When Ideology Trumps Evidence: Abortion and Mental Health

The legal justification for 98% of abortions in the UK is that “the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman” (section 1 of the Abortion Act ,1967). The overwhelming majority of these are based on the “mental health” clause. That is, the overwhelming majority of abortions in this country are based on the ostensible risk of mental health to the mother.

But the problem is that there is minimal evidence that abortion has any positive effect on mental health, and some evidence that abortion worsens mental health. This is the conclusion, at least, of the pro-choice atheist David Fergusson, Professor of Psychology at the University of Otago, New Zealand:

“…at the present time there is no credible evidence to support the research hypothesis that abortion reduces any mental health risks associated with unwanted or unplanned pregnancy that come to term…

“These conclusions have important, if uncomfortable, implications for clinical practice and the interpretation of the law in those jurisdictions (England, Wales, Scotland, Australia, New Zealand) which require abortion to be authorized on medical grounds. In these jurisdictions, the great majority of abortions are authorized on mental health grounds… The present re-analysis suggests that, currently, there is no evidence that would support this practice…

“…this conclusion suggests an urgent need to revisit both clinical practice and the law in those jurisdictions in which mental health grounds are the principal criteria for recommending and authorizing abortion. The history of abortion law and law reforms shows that this is likely to resurrect politically uncomfortable and socially divisive debates about access to legal abortion… It is probably awareness of these consequences that explains the almost complete lack of discussion of the evidence for therapeutic benefits of abortion in recent reviews of abortion and mental health. However, it is our view that the growing evidence suggesting that abortion does not have therapeutic benefits cannot be ignored indefinitely, and it is unacceptable for clinicians to authorize large numbers of abortions on grounds for which there is, currently, no scientific evidence.” (David M Fergusson et al (2013), “Does abortion reduce the mental health risks of unwanted or unintended pregnancy? A re-appraisal of the evidence.” Aust N Z J Psychiatry, 47(9), 819-27.)

This 2013 review comes on the back of several studies by Fergusson and his colleagues, His 2006 cohort study concluded that “[those] having an abortion had elevated rates of subsequent mental health problems including depression, anxiety, suicidal behaviours and substance use disorders. This association persisted after adjustment for confounding factors.” (David M Fergusson et al (2006), “Abortion in young women and subsequent mental health.” J Child Psychol Psychiatry, 47(1), 16-24.) His 2008 study had a similar conclusion (David M Fergusson et al (2008), “Abortion and mental health disorders: evidence from a 30-year longitudinal study.” Br J Psychiatry, 193(6), 444-51.)

This more recent review surveys a wider range of data from various authors, concluding that “[there] is no available evidence to suggest that abortion has therapeutic effects in reducing the mental health risks of unwanted or unintended pregnancy. There is suggestive evidence that abortion may be associated with small to moderate increases in risks of some mental health problems.” Fergusson discusses two other recent reviews, one of which concluded that abortion was associated with increased risk of mental health problems, the other of which declared that there was no association either way. The theme common to all 3 reviews, Fergusson notes, is that the evidence linking abortion with better mental health is non-existent.

The implication, Fergusson rightly points out, is that these results render the practice of UK (and other) clinicians thoroughly dubious on legal grounds alone: “Given the high frequency with which mental health grounds are used in these jurisdictions to authorize abortion, it becomes important for both clinical and legislative reasons to examine the evidence on the extent to which abortion has therapeutic benefits that mitigate any mental health effects of unwanted pregnancy.” Clinical practice is often based on specious evidential grounds, but surely rarely as specious as this. If we’re going to put an end to human life, we’d better be sure that we have some very good grounds to do so, and that the evidence supports these grounds. But if the grounds are mental health, and the only evidence we have shows either no association or that abortion damages mental health, then the ideological motivations for clinical decisions become clear, taking precedence not only over the life of the thousands of foetuses aborted in the UK every year, but even over the mental health of those whose lives we can all agree are valuable: the thousands of young women in the UK in this situation. In any other clinical domain, we would have the evidence-based medicine proponents out in droves, lambasting the poor evidential basis for this “treatment”. We would even have legitimate legal cases against doctors who advised or carried out these procedures. But when it comes to abortion, evidence is sacrificed at the altar of women’s choice, and we continue to pour NHS money and effort into these procedures to preserve it.

As a firm pro-choicer, Fergusson has no pro-life axe of his own to grind, and so he recommends a solution: “the most straightforward way of resolving these tensions between the law and clinical practice in jurisdictions that use health criteria as grounds for authorizing abortion is to extend these criteria to include serious threats to the social, educational, or economic wellbeing of the woman and her immediate family as legitimate grounds for authorizing abortion. This revision would more closely align the criteria for authorizing abortion with the multiple personal reasons… for which women seek abortion.”

Of course, such a solution would undermine those doctors within the NHS who want to recommend abortions for any unplanned pregnancy, as well as undermining the NHS’ financial and infrastructural support for abortions. And it would make clear that abortion really has nothing to do with mental health, and everything to do with women’s choice to do what they want with their children (so long as they’re at the politically insignificant end of the birth canal) which, of course, sounds much less like a clinical decision about healthcare when one puts it that way.

Of course, this should not detract from the proper grounds of opposition to abortion. The danger of highlighting various secondary problems in the position and practice of pro-choicers is that they may give the impression that opposition to abortion is really based on things like mental health and taxpayers’ money. Of course, these things are to some small extent relevant, but they occasionally obscure the real reason pro-lifers are against abortion: because abortion is the killing of a member of the human family (and yes, many of us are pro-life in other domains too). None of the secondary arguments are even remotely as important as this. So my point here is not to bolster the case for being pro-life; it is to expose the rampant ideological motivations at the heart of the pro-choice movement ostensibly concerned about women’s mental health. It is to give just one demonstration of the extent to which this ideology has entrenched itself in our society, such that even objective evidence is contradicted in order to pretend that we have some sort of justification for the practice.

Do not be fooled, ladies and gentlemen, into thinking that the pro-choice movement is about women’s health, or that it relies on honest and scientifically substantive tactics and information, or that it makes the most compelling arguments for its cause. Even within the allegedly neutral scientific community, David Fergusson had trouble publishing his results on account of their inconvenience. Fergusson himself expected the link between abortion and poorer mental health to be explained by confounding factors, but his own statistical inquiry led him to believe otherwise, that abortion was an independent risk factor. And, of course, he was asked by his country’s government-appointed Abortion Supervisory Committee not to publish the results in case they were used for political purposes. No prizes for guessing which side they were concerned about using them. All of this should make pro-choicers and clinicians who have not thought about the matter wary. Most of them have simply been indoctrinated while growing up into thinking that abortion is perfectly acceptable, that it is often a clinically beneficial decision, and that there is no way this teaching is just a result of pure, evidentially vacuous ideology on the part of the pro-choice lobby. The fact that we have government committees asking for scientific results not to be published, and that scientifically untenable hypotheses are wholly and unquestioningly endorsed by the medical community (which, in the UK alone, licenses around 200,000 abortions every year), and the fact that the widespread clear-contravention of UK law in clinical practice is virtually ignored should alert us to the fact that there may be something amiss in the pro-choice misinformation thrown onto us and bullied into us as we grow up. And indeed it is.

The simple fact is this: out of nearly 200,000 abortions performed every year in the UK, 97-98% are licensed (and most of those funded) by the NHS on the grounds of risk to mental health of the mother. The only evidence we have shows no connection, or that abortion is independent risk factor for mental health problems, even when the data is corrected for plausible confounding factors. Any other practice so widespread and so contrary to the evidence would rightly be condemned as negligent at best, especially if it involved the killing of human life which, for all we know, could be valuable. But because of the political correctness and expedience of supporting the pro-choice agenda at all costs and against any intellectual, scientific or ethical integrity, the practice persists. Please speak up against it.

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3 thoughts on “When Ideology Trumps Evidence: Abortion and Mental Health

  1. I would love to know how this study was carried out, but I cannot access it. It seems to me that to come to such a conclusion Dr Fergusson would need to get a large group of women who all desperately wanted abortions, and then deny abortions to half of them and look at the subsequent effects on mental health of both groups. I can’t imagine this getting past an ethics committee.

    Could you clear this up for me?

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