By Priscilla Coleman, Ph.D.
On October 6th an article titled “Is So-Called Post-Abortion Trauma Syndrome a Myth?,” written by Zawn Villines, appeared on GoodTherapy.org. In order to address the question she poses, Villines does not focus on the large international body of peer-reviewed scientific evidence indicating that abortion increases women’s risk of experiencing mental health problems. Instead she exclusively describes results of the flawed Turnaway Study, led by Diana Greene Foster.
Villines highlights the Turnaway findings that there were no significant differences in mental health trajectories between (1) women who had abortions and (2) those denied abortions, because their pregnancies had advanced beyond the legal gestational limit. Villines neglected to mention that 60 percent of the women in the Turnaway group who continued their pregnancies expressed happiness about their pregnancies. And no mention is made by Villines of the glaring methodological shortcomings of the Turnaway study.
The following major problems, among others, preclude trust in all the results obtained.
First, fewer than one-third of the women who were asked to participate agreed to do so. This is unacceptably low because those consenting may have differed systematically from those who declined. Consent to participate rates should be at least 70 percent for a study to be considered valid.
Second, women who obtained or were denied abortions due to gestational limits in local laws included women for whom the legal limit ranged from 10 weeks through 27 weeks. This is not a variable that can be loosely defined, as there is a wealth of data indicating the psychological impact of abortion differs between first and second trimester abortions. Women aborting at such widely varying points in pregnancy cannot be lumped together.
Third, the increased risk of late-term abortion to women’s physical well-being is not addressed by Foster (the study’s author) or by her cheerleader, Villines. Physical risks are uncontested in the professional literature. For example, using national data, Bartlett and colleagues (2004) reported that per 100,000 abortions, the relative risk of abortion-related mortality was 14.7 at 13–15 weeks of gestation, 29.5 at 16-20 weeks, and 76.6 at 21 weeks or later. This compares to a 12.1 rate for childbirth.
Fourth, the vast majority of research studies addressing the psychological implications of abortion do not measure “Post-Abortion Syndrome;” instead they examine mental illnesses identified by mainstream professional organizations. The results of hundreds of studies published in leading peer-reviewed journals over the past four decades indicate abortion is a substantial contributing factor in women’s mental health problems, including depression, anxiety, substance abuse, and death from suicide.
In 2011, I published a meta-analysis titled “Abortion and Mental Health: A Quantitative Synthesis and Analysis of Research Published from 1995-2009.” A meta-analysis has much more credibility than the results of individual empirical studies or narrative reviews. In a meta-analysis, the contribution or weighting of any particular study to the final result is based on objective scientific criteria (sample size and strength of effect). The sample consisted of 22 studies and 877,297 participants (163,880 experienced an abortion). Results revealed that women who aborted experienced an 81 percent increased risk for mental health problems. When compared specifically to unintended pregnancy delivered, women were found to have a 55 percent increased risk of experiencing mental health problems. This review offers the largest quantitative estimate of mental health risks associated with abortion available in the world.
The Turnaway study researchers reported that two years later, women in both the abortion and childbirth groups were equally likely to still be with their romantic partners, implying that abortion does not introduce problems in relationships. This result is not consistent with the wealth of published results indicating the opposite. Partner communication problems and an increased risk for separation or divorce following an abortion has been reported in several studies. In one study by Lauzon and colleagues (2000), 12 percent of the women and 18 percent of the men indicated that an abortion performed up to 3 weeks earlier had negatively impacted their relationship. Rue and colleagues reported that 6.8 percent of Russian women and 26.7 percent of American women indicated relationship problems caused by an abortion experience; whereas relationship benefit was reported by very few Russian women (2.2 percent) and American women (0.9 percent).
Finally, the Turnaway study authors reported that women in abusive relationships experience a decrease in violence following an abortion; whereas they are likely to report an increase in violence corresponding to childbirth. Based on the methodological shortcomings addressed above, these findings are suspect as well and represent an over-simplification of complex phenomena.
We do know that women in abusive relationships are more likely to be abused when pregnant. In fact, there are a number of peer-reviewed articles documenting murder of pregnant women by their intimate partners, particularly during early pregnancy, as a major cause of death among pregnant women. Many of the women killed are likely to have refused an abortion that an abusive partner was demanding. In fact, many homicide cases over the last several decades have been traced to women’s refusal to undergo an abortion.
A study by Pallitto and colleagues (2013) was recently published in the International Journal of Gynecology and Obstetrics based on results of the WHO Multi-Country study examining intimate partner violence, abortion, and unintended pregnancy. The results indicated that 30 percent of abortions are due to intimate partner violence. The authors concluded their report by stating:
The time has come for greater recognition of the fact that [under] the visible physical bruises of violence lie the less visible yet potentially more debilitating consequences to women living in an environment where their physical, emotional, and reproductive health are at risk in the short and long term.
Knowing this, shouldn’t all women who present at abortion clinics be actively screened for violence with a protocol in place to help them to safety, as opposed to quickly performing the procedure and sending them back into the hands of an abuser?
Priscilla K. Coleman, PhD is a Professor of Human Development and Family Studies at Bowling Green State University in Ohio. Her research has been published in close to 50 professional journals and she serves on the editorial boards of five international psychological and medical journals. In recent years, she has presented her research at conferences in Australia, Chile, the United States and three European nations. Dr. Coleman is a founder of WECARE, the World Expert Consortium for Abortion Research and Education.
This article was originally published at Aleteia, and is reprinted with permission of the author.
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