New RCOG draft guidance on abortion perpetuates myth that abortion has few physical or psychological consequences for women

I never cease to be amazed by the accelerating rate at which new government and other official ‘consultations’ on important matters of public policy are appearing.

The faster they come, the less they are publicised and the shorter the deadlines – meaning that it is less and less possible to make an intelligent response within the specified time frame.

Is this some kind of plot to wave through controversial policy quietly whilst appearing take notice of stakeholders’ opinions? That is certainly the impression created.

The latest consultation to come to my attention (and I cannot believe how I missed this until now) is from the RCOG (Royal College of Obstetricians and Gynaecologists) which is revising its controversial document ‘The Care of Women Requesting Induced Abortion’

This RCOG guideline, which provides the basis for the supposed ‘evidence-based counselling’ of women with crisis pregnancies was first published in 2000. An updated version followed in 2004 and that guideline served until this latest revision which took place during 2010.

This latest revision was prompted mainly by a recommendation of the House of Commons Science and Technology Committee which in 2007 had considered Scientific Developments relating to the Abortion Act 1967.

The latest revision (see draft) has been undertaken by a ‘multi-professional group’ which, as before, consists of representatives from the RCOG, the RCOG’s Faculty of Sexual and Reproductive Health (FSRH), the Royal College of General Practitioners (RCGP),and the abortion industry (namely the two largest abortion providers BPAS and Marie Stopes International). The participants are almost exclusively ‘pro-choice’.

There are, as before, no psychiatrists on the panel, which is rather odd given that the Royal College of Psychiatrists has recently changed its position on the link between abortion and mental illness (it now acknowledges one) and is presently in the process of reviewing the scientific literature again.

The RCOG has been heavily criticized in the past for underplaying the physical and psychological consequences of abortion for women and this new document appears to continue in that vein.

Among the draft document’s recommendations are the following: Women should be informed that induced abortion is not associated with an increase in breast cancer; Women should be informed that there are no proven associations between induced abortion and subsequent ectopic pregnancy, placenta praevia or infertility; Women should be informed that induced abortion is associated with a small increase in risk of subsequent preterm birth, which increases with the number of abortions; Women should be informed that most women who have abortions do not experience adverse psychological sequelae.

These areas are all hugely controversial – see our own CMF review of the literature.

The closing date for submissions is February 18th. Details here.

There is more information about the consultation document(s) on the RCOG website.

I also received this morning from AAPLOG an update on the scientific evidence for the link between abortion and preterm birth – a connection which has been constantly underplayed by the RCOG. The new draft continues this misreporting.

The AAPLOG report reads as follows:

One of the most egregious educational omissions from current medical education/residency program, or just plain from the American medical literature in general, is the association of induced abortion with subsequent preterm birth. It is a kind of ‘denial by silence’.

There are at least 119 articles in the world literature attesting to this association, and very few indeed that contest the association. (see review) And even the admission of the association is trivialized. Iams, a MFM Professor from Ohio State, allows that abortion is followed by ‘a very small but apparently real increase in the risk of subsequent spontaneous preterm birth (PTB)’.

‘Apparently real’ is an interesting way to say ‘119 studies, and all of the recent major studies’. Do we believe in evidence based medicine? ‘Very small’ - (and here Iams references the 2009 BJOG Shaw study that found a 36% increase in PTB subsequent to abortion)—how big is ‘very small?’ With nearly any other serious complication, a 36% increase with one exposure (in this case, to abortion) would be extremely significant. Not so, here. Rather, it is a ‘very small’ association.

And-same Shaw study- women with more than one prior abortion raised their 'preemie' delivery risk by 93% - a HUGE increase (almost double the 'preemie' risk when compared to women with zero prior abortions). See our analysis of Iams article

We see here an example of a new principle, the ‘abortion distortion’. In legal, and medical, and societal, and governmental arenas-(as in ‘Philadelphia Dept of Public Health’)-, the rules and standards change when the topic is abortion. Overwhelming medical evidence becomes ‘apparently real’, a 36% increase becomes a ‘very small’ increase, Philadelphia public health department responsibilities to women's health become a joke. Worse. An unspeakable travesty.

I do hope that the RCOG will be challenged about the scientific bias in its draft guidance and consider a further revision in the light of new evidence, but on the basis of its past performance I am not holding my breath.

Asking this group to comment objectively and honestly about the physical and psychological consequences of abortion for women is like asking Philip Morris or BAT to review the health consequences of smoking or Macdonald’s to outline the adverse effects of fast food consumption. There are simply too many financial and ideological vested interests at stake that threaten a fair assessment.

I have just read in the draft guidance that ‘All members of the Group made formal declarations of interest and this record is kept on file. The College was of the opinion that in each case the interests declared did not conflict with the guideline development process.’

I guess that is meant to reassure us. But in reality this group is as unbalanced as the discredited Falconer Commission on so-called ‘assisted dying’.