David Fergusson wades in to defend Coleman over abortion mental health link

Priscilla Coleman’s recent meta-analysis showing a link between abortion and mental health problems not surprisingly has created a storm, coming as it did in the middle of the recent parliamentary debate over independent abortion counseling.

Whilst the left wing press and the BBC chose to ignore it, other academics in the field have attempted to undermine it in a flurry of letters to the British Journal of Psychiatry.

But David Fergusson, veteran researcher in the field, has just waded in to Coleman’s defence.

His letter is available on the BJ Psych website but here are some key excerpts. Fergusson writes:

The letter by Louise Howard and colleagues follows a well-trodden strategy which has been used in a number of reviews to dismiss any evidence suggesting that abortion may have adverse effects on mental health. In this strategy:

a) Methodological criteria are constructed to classify studies
b) No numerical analysis combining study findings is provided
c) Strong conclusions are drawn on the basis of a small number of ‘high quality’ studies

The use of this strategy led the APA review to claim that there was no evidence of adverse effects of single first trimester abortion on the basis of a single study, the conclusions drawn by Charles et al were based on four studies. Howard et al use a similar strategy in which they question the methodological quality of studies reviewed in the Coleman analysis and draw conclusions about the absence of association between abortion and mental health on the basis of a small number of studies. If the evidence is indeed as weak and as limited as these reviewers have claimed the appropriate conclusion to be drawn is that no firm conclusions can be made about the mental health consequences of abortion until further and better research is completed.

In the meantime, Coleman has done the field a service by bringing together a quantitative review of a large number of studies that have addressed the issue of abortion and mental health. What will be clear to any alert analyst is that there is a clear statistical footprint suggesting elevated risks of mental health problems amongst women having abortions, irrespective of the comparison group used or the outcome studied. This evidence clearly challenges the conclusions drawn from the reviews cited above.

Following the Coleman meta-analysis we have conducted a more refined analysis which addresses some of the concerns raised by Howard and colleagues. In this we confined the analysis to only those studies using an unwanted/unintended comparison and data was extracted from the original sources by two reviewers. This search yielded a total of eight studies reporting 14 results. These findings were used to conduct a series of meta-analyses for five separate outcomes: anxiety disorder; mood disorder; alcohol misuse; illicit drug use/misuse and suicidal behaviours. The results tell a clear story in which, with the exception of depression, there are significant small to moderate associations between abortion and increased risks of mental health problems.

The implications of this analysis are inescapable: despite the claims made in previous reviews about the absence of association between abortion and mental health, when data are pooled across studies there is consistent evidence suggesting that women having abortions are at modestly increased risks of mental health problems when compared with women coming to term with unplanned/unwanted pregnancies.

Fergusson is modest in his conclusions but his intervention is significant.

He promises a further review to be published soon.

Inaccuracies, lack of transparency and overconfident conclusions in RC Psych review on abortion and mental health

I previously blogged on the Royal College of Psychiatrists systematic review of the relationship between induced abortion and mental health. The consultation into the review closed on 29 June and the revised review document with be published later this year.

The RCOG will not be able to finalise their own guidance on termination of pregnancy until the RC Psych review is finalised.

I have reproduced below the statement from the Christian Medical Fellowship about the review. CMF’s full submission is available on the CMF website along with a summary of its main points .

Overall CMF has welcomed the RC Psych review on abortion and mental health but has raised concerns about inaccuracies, lack of transparency and overconfident conclusions

CMF Statement

The Department of Health and the Royal College of Psychiatrists (RCPsych) are to be congratulated on funding and carrying out a major review of the impact of abortion on women’s mental health. They, like the Christian Medical Fellowship (CMF), clearly regard this topic as one of great importance for the health and wellbeing of the over 200,000 women who face abortion decisions each year.

The opportunity for the public and stakeholders to review and comment on the RCPsych’s draft consultation document is one we have welcomed. It stands in stark contrast to the Royal College of Obstetricians and Gynaecologists attempt to review its guidance on the care of women requesting induced abortion, which was carried out without proper consultation or thorough research in January this year.

Having consulted widely ourselves for comments on the draft review paper, we have already sent a detailed submission to the RCPsych, which is now available on our website, along with a paper summarising our main points.

While we do have a number of significant concerns with the draft paper, our feedback to the RCPsych on the review has by no means all been negative. We have welcomed the consultation and have acknowledged that this review of the issue is more robust than some previous, widely cited, reviews (e.g. Charles and APA).

We have particularly welcomed the working party’s recommendation that support and monitoring should be provided for all women with an unwanted pregnancy who face the risk of later mental health problems, and for NICE guidance to underpin this support.

One of our main concerns with the RCPysch draft paper is that several of the summary evidence statements are stronger and more definitive than the actual research cited in their review supports. Whilst this might provide strong headlines and summary statements it is at the expense of accuracy and transparency.

On the basis of the available data the conclusions should be more nuanced and tentative.

In particular, the review is wrong to claim that there is no evidence of an elevated risk of mental health problems post-abortion compared to post-pregnancy. This definitive statement is simply not justified by all the data presented in their review and reflects reporting bias. Indeed, the four main research studies selected for this section of the review each found some mental health problems were more common following one or two abortions. It would have been more accurate simply to state, at the very least, that there is conflicting evidence about the relationship between abortion and mental health.

We were also concerned about the lack of stated rationale behind the reviewers’ re-analysis of research data in an important paper by Fergusson. This is important because this reanalysis produced a finding directly contradicting the conclusions of his published paper, which found higher mental health problems for those exposed to abortion.

We have also queried the lack of full transparency over decisions involving data selection and grading, which made it impossible for stakeholders objectively to verify the selection decisions made.

We did moreover note that the review had two different wordings for one of its three main questions. At the very least this reflects some sloppiness in writing but of more concern, the two questions posed could well produce different answers. The answer to the question: ‘Are mental health problems more common in women who have an induced abortion, when compared with women who delivered a live birth?’ (p65) would be ‘yes’. The answer to the alternatively worded question: ‘Are mental health problems more common in women who have an induced abortion, when compared with women who deliver an unwanted pregnancy?’ (p18, p87) depends on the concept of ‘wantedness’ of the pregnancy, which we argue is subjective, difficult to measure and changeable and therefore should be used with more caution than the review uses it.

Interestingly, research in the review shows that, even after controlling for confounding variables, there are higher rates of mental health problems post-abortion, for women with no prior history of mental health problems, compared to women in the general population. Our concern is that while this is stated in the main report, it is not included in the summary evidence statements. It is clearly a finding that women need to be made aware of in order to make a fully informed decision.

Undoubtedly this review will strongly influence any future Government policy and advice on the health consequences and care of women requesting abortion. Therefore it is essential that the final version of the review fairly and accurately reflects the research findings and that the process of study selection and data reanalysis is fully transparent.

This draft is a solid foundation to build upon, but it now requires greater clarification in places along with more caveats and information within the summary statements.

Overall however, if this review does indeed lead to more support and monitoring being offered to all women with an unplanned pregnancy, especially if underpinned by official guidance, it will have had some real long-term value. And that we would certainly welcome.

CMF Public Policy Department
July 2011

Response to Tom Chivers’ (Daily Telegraph) comments on my previous blog about abortion and mental health

Tom Chivers of the Daily Telegraph has now responded to my criticism of his original article on the Dorries/Field amendment on abortion counselling.

Here is my response to his latest article. I have also attempted to post it on his blog but have so far been unsuccessful (probably me not understanding the technology properly).

Dear Tom,

Thanks for responding to the comments on my blog and for acknowledging the errors in your original post.

First let me say that I was not attempting to ‘fisk’ you (ie do a line by line rebuttal of your blog) as to do so would have taken far more time than I had then or have now.

I just wanted to correct your initial misreading of the evidence about the 30% figure – but I will come back to a full ‘fisk’ if need be :-)

May I also ask – as you are so rightly concerned about the linking of primary sources – that you actually link my blog directly in your article so that others can read my comments in full along with the responses.

May I also correct a continuing misinterpretation in your new post with respect to the 1.5-5.5% figure as I’m not sure you have yet understood this correctly.

It is easiest to understand if you quote the relevant sentences in Fergusson’s abstract in full.

They read as follows:

‘After adjustment for confounding, abortion was associated with a small increase in the risk of mental disorders; women who had had abortions had rates of mental disorder that were about 30% higher. There were no consistent associations between other pregnancy outcomes and mental health. Estimates of attributable risk indicated that exposure to abortion accounted for 1.5% to 5.5% of the overall rate of mental disorders.'

What I understand this to mean is:

1.Women who have abortions had a 30% higher incidence of mental health problems after correcting for all other possible confounding variables. Ie The risk is real
2.Other outcomes of pregnancy (eg miscarriage, stillbirth, live birth etc) don’t affect mental health in the same way
3.Abortion however only accounts for between 1.5% and 5.5% of all mental health problems in the general population.

It makes further sense if you look at Fergusson’s final section on ‘Implications’.

‘The conclusions drawn above have important implications for the ongoing debates between pro-life and pro-choice advocates about the mental health effects of abortion. Specifically, the results do not support strong pro-life positions that claim that abortion has large and devastating effects on the mental health of women. Neither do the results support strong pro-choice positions that imply that abortion is without any mental health effects. In general, the results lead to a middle-of-the-road position that, for some women, abortion is likely to be a stressful and traumatic life event which places those exposed to it at modest risk of a range of common mental health problems.’

Again you have neglected to mention the Royal College of Psychiatrists’ position on this. In the light of the Fergusson study (and others) they have now changed their official position to acknowledge that there are some studies which do show a risk to mental health from abortion. They are currently carrying out a further review and the RCOG is I understand awaiting that review before it finalizes its guidance.

You can access the 2008 RCPsych statement here

So Nadine Dorries and Frank Field are actually right in claiming a 30% increase in mental health problems after abortion on the basis of this study.

Fergusson’s was a particularly robust long term prospective study which is why people have taken it so seriously. It would be best if readers were to access Fergusson’s full article and not just the abstract you have quoted (full primary sources and all that!).

I am not in a position to comment on the three meta-analyses you have listed apart from that by the American Psychological Association (APA) which has been criticised for cherry-picking studies – ie excluding those which challenge its conclusions and including less robust studies which don’t. I know that similar claims have been made about the other two but to deal with them in detail here would be a huge job.

I have however blogged previously about the APA study.

This is a complex area – but one of the reasons the RCOG has been criticized, I believe with some justification, is for underplaying the mental health effects of abortion.

There is a much fuller rebuttal of their guidance on the CMF website.

I am aware that many other groups and individuals have made similar criticisms.

Kind regards

Peter Saunders

Don’t believe everything you read in the Washington Post - A compendium of the most recent medical evidence linking abortion and mental health

I recently blogged about an adjournment debate in the House of Commons in which Nadine Dorries MP spoke about the mental health consequences of abortion and argued the case for a law ensuring that women seeking abortion be offered information about the health consequences of their decision.

The day after the debate the Daily Telegraph published a letter from six consultant psychiatrists supporting Nadine Dorries' position and calling for a change in the law.

The letter noted that in March 2008, the Royal College of Psychiatrists issued a position statement in which they recognised that good practice in relation to abortion should include informed consent involving the provision of adequate and appropriate information regarding the possible risks and benefits to physical and mental health.

I was therefore interested to see just a few days later an article published in the Washington Post titled ‘The big lie about abortion and mental health’. The author, Brenda Major, argued as follows:

‘Rigorous U.S. scientific studies have not substantiated the claim that abortion, compared with its alternatives, causes an increased incidence of mental health problems. The same conclusion was reached in 2008 by an American Psychological Association task force, which I chaired, as well as by an independent team of scholars at Johns Hopkins University.’

I’m not sure if the Washington Post intends to grant column inches to those who might want to contest Major’s claim, but the claim has been since contested and I reproduce Professor Priscilla Coleman’s response to Major’s article here:

On Sunday, November 7, the Washington Post published an opinion by Dr Brenda Major titled ‘The Big Lie about Abortion and Mental Health.’ I would like to offer another perspective on the dishonesty permeating the scientific study of abortion and mental health and the dissemination of information on the topic. Like Brenda Major, I am a tenured full professor at a well-respected American university who has published peer-reviewed scientific articles in reputable journals. (In fact, my publication record far exceeds Dr. Major’s on the topic of abortion and mental health.)

Dr. Major is absolutely correct that an informed choice regarding abortion must be based on accurate information. An unbiased and valid synopsis of the scientific literature on increased risks associated with abortion would include depression, substance abuse, and anxiety disorders (including PTSD), as well as suicide ideation and behaviors. The body of literature on the subject is made up of hundreds of studies — including 30 in just the last five years — published in major medical and psychological journals throughout the world. The conscientious reader is encouraged to check the studies out. No lies, just scientifically derived information that individual academics, several major professional organizations, and abortion providers have done their best to hide and distort.

Dr Major’s opinion piece followed on the heels of a highly biased ‘Task Force Report on Abortion and Mental Health’ from the American Psychological Association. Six colleagues and I sent a petition letter to the APA criticizing their methods and conclusions; as a group, the seven of us in 2008 had published nearly 50 peer-reviewed articles indicating abortion is associated with negative psychological outcomes.

These two examples are just the latest in a long line of efforts to divert attention from sound published data on the emotional consequences of abortion. The literature now echoes the voices of millions of women for whom abortion was not a liberating, health-promoting choice: A conservative estimate from the best available data is 20 to 30 percent of women who undergo an abortion will experience serious and/or prolonged negative consequences. Yet a socio-political agenda seeks to keep the truth from women in order to ensure that the big business of abortion continues unimpeded.

Any interpretation of the available research that does not acknowledge the strong evidence now available in the professional literature represents a conscious choice to ignore basic principles of scientific integrity. The human fallout from such a choice: misinformed professionals, millions of women struggling in isolation to make sense of a past abortion, thousands who will seek an abortion today without the benefit of known risks, and millions who will make this often life-altering decision tomorrow without the basic right of informed consent. In publishing Major’s opinion without soliciting other voices on the topic, the Washington Post has perpetuated a serious injustice.

I note that the Association of Prolife American Obstetricians and Gynecologists (AAPLOG ) also has on their website evidence based conclusions from the world literature on the mental health disasters following abortion for many women, disasters ranging from substance abuse, to depression, to suicide.

Also worth reading (if you have the time) are AAPLOG’s comments on the ‘sweeping and strange conclusion’ of the American Psychological Association (APA) in their 2008 task force report .

Studies published in the last five years linking abortion and mental health

Bradshaw, Z., & Slade, P. (2005). The relationship between induced abortion, attitudes toward sexuality, and sexual problems. Sexual and Relationship Therapy, 20, 390-406.

Brockington, I.F. (2005). Post-abortion psychosis, Archives of Women's Mental Health 8: 53-54.

Broen, A. N., Moum, T., Bodtker, A. S., & Ekeberg, O. (2006). Predictors of anxiety and depression following pregnancy termination: A longitudinal five-year follow-up study. Acta Obstetricia et Gynecologica Scandinavica 85: 317-23.

Broen, A. N., Moum, T., Bodtker, A. S., & Ekeberg, O. (2005). Reasons for induced abortion and their relation to women's emotional distress: A prospective, two-year follow-up study. General Hospital Psychiatry 27:36-43.

Broen, A. N., Moum, T., Bodtker, A. S., & Ekeberg, O. (2005). The course of mental health after miscarriage and induced abortion: a longitudinal, five-year follow-up study. BMC Medicine 3(18).

Coleman, P. K. (2005). Induced Abortion and increased risk of substance use: A review of the evidence. Current Women's Health Reviews 1,21-34.

Coleman, P. K. (2006). Resolution of unwanted pregnancy during adolescence through abortion versus childbirth: Individual and family predictors and psychological consequences. Journal of Youth and Adolescence, 35, 903-911.

Coleman, P. K. (2009). The Psychological Pain of Perinatal Loss and Subsequent Parenting Risks: Could Induced Abortion be more Problematic than Other Forms of Loss? Current Women's Health Reviews, 5, 88-99.

Coleman, P. K., Coyle, C. T., & Rue, V.M. (2010). Late-Term Elective Abortion and Susceptibility to Posttraumatic Stress Symptoms, Journal of Pregnancy, vol. 2010, Article ID 130519.

Coleman, P. K., Coyle, C.T., Shuping, M., & Rue, V. (2009), Induced Abortion and Anxiety, Mood, and Substance Abuse Disorders: Isolating the Effects of Abortion in the National Comorbidity Survey. Journal of Psychiatric Research, 43, 770- 776.

Coleman, P. K., Maxey, C. D., Rue, V. M., & Coyle, C. T. (2005). Associations between voluntary and involuntary forms of perinatal loss and child maltreatment among low-income mothers. Acta Paediatrica, 94(10),--76-1483.

Coleman, P. K., & Maxey, D. C., Spence, M. Nixon, C. (2009). The choice to abort among mothers living under ecologically deprived conditions: Predictors and consequences. International Journal of Mental Health and Addiction 7, 405-422.

Coleman, P. K., Reardon, D. C., & Cougle, J. R. (2005). Substance use among pregnant women in the context of previous reproductive loss and desire for current pregnancy. British Journal of Health Psychology, 10 (2),255-268.

Coleman, P. K., Reardon, D. C., Strahan, T., & Cougle, J. R. (2005). The psychology of abortion: A review and suggestions for future research. Psychology and Health, 20, 237-271.

Coleman, P.K., Rue, V.M. & Coyle, C.T. (2009). Induced abortion and intimate relationship quality in the Chicago Health and Social Life Survey. Public Health, 123, 331-338.DOI: 10.1016/j.puhe.2009.01.005.

Coleman, P.K., Rue, V.M., Coyle, C.T. & Maxey, C.D. (2007). Induced abortion and child-directed aggression among mothers of maltreated children. Internet Journal of Pediatrics and Neonatology, 6 (2), ISSN:1528-8374.

Coleman, P. K., Rue, V., & Spence, M. (2007). Intrapersonal processes and post-abortion relationship difficulties: A review and consolidation of relevant literature. Internet Journal of Mental Health, 4 (2).

Coleman, P.K., Rue, V.M., Spence, M. & Coyle, C.T. (2008). Abortion and the sexual lives of men and women: Is casual sexual behavior more appealing and more common after abortion? International Journal of Health and Clinical Psychology, 8 (1), 77-91.

Cougle, J. R., Reardon, D. C., & Coleman, P. K. (2005). Generalized anxiety following unintended pregnancies resolved through childbirth and abortion: A cohort study of the 1995 National Survey of Family Growth. Journal of Anxiety Disorders, 19, 137-142.

Coyle, C.T., Coleman, P.K. & Rue, V.M. (2010). Inadequate preabortion counseling and decision conflict as predictors of subsequent relationship difficulties and psychological stress in men and women. Traumatology, 16(1), 16-30. DOI:10.1177/1534765609347550.

Dingle, K., et al. (2008). Pregnancy loss and psychiatric disorders in young women: An Australian birth cohort study. The British Journal of Psychiatry, 193, 455-460.

Fergusson, D. M., Horwood, L. J., & Boden, J.M. (2009). Reactions to abortion and subsequent mental health. The British Journal of Psychiatry, 195, 420-426.

Fergusson, D. M., Horwood, L. J., & Ridder, E. M. (2006). Abortion in young women and subsequent mental health. Journal of Child Psychology and Psychiatry, 47, 16-24.

Gissler, M., et al. (2005). Injury deaths, suicides and homicides associated with pregnancy, Finland 1987-2000. European Journal of Public Health, 15, 459-463.

Hemmerling, F., Siedentoff, F., & Kentenich, H. (2005). Emotional impact and acceptability of medical abortion with mifepristone: A German experience. Journal of Psychosomatic Obstetrics & Gynecology, 26, 23-31.

Mota, N.P. et al (2010). Associations between abortion, mental disorders, and suicidal behaviors in a nationally representative sample. The Canadian Journal of Psychiatry, 55(4), 239-246.

Pedersen, W. (2008). Abortion and depression: A population-based longitudinal study of young women. Scandinavian Journal of Public Health, 36, No. 4, 424-428.

Pedersen, W. (2007). Childbirth, abortion and subsequent substance use in young women: a population-based longitudinal study. Addiction, 102(12), 1971-78.

Reardon, D. C., & Coleman, P. K. (2006). Relative treatment for sleep disorders following abortion and child delivery: A prospective record-based study. Sleep, 29 (1), 105-106.

Rees, D. I. & Sabia, J. J. (2007). The Relationship between Abortion and Depression: New Evidence from the Fragile Families and Child Wellbeing Study. Medical Science Monitor. 13(10): 430-436.

Suliman et al. (2007) Comparison of pain, cortisol levels, and psychological distress in women undergoing surgical termination of pregnancy under local anaesthesia versus intravenous sedation. BMC Psychiatry, 7 (24), p.1-9.

Powerful arguments advanced in UK parliament for a change in the law to ensure properly informed consent for abortion

Last night Nadine Dorries, Conservative MP for Mid Bedfordshire, spoke in an adjournment debate on the subject of informed consent for termination of pregnancy.

Adjournment debates allow the House of Commons to hold a general open-ended debate on a subject or a government policy without reaching a formal decision about it. This is often a forerunner of an attempt to change the law.

You can watch the whole video or read the transcript on the parliamentary website.

The key points in her speech were as follows:

Although the abortion figures for last year were slightly reduced by 3.2%, there were still 200,000 abortions carried out in the UK last year-572 per day. Abortion in this country is an industry from which a small number of organisations and individuals make vast amounts of money. No sensible person would condone this. In examining the legislative abortion procedures of European countries with far lower numbers than ours, it occurred to me that for those countries in which informed consent before an abortion takes place is enshrined in law-Germany, France, Belgium, Finland and others-the abortion rate was much lower.

I have deliberately excluded countries with religious and cultural influences, such as Italy, Spain and Portugal from that analysis. It also appears to me that in those countries, the abortion procedure is a far kinder one, which takes much more account of the vulnerable position a woman might be in at the time of her request for an abortion and provides her with alternatives to consider and a cooling-down time in order to think, breathe and take stock of what is happening.

All those countries with good informed consent legislation had significantly lower than average daily abortion rates than the countries that do not have such informed consent legislation. Although a causal link is impossible to prove, these figures suggest that informed consent legislation might prove a good way of reducing Britain's abortion figures.

Women are entitled to an option. They are entitled to give informed consent, which should be explicitly supported by pro-choice and pro-life campaigners. When it comes to a decision of such magnitude, it is vital for women to receive information that is absolutely accurate and is given calmly, without coercion or a principled bias and, in particular, without political ideology.

Last month ComRes, the pollsters, revealed after an extensive survey that 89% of people agreed with that. They think that women should be entitled to have more information when requesting an abortion. Given that overwhelmingly high figure, it is time that this House paid some attention. I hope the Minister agrees that it is time that we took a little more care of women undergoing such a procedure. It is time that we introduced a statutory process of informed consent and a cooling-off period. The European evidence shows that that could provide us with a considerable reduction in the number of abortions, and everyone would surely welcome that.

It is time for the UK to catch up with the rest of Europe and introduce informed consent… It is time for this country to start looking after our young girls and women at the most vulnerable time in their lives and treat them with some respect.

You can find a review of the European evidence backing up Ms Dorries position on the CMF website.

In reply Health Minister Anne Milton congratulated Ms Dorries for securing the debate and was not unsympathetic to her position.

She said that the Government would be responding to the House of Commons Select Committee on Science and Technology recommendation to update advice on the mental health consequences of induced abortion and that they have commissioned a systematic review of the evidence, with the report due to be published in spring 2011.

She agreed that the annual figure of 189,000 abortions for England and Wales was ‘still way too high’, that ‘a woman faced with an unwanted pregnancy is extremely vulnerable’ and that ‘the consequences of abortion can be traumatic and far reaching’.

She concluded, ‘Having in place informed consent, appropriate counselling and the right support for women at this vulnerable time will ensure that we do not fail them for the future.’

This morning the Daily Telegraph published a letter from six consultant psychiatrists supporting Nadine Dorries position and calling for a change in the law.

I have reproduced it here:

Dear Sir,

We welcome last night's parliamentary debate on government policy surrounding the provision of information to women seeking a termination of pregnancy.

In March 2008, the Royal College of Psychiatrists issued a position statement in which they recognised that good practice in relation to abortion should include informed consent involving the provision of adequate and appropriate information regarding the possible risks and benefits to physical and mental health.

A major 30-year longitudinal study that was published in the British Journal of Psychiatry in 2008 showed, after adjustment for confounding variables, that women who had had abortions had rates of mental disorder that were about 30% higher than their peers.

Moreover, the notion of 'informed consent' enjoys massive public support. A ComRes poll published on the anniversary of the Abortion Act last week, shows that 89% of British adults support ‘a woman’s right, enshrined in law, to be informed of all the physical, psychological and emotional risks associated with abortion’.

As consultant psychiatrists we strongly urge Parliament to introduce legislation ensuring that women seeking abortion are fully informed about the possible consequences of their abortion decision.

ANDREW SIMS
Past President Royal College of Psychiatrist; Emeritus Professor of Psychiatry, University of Leeds

PATRICIA CASEY
Professor of Psychiatry, University College, Dublin; Consultant Psychiatrist, Mater Hospital

CHRISTOPHER FINDLAY
Consultant Psychiatrist, Cheshire

NICK LAND
Consultant Psychiatrist, Middlesborough

SUNIL RAHEJA
Consultant Psychiatrist, London

ADRIAN TRELOAR
Consultant Psychiatrist, London

Media coverage and other resources

MP in call for pre-abortion counselling provision(Independent, 3 November 2010)

Last night's debate(Nadine Dorries Blog, 3 November 2010)

Call for pre-abortion counselling (Press Association, 3 November)

EDM 834 on Informed Consent for Aborion (Therese Coffey, 14 October 2010)

Please consider signing LIFE petition on informed consent