion to various disorders and to understand individual difference factors associated with vulnerability to developing a particular mental health problem after abortion.

Abortion and Poverty

Despite the claims made by many left-leaning groups this past election that abortion is caused by poverty and the best way to reduce or eliminate abortion is to elect pro-choice politicians, the data indicate that poor women are actually less likely to abort unintended pregnancies than upper income women. See here at Table 1: http://www.guttmacher.org/pubs/psrh/full/3809006.pdf . Women under the poverty line aborted 42% of unintended pregnancies, while those at 200% above the poverty line aborted 54% of such pregnancies.

Pregnancy loss and psychiatric disorders in young women: an Australian birth cohort study

Kaeleen Dingle, Rosa Alati, Alexandra Clavarino, Jake M. Najman, and Gail M. Williams BJP 2008 193: 455-460. http://bjp.rcpsych.org/cgi/content/abstract/193/6/455 Young women reporting a pregnancy loss had nearly three times the odds of experiencing a lifetime illicit drug disorder (excluding cannabis): abortion odds ratio (OR)=3.6 (95% CI 2.0–6.7) and miscarriage OR=2.6 (95% CI 1.2–5.4). Abortion was associated with alcohol use disorder (OR=2.1, 95% CI 1.3–3.5) and 12-month depression (OR=1.9, 95% CI 1.1–3.1).

Diagnostic categorization of post-abortion syndrome.

Gómez Lavín C, Zapata García R. Actas Esp Psiquiatr. 2005 Jul-Aug;33(4):267-72.

Domestic Violence and Abortion

Aston, G, Bewley, S. "Abortion and domestic violence." The Obsterician and Gynaecologist 2009, 11: 163-168.

A new British review study reports that women having repeat abortions were more likely to be in an abusive relationship.

The study, published in The Obstetrician and Gynaecologist, the journal of the Royal College of Ob-Gyns., found that 30 percent of women having a second abortion reported being in an abusive relationship and that the number increased for women having three or more abortions. One in three women in the study said they had experienced sexual and physical abuse throughout their lives.

The research follows a U.S. study published last December showing that women who had abortions were more likely to report a history of sexual abuse and to have experienced stressful events in adulthood, such as miscarriage, physical violence or being in a life-threatening accident. The U.S. researchers noted that women who experience domestic violence are more likely to abort compared to women who are not in violent situations.

And a New Zealand study published last August found that one in 10 women reported being abused while pregnant and that abused women were 2.5 times more likely to undergo an abortion compared to women who were not abused.