Saturday, January 27, 2007

Post-Abortion Syndrome- An Epidemiological and Political Lie

Last week's New York Times Magazine featured a cover story about anti-choice organizations that are working to dissuade women from having abortions, largely based on the existence of a "post-abortion syndrome"- that women who have abortions suffer from enormous depression and/or some source of post-traumatic stress disorder as a direct result of the abortion.

This is a remarkably stupid idea for a number of reasons, perhaps the largest being that, as the article discusses, "the scientific evidence strongly shows that abortion does not increase the risk of depression, drug abuse or any other psychological problem any more than having an unwanted pregnancy or giving birth." As a matter of science, actually, there is pretty much no way that one could show that an aborted pregnancy causes anything different from any other unintended pregnancy.

Without explaining much about epidemiology, there are three related principles that would make such a finding impossible:

1) No control — It's impossible to have a "control" group- Women who are in the exact same circumstances except one group has an abortion, and one group does not. The choices that lead some women to terminate pregnancies, some to put their children up for adoption, and some to raise a child are inherently personal and individualized. But factors that lead to those different outcomes may affect what kinds of psychological outcomes women have. For example, if a pregnancy is the product of rape, the woman may not want to carry the pregnancy to term. If she is depressed after the abortion, is it because of the rape or the abortion?

2) Confounders — If women who have abortions are having high rates of depression, there may be a confounder at play. A confounder is the unknown or unobserved factor that actually brings about an outcome, even though another exposure may nonetheless seem correlated. For example, a study of 10000 people who drink alcohol regularly might find higher rates of lung cancer than in the general populations. So many people might thus conclude that alcohol leads to higher cancer rates. The confounder in such a circumstance would likely be cigarette smoking. Cigarette smoking is independently correlated with drinking, and is the real cause of the lung cancer.

In this case, many of the circumstances that may lead a woman to terminate her pregnancy may be confounders. The article's main interviewee, now a "minister" trying to save women from the health effects of abortion is a prime example. She was sexually abused by a stepbrother and raped at age 14, and then her father died a grotesque death. Anyone of these events would have put her at a higher risk of unintended pregnancy, and abortion, and any one of these events may have also been the cause of her ensuing depression and drug addiction.

3) Mislabeled variables — What are we measuring here? The impact of an abortion on a woman's mental health? Or the impact of an unintended pregnancy? I don't think anyone will argue that unintended pregnancies are happy things that most women just "smile and move on" from. Is it the abortion itself that leads to depression? Or just having a pregnancy that doesn't end in raising a child?

Finally, in a legal/political sense, this argument is inauthentic at best. As Reva Siegel points out in the article, thw thing that these ministers are seeking to "save" women from are not the health effects, but the religious condemnation. If these ministries were really trying to protect the health of women, they'd support options for contraception being widely available, state-provided comprehensive mental health care, etc.

If sexual politics is really about the health of those involved, then that's a clear reason why sodomy laws are properly unconstitutional, and LGBT individuals should be encouraged to come out without fear of "reparative therapy." After all, the repression of homosexuality or trans-identity leads to far greater negative health outcomes than living openly. Gay marriage should be legal, because then the positive psychosocial health benefits or marriage would be available to all. There's a certain dishonesty about this health argument, beyond the scientific inaccuracy, which apparently C. Everett Koop, Reagan's Surgeon General, recognized when refusing to issue a report on "Post-Abortion Syndrome." If you're going to make this about health, anti-choice advocates are going to lose.

I agree with President Clinton's oft-mocked/repeated expression that abortions should be safe, legal, and rare- but not because of any health effects abortions have, but because being in the situation of having to make that situation is inherently unhealthy itself.



At 1:51 AM, Anonymous PG said...

How often do we ban something because it makes people depressed, anyway? Post-traumatic syndrome from war is a much better recognized phenomenon, yet we are sending *more* troops into combat, not less. I guess depression is only a conclusive argument against something if we're talking about women.

At 4:35 AM, Blogger aus blog said...

Post traumatic stress syndrome(PTSD)

The essential feature of Post
Traumatic Stress Disorder is the development of characteristic symptoms following a psychologically distressing event that is outside the range of usual human experience.

Many things can trigger PTSD though note that I said trigger not cause. War is a trigger, abortion is another, in fact any traumatic experience can do it.
The real cause is a predisposition to the disorder.
Only problem is that many of us may be susceptible given a harrowing enough experience.

At 9:44 PM, Blogger aus blog said...

Post Traumatic Stress Disorder (PTSD).

The essential feature of "Post Traumatic Stress Disorder" is the development of characteristic symptoms following a psychologically distressing event that is outside the range of usual human experience.

Many things can cause PTSD. War can be a trigger, as can abortion, in fact any significant traumatic experience can do it.

In people who have experienced a traumatic event, about 8% of men and 20% of women develop PTSD after a trauma.

Symptoms of PTSD can include the following: nightmares, flashbacks, emotional detachment or numbing of feelings (emotional self-mortification or dissociation), insomnia, avoidance of reminders and extreme distress when exposed to the reminders ("triggers"), irritability, hypervigilance, memory loss, and excessive startle response, clinical depression and anxiety, loss of appetite, powerlessness, hopelessness and profound guilt, just to name a few.

Many of us may be susceptible given a harrowing enough experience.


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