APA Abortion Report

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• 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.

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. it also appears that the APA is identifying adolescents are at higher risk compared to older women. This is most evident in the parsing of thir 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."

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.'"