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![[Read eLetter]](/icons/misc/sectionDOWN.gif){kind=icon}
Psychological sequelae following induced abortion
The face of post abortion trauma...
Re: The Suppposed Link Between Abortion and Psychiatric Illness
Response to Brenda Major Commentary on Reardon Study
Denial of valid research does not make it invalid
The Suppposed Link Between Abortion and Psychiatric Illness
Enough is Enough
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Leverett L deVeber, MD President, The deVeber Institute for Bioethics and Social Research
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bioethics{at}deveber.org Leverett L deVeber, MD
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In response to Dr. Major's article on psychological sequelae following induced abortion, we would like to make the following comments: While she is to be commended for pointing out the need for more rigorous long-term studies, it is unfortunate that Dr. Major has minimized the psychological and psychiatric problems that may arise following induced abortion. Chapter 14, "Behavioral Outcomes, Suicide, Healing," of Women's Health after Abortion: The Medical and Psychological Evidence, identifies self-destructive behaviours as being more common in post- abortive women than in women who give birth.(1) Of note is a prestigious Finnish study of the records of almost 600,000 women: it showed a suicide rate among women who aborted nearly six times greater than among women who delivered, and three times the general suicide rate.(2) A Welsh study of 408,00 women found the relative risk of suicide after induced abortion to be 3.25.(3) Other self-destructive behaviours, such as increased substance abuse, attempted suicide, self- mutilation, and eating disorders have been found more commonly in post- abortive women.(4) In spite of apparent conflicts in the literature and methodological problems including high drop-out rates,(5) it is clear there are serious psychological problems following induced abortion. Indeed Dr. Major found 25-35 per cent of women she sampled were depressed or dissatisfied with their decision to abort.(6) Evidence of significant post-abortion psychological dysfunction is seen in the large numbers of post-abortive women seeking counselling from organizations such as Project Rachel(7) and The Healing Choice.(8) The National Office for Project Rachel deals with 5,000 cases a year, has trained 4,000 counsellors, all of whom are fully occupied, and knows of twenty-five other counselling programs. The Healing Choice states that at least ten per cent of post-abortive women have problems requiring counselling. If one considers the large numbers of abortions done in the U.S. and Canada every year, should even a small percentage result in post- abortion psychological problems, there is a significant, cumulative public health problem requiring attention. Doctors have a "continuing duty" as well as an obligation to inform their clients about risks associated with abortion. Prior to the procedure, a woman must be advised of the possibility of mental health problems developing at any time following abortion in addition to other risks she may face such as preterm birth, placenta praevia, and breast cancer. Sincerely, L.L. deVeber, MD, FRCP(C) President Martha Crean Project Leader Women's Health after Abortion 1. Ring-Cassidy E, Gentles I. Women's Health after Abortion: The Medical and Psychological Evidence Toronto: The deVeber Institute for Bioethics and Social Research, 2002, 333 pages. Based on an analytic review of more then 500 books and scientific articles the text is a careful summary of the recent medical evidence of the impact of abortion on women's health. 2. a) Gissler M, Hemminki E, Lonnqvist J. Suicides after pregnancy in Finland 1987-94: register linkage study. BMJ 1996, Dec. 7; 313(7070): 1431-4. b) Gissler M, Hemminki E, Lonnqvist J. Letters: Suicides after pregnancy-Authors Reply. BMJ 1997 Mar. 22; 314(7084): 902-3. 3. Morgan CL Evans M, Peters JR, Currie C. "Suicides after pregnancy. Mental health may deteriorate as a direct effect of induced abortion." BMJ March 22; 314: 902 4. For example: a) Reardon DC, Ney PG. Abortion and subsequent substance abuse. American Journal of Drug and Alcohol Abuse 2000 Feb.; 26(1):61-75. b) Frank et al., Cocaine use during pregnancy: Prevalence and correlates. Pediatrics 1988 Dec.; 82(6):888-95. c) Mensch B, Kandel DB. Drug use as a risk factor for premarital teen pregnancy and abortion in a national sample of young white women. Demography 1992 Aug.; 29(3):409-29. 5. Soderberg H et al. "Selection bias in a study on how women experience induced abortion" European Journal of Obstetrics & Gynecology and Reproductive Biology 77 (1998) pp.67-70. 6. a) Major et al. Psychological responses of women after first trimester abortion" Archives of General Psychiatry Vol. 57, August 2000 pp. 777-784. b) Major, Cozzarelli et al. Women's experiences of and reactions to anti- abortion picketing. Basic and Applied Social Psychology 22(4) pp. 265-275. 7. Project Rachel, National Office of Reconciliation and Healing, Milwaukee, Wis. 53207; or, Box 2400, London ON N6A 4G3. 8. De Puy C and D Dovitch. The Healing Choice: Your Guide to Emotional Recovery After an Abortion. N.Y.: Fireside, 1997. Conflict of Interest:None declared |
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Celia M. Ryan, Clinical social worker, grief therapist www.GriefWorks.com
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celiaryan{at}griefworks.com Celia M. Ryan
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In response to the article "Psychiatric admissions of low-income women following abortion and childbirth" and the reactions from Brenda Major and others, I would like to offer a personal glimpse into the aftermath of an abortion experience for some women and men. I have run a post abortion support group for eight years now, ever since I realized that abortion is a classic disenfranchised grief in our society and there is little or no support, validation or healing for the experience that, for some men and women, is incredibly traumatic and destructive. I am not a researcher, and the hurting men and women who come to my office for counseling, or to my groups, are not interested in statistics or expectable outcomes. They are interested in having a language, structure and a framework for their abortion experience and an opportunity to use that information in a helfpul and healing way. They are grateful and relieved to finally be able to name and explore an issue that society says does not exist. They are no longer disenfranchised from their appropriate grief. Any change can bring loss and loss is often accompanied by grief - to deny that something has changed is to deny reality. How that reality is experienced is obviously affected by numerous factors but in no other area of a person's life does society so totally deny an individual's reported experience. As a clinical social worker and specialised grief therapist I can try to set aside my own politics and judgments to offer my understanding of traumatic grief to a hurting persons so they can begin to understand that they have had a life-changing experience and to find a way to accomodate this which does not disable or destroy them. Denial disables, validation empowers; until society is able to recognize and validate the hurt and pain of an abortion experience, for some people, we will disenfranchise them and we will all have to accomodate the "walking wounded". |
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Shauna C Hollingshead, Medical Student University of Alberta, Canadian Physicians for Life
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shauna{at}ualberta.ca Shauna C Hollingshead
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I would like to respond to a recent letter (May 20, 2003) by Laetitia Poisson de Souzy regarding Reardon's study. As a future colleague, I would encourage Ms. Poisson de Souzy to review the literature regarding the possible risks of abortion. Clearly her statement, "Publishing this article represents a serious breach of medical ethics on the part of the CMAJ...", is misinformed. Within medical ethics, the concept of informed consent is of paramount importance. Regardless of one's opinions surrounding the abortion issue, educating patients about the relevant benefits and risks of a medical intervention is integral to good medicine. As a "future Ob/Gyn", Ms. Poisson de Souzy may wish to inform her future patients of the risks associated with abortion. Aside from the usual risks of a surgical procedure, these include increased risks of the following: psychiatric illness1, future pre-term birth2, and breast cancer3,4. I commend the CMAJ for refusing to allow politics to trump the scientific progress of women's health care. References 1. Reardon DC et al. Psychiatric admissions of low-income women following abortion and childbirth. CMAJ 2003; 168 (10): 1253-6. 2. Henriet L, Kaminski M. Impact of induced abortions on subsequent pregnancy outcome: the 1995 French national perinatal survey. British J Obstetrics Gynaecology 2001; 108: 1036-42. 3. Brind et al. Induced abortion as an independent risk factor for breast cancer: a comprehensive review and meta-analysis. J of Epidemiology & Community Health 1996; 50: 481-96. 4. Daling, JR et al. Risk of Breast Cancer Among Young Women: Relationship to Induced Abortion. Journal of the National Cancer Institute 1994; 86; 1584-92. |
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John B. Shea M.B. FRCP...(C), retired physician , George P. Dienesch M.A.
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jbshea{at}rogers.com John B. Shea M.B. FRCP...(C), et al.
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One can only agree with Dr. Brenda Major when she writes that “it is essential that health providers and policy-makers base their conclusions on reputable scientific research that is methodologically rigorous, conceptually sound and free from ideological bias. ”Major, CMAJ, May 13, 2003. P.1257. This is especially important in light of the patient’s legal right to be informed about the pertinent facts, in making reproductive health decisions. Dr. Major is somewhat inaccurate, however, when she states of Reardon et al. that “their conclusion implies that this (higher psychiatric admission rate post abortion) was the result of problems related to aborting a pregnancy.” Actually Reardon et al., simply apply H.P. David’s earlier study’s methodology, to a large North American sample of low income women, thus deriving an epidemiologically significant association.(1) Reardon et al. are fully aware that causal etiology is a complex thing to determine, and offer three possible explanations. As they note, the observed associations may be the result of a) less social support for women who have an abortion compared with women who deliver, b) reactions to abortion itself, or c)common risk factors(not yet identified) among mentally ill women and those who have abortions. What is clear is that the statistical association is significant enough to warrant further study. Clearly there are many problems to consider in studying post abortive sequelae. Methodological problems must be addressed, and studies replicated with fine tuning of classification instruments and analysis. As Thorp et al. recognize “A clear and overwhelming need exists for a large epidemiologic, cohort study of women with an unintended or crisis pregnancy. Follow-up across participants’ lifetimes with careful measurement of other pertinent exposures would dramatically advance knowledge.”(2) Major’s own work would point to the need for further research. A recent study by Major et al., of women at three Buffalo N.Y. abortion centers, finds that after 2 years follow up 153 of 438 women in her study (35%) were either depressed or dissatisfied with their decision to abort. 16.3% were dissatisfied, 19% would not make the same decision again,17% reported physical complications. Six of 442 (1.4%) met the diagnostic criteria for Post Traumatic Stress Disorder.(3) Analyzing the same sample of post abortive women in another article, Major et al. note that 24.5% scored above the cutoff for clinical levels of depression at the two year follow up point.(4) What must be kept in mind is that Major et al. had a 50% dropout rate from their study by the 2 year mark. (Originally 882 women had agreed to participate in the study) In a study of attrition rates as regards post abortion follow up, Dr. Nancy Adler states: “A review of 17 studies shows that the percent of the initial sample lost to follow-up ranges from a low of 13% to a high of 86%. Younger women and Catholic women appear to be less likely to participate in follow-up. Since both of these characteristics are associated with a greater likelihood of negative sequelae, follow-up studies may be underestimating the extent of negative reaction to abortion.” Furthermore Adler noted that unmarried women were less likely than married women to participate in follow up research. “Since the women in the sample who did experience post-abortion sequelae were all unmarried, the underrepresentration of unmarried women in the sample would lead to an underestimation of the incidence of post- abortion sequelae in the total population.”(5) Adler also notes that a major reason for attrition in follow up studies is stressor avoidance.“Non returners may be more likely than returners to use avoidance as a general coping strategy, or may have greater need specifically to avoid thinking about the abortion.”(p.257) Studies consistently show that those who use avoidance as a coping strategy are far more likely to develop serious psychological sequelae.(6) In their epidemiological review Thorp et al. note that: “Although earlier studies focusing on secondary outcomes were reassuring, more recent, large cohort studies linking abortion to the “hard” outcomes of either suicide, psychiatric admission, or deliberate self harm are concerning. A major question remains unanswered because of the lack of a proper control group. Is the observed phenomena a correlate of the circumstance that may lead to a crisis or unintended pregnancy regardless of a woman’s decision to choose abortion, or is this a function of both? Until that question can be answered, it will be hard to inform women as to what, if any, additional risk a decision to terminate will produce. Likewise, the uncertainty limits a clinician’s ability to reassure such a woman that her decision will not have long-term mental health effects. The observation of the association, regardless of the lack of causal linkage, suggests careful screening and follow-up for depression and anticipatory guidance/precautions for women who choose elective abortion.”(7) For an analytic synopsis of the major studies regarding psychological risk factors, sequelae such as suicide, deliberate self harm and substance abuse, see: the DeVeber Institute study Women’s Health after Abortion The Medical and Psychological Evidence.(8) (1)H.P. David showed 50% higher rates of admittance to psychiatric hospitals, of women following abortion as compared to delivery. David, H.P. Post-abortion and post-partum psychiatric hospitalization. Ciba Foundation Symposium 1985; 115: 150-64. (2)J.M.Thorp M.D.,K.E.Hartmann M.D.,Phd.,E.Shadigian M.D.,“Long term Physical and Psychological Health Consequences of Induced Abortion: Review of the Evidence” Obstetrical and Gynecological Survey 2003; 58(1): 67-79. (3)B.Major, C.Cozzarelli et al. “ Psychological Responses of women after First Trimester Abortion” Archives of General Psychiatry Vol. 57, Aug. 2000 p. 777-786 (4)C.Cozzarelli, B.Major,et al.“Women’s Experiences of and Reactions to Antiabortion Picketing” Basic and Applied Social Psychology Vol. 22(4) 2000, p. 265-275 (5)N.E. Adler,“Sample Attrition in Studies of Psychosocial Sequelae of Abortion:How Great a Problem?” Journal of Applied Social Psychology 1976, 6(3) p.240-259 (6)For an important recent study of selection bias and attrition see: H. Soderberg, C. Andersson et al.“Selection bias in a study on how women experienced induced abortion”. European Journal of Obstetrics, Gynecology and Reproductive Biology 1998:Vol. 77(1)p.67-70. (7)Ibid. Thorp et al. (8)E. Cassidy, I. Gentles, Women’s Health after Abortion: The Medical and Psychological Evidence. Toronto, ON. The DeVeber Institute for Bioethics and Social Research, 2002 332 pages. Based on the research findings of more then 500 books and scientific articles,a comprehensive up-to-date report of the physical and psychological impact of induced abortion on women. Dr. John B. Shea M.B. FRCP…(C). jbshea@rogers.com George P. Dienesch M.A. |
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Annie D. Banno Silent No More
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smok22{at}earthlink.net Annie D. Banno
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To Brenda Major: I'd direct your attention to: "Depression and unintended pregnancy in the National Longitudinal Survey of Youth: a cohort study," British Medical Journal, 324: 151-152. This study from December 2001 indicates that women who abort a first pregnancy are at greater risk of subsequent long-term clinical depression compared to women who carry an unintended first pregnancy to term. An average of eight years after abortion, married women were 138 percent more likely to be at high risk of clinical depression compared to similar women who carried their unintended first pregnancies to term. "State-funded abortions vs. deliveries: A comparison of outpatient mental health claims over five years." American Journal of Orthopsychiatry, 2002, Vol. 72, No. 1, 141-152. In this record-based study of 173,000 California women, women were 63 percent more likely to receive mental care within 90 days of an abortion compared to delivery. In addition, significantly higher rates of subsequent mental health treatment persisted over the entire four years of data examined. Abortion was most strongly associated with subsequent treatments for neurotic depression, bipolar disorder, adjustment reactions, and schizophrenic disorders. "History of induced abortion in relation to substance use during pregnancies carried to term." American Journal of Obstetrics and Gynecology. December 2002; 187(5). This study indicates that women with a prior history of abortion are twice as likely to use alcohol, five times more likely to use illicit drugs, and ten times more likely to use marijuana during the first pregnancy they carry to term compared to other women delivering their first pregnancies. "Deaths associated with pregnancy outcome: a record linkage study of low income women." Southern Medical Journal, August 2002, 95(8):834-841. This study reveals that women who have abortions versus those who carry to term are almost twice as likely to die in the two years following the pregnancy outcome. Over the full eight year period studied, women who aborted had a 154 percent higher risk of death from suicide and an 82 percent higher risk of death from accidents. "The quality of care giving environment and child development outcomes associated with maternal history of abortion using the NLSY data." Journal of Child Psychology and Psychiatry. 2002; 43(6):743-757. "The results of our study showed that among first-born children, maternal history of abortion was associated with lower emotional support in the home among children ages one to four, and more behavioral problems among five- to nine-year-olds," said Dr. Priscilla Coleman, a professor at Bowling Green State University and the lead author of the study. "This held true even after controlling for maternal age, education, family income, the number of children in the home and maternal depression." It would appear that Reardon et al. are not alone in finding empirical evidence to indicate that abortion is a severe risk factor for several types of substantial emotional and physical trauma. Further, you are quoted as stating that it's equally possible "that psychiatric problems cause women who become pregnant to feel less capable of raising a child and to terminate their pregnancy." In the study, it explicitly states that "only women who had no psychiatric admissions or pregnancy events during the year before the target pregnancy event were included." I knew none of the above damage was possible when I had my abortion in 1979, and after only 6 years of legalized abortion, I daresay NO ONE knew this. And this is exactly why it should never have been made legal, and should now be made illegal, because of the massive damage to women that abortion has inflicted. I could go on with citation after citation, but you certainly have denied the numerous studies which have shown the physical, reproductive and emotional damage which women suffer from abortion. Twenty-four years after "choosing" abortion, I still cry. I have never cried so much in my entire life than I have over what I have done to my first child. I cannot compare the remorse and anguish I have had, every day of my life, to anything else I know. Twenty years of burying this utter pain has taken its toll on me (it's called constriction, in Post Traumatic Stress Disorder terminology). I still feel overwhelming guilt and raw grief when I allow myself to think about the daughter I will never hold in my arms. But each time another woman, a total stranger, contacts me or wraps her arms around me on the street to thank me for trying to help other post -abortive women, I am grateful that I have been able to find some help, since I know the millions of others will too. If one looks at the peer-reviewed research, one can conclude that 17 million or more women suffer many or all of the diagnosable symptoms of PTSD as a result of their abortions. How can you possibly say that you are pro-woman? Even Dr. Janet Daling, who is pro-choice, wrote this in a 1994 NCI Journal: "If politics gets involved in science, it will really hold back the progress we make. I have three sisters with breast cancer, and I resent people messing with the scientific data to further their own agenda, be they pro-choice or pro-life. I would have loved to have found no association between breast cancer and abortion, but our research is rock solid, and our data is accurate. It's not a matter of believing. It's a matter of what is." Sincerely, Annie Banno OPERATION OUTCRY: SILENT NO MORE, CT State Leader, 203-820-9898; E-mail: smok22@earthlink.net , www.silentnomorecampaign.com, National Helpline: 1-800-395-HELP. www.CatholicExchange.com Columnist |
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Laetitia Poisson de Souzy, Medical Student UC Davis School of Medicine
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laetitiapds{at}yahoo.com Laetitia Poisson de Souzy
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As a future Ob/Gyn, I am incredibly disappointed by your journal's recent publication of Dr. Reardon's article. With all due respect, I think that your staff was acting irresponsibly. Publishing this article represents a serious breach of medical ethics on the part of the CMAJ, one of most prestigious medical journals in the world. The article was not properly peer-reviewed, because the CMAJ should have checked Reardon's background and the politics of all the authors. The purpose of a medical journal is to advance medicine, not stir controversy in order to increase readership, and in the process impugn abortion practice and harm women. | |||
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Theresa Bonopartis, Director of Program
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Tbonop{at}optonline.net Theresa Bonopartis
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As a post abortive woman I find it very disturbing that Dr Major refuses to acknowledge the pain countless women have felt as a result of their abortions. . For years I suffered emotionally as a result of an abortion I had in my teens. It impacted all aspects of my life until I finally found a mental health professional willing to address the very real pain I was feeling instead of telling me to "get over it" ,"it is in your past" or "it must be something else, not your abortion." Over the past ten years, I have worked with hundreds of other women who have suffered with depression, guilt, shame and countless other things who have been told the same ridiculous things because the mental health profession refuses to acknowledge the impact of abortion. One women I know ended up in a psychiatric hospital every year for 20 years on the anniversary of her abortion. This past year she finally found someone who would listen and for the first time, passed the anniversary in tact. It is a travesty! Thank goodness, it is beginning to change as more and more professionals are hearing the suffering of their clients and beginning to realize this cannot be ignored anymore. Dr Majors is doing a great injustice to women. In fact, women are being aborted by a society who endorses abortion yet refuses to recognize its detrimental effects because of political reasons. If women were truly cared about, those who are impacted would be helped and damage done to them proclaimed with outrage no matter what their stance on abortion. As it stands now, the only women cared about are the ones who are ok with their abortions. It is time all women are cared for...not just those who are poltically correct. Theresa Bonopartis Director/Lumina, Hope and Healing After Abortion PO Box 242 Harrison, NY 10528 |
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