“New study finds 99 per cent of women have no regrets after an abortion,” reads the headline from a syndicated article published on Stuff.co.nz.
The study, published in the journal PLoS One, actually claims that 95 percent of women having abortions do not have regrets afterward and far from settles the debate around abortion and mental health.
From the study:
Women experienced decreasing emotional intensity over time, and the overwhelming majority of women felt that termination was the right decision for them over three years. Emotional support may be beneficial for women having abortions who report intended pregnancies or difficulty deciding.
Rather than settling the debate, however, the study has a number of flaws that belie the conclusions drawn by the authors. Among the flaws:
- This study’s findings and conclusions are overreaching due to self-selection and high drop out rates. To quote from the study: “Overall, 37.5 percent of eligible women consented to participate, and 85 percent of those completed baseline interviews (n = 956). Among the Near-Limit and First-Trimester Abortion groups, 92 percent completed six-month interviews, and 69 percent were retained at three years; 93 percent completed at least one follow-up interview.” This means 62.5% of women refused to participate in the study, at first request, and another 15% dropped out before or during the baseline interview, yielding only a 31.9% participation rate at baseline.
- With 68.1% percent of eligible women refusing to participate in the study at baseline, it is improper for the authors to suggest that their findings reflect the general experiences of most women. There are numerous risk factors which have been identified as predicting which women will have the most severe post-abortion reactions. One of these risk factors, for example, is ambivalence about having an abortion or carrying to term. Another is the expectation that one will have more negative feelings about the abortion. In a similar post-abortion interview study by Soderberg, the author reported that in interviews with those declining to participate “the reason for non-participation seemed to be a sense of guilt and remorse that they did not wish to discuss. An answer often given was: ‘Do do not want to talk about it. I just want to forget.’”
- It is very likely that the self-selected 31.9% percent of women agreeing to participate were more highly confident of their decision to abort prior to their abortions and anticipated fewer negative outcomes. This concern about selection bias is highlighted by the study’s own finding that “women feeling more relief and happiness at baseline were less likely to be lost [to follow-up].” Clearly, due to the large numbers of women choosing not to be questioned about their experience, and the large drop out rate of those who did agree, this sample is not representative of the national population of women having abortions.
- Despite the initial selection bias, 15 percent of those agreeing to be interviewed subsequently opted out of the baseline interview and another 31 percent opted out within the three year followup period. This indicates that even among women who expected little or no negative reactions, the stress of participating in follow up interviews lead to a change of mind. Previous research shows that women with a history of abortion feel more discomfort in answering questions about their reproductive history.
- The study population is also non-representative of the women having abortion in that it included 413 women who had an abortion near the end of the second trimester compared to only 254 women having an abortion in the first trimester. This is totally disproportionate. It again shows that the authors should not be extending conclusions about this non-representative sample to the general population.
- The authors report that sample has an elevated number of low socioeconomic backgrounds. That, too, makes the sample non-representative. The offer of $50 per interview may also have created a participation bias toward women who most desperately needed the money.
- Another oddity, the authors report that in the final group analyzed, average age 25, 62% were raising children. This would appear to be a very high rate that is not typical of national averages for women seeking abortion.
- The deceptive practices of the research team are made clear in press releases and an infographic purporting to summarise the study. In these “summaries” the research group conceals the details regarding the high non-participation rate and boldly claims “95 percent of women who had abortions felt it was the right decision, both immediately and over 3 years” — omitting the fact that 62.5 percent refused to participate at the time of their abortion, another 15 percent dropped out prior to the baseline interview, and of those interviewed another 31 percent dropped out by the third year. The fact that the abstract, press release, and other summarising materials published by the authors consistently omit mention of the high rate of non-participation is problematic itself. The fact that they, to the contrary, consistently imply that their results apply to the entire population of women having abortions is clearly deceptive.
Notably, the claim of declining regret and declining negative reactions is at odds with Brenda Major’s two year longitudinal study, which also had high drop out rates, that found that there was a trend of decline in relief and increase in negative emotions over the two year period among those who did not drop out of her study. (See Major B, et al. Psychological responses of women after first-trimester abortion. Archives of General Psychiatry. 2000: 57(8), 777-84.)
Additionally, the authors do not report on any assessment of whether women experiencing negative emotions sought any post-abortion psychological or spiritual counseling. In other words, it is unclear if the women reporting a decline in negative emotions experienced this decline because of intervention (counseling) or reconciliation (spiritual effort) or whether the decline is “natural” as the authors suggest.
The focus of this report in on women’s persistent satisfaction with their abortion decisions, “decision rightness,” as measured by a single question of whether or not the “abortion was right for them.” Women were asked to answer this question “yes”, “no” or “uncertain.” A better research approach would have been to have this question rated on a numeric scale (1 to 10, for example) in order to better identify any shift in attitudes.
Questions regarding decision satisfaction may produce reaction formation and therefore defensive answers affirming the rightness of a decision even if there are actually unresolved anxieties or other issues. (To voice dissatisfaction may invite anxiety provoking thoughts. Responding the way one is expect to respond, avoids reflection). Additional questions should have been asked to better gauge the subjects thoughts. For example, in the Soderberg study, including a one year post-abortion interview of 847 women (after a 33% self-exclusion rate), 80% of the women were satisfied with their decision to abort but 76% also stated that they would never abort again if faced with an unwanted pregnancy. A woman expressing unwillingness to not have another abortion may tell us more than her expression of the “rightness” of a past abortion decision that cannot be changed.
While the report and accompanying press release claim that this study proved there is “no evidence of widespread ‘post-abortion trauma syndrome,’ in fact it did not use any standard scales for assessment of psychological well being. They certainly did not overcome the findings of record linkage studies which have shown an elevated risk of psychiatric admissions following abortion or elevated rates of suicide. Instead, their assessment of psychological health is all inferred from an assessment of just six emotional reactions they associated with their abortion: relief, happiness, regret, guilt, sadness and anger.
But there is clear evidence from other studies that many women experience symptoms of post-traumatic stress disorder which includes symptoms of denial and avoidance behavior. In a study by Vincent Rue, for example, among women reporting intrusive memories and dreams related to their abortion, only half attributed these thoughts to their abortions. In other words, half were in such denial that while on one hand they could report certain intrusive thoughts, half denied that these thoughts had anything to to do with their abortions.
Therefore, women reporting less “anger” relative to their abortion may in fact have more feelings of anger in their lives but may not be attributing this anger to their abortions, but rather to other problems, though perhaps in counseling, they might discover their increased feelings of anger were projected on other issues but are related to unresolved hurt over the past abortion.
I often wonder where they get the women for these “studies.” Certainly not from places where women who are seeking help go. This one in particular was done at the Bixby Center for Global Reproductive Health at UC San Francisco’s School of Medicine. Biased? Please!
The study only looked at three years after a woman’s abortion. Most women do not even begin to deal with an abortion until around seven years after.
Lumina receives about 200 new women every year who come to us because they are suffering from a past abortion and have many regrets. The prochoice side itself says that 10 percent of women who have abortions suffer, which in a country where over 56 million abortions have occurred, brings the figure to millions of women.
Other studies prove differently. One only has to visit the Elliot Institute web site, orPriscilla Coleman’s research, or many others, too many to list, to find that out. Time magazine’s article “Hardly Any Women Regret Having an Abortion…” which was just published and written by “staff” makes a bold statement, while only looking at this one study.
To be honest, this makes me angry. Mostly because it perpetuates the feeling of being crazy if your abortion does bother you, like there is something wrong with you if it does. So, if you see this article and are suffering, please reach out for help, You are not alone; there are millions of us out there and many great resources for healing. Hope and healing are possible.
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