Abortion may be bad for a woman’s mental health. Discuss

Last November, Margaret Forrester, a mental health worker for the Central North West London Mental Health Trust in Camden was suspended for giving a colleague a charity booklet called “Forsaken – Women From Taunton Talk About Abortion” to a colleague –  they’d been discussing the information they offered to patients. It had the stories of five women who had experienced what the author describes as ‘post-abortion syndrome’, including depression, relationship issues, suicidal feelings and fertility problems. So, the downside of abortion, then.

To begin with – no problem. Her colleague didn’t seem offended. But a few days later her manager told her she was being sent home on ‘special leave with full pay’. She was ordered not to see any patients and to stay away from any NHS site. She has since been allowed to return to work, but Claire Murdoch, chief executive of Central and North West London NHS Foundation Trust, said:

‘It is clear that the booklet Miss Forrester distributed offers a seriously unbalanced and one-sided view of abortion and that it is offensive to NHS staff. The booklet implies that abortion can lead to alcohol and drug abuse, suicidal thoughts and increased risk of cancer. This could be very worrying and deeply offensive for women who may need an abortion and want balanced, sensible advice. We simply cannot allow NHS staff to distribute material that we know to be seriously unbalanced.’

Well, there are free speech and control freakishness issues here but there’s also a question of truthfulness. Was Margaret Forrester right in suggesting that abortion may lead to depression and suicidal feelings, let alone the raft of other symptoms? One aspect of the question seemed to have been settled for the foreseeable future by a study published in the New England Journal of Medicine last week, viz, whether or not abortion leads to a greater risk of mental health problems.

Based on a very large study group, of Danish women who had had either their first (early) abortion or their first birth between 1995 and 2007, it concluded that having an early abortion was no worse for your mental health than having a baby. Indeed, the Daily Mail report last Friday declared roundly that having a baby was more likely to give you mental health issues.
The summary of the original report actually concluded that “the finding that the incidence rate of psychiatric contact was similar before and after a first trimester abortion does not support the hypothesis that there is an increased risk of mental disorders after a first trimester induced abortion.”

And if you want the grit of the thing, “the incidence rate of psychiatric contact per 1,000 person-years among girls and women who had a first abortion were 14.6 before abortion and 15.2 after abortion. The corresponding rates among girls and women who had a first childbirth were 3.9 before delivery and 6.7 post partum. The relative risk of a psychiatric contact did not differ significantly before abortion and compared with after abortion but did increase after childbirth as compared with before childbirth.” That seems pretty conclusive; even if you consider that the study was funded in part by the Susan Thompson Buffet Foundation – in other words, by Warren Buffet, the mega-philanthropist, whose pet projects conspicuously include pro-choice initiatives.

But a few things jump out even from this bald summary. One is that the women who have abortions are far more likely to have mental health problems in the first place than the women who don’t get pregnant at all or the ones who give birth to a baby. The report only examines psychiatric contact in the nine months before the birth or the abortion and the twelve months after that.

And this is one of the areas where Priscilla Coleman, a professor of Human Development and Family Studies at Bowling Green State University, takes issue with the study. In a riposte, she notes that many of the women who had mental health problems before the abortion may have been wrestling with the prospect of the abortion when they went to see a psychiatrist. None of them had mental health problems earlier. In other words, even before you have an abortion you may get stressed or depressed about the whole idea – which makes the comparison of your state before and after more complicated than it seems.

What’s more, Prof. Coleman says, women who already have mental health problems are more likely to have those difficulties aggravated by an abortion – and the study filtered out those women. Similarly, women who have multiple abortions may have more psychiatric problems than those who have just the one, and they too were filtered out. There were no controls in the study for the women’s marital status, whether they wanted a baby, whether they suffered violence in the home, their income and education, all of which have a bearing on a woman’s vulnerability. And finally, lots of women experience post-natal depression. But if you carried your study further, beyond the first year after birth, why, the upside of having a baby starts to be more evident. As for abortion, she’d say that its effects are felt long after, so any study of the problems should be rather longer term. In short, she thinks that if all these factors were taken into account, you might see results along the lines of the 35 recent studies showing a link between abortion and mental health problems.

Professor Coleman isn’t alone in taking issue with the Danish study. Patricia Casey, professor of psychiatric medicine at University College Dublin, also has doubts about it. The women in the study had to have referrals from their GP to make it to psychiatric treatment, and in her experience, many women who feel bruised by their abortion don’t return to the GP who sent them to have it. What’s more, she says, “many women themselves often do not understand their sadness and they themselves ascribe it to an understandable reaction whereas it may be indicative of anxiety or depressive disorder”.

In other words, the vexed question of whether abortion is bad for your mental health is still open. And Margaret Forrester was, I’d say, perfectly within her rights to raise it.