APA Abortion Report

The APA Task Force report was prepared by Brenda Major, Nancy Russo and others. The task force was selected to include only abortion proponents.

Article Related to APA Task Force

• Tales From an Insider: How The APA Denied Abortion's Mental Health Risks by Rachel McNair, Ph.D.

• The APA Task Force Report dismisses a large body of evidence demonstrating a link between abortion and mental health problems. And in the end it is left with only one study which it deems to be definitive in demonstrating no higher mental health risks associated with abortion. That study Gilchrist has a number of flaws described here which demonstrate that the findings should not be treated with any greater preference than the other studies reviewed.

• Researcher: APA Chair Withholding Info on Abortion's Mental Health Risks by Steven Ertelt

• Brenda Major, Chair of APA Abortion Task Force - Biography and biases

• Letters to APA Regarding Task Force on Abortion

• David Fergusson reacts to the APA Mental Health and Abortion task force report

• Psychiatric Bulletin publishes David Fergusson editorial on mental health and abortion

• Allegations cloud APA Mental Health and Abortion report

• APA denials of abortion mental health risk contradicted by other studies Good overview article from Catholic News Service.

• APA abortion and mental health report: Single abortion not a threat to women’s mental health

• What the headline's avoid saying, "APA finds more than one abortion is threat to women's mental health"

• APA Report Unconvincing. 100 Scientists Report Abortion Does Cause Mental Health Problems

• On March 14, 2008, the British Royal Academy of Psychiatrists recognized the need to screen for risk factors associated with mental health problems associated with abortion, stating:

“Healthcare professionals who assess or refer women who are requesting an abortion should assess for mental disorder and for risk factors that may be associated with its subsequent development. If a mental disorder or risk factors are identified, there should be a clearly identified care pathway whereby the mental health needs of the woman and her significant others may be met."

“The Royal College of Psychiatrists recognizes that good practice in relation to abortion will include informed consent. Consent cannot be informed without the provision of adequate and appropriate information regarding the possible risks and benefits to physical and mental health."

Here is the full text of the Royal College of Psychiatrists statement

• Women Hurting From Abortions Say APA Report Discounts Their Experiences

• Researcher on Abortion-Depression Link Says APA Report Ignores Best Studies

• APA Report on Abortion-Mental Health Problem Link Politically Biased

Media Reports

• Medpage Today

Excerpts:

The review identified several factors predictive of more negative psychological responses following first-trimester abortion:

• Included perceptions of stigma
• Need for secrecy
• Low or anticipated social support for the abortion decision
• Prior history of mental health problems
• Personality factors such as low self-esteem and use of avoidance and denial coping strategies
• Characteristics of the particular pregnancy, including the extent to which the woman wanted and felt committed to it
• Prior mental health which was the strongest predictor of postabortion mental health

The report noted that many of these same factors also predict negative psychological reactions to other types of stressful life events, including childbirth.

National Health Services

Daily Herald

Abortion has risks, whatever the research says The Times August 19, 2008

Med India

"Certain factors were found to increase the risk of lingering mental health effects ranging from higher stress levels to anxious feelings to full-blown depression:

• Being pressured into having an abortion when the pregnancy was wanted

• Not having adequate emotional support after the abortion

• Feeling the need to keep the abortion a secret from loved ones because of the stigma associated with it

Standard for Medical Recommendations

The U.S. Preventive Services Task Force (USPSTF) within the Agency for Healthcare Research and Quality, which is a division of the U.S. Department of Health and Human Services (http://www.ahrq.gov/clinic/3rduspstf/ratings.htm), has identified basic guidelines for how scientific evidence should be used to inform practice. These are summarized below and are based on an analysis of risks and benefits as established in the scientific literature.

• Level A: Good scientific evidence indicates the benefits of the service substantially outweigh the risks with clinicians advised to discuss the service with eligible patients.

• Level B: Fair scientific evidence indicates the benefits of the service outweigh the risks with clinicians encouraged to discuss the service with eligible patients.

• Level C: At least fair scientific evidence indicating benefits are provided by the service, but the balance between benefits and risks precludes general recommendations. Clinicians are advised to only offer the service if there are special considerations.

• Level D: At least fair scientific evidence indicates the risks of the service outweigh benefits with clinicians advised not to routinely offer the service.

• Level I: Scientific evidence is deficient, poorly done, or conflicting precluding assessment of the risk benefit ratio. Clinicians are advised to convey the uncertainty of evidence surrounding the service to patients.

Given these guidelines, it is clear that responsible physicians should not be routinely offering abortion. The best published evidence shows clear risks associated with abortion but no clear benefits, meaning that Level's D and I are most applicable.

US Preventive Services Task Force Ranking of Evidence Quality

Systems to stratify evidence by quality have been developed, such as this one by the US Preventive Services Task Force|U.S. Preventive Services Task Force for ranking evidence about the effectiveness of treatments or screening:

• Level I: Evidence obtained from at least one properly designed randomized controlled trial.
• Level II-1: Evidence obtained from well-designed controlled trials without randomization.
• Level II-2: Evidence obtained from well-designed cohort study or case-control analytic studies, preferably from more than one center or research group.
• Level II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
• Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

Recommendations for Improving Observational Studies - STROBE

(Abstract) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies

ABSTRACT: Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. 18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed Explanation and Elaboration document is published separately and is freely available on the Web sites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE Statement will contribute to improving the quality of reporting of observational studies.

A number of strategies for accessing the quality of observational studies have been proposed and tested.

Comparative Effectiveness Research

From the Agency for Healthcare Research and Quality:

What Is Comparative Effectiveness Research?

Comparative effectiveness research is designed to inform health-care decisions by providing evidence on the effectiveness, benefits, and harms of different treatment options. The evidence is generated from research studies that compare drugs, medical devices, tests, surgeries, or ways to deliver health care.

There are two ways that this evidence is found:

• Researchers look at all of the available evidence about the benefits and harms of each choice for different groups of people from existing clinical trials, clinical studies, and other research. These are called research reviews, because they are systematic reviews of existing evidence.
• Researchers conduct studies that generate new evidence of effectiveness or comparative effectiveness of a test, treatment, procedure, or health-care service.

...It’s true that some treatments may not work for everyone, and that some treatments may work better for some people than others. This research can help identify the treatments that may work best for you. ... Every patient is different — different circumstances, different medical history, different values. These reports don’t tell you and your doctor which treatment to choose. Instead, they offer an important tool to help you and your doctor understand the facts about different treatments.

More Material of Interest

Still highly relevant article: Limitations on Post-Abortion Research: Why We Know So Little by David C. Reardon

Link to the official APA task force report.

Risk Factors identified:

• This review identified several factors that are predictive of more negative psychological responses followingfirst-trimester abortion among women in the United States. Those factors included perceptions of stigma, need for secrecy, and low or anticipated social support for the abortion decision; a prior history of mental health problems; personality factors such as low self-esteem and use of avoidance and denial coping strategies; and characteristics of the particular pregnancy, including the extent to which the woman wanted and felt committed to it. Across studies, prior mental health emerged as the strongest predictor of postabortion mental health. (p4.)

• Research derived from a stress-and-coping perspective has identified several factors that are associated with more negative psychological reactions among women who have had an abortion. These include terminating a pregnancy that is wanted or meaningful; perceived pressure from others to terminate a pregnancy; perceived opposition to the abortion from partners, family, and/or friends; and a lack of perceived social support from others. Other factors found to be associated with more negative postabortion experiences include personality traits (e.g., low self-esteem, a pessimistic outlook, low- perceived control) and a history of mental health problems prior to the pregnancy. (p11)

• The most methodologically strong studies in this group showed that interpersonal concerns, including feelings of stigma, perceived need for secrecy, exposure to antiabortion picketing, and low perceived or anticipated social support for the abortion decision, negatively affected women’s postabortion psychological experiences. Characteristics of the woman also predicted more negative psychological experiences after first-trimester abortion, including a prior history of mental health problems, personality factors such as low self-esteem and low perceived control over her life, and use of avoidance and denial coping strategies. Feelings of commitment to the pregnancy, ambivalence about the abortion decision, and low perceived ability to cope with the abortion prior to its occurrence also predicted more negative postabortion responses. (p 92)

• They also report a positive association between more mental illness and multiple abortions (dose effect) and limit their conclusion that abortion has no higher risk to women who have an "adult women who have an 'unwanted pregnancy'" (p4)

• "[I]t is clear that some women do experience sadness, grief, and feelings of loss following termination of a pregnancy, and some experience clinically significant disorders, including depression and anxiety." (p4)

COMPLETE APA LIST OF RISK FACTORS

1. terminating a pregnancy that is wanted or meaningful
2. perceived pressure from others to terminate a pregnancy
3. perceived opposition to the abortion from partners, family, and/or friends
4. lack of perceived social support from others
5. various personality traits (e.g., low self-esteem, a pessimistic outlook, low-perceived control over life)
6. a history of mental health problems prior to the pregnancy
7. feelings of stigma
8. perceived need for secrecy
9. exposure to antiabortion picketing
10. use of avoidance and denial coping strategies
11. Feelings of commitment to the pregnancy
12. ambivalence about the abortion decision
13. low perceived ability to cope with the abortion
14. history of prior abortion
15. late term abortion
16. By parsing of the APA summary conclusion that "adult women who have an unplanned pregnancy the relative risk of mental health problems is no greater if they have a single elective first-trimester abortion than if they deliver that pregnancy," it also appears that the APA is identifying the following as risk factors

• being an adolescent (not an adult)
• having a non-elective (therapeutic or coerced) abortion
• prior history of abortion (having a second or third abortion, or more)

Others Recommending Screening and Doctor's Obligation

When is a physician legally or ethically obligated to refuse a contraindicated abortion? Sylvia Stengle, executive director of the National Abortion Federation, which represents abortion clinics, admitted in a Wall Street Journal interview (October 28, 1994) that at least one in five patients (probably a low estimate) are at psychological risk from abortion due to prior philosophical and moral beliefs contrary to abortion. In short, because of external pressures, they are aborting in violation of their consciences. Stengle admits that "It's a very worrisome subset of our patients. Sometimes, ethically, a provider has to say, 'If you think you are doing something wrong, I don't want to help you do that.'"

Selective Use of Foreign Studies

APA report embraces a single foreign study by [Gilchrist]] as the only reliable study on abortion and mental health. Therefore, one should carefully review this posting regarding the Gilchrist study to understand that it too has flaws.

What is most curious, however, is that the APA also deliberately chose to ignore a number of important foreign studies, precisely because they did not support their agenda.

This included ignoring the latest New Zealand studies by Fergusson, even though they were provided advanced copies, and also the Suliman 2007 which disclosed about 18% of women had PTSD after an abortion. What is striking about the Suliman study is that it was prompted by abortion doctors at a Marie Stopes clinic noticing a "high" rate of PTSD in their clients which prompted the docs to undertake a study to see if one type or anesthesia or another would make any difference. It didn't. Three months out, 18% of the post-abortive women had PTSD. The authors, apparently pro-abortion, pointed that this was almost one in five, and pointed out that they considered this a "high" rate of PTSD. So, how can the APA be so certain that nobody but nobody ever gets PTSD after abortion which is how they want to spin this.

Also ignored were the very excellent studies by Soderberg Using extensive interviews, Soderberg found that at a 12 month follow-up, 50-60% of women undergoing induced abortion experienced some measure of emotional distress, classified as severe in 30% of cases.

Bias of the APA

1. The APA has adopted a political, not a scientific, position on abortion. This was officially done in 1967 by a vote to treat abortion as a "civil right."

2. The bias of the APA to promote an "ultra-liberal agenda" has been documented in the 2005 book 'Destructive Trends in Mental Health: The Well Intentiond Path to Harm', by Rogers H. Wright, Nicholas A. Cummings. See a review here

3. The APA Task Force report was prepared by Brenda Major, Nancy Russo and others. The task force was selected to include only abortion proponents.

More Examples of Political Bias in "Official Scientific Consensus"

ACOG's "official" report on partial birth abortions was edited by White House staffer, Elena Kegan to insert language that would be cited by the courts. According to Slate columnist William Saletan,

With this clever phrasing, she obscured the truth: By reframing ACOG's judgments, she altered their political effect as surely as if she had changed them.

She also altered their legal effect. And this is the scandal's real lesson: Judges should stop treating the statements of scientific organizations as apolitical. Such statements, like the statements of any other group, can be loaded with spin. This one is a telling example....

[The courts], like the rest of us, was apparently unaware that after the ACOG task force formulated its proposed statement, the statement was politically vetted and edited. Kagan's memos and testimony confirm that ACOG consulted the White House and altered its statement accordingly. As a result, the statement reframed ACOG's professional findings to support the policy views it shared with the White House.