Making Sense of Medicine

According to the Guttmacher Institute (http://web.archive.org/web/20080313054435/http://www.guttmacher.org/in-the-know/incidence.html ) 46 million abortions occur yearly, worldwide. I can’t wrap my mind around 46 million, so I’ll focus on the U.S., in which 3400 occur every day.

And who are those 3400 women? 41 percent are white, 32 percent are black, and 20 percent are Hispanic. Woman for woman, though, more blacks and Hispanics have abortions, compared with white women. For every 1000 white American women, 13 have an abortion each year, whereas black women have 49 per 1000, and Hispanics have 33 per 1000. The Guttmacher Institute (http://web.archive.org/web/20080311171704/http://www.guttmacher.org/in-the-know/characteristics.html) concludes, “Over time, women having abortions have become increasingly likely to be poor, nonwhite and unmarried, and to already have one or more children.”

If you take a group of 45-year-old American women, who have reached the age when the likelihood of pregnancy is small, one out of three will have had an abortion. A lot of those women regret that abortion, and I ache for them. 

I say I’m wondering, but I’m really not. As I wrote yesterday, abortion is a highly politicized topic in America. That politicization (I guess that is a word) extends into the hallways of academic medicine. I don’t know whether Priscilla Coleman, PhD, the author of the paper, tried to get it published in America before she sent it to Britain, but I highly suspect she tried, and tried hard.

The British Journal of Psychiatry is a highly respected medical journal, worldwide, and, before a paper can get published in it, “peer reviewers” must read it and make sure the science is reliable. The same is true of the best journals in America, but unfortunately these peer reviewers can act as gate-keepers, keeping out good science that doesn’t fit with their philosophical bent. 

But it’s timely that Dr. Coleman’s study was published in Britain just now. Hotly debated in Parliament is a proposal to require a woman seeking an abortion to receive independent counseling first. You would think abortion providers would be happy to have women receive counsel on the risks and benefits of abortion beforehand, but you would think wrong. The member of Parliament who proposed it, Nadine Dorries, apparently has been receiving “constant vilification and near-daily death threats” over her stance on abortion. There is something seriously wrong, here.

If most abortions are performed, as I believe they are, to avoid emotional distress, then the news that they do not needs to be made public, and needs to be widely discussed.

This meta-analysis shows that women are more likely to be troubled after an abortion than are women who have not had an abortion.

In fact, women with an abortion history have an 81 percent increased risk for mental health problems. The studies break down the various types of mental health problems:

·      Anxiety disorders – 34 percent increased risk.

·      Depression – 37 percent increased risk

·      Alcohol abuse – 110 percent increased risk

·      Marijuana use – 220 percent increased risk

·      Suicide attempt – 155 percent increased risk

And what about comparing not just women “with” and “without” history of abortion? That is, what about comparing women with an abortion history with women who carried an unintended pregnancy to term? When this meta-analysis looked at those two groups of women, the women who chose abortion had a 55 percent increased risk of mental health problems.

Talking about abortion is so politicized in America, it’s hard for people from different perspectives to have a rational conversation. Yet for those of us who care about women’s long-term mental health, studies like these are invaluable.

The author of the meta-analysis, Priscilla Coleman, PhD, who is a professor at Bowling Green State University in Ohio, concludes, “There are, in fact, some real risks associated with abortion that should be shared with women as they are counseled prior to an abortion.”