Meta-analysis challenges abortion policies

The media seems to have ignored a significant study on the effects of abortion which has appeared in latest issue of the British Journal of Psychiatry. After a meta-analysis of 22 published studies with data on 877,181 participants, 163,381 of whom had experienced an abortion, Priscilla K. Coleman, of Bowling Green State University, in Ohio, has concluded that abortion is associated with mental health problems.

“Overall, [she writes] the results revealed that  women who had undergone an abortion experienced an 81% increased risk of mental health problems, and nearly 10% of the incidence of mental health problems was shown to be directly  attributable to abortion. The strongest effects were observed when  women who had had an abortion were compared with women  who had carried to term and when the outcomes measured related  to substance use and suicidal behaviour.”

Abortion is probably the most contentious issue in medicine – and bioethics – so it is rather surprising that these challenging conclusions in a respected journal (impact factor 5.78) have been largely ignored, apart from a few pro-life sites.

The results of review put a cloud over previous reviews which argue that the mental health of women who have had an abortion is related to their existing problems, not to the abortion itself. In 2009 a task force of the American Psychological Association reported, for instance, that “There is no credible evidence that a single elective abortion of an unwanted pregnancy in and of itself causes mental health problems for adult women.”

However, Dr Coleman says that recent meta-analyses are flawed for three reasons. Only a handful of studies have actually included unintended pregnancy carried to term as a control group. Many recent studies were not taken into account. And finally, the reviews “lacked sufficient methodologically based selection criteria”. She singles out the APA review for ignoring “dozens of methodologically sophisticated international studies”.

The policy implications of Dr Coleman’s study are obvious. Ninety percent of UK abortions are carried out “on the presumption that abortion actually reduces the risk to mental health associated with continuing the pregnancy”. If this is not true, then “clinicians should convey the current state of uncertainty  related to benefits of abortion”.

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