Researchers Drew the Wrong Conclusions
in New England Medical Journal Study
Springfield, IL (February 2, 2011) — A study that is being reported as showing abortion doesn’t increase women’s mental health risks actually shows a higher rate of problems among women who have abortions compared to those who give birth, a leading expert says.
The study, published in the New England Journal of Medicine, was based on a comparison of medical records among women in Denmark who had a first-trimester induced abortion or a first childbirth between 1995-2007. The researchers, led by Trine Munk-Olsen, compared inpatient and outpatient psychiatric treatments for nine months before the abortion or birth took place and twelve months afterward. Women who had a history of mental health problems before the study period were excluded.
Dr. David Reardon of the Elliot Institute said the findings showed that aborting women were three times more likely to seek treatment for mental health problems in the year following abortion compared to women who gave birth or who had not been pregnant.
The study’s authors, on the other hand, focused on a finding that the rate of psychiatric treatment was similar for women both before and after abortion. They concluded that the study “does not support the hypothesis that there is an increased risk of mental disorders after a first-trimester induced abortion.”
But Reardon, who has worked on more than a dozen studies finding increased mental health problems among women who abort, said the findings don’t support this conclusion.
He said the two to three times higher rate of psychiatric treatment among aborting women confirms other studies finding that women who have abortions have higher rates of mental health problems compared to women who give birth. More than 35 such studies have been published in the last five years alone.
“Other studies have also found that abortion is a marker for mental health problems, and this study agrees with those findings,” Reardon said. “The finding that women who have abortions are more likely to seek psychiatric treatment compared to women who give birth is consistent with previous findings.”
Study Raises More Questions
Reardon believes the study’s failure to distinguish between groups of the women having abortion tends to “obfuscate rather than clarify the key issues at hand.”
For example, although the researchers asserted that they were comparing women having a first trimester abortion to women giving birth for the first time, the study actually mixed the groups. Delivering women who had a previous abortion were included in both the birth group and abortion group. Similarly, women who gave birth to one or more children and then had a subsequent abortion were also included in both groups.
“This division of groups is nonsensical,” said Reardon. “In all similar record linkage studies, women with both abortion and childbirth experiences as a third group, one which can be then be compared to both the group of women having only a history of abortion and those having only a history of childbirth.”
Why Munk-Olsen and her team did not follow this precedent has not been explained. Reardon believes the mixing of groups was deliberately done to dilute the findings.
“Several other other studies have already shown that a history of abortion increases the risk of psychiatric problems during subsequent pregnancies that are delivered,” said Reardon. “Indeed, preparing to give birth to a first live born child can itself trigger unresolved emotional issues regarding a prior abortion. The failure to identify the delivering women in a study who previously had abortions will therefore increase the overall average of psychiatric issues attributed to childbirth even though a significant portion of the effects may actually have been due to the prior abortions.”
Another problem, according to Reardon, is that instead of examining psychiatric history for at least a year prior to the estimated date of conception (as has been done in other studies), Munk-Olsen’s team used a nine month period before the pregnancy outcome. That means were comparing the nine months delivering women were pregnant (on average) with approximately seven months prior to conception combined with two months of pregnancy for women who were having abortions. That’s an apples to oranges comparison, according to Reardon.
Yet another methodological problem, said Reardon, is that “The researchers just lump all women who have a first abortion into a single group without regard to whether or not they sought any psychiatric help in the nine months prior to the abortion. The only way to really shed light on why psychiatric treatment rates are three times higher for women who abort than for women who carry to term is to break the aborting group into two groups: those with prior psychiatric problems and those without.”
“If it was mostly the same women who underwent treatment both before and after abortion, it would indicate that seeking psychiatric care prior to abortion is a risk factor for mental health problems after abortion,” Reardon said. “In that case, women with a history of seeking mental health care prior to an abortion might be advised to continue seeking mental health treatment.”
“On the other hand, if a large number of the women who did not have prior mental health treatments were responsible for the higher rate of psychological treatments after their abortions, it seems likely that the abortion did trigger or worsen their psychological well being,” he said.
The researcher’s failure to distinguish between these two cases, he says, “obscures what the data would reveal if it were more carefully analyzed.”
Given the weaknesses of the study design, Reardon believes that the published results “simply do not justify the authors’ glowing generalization that the three fold higher rate of mental health they found for women who aborted is purely incidental.”
Limitations and Flaws
Additional critics have pointed to a number of other flaws and limitations in the study design.
For example, the study did not control for other factors that could affect a woman’s mental health, including whether or not the pregnancy was wanted, coercion to abort, and exposure to violence or other traumas.
And while the study only looked at women’s mental health for a year following abortion, previous research has indicated that mental health problems often emerge or persist after that point. A record-based study of psychiatric treatment rates among women receiving state-funded medical care in California, which Reardon co-authored, found that rates of psychiatric treatment remained significantly higher for at least four years after abortion.
Even though the new study did not look beyond one year, a breakdown of the rates of psychiatric treatment for each month within the first year after abortion did show a significant increase in the rates of psychiatric treatment for specific problems — such as stress, neurotic, behavioral and personality disorders. But the study’s authors downplayed this finding.
Reardon says the new study simply doesn’t contradict the findings of previously published studies that link abortion to higher rates of mental health problems. Instead, he says, it actually adds to the growing body of evidence linking abortion and mental health problems.
“It’s most important contribution is that it raises new questions about whether psychiatric care before abortion benefits women. What is doesn’t show is that having an abortion benefits women who are facing a crisis or erases their problems. Instead, it may contribute to them.”
Munk-Olsen, T, Laursen TM, Pedersen CB, Lidegaard Ø. Induced First-Trimester Abortion and Risk of Mental Disorder. Dr.Med.Sc., and Preben Bo Mortensen, Dr.Med.Sc. N Engl J Med 2011;364:332-9.