IMAGE: BOB AL-GREENE / MASHABLE
An abortion can be an emotional experience that raises questions about a woman’s relationships, past regrets, and future. She might want to confide in someone about these feelings in the following weeks, months, or years.

Abortion opponents have taken that complex reality to a disturbing extreme, with the hope of convincing the public and lawmakers that ending a pregnancy puts many women at significant risk for mental health problems like substance abuse, depression, and suicide.

To vividly and persuasively make their case, anti-abortion rights activists often point to scientific research that makes dubious connections between the medical procedure and long-term psychological turmoil or suffering. What politicians looking to restrict abortion don’t tell the public is that not all research in this field is equal.

“No one needs to tell us that we need to take time to think. People are doing it anyway.”This strategy has found its way into statehouses across the country. A recent report from the Guttmacher Institute, a research and advocacy organization, found that more than half of all women of reproductive age in the U.S. live in a state with at least two types of abortion restrictions that have no basis in scientific evidence, including counseling requirements and mandatory waiting periods.

Not all of these laws are explicitly premised on the notion that abortion causes lasting emotional or psychological damage, but many are routinely defended as measures to protect women’s health.

“I don’t think requirements are the solution to anything,” said Melissa Madera, who has interviewed 288 people about their abortion experiences as founder and director of the podcast The Abortion Diary. “No one needs to tell us that we need to take time to think. People are doing it anyway.”

Meanwhile, a battle over the science of abortion and mental health continues to unfold: Reputable medical and professional organizations in the field have found that the procedure doesn’t cause long-term psychological harm, but a group of researchers insist it’s devastating.

The losers in this fight? People who’ve had or may need an abortion and hear conflicting messages about the research, and who may face long waits to get care because of laws designed to slow the process.

While many women who’ve had abortions can share how the experience affected them, scientists can’t rely on these anecdotes to draw conclusions about mental health for an entire population. Instead, the best scientific research minimizes bias and controls for variables. When randomized trials are possible, scientists can recruit volunteers who are then assigned different outcomes.

With abortion, however, that would mean randomly selecting whether a woman carries an unintended pregnancy to term or ends it — disturbing, unethical, and impossible. Instead, research on abortion and mental health outcomes must rely on what are known as observational studies. That means women choose whether to end or complete their pregnancy, and then scientists follow those two groups over time to observe and compare their mental health outcomes. Scientists can make inferences about what they find in observational studies, but it’s more challenging to draw a straight line between cause and effect.

The path from pregnancy to developing a specific mental health experience can be nearly impossible to accurately track. Efforts to untangle the relationship between pregnancy and a specific mental health experience, particularly when abortion is involved, often fall short, said Julia Littell, a professor of social work at Bryn Mawr College who specializes in research design and synthesis but does not publish on abortion.

Research shows, for example, that the experiences that make women more likely to have an unintended pregnancy or abortion — like poverty, childhood sexual and physical abuse, and domestic violence — also are associated with an increased risk of developing a mental health condition. If they experience depression or anxiety and have had an abortion, it’s crucial for researchers to know which came first.

In the past decade, two major U.S. and UK professional organizations, the American Psychological Association and the Academy of Medical Royal Colleges, conducted in-depth reviews and found that the best evidence indicated ending an unplanned pregnancy in the first trimester posed no greater risk for mental health problems than giving birth.

That comparison helps to lay bare a political agenda that’s often more obsessed with protecting women from the potential effects of abortion than supporting women with the various emotional and psychological challenges of motherhood. Politicians, for instance, aren’t clamoring to pass laws making it harder for women to get pregnant because they might experience postpartum depression, anxiety, or psychosis.

More than 20 years ago, Mika Gissler, an epidemiologist and research professor of public health at The National Institute for Health and Welfare in Finland, published a study that anti-abortion activists have cited as proof that abortion can lead to suicide.

He analyzed the mortality risk of more than 600,000 women in a national register who gave birth or had an abortion. In his 1996 BMJ study, those who ended a pregnancy were at a much higher risk of dying by suicide, and he found the same to be true again in a studypublished in the European Journal of Public Health, in May.

But Gissler, after studying this cohort for two decades, believes there’s a more complex explanation for the association between abortion and suicide. First, his studies can’t account for pre-existing mental health conditions because the register lacks detailed information about their experiences. Gissler also thinks that motherhood itself largely reduces risky behavior like self-harm. The Finnish healthcare system plays a critical role as well by giving teenage mothers, the subject of his latest study, intense support during and after pregnancy. Teens who have an abortion don’t get the same reinforcements.

Though his 1996 study noted the possibility that abortion might negatively affect women, he holds no reservations now. “[I]t’s quite clear it’s not the abortions,” he said. “It’s the complex situation of the women.” Abortion and suicide, he noted, share the same risk factors, including economic instability and limited education.

Gissler said he’s been courted by anti-abortion researchers, some of whom he characterizes as well-versed in statistics but lacking expertise in mental or reproductive health epidemiology.

“They are making wrong conclusions and really bad science, if you can even call it science,” he said.

Though it might surprise some to learn that peer-reviewed journals publish questionable research, Littell said it does happen. A journal editor, for example, may not fully understand a study’s methodology and findings.

In 2008, a group of researchers published a review in Contraception suggesting that quality made a huge difference in abortion research. The highest quality studies did things like control for pre-existing mental health conditions and other important confounders, use the most appropriate comparison groups, and use widely accepted mental health measures. The review concluded that the highest quality studies don’t indicate abortion leads to long-term mental health problems, whereas the low quality studies largely reported a relationship between the two experiences. The authors also acknowledged that a “minority” of women experience “lingering post-abortion feelings of sadness, guilt, regret, and depression.”

“The goal of any such research should be to uncover the truth and share that with women and patients.”“The goal of any such research should be to uncover the truth and share that with women and patients,” said Chelsea B. Polis, co-author of the Contraception study and a senior research scientist at the Guttmacher Institute.

If that seems self-evident, consider that the debate over abortion and mental health is a lot like the controversy that has plagued research on climate change, evolution, or vaccines: A vocal group of researchers sees the scientific consensus as the product of bias, ethical misconduct, or even conspiracy and sows doubt at every possible turn. This isn’t just professional disagreement — it quickly begins to look like an ideological struggle.

Take, for example, what happened in December when JAMA Psychiatry published the largest and longest prospective study in the U.S. comparing the mental health outcomes of women who had an abortion to those of women denied an abortion. It followed 956 women over the course of five years, compared four groups with different abortion outcomes, and found that ending a pregnancy did not appear to increase a woman’s risk of developing mental health symptoms.

Those who had an abortion did not experience higher rates of anxiety, depression, low self-esteem, or low life satisfaction than those who were denied the procedure. In fact, women turned away from a clinic because they exceeded the facility’s gestational limit initially had higher levels of anxiety, lower self-esteem and less life satisfaction than those who had the procedure. Between six and 12 months, however, all of the women had similar mental health outcomes throughout the remainder of the study.

“I think that if the claim is to protect women’s mental health, what researchers are finding is that allowing women to make decisions and access care is more protective than denying them care,” M. Antonia Biggs, the study’s lead author, said.

The study garnered praise as providing “the best scientific evidence” on the mental health effects of abortion from a former director of reproductive health at the Centers for Disease Control and Prevention.

However, Priscilla K. Coleman, a professor of human development and family studies at Bowling Green State University whose own body of work consistently demonstrates a relationship between abortion and increased risk for mental health problems, criticized the study as methodologically flawed in a self-published rebuttal, and suggested there was a broader conspiracy to publish fraudulent results that bolstered the case for abortion rights.

“If we really wanted to promote [an agenda], we would have wanted to find more negative outcomes for the women denied abortion,” said Biggs, who is a social psychologist researcher with Advancing New Standards in Reproductive Health, a research group at the University of California at San Francisco.

Coleman said that she supports waiting periods and “sensitive, individualized pre-abortion counseling” and will oppose abortion until well-designed studies demonstrate it is beneficial to women. Coleman has served as a paid expert witness in abortion-related legal cases and for legislatures that considered restrictive measures, but her research has also been thoroughly critiqued.

“I know it’s appropriate science. I know I care about women. I just know what I’m doing is right.” A 2009 study Coleman published in the Journal of Psychiatric Research, which did not account for whether women had pre-existing psychological conditions, became the subject of heated criticism, and elicited a critical note from one of the journal’s editors. In 2012, the Eighth Circuit Court of Appeals cited her testimony when it upheld a South Dakota law that required physicians to tell patients they may be at greater risk of suicide if they have an abortion. The decision also cited Gissler’s 1996 paper. The dissent noted, however fruitlessly, that Gissler disavowed a causal link between abortion and suicide.

“We have to promote sexual and reproductive health and mental health, and have a checkup after the abortion to avoid any suicide [risk] instead of restricting women’s possibility to terminate pregnancy when they need it,” Gissler recently said.

In 2011, Coleman published a controversial study in the British Journal of Psychiatry. It attracted some support, but also prompted several letters of concern from researchers across disciplines who said the meta-analysis was poorly designed and didn’t account for the quality of the evidence it cited. Littell argued that it violated basic rules for synthesizing scientific research and called for its retraction. The editor declined to do so, a point Coleman raises in defense of her work.

Coleman said that she doesn’t routinely include published criticism of her work in expert testimony, but does address them in rebuttals when necessary. “I know it’s appropriate science,” she said of her research. “I know I care about women. I just know what I’m doing is right.”

Whether women might need emotional or psychological support after an abortion is an important public health question. The National Abortion Federation advises clinics to provide patients with counseling referrals and resources, and all medical providers must abide by informed consent laws and present patients with information about the procedure, its risks, and alternatives.

“You can make the choice to have an abortion and still feel complicated feelings about it.”Lawmakers opposed to abortion, however, just don’t believe any of those measures go far enough.

Madera believes that counseling should be easily accessible for abortion patients. Her intimate knowledge of other people’s abortion experiences, along with her own at the age of 17, has made her skeptical of competing social or political narratives that abortion is always traumatic or always simple.

“You can make the choice to have an abortion and still feel complicated feelings about it,” she said.

Instead of acknowledging that reality, though, politicians are using it to justify restricting a woman’s right to choose in the first place.

http://mashable.com/2017/08/17/abortion-mental-health-science/?utm_source=nar.al&utm_medium=urlshortener&utm_campaign=FB#TDoKmSnpMqqC