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
a newspaper possibly twisting the truth to sell a story? gosh i am schocked to the core! without wanting to sound petty - does he actually read what he writes?
ReplyDeletegood article by the way Peter. keep them coming - primary sources included!
Peter
ReplyDeleteI asked for clarification on Fergusson's definition on what he classed as the possible pregnancy outcomes on Chivers' blog, but I guess you haven't continued to contribute there.
I have managed to find out for myself. Here's Fergusson's "other pregnancy outcomes", as listed in the study:
Using the information on timing and outcome for each reported pregnancy, the woman’s pregnancy history for any given period of interest was classified using four dichotomous measures of pregnancy outcomes.
Whether the woman reported having an elective abortion during the interval.
Whether the women experienced a pregnancy loss during the interval. Pregnancy loss was defined to include miscarriage, stillbirth and termination of ectopic pregnancy.
Whether the woman had a live birth during the interval for which she reported an adverse reaction to the pregnancy. An adverse reaction was defined to include where the woman reported that the pregnancy was unwanted or that she had been distressed or very distressed on learning of the pregnancy.
Whether the woman had a live birth during the interval with no adverse reaction to the pregnancy
So the answer is that the study doesn't specifically include women who were forced to go full term (the phrase "where the woman reported that the pregnancy was unwanted" also covers distress exhibited during the traumatic act of childbirth itself, which is often temporary), and it gives itself wiggle room to only theoretically include women who attempt DIY abortions with varying degrees of success (although practically, it won't include them, given that abortion is legal in New Zealand).
Therefore, the results of the study are flawed.
It's a nice attempt, though. Perhaps the study should be performed again in a county where abortion is illegal yet its citizens have a degree of access to abortion - Ireland, perhaps? Of course, you'd need to factor out the cultural effects of state players deliberately trying to make women feel guilty for their actions, but it may offer more interesting information than an incomplete study performed in a socially liberal country.
Hello Peter
ReplyDeleteI've just jumped over here from the response you made on Tom's blog, where you'll see that I agree with you that 'flawed' is not the right word in this instance. Here it is, pasted in for uniformity.
Regards - Martin
= = =
Peter
Fair point - 'flawed' is a bit strong, because the study isn't flawed when viewed in isolation.
The problem is trying to extrapolate a message from the study into the wider world - it is that act that is 'flawed', for reasons I've already outlined.
I immediately took issue with the study because the wording from the results at the beginning of the paper makes it feel like it is claiming to catch all possible outcomes from pregnancy ("There were no consistent associations between other pregnancy outcomes and mental health." - my emphasis in bold) - it's only when you read the four dichotomous measures listed in his method that you are certain that "other" doesn't mean "all other".
But I agree - it's not "flawed" - but it is limited in what it can research (given the scenarios that we've agreed on). It's not the study's fault - it's the fault of those who seek to use it.
As I mentioned in your own blog, it would be interesting to see a similar study from a place like Ireland where you could find a group of women forced to go full term as a control - I'm not going to do a (James) Delingpole and spray around scientific terms that I barely understand, but some kind of meta-study that can minimise cultural differences would be very useful, because decision-makers hanging their hat on Fergusson's study alone makes me feel quite uncomfortable.
Here is my earlier reply to Martin on the Telegraph website which he has responded to above:
ReplyDeleteMartin,
Thanks for this. Rather pressed today but you raise some good points that need good answers and I will come back you when I can in more detail both here and on the blog.
To dismiss Fergusson's study as 'flawed' though on the basis of this argument is rather far-fetched and you would, with due respect, be laughed out of court by most reviewers.
In brief Fergusson allowed for 30 confounding variables in all. There are very few studies that come anywhere near this and if you disregard his work then you end up throwing out virtually all research in this arena and in fact most scientific studies on anything at all.
It is true that he did not specifically exclude a control group of women 'forced to carry to term an unwanted pregnancy to term'
Such control groups do not exist in most countries (and certainly not in New Zealand) but there is other research that bears on this question.
Also 'unwantedness' is complex and the degree of wantedness (intendedness is the term now used) often changes over time.
But more later - must dash now.
Cheers
Peter
I've just jumped over here from the response you made on Tom's blog.
ReplyDeleteeye lift