Monday, July 02, 2007

Objectivity in Studying Abortion

Do women who receive abortions experience lasting psychiatric trauma as a result of that choice?

A lot of (pro-life) groups claim yes, while (pro-choice) women's clinics say no. The mere existence of post-abortion syndrome (PAS) is controversial. Cherie Black of the Seattle Post-Intelligencer wrote a nice article in today's paper about this topic. She seemed not to favor a particular view, and objectively presented opposing sides on this debate (both a Christian program called Project Rachel and physicians decrying the hijacking of medical terminology); Black even addressed the misuse of science occurring in each groups' claims.

One question the author did not raise was whether it is even possible to set up an objective study of whether there is anything real about post-abortion syndrome. I can imagine that the academics or interest groups that have the skills and means to conduct a study might also have considerable underlying bias. If such a study were conducted, what methods could be applied to assure objectivity?

The anecdotes presented in Black's article suggest patients' backgrounds and beliefs before the treatment might inform their response to having an abortion afterwards, but that women report mental trauma should keep open the possibility that their psychiatric pain is real. One side claims support from science, while the other (populated more heavily with scientists) claims uncertainty.

Could there be other situations that could inform this one? What other sorts of personal experiences have the potential for lasting effects from a personal decision? Military post traumatic stress disorder doesn't count in my book - soldiers don't make explicit decisions to see specific horrific situations. Nor does criminal remorse provide the same situation - abortion is legal.

Unless we can find someone familiar with this issue who is undecided on abortion (good luck!), the only way to honestly purse the question of post-abortion syndrome is to form a team consisting of investigators with opposing viewpoints. Such a team will need more than luck!

Update July 3: The Seattle P-I printed a vitriolic editorial today criticizing Project Rachel's misrepresentation of science. I think the emotion was justified if targeting the misuse of science, but I have the feeling that collateral damage could include the individuals seeking counsel for their grief. I responded in their Soundoff comments section, and a commenter named veritas rex offers there more scientific data and medical history related to this issue.

Update July 5: Some folks asked me what my personal take on the abortion issue was. My answer: I find dubious the claims made by many fellow Christians that the Bible prohibits abortion, but am uncomfortable with the widespread acceptance of abortion as a birth control method. My reading leaves ambiguous the Bible verses often cited as determining fetal personhood. (These are the same as those championed by Pro-Life advocates as proof that abortion is murder.) Please see this post for more details.

Update July 10: An OB/GYN doc has a guest column in the Seattle P-I today and offers a retort against there being any evidence of post abortion syndrome. The problem I find with her rebuke is that she stakes her claims on statistics that could actually be used against her argument. Pointing out that "76 percent of women report feeling relief after abortion", she asserts that
no negative medical or psychological consequences
arise from abortion. Okay, I follow that - in politics, this would qualify as an overwhelming majority. In medicine however, 17% is a pretty high rate for side-effects.

17% is particularly important given the columnist's take-home message:
There are 1.3 million abortions performed every year in this country and one in four American women has at least one abortion while reproductively active.
Every year, 221,000 women feel guilt from abortions, and that its possible that 6.7 million women in America regret undergoing the procedure. Don't you think there is a small chance that a few of these women could experience more serious psychological consequences? Will you not take these women's claims seriously? Even if the grief does arise from existing social or religious constructs, isn't it the care provider's prerogative to address these concerns? Perhaps physicians' refusals to acknowledge these women's pain belies the success of programs like Project Rachel.

The more this argument escalates, the more devices from the denialist's deck of cards are employed. I've identified a couple for you in this post.

2 comments:

Drugmonkey said...

One way to get at this question is to study post-abortion attitudes across societies in which the general viewpoint is different. Those who interact with substantial numbers of women from ex-Communist or recovering-Communist countries, as one example, can get some rather startling insights. The example with which I'm familiar is of course post-docs but contrasting the attitudes of US feminist/pro-Roe/leftie women scientists about abortion on a personal level with those of the abovementioned women is...interesting. I've yet to meet a US pro-choice type that is quite so casual about abortion.

N.b., trauma that is socially-induced at root is still trauma. not trying to belittle this.

ema said...

Unless we can find someone familiar with this issue who is undecided on abortion (good luck!), the only way to honestly purse the question of post-abortion syndrome is to form a team consisting of investigators with opposing viewpoints.

No, the only way to honestly purse this question is to conduct scientific studies. The investigators' personal viewpoints are irrelevant if the study is properly constructed and implemented.

Balancing the investigators' biases in order to insure an accurate study result is not part of the scientific method.

[I] am uncomfortable with the widespread acceptance of abortion as a birth control method.

"Widespread"? There's only one country where [voluntary] abortion is an accepted method of birth control, namely Japan. [There are a few other countries, like China and Romania, where the practice is common, but for different reasons than the ones under discussion.]

Pointing out that "76 percent of women report feeling relief after abortion".... In medicine however, 17% is a pretty high rate for side-effects.

Not when you consider the relevant side-effect of pregnancy: 58.7%* self-reported postpartum depression (51.6% low to moderate; 7.1% severe).

Don't you think there is a small chance that a few of these women could experience more serious psychological consequences? Will you not take these women's claims seriously?

Please support your assertion that physicians don't take patients' complaints seriously just because the patients happen to be s/p termination.

*different study