C. Everett Koop

The Koop Report on Abortion

In July of 1987, President Ronald Reagan asked Surgeon General C. Everett Koop, to to prepare a report for the nation on the health risks of abortion for women.

In brief, in a letter to the President seventeen months later, Dr. Koop ducked the assignment claiming that due to an inadequate base of research no definitive statements could be made. The pro-abortion media immediately twisted Koop’s non-report into a claim that no dangers to abortion could be found, ergo, abortion is safe. Similar distortions of Koop’s statements continue to this day particularly in medical journals where pro-abortion researchers frequently cite the Surgeon General’s letter as an “authoritative” review which confirmed the safety of abortion. For his part, Dr. Koop continues to be haunted by the whole matter, facing the sporadic denouncements of conservatives who believe that he “betrayed” the cause.

What really happened? What did Koop really say and what could he have said?

The Unwanted Assignment

It all began when the President was preparing for a summit meeting with pro-life leaders who were outraged over the firing of JoAnn Gasper from the Department of Health and Human Services. (Mrs. Gasper had been fired for enforcing a hard line interpretation of federal regulations banning abortion funding, a position her immediate supervisors in the Administration did not share.) At the urging of at least one pro-life aide, President Reagan was convinced that pro-lifer’s would be mollified by allowing Koop, one of their own, to produce a report which would prove the negative health effects of abortion on women and thus contribute to the reversal of Roe v. Wade. Having personally reviewed a number of post-abortion testimonies himself, Reagan was perhaps so convinced of abortion’s traumatic effects that he assumed that the assignment would be an easy one which Koop would relish. (It is even reported that President Reagan frequently gave copies of post-abortion testimonies to others in defense of his anti-abortion position.)

Koop, for his part, did not relish the assignment. On at least two occasions Koop attempted to convince the president to withdraw his request for a report.

When his petitions were rejected, Koop assigned the task to an assistant, Commander George Walter, explaining that he wanted to “distance” himself from the report. Walter obtained a list of articles from the Centers for Disease Control and Prevention (CDC), authored mostly by CDC pro-abortion surveillance staff (several of whom moonlighted as abortion providers). It is also reported that Walter consulted with Planned Parenthood's Alan Guttmacher Institute.

When Walter's report was given to Koop, Koop didn't believe the report had sufficient merit to give it his stamp of approval. Koop, therefore, decided that no final “report” could be given at all.

Instead, he provided a letter to the President Reagan explaining why there was insufficient data on which to base a report, stating, "the available scientific evidence about the psychological sequelae of abortion simply cannot support either the preconceived beliefs of those pro-life or of those pro-choice," and again, "the data do not support the premise that abortion does or does not cause or contribute to psychological problems. Anecdotal reports abound on both sides. However, individual cases cannot be used to reach scientifically sound conclusions."

In conclusion, Koop wrote that "the scientific studies do not provide conclusive data about the health effects of abortion on women. I recommend that consideration be given to going forward with an appropriate prospective study." In that regard, he stated that "The most desirable prospective study could be conducted for approximately $100 million over the next five years. A less expensive yet satisfactory study could be conducted for approximately $10 million over the same period of time. This $10 million study could start yielding data after the first year."

Koop's Moral Bind

Koop was a well known as a Evangelical pro-life advocate. But he believed abortion should be addressed as a moral issue, not a public health issue.

In an interview with leaders of The Rutherford Institute shortly after release of his letter to the president, Koop sharply criticized the efforts of pro-lifers who were working to increase public awareness of abortion complications for women.

According to Koop, “I think it is wrong for the prolife forces to get all upset about the health effects of abortion on women and get away from the health effects of abortion on the fetus. This is the marker issue there . . . [A]s soon as you contaminate the morality of your stand by getting worried about the health effects of abortion on women, you have weakened the whole thing…”

This view suggests an important reason why Koop did not want to undertake President Reagan's assignment. To Koop, it posed a moral quandary. He believed Reagan's request was not only a strategic mistake . . . it was morally topsy-turvey, threatening to turn attention away the core moral issue, the sanctity of human life, by diverting attention to purely health issues.

In short, if he had written a report which validated concerns of abortion’s health risks for women, he would have been contributing to the abandonment of the moral high ground. Abortion, he believed, should not be opposed for what it does to women, but for what it does to the unborn.

Misrepresentations of Koop's Letter

Abortion proponents immediately began to insist that Koop's letter proved there was no evidence of abortion harming women, a misrepresentation that was widely reported in the media. But Koop himself vigorously denied this, insisting that there was “no doubt in my mind” that there are serious physical complications and “tremendous psychological problems” resulting from abortion. In subsequent testimony, Koop stated:

"It is worth mentioning that the first press release by a wires service after my visit to the White house completely misinterpreted my letter to the President. The release said that there was "no evidence of health effects post-abortion" rather than saying that there was insufficient scientific and statistical evidence on which to base an unimpeachable report. That erroneous news release was picked up by all three major networks and repeated verbatim. Since then, the incorrect conclusions have surfaced periodically and have been used improperly to further notions held by those on one side or other of the abortion argument. I would like to make it clear that the letter I wrote the President did not eliminate his question on psychological sequelae, it merely postponed the answer."

Then, after submitting the letter to the President, Koop told his staff to discontinue any further efforts on the report because it was simply not possible "prepare a report that could withstand scientific and statistical scrutiny." But his instruction were ignored by Walter who revised his draft and again submitted it to Koop who instructed him to shelve the draft and to not release any report other than his letter from his office. Walter subsequently released the draft under Koop's name anyway.

Eventually Congressional hearings were called for and led by pro-abortion Democrats with the explicit goal of trying to make Walter's pro-abortion leaning report part of the official record. Koop distanced himself from Walter's report insisting he had not even read it until preparing for the congressional hearing and that it was, in fact, only "Commander Walter's report" not the report of the Surgeon General.

In his testimony, Koop reiterated his position that the studies on abortion's psychological effects at that time were too flawed to make any estimate regarding how many women were negatively effected by abortion, but he insisted that "there is no doubt about the fact that there are those people who do have severe psychological problems after abortion. I have counseled such people in my own life."

The effort to get Koop to say anything that would further advance their efforts to "close the file" on abortion safety, was exemplified by this exchange:

Congressman Ted Weiss: "And yet the American Psychological Association's conclusion that severe long-term psychological effects of abortion are rare seems to be consistent with your remarks at several meeting on this topic in which you refer to the psychological problem as "minuscule" from the public health perspective."

Koop: "From a public health perspective, that is true. From the personal perspective, from the family perspective, it is overwhelming. All this leads up to my conclusion to the President that we don't know what we are talking about, and if you want to know what you are talking about and feel certain about what you are saying you have to do a prospective study..."

Subsequent news reports not only wrongly attributed the words of Ted Weiss, "minuscule from a public health perspective," to Koop but also failed to to report that Koop's admission of lack of evidence regarding the scale of psychological problems (which itself suggests no one can know if the problem is "minuscule") was immediately followed by an emphasis on his certainty that psychological effects are "overwhelming" for at least some women and families.

NOTES

The above article includes sections and excerpts of Revisiting the “Koop Report” by David C. Reardon, Ph.D., with permission from the Elliot Institute and excerpts from Wikipedia...reprinted with permission from the public domain.

Statement of C. Everett Koop, M.D. Surgeon General Before the House Committee on Government Operations. March 16, 1989

The C. Everett Koop Papers: Reproduction and Family Health

The Koop Letter

(The letter from C. Everett Koop to President Reagan regarding the President's request that he prepare a report on the physical and mental health effects of abortion.)

January 9, 1989

Mr. Ronald Reagan The President of the United States The White House 1600 Pennsylvania Avenue, NW Washington, DC 20500

Dear Mr. President:

On July 30, 1987, in remarks at a briefing for Right to Life leaders, you directed the Surgeon General to prepare a comprehensive report on the health effects of abortion on women. It was clear from those remarks that such a report was to cover the mental, as well as the physical, effects of abortion. A review of the scientific literature, the expertise of the Public Health Service, and the experience of national organizations with an interest in this issue form the basis for my conclusion.

The health effects of abortion on women are not easily separated from the hotly debated social issues that surround the practice of abortion. Therefore, every effort has been made to eliminate the bias which so easily intrudes even into the accumulation of scientific data. In this study I have purposely avoided any personal value judgement vis-à-vis abortion as a social issue.

I have approached this task as I did in writing the AIDS report which you requested in 1986. Scientific, medical, psychological, and public health experts were consulted. I met privately with 27 different groups which had philosophical, social, medical, or other professional interests in the abortion issue. The process involved groups such as the Right to Life National Committee, Planned Parenthood Federation of America, the U.S. Conference of Catholic Bishops, the American College of Obstetricians and Gynecologists, and women who had had abortions.

In summary of the situation, each year approximately 6 million women become pregnant; of that number 54 percent or 3.3 million of those pregnancies are unplanned. Over 1.5 million women, or 25 percent of those pregnant, elect abortion each year. Since the legalization of abortion in 1973, over 20 million abortions have been performed. Even among groups committed to confirming a woman's right to legal abortion there was consensus that any abortion represented a failure in some part of society's support system, - individual, family, church, public health, economic, or social.

At the time the report was requested, there were those advising you and intimately involved with the social issues of abortion who truly believed that such a report could be put together readily. In the minds of some of them, it was a foregone conclusion that the negative health effects of abortion on women were so overwhelming that the evidence would force the reversal of Roe v. Wade.

There were also others who truly believed differently. While they acknowledge that any surgical procedure done 1.5 million times a year may have some negative health effects on women, in their minds the positive effects of abortion - release from the unwanted pregnancy - far outweighed the perceived negative results.

It is difficult to label the opposing groups in the abortion controversy. Those against abortion call themselves pro-life. On the other hand, those who are not pro-life say the are not pro-abortion; rather, they refer to themselves as pro-choice and supporters of a woman's right to choose abortion.

It is also true that some who are pro-choice are personally opposed to abortion. It is not clear to them where the lines should be drawn between the right of the fetus and the right of the mother. So the pro-choice forces are not monolithic.

Nor are the pro-life forces monolithic. Many ardent pro- life individuals who are dedicated to preserving the life of the fetus do not consider contraception to be ethically, morally, or religiously wrong. But others in the pro-life camp do; indeed, some equate contraception with abortion.

I believe that the issue of abortion is so emotionally charged that it is possible that many who might read this letter would not understand it because I have not arrived at conclusions they can accept. But I have concluded in my review of this issue that, at this time, the available scientific evidence about the psychological sequelae of abortion simply cannot support either the preconceived beliefs of those pro-life or of those pro-choice.

Today considerable attention is being paid to possible mental health effects of abortion. For example, there are almost 250 studies reported in the scientific literature which deal with the psychological aspects of abortion. All of these studies were reviewed and the more significant studies were evaluated by staff in several of the Agencies of the Public Health Service against appropriate criteria and were found to be flawed methodologically. In their view and mine, the data do not support the premise that abortion does or does not cause or contribute to psychological problems. Anecdotal reports abound on both sides. However, individual cases cannot be used to reach scientifically sound conclusions. It is to be noted that when pregnancy, whether wanted or unwanted, comes to full term and delivery, there is a well documented, low incidence of adverse mental health effects.

For the physical situation, data have been gathered on some women after abortions. It has been documented that after abortion there can be infertility, a damaged cervix, miscarriage, premature birth, low birth weight babies, etc. But, I further conclude that these events are difficult to quantify and difficult to prove as abortion sequelae for two reasons. First, these events are difficult to quantify because approximately half of abortions are done in free-standing abortion clinics where records which might have been helpful in this regard, have not been kept. Second, when compared with the number of abortions performed annually, 50 percent of women who have had an abortion apparently deny having had one when questioned. Further, these events are difficult to prove, as sequelae of abortion because all of these same problems can and do follow pregnancy carried to term or not carried to term, - indeed can occur in women who have never been pregnant previously. Clearly, however, the incidents of physical injury is greater in instances where abortions are performed or attempted by those not qualified to do them or under less than sterile conditions.

I have consulted with the National Center for Health Statistics and Centers for Disease Control about the design of appropriate studies which could answer the questions dealing with the physical and psychological effects of abortion.

There has never been a prospective study on a cohort of women of child-bearing age in reference to the variable outcomes of mating. Such a study should include the psychological effects of failure to conceive, as well as the physical and mental sequelae of pregnancy, - planned and unplanned, wanted and unwanted - whether carried to delivery, miscarried, or terminated by abortion. To do such a study that would be above criticism would consume a great deal of time. The most desirable prospective study could be conducted for approximately $100 million over the next five years. A less expensive yet satisfactory study could be conducted for approximately $10 million over the same period of time. This $10 million study could start yielding data after the first year.

There is a major design problem which must be solved before undertaking any study. It is imperative that any survey instrument be designed to eliminate the discrepancy between the number of abortions on record and the number of women who admit having an abortion on survey. It is critical that this problem of "denial" be dealt with before proceeding with further investigations.

That is where things stand at this moment. I regret, Mr. President, that in spite of a diligent review on the part of many in the Public Health Service and in the private sector, the scientific studies do not provide conclusive data about the health effects of abortion on women. I recommend that consideration be given to going forward with an appropriate prospective study.

Sincerely,

/s/

C. Everett Koop, M.D., Sc.D.

Surgeon General, U.S.P.H.S