Wednesday, August 27, 2008

Earlier this month, the American Psychological Association plunged headlong into controversy with the release of a report from the Task Force on Mental Health and Abortion.

The panel, chaired by University of California psychology professor Brenda Major, produced a 91-page report with several conclusions. Principally, the APA reported that the best scientific evidence published indicates that among 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.The task force said the research was less clear about the effects of multiple abortions. However, they speculated that the culprit for association between women with multiple abortions and later mental health problems was not the abortion per se but conditions which lead to multiple unplanned pregnancies. Finally, the committee called for more research.

The report was immediately attacked by pro-life advocates and psychologists who questioned the objectivity of the APA. Critics pointed out that three members of the task force believed abortion was unrelated to adverse outcomes prior to commencing work on the report. Furthermore, since 1969, the APA has consistently advocated for a woman’s right to choose abortion as a civil right. In 1989, the APA took the position that the evidence did not support a link between adverse mental health consequences and abortion. Some of the same people who were on the 1989 committee were on this task force. Finally, the APA leadership consistently refused to meet with women who claim adverse effects from abortion.

When asked about these criticisms, the APA’s response is consistent. APA spokesperson Rhea Farbermantold mein an e-mail: “The APA’s report is a rigorous review of the best available science. It calls to light the need for more research to better understandthe potential mental health effects of abortion.”

The casual observer might conclude that the issue of post-abortion effects is hopelessly subject to bias. The pro-life researchers line up on one side and the pro-choice researchers line up on the other. However, there is one prominent pro-choice researcher who also questions the APA’s conclusions and method of finding them.

That scholar is David Fergusson, who is executive director of the Health & Development Study at the Christchurch School of Medicine & Health Sciences in New Zealand. In 2005, Dr. Fergusson published a longitudinal study of young women, which found adverse mental health effects associated with abortion. What is striking about his work is that he began his study with the expectation that abortion would not prove harmful. What he found convinced him that the concerns about mental health effects were credible. Because of his work, Dr. Fergusson was selected to be one of 20 reviewers of the preliminary draft of the APA paper.

After reviewing the APA final report, Dr. Fergusson pointed out that the APA task force primarily relied on one study for their conclusions. It seems incredible that the APA would use just one study to make conclusions, but this approach is evident on page 68:

“In summary, although numerous methodological flaws prevent the relative mental health risks associated with abortion per se compared to its alternatives (childbirth of an unplanned pregnancy), in the view of the TFMHA [Task Force], the best scientific evidence indicates that the relative risk of mental health problems among adult women who have an unplanned pregnancy is no greater if they have an elective first-trimester abortion than if they deliver that pregnancy (Gilchrist et al., 1995).”

As a basis for policy, there are multiple problems with the Gilchrist study. First, mental health outcomes were not assessed by mental health professionals or standardized surveys but rather by reports to general practitioners. In addition, well over half of the women dropped out of the study and were not available for follow up. Dr. Fergusson concludes:

“Since most of those having mental health problems do not attend general practitioners, this approach to assessment of mental health is poor. Thus, from the standpoint of the U.S. debate, basing conclusions on evidence that was gathered in the United Kingdom in 1995 and in which mental health was not adequately assessed is scarcely adequate grounds for confidently informing the U.S. public that the Committee’s findings are based on “the best scientific evidence.”

Dr. Fergusson also questioned the rationale for making policy in the absence of more evidence, saying, “What the Committee has, in effect, said is that until there is compelling evidence to the contrary, people should act as though abortion has no harmful effects. This is not a defensible position in a situation in which there is evidence pointing in the direction of harmful effects. The moral of all of this is very simple: In science, drawing strong conclusions on the basis of weak evidence is bad practice. The APA report on abortion and mental health falls into this error.”

I think Dr. Fergussoncaptured the heart of the matter. Best may not be good enough. Earlier this year, the British Royal College of Psychiatrists took the more cautious approach saying, “The specific issue of whether or not induced abortion has harmful effects on women’s mental health remains to be fully resolved. The current research evidence base is inconclusive - some studies indicate no evidence of harm, whilst other studies identify a range of mental disorders following abortion.”

When scholars on both sides of the ideological spectrum question objectivity, it is time to go back to the drawing board. The APA should not conclude work at this point, but start over. It would be a remarkable act of scientific integrity to acknowledge they were premature, but it would be the right thing to do. When the “best scientific evidence” isn’t good enough, why say anything else?

Warren Throckmorton is associate professor of psychology and fellow for psychology and public policy at Grove City College’s Center for Vision and Values.

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