Mental health outcome after abortion is a question that won’t go away in a hurry.
Counsellors know what so many women in their heart of hearts already feel - abortion has a damaging impact on the emotional lives of some women. And even when the effect does not rise to the threshold of a defined mental illness like depression, anxiety, PTSD or substance abuse, negative emotions like grief and regret, sometimes delayed by years or decades, can linger to haunt.
There has been a lot of research over the years exploring the link between abortion and adverse mental health outcomes - in fact one of New Zealand’s best, David Fergusson from the University of Otago, has concluded that abortion is associated with poor mental health outcomes and may even cause them.
Others, like Sullins, Coleman, Reardon, and Jacob, have come to a similar conclusion. Jacob’s 2019 study is particularly interesting because it included 57,770 women, giving it serious clout.
Even stronger evidence exists for adverse mental health impact when there are multiple abortions, or for reasons of foetal anomaly.
Despite this, some peak bodies have rushed headlong to dispel any notion that abortion may lead to mental health problems. One researcher in the field responded this way,
[there is a] … truly shameful and systematic bias that permeates the psychology of abortion. Professional organisations in the USA and elsewhere have arrogantly sought to distort the scientific literature and paternalistically deny women the information they deserve to make fully informed healthcare choices and receive necessary mental health counselling when and if an abortion decision proves detrimental
But the problem is deeper, because not all research is equal. It’s a complex business, and some is done well, and some not. Some is weak by nature of design or analysis, and some is flawed because women who have had an abortion are often reluctant to talk about it. In fact, it is more likely that women who have rationalised things and are convinced it was the right thing to do, will be more prepared to participate in research. Distressed women will understandably back away.
This is the reason why a particular study touted by some to put an end to debate has instead stimulated it. It has been heavily criticised.
That study is the Turnaway study, recently the subject of a piece in the NZ Herald by Terry Bellamak titled “Self-selection is entirely different to purposive sampling”. (NZ Herald, May 9), written in response to another by Rachael Wong titled "Recognising the end of pregnancy in cases of abortion and miscarriage" (NZ Herald, April 30). Wong had rightly pointed to serious flaws in the Turnaway study, mainly to do with what is called selection bias. That is, not getting a representative sample because distressed women refuse to participate.
Bellamak tried to baffle us on a technicality about the differences between self-selection sampling and purposive sampling, which unfortunately is irrelevant to the question of selection bias.
The Turnaway study - made to look terribly complicated by the 20 plus papers that have come from one flawed data set – in reality has one central easily identified error. At the outset, a full 68% of women who were approached refused to participate. Nearly another third had pulled out by the 3 year mark. If as expected, these women were those too distressed to want to talk about their abortions, and more likely to suffer adverse mental health effects in subsequent years, the study ends up being really skewed and biased.
Bellamak concludes by accusing anti-abortion groups of liking “ … nothing better than to pretend abortions are harmful to the mental health of pregnant people.” But no-one wants to see adverse mental health outcomes for women - especially pro-lifers who happen to be the ones setting up post-abortion care organisations to assist women recover.
As is not uncommon, perhaps we will have to wait for research to catch up to the reality of individual experience.
Dr Greg Pike is the Director of the Adelaide Centre for Bioethics and Culture.