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Read Carefully, then Act Thoughtfully

September 15, 2008

In the past couple days, I’ve received emails from different groups asking for their constituents to write to the American Psychological Association (APA) requesting a more scientific, comprehensive report than the one they issued August 18, regarding mental health effects on post-abortive women. The APA’s report claims to: “.. collect[ing], examine[ing], and summarize[ing] the scientific research addressing the mental health factors associated with abortion, including the psychological responses following abortion.”  Groups like the Family Research Council, and pro-life groups, say the APA report is biased because it doesn’t include certain types of studies in its review, which necessarily skews the outcome and any conclusions drawn from the review. For several years now, people for and against abortion have argued over whether women who have abortions experience negative psychological, emotional, and/or physical consequences as a result of the abortion. It reminds me of something my uncle said to me during a moot court competition I was in during law school. He said, “How can you tell who wins? It seems like it’s just lies on one side, and when the other side gets up then there’s lies on the other side.”  Some studies seem to show that post abortive women experience nothing more than the equivalent of an emotional hiccup, while other studies seem to suggest that the life of almost every woman who’s had an abortion will go into an unstoppable tailspin. Even for someone like me, who is familiar with the abortion issue, it can sometimes be hard to discern what’s really happening, and what the proper response should be.

It seems if we really want to understand how to read and understand scientific studies, and the conclusions given by the researchers, we need to do several things. First, be aware of how the researcher(s) define the scope of the research. The answer given will depend on the question asked, right?  Here’s what the APA task force defined as the scope of its review:  To keep its task manageable, the TFMHA [APA Task Force on Mental Health and Abortion] limited its review and evaluation to the empirical literature on the implications of induced or intentional termination of pregnancy for women’s mental health.”  The task force then further qualifies the phrase ‘mental health’ (this quote is long, but I want to give the full context):

 We also limited our review to studies examining the implications of induced abortion for mental health outcomes. Other outcomes potentially related to abortion (either as antecedents or consequences), such as education, income, occupational status, marital status, and physical health, are beyond the scope of this report. We conceptualized mental health broadly, relying on the World Health Organization (WHO) definition of mental health as a “state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (World Health Organization [W]HO], 2007). This report thus considers a wide array of outcomes related to mental health, including measures of psychological well-being (e.g., self-esteem, life satisfaction), emotions (e.g., relief, sadness), problem behaviors (e.g., substance abuse, child abuse), and measures of severe psychopathology.

This gives the impression that the task force will be considering the results of studies that show evidence of a wide range of mental health conditions related to abortion experience, right? But read a little further, and it becomes clear what they are really concentrating on:

In considering the mental health implications of abortion, it is crucial to distinguish between clinically significant mental disorders, such as major depression, generalized anxiety disorder, or posttraumatic stress disorder, and a normal range of negative emotions or feelings one might experience following a difficult decision, such as feelings of regret, sadness, or dysphoria. While the latter feelings may be significant, by themselves they do not constitute psychopathology. In this report, we use the term mental health problems to refer to clinically significant disorders assessed with valid and reliable measures or physician diagnosis. We use the term negative psychological experiences or reactions to refer to negative behaviors (e.g., substance use) and emotions (e.g., guilt, regret, sadness), and the term psychological well-being to refer to positive outcomes, such as self- esteem and life satisfaction.

 

Why is it important to notice this distinction the task force is making? Because much of the published literature about womens’ experiences following abortion is framed in terms of emotional symptomology, i.e. feelings of regret, sadness, and the like. So what the task force is saying is that they limited their review to studies that addressed certain types of mental health issues as they relate to abortion. This becomes crystal clear when the task force discusses the questions posed and answered by their review:

How prevalent are mental health problems among women in the United States who have had an abortion? This question focuses attention on the extent to which abortion poses a threat to women’s mental health, i.e., is associated with a clinically significant mental disorder (see Wilmoth et al., 1992 for a discussion of this issue).

Very quickly and smoothly, the task force equates mental health, in the broadest sense, with a very specific category of mental condition-a clinically significant mental disorder, which they have defined in the quote above as ‘mental health problems’. So there it is. Basically, the task force is saying, ‘in order for us to conclude that abortion affects a woman’s mental health, she must have been diagnosed by a physician, or have been assessed by a ‘valid and reliable measure’.  Which perfectly sets them up to draw the following conclusion:

…the prevalence of mental health problems observed among women in the United States who had a single, legal, first- trimester abortion for nontherapeutic reasons appeared to be consistent with normative rates of comparable mental health problems in the general population of women in the United States.
 
In other words, abortion is not related to higher incidences of mental health problems compared to women who have not had abortions. The task force’s conclusion, and method of arriving at that conclusion, have particularly significant implications for the African-American population.  The fact that African-Americans, including women, do not tend to seek help for what the task force is defining as mental health problems, i.e., depression, anxiety disorders, etc., means that these women are likely not included in very many of these studies reviewed by the APA. Therefore, the conclusion drawn by the APA doesn’t necessarily apply in any meaningful way to African-American women. But by the same token, neither do studies that conclude that mental health is affected by abortion, to the extent that they suffer from the same lack of inclusiveness.

But what about common sense? What about physicians who do treat African-American women? Should we believe them? Dr. Karen Stevenson, an African-American psychiatrist who has treated African-American women, says, “I have encountered tortured women who were struggling with depression, suicidal thoughts, anxiety, and drug and alcohol abuse who have had encounters with this thing called ‘the women’s right to choose.’ I’ve seen women touched by the horror of abortion, yet during my training, this issue was never discussed by my professor as a possible contributor to the person’s present state of emotional turmoil.” Hmm…depression, suicidal thoughts, anxiety…? Those sound like mental health problems to me, even based on the APA’s definition.

Also, forum and message boards on websites that offer help for post-abortive women are full of entries from Black women who are, in their own words, describing their turmoil since their abortion(s). I’m sorry, but I don’t need the APA to tell me that women of all ethnicities are suffering because of abortions. But if they are going to publish reports, and trade on the assumed credibility given them by the general public, I do need them to act with integrity and not try to mislead people about a legitimate health issue. So what do we do? Should we jump on the bandwagon and send letters to the APA, insisting they conduct another review? Should we just chalk it up to another liberal organization trying to force reality to conform to its views? Should we forget the whole thing? I suggest we: 1) read reports like the APA’s for yourself, and in their entirety; 2) consider what action will have the greatest impact on the situation, and what the objective of the action is. With this APA report, is asking them to issue a new report really going to make the biggest impact? They are a private professional organization with voluntary membership. Maybe finding out who the task force members are and trying to deal with them directly is better? Or what about simply discrediting the report by writing to newspapers (yes, many of them are controlled by the same type of people who run the APA, but sometimes a newspaper editor’s desire for at least the appearance of editorial diversity and objectivity will win the day); writing to bloggers; telling anyone who will listen? We’ve got to become smarter, more savvy with how we approach these types of situations. Read. Think. Then Act.

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