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).
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.