Hacktitioner Alert #1

Sarah-Kate Templeton, late of the Sunday Herald and current the Health Editor at the Times is, so I understand, an award-winning health journalist…

…not that that seems to mean very much on the evidence of her coverage of the revised guidance issued by the Royal College of Psychiatrists in regards to abortion and mental health:

Women may be at risk of mental health breakdowns if they have abortions, a medical royal college has warned. The Royal College of Psychiatrists says women should not be allowed to have an abortion until they are counselled on the possible risk to their mental health.

Not true.

Nowhere in the revised guidance, which has been issued at the express request of the House of Commons Science & Technology Committee, does it state that women should not be allowed to have an abortion until they are counselled on risks to their mental health. What the guidance does state, quite correctly, is that:

Healthcare professionals who assess or refer women who are requesting an abortion should assess for mental disorder and for risk factors that may be associated with its subsequent development. If a mental disorder or risk factors are identified, there should be a clearly identified care pathway whereby the mental health needs of the woman and her significant others may be met.

And quite right too, in fact one would expect nothing less from a conscientious healthcare professional.

This overturns the consensus that has stood for decades that the risk to mental health of continuing with an unwanted pregnancy outweighs the risks of living with the possible regrets of having an abortion.

No it doesn’t, and to make matters even more absurd, the Times actually provides the evidence to prove this in the form of two PDF documents linked at the end of the article, the Royal College’s  revised guidance and its previous guidance (from 1994) which is contained in the Rowlinson report,  and although the latter goes into somewhat more detail on the subject, the guidance issued by both reports in regards to pre-abortion assessments is the same. Women who present requesting an abortion should be assessed for any pre-existing psychiatric conditions or significant risk factors and if these are present, then a care plan should be put in place to support them regardless of their ultimate decision on whether to go ahead with an abortion or not because, as the RCoP notes:

Women with pre-existing psychiatric disorders who continue with their pregnancy, as well as those with psychiatric disorders who undergo abortion, will need appropriate support and care. Liaison between services, and, where relevant, with carers and advocates, is advisable.

So what has actually changed to ‘merit’ the claims made by this article?

Well, back in 1994, there was no credible evidence to suggest that women who had an abortion would experience significant mental health problems afterwards and this was reflected in the RCoP’s guidance.

And now?

The specific issue of whether or not induced abortion has harmful effects on women’s mental health remains to be fully resolved. The current research evidence base is inconclusive – some studies indicate no evidence of harm, whilst other studies identify a range of mental disorders following abortion.

So in 14 years, and despite the best efforts of the anti-abortion lobby to establish a link between abortion and subsequent mental health problems, we’ve gone from no evidence to having some inconclusive evidence, which in the main means this  2006 study from New Zealand, one that is certainly better constructed than most but which is still not without its methodological issues, which the authors freely acknowledge:

On the basis of the current study, it is our view that the issue of whether or not abortion has harmful effects on mental health remains to be fully resolved. Certainly in this study, those young women who had abortions appeared to be at moderately increased risk of both concurrent and subsequent mental health problems when compared with equivalent groups of pregnant or non-pregnant peers. While it is possible to dismiss these findings as reflecting shortcomings in the assessment of exposure to abortion or control of confounders (see above), it is difficult to disregard the real possibility that abortion amongst young women is associated with increased risks of mental health problems. There is a clear need for further well-controlled studies to examine this issue before strong conclusions can be drawn about the extent to which exposure to abortion has harmful effects on the mental health of young women.

If you’re comfortable with reading research papers, then this paper is certainly well worth reading, especially for its discussion of the difficulties of drawing strong conclusions from studies of this kind and its own limitations vis-a-vis the reporting of abortions by women included in the study:

2. Errors in the ascertainment of abortion: Comparison of the rates of abortion reported by this cohort with a population estimate based on official record data suggested moderate accuracy in the reporting of abortion, with the reported rates for the cohort being 81% of the estimated population rate for women aged 15–25. These estimates suggested some underreporting of abortion in the cohort (see Methods). In turn, this raises the possibility that errors in the reporting of abortion may have distorted the results (Reardon & Cougle,
2002).

And the possibility of contextual confounding factors:

3. The role of contextual factors: An important threat to study validity comes from the lack of information on contextual factors associated with the decision to seek an abortion. It is clear that the decision to seek (or not seek) an abortion following pregnancy is likely to involve a complex process relating to: a) the extent to which the pregnancy is seen as wanted; b) the extent of family and partner support for seeking or not seeking an abortion; c) the woman’s experiences in seeking and obtaining an abortion. It is possible, therefore, that the apparent associations between abortion and mental health found in this study may not reflect the traumatic effects of abortion per se but rather other factors which are associated with the process of seeking and obtaining an abortion.

These points serve to emphasise the utter hypocrisy of the anti-abortion lobby when it comes to citing the possibility of elevated risks to mental health as grounds for restricting access to abortion and, in particular, opposing liberalising measure designed to make access easier at the earliest stages of pregnancy because, as should be obvious, what the study raises is the possibility that if there is such a moderately elevated risk then it may well be that the stigma applied to abortion, one which features heavily in the tactics of this lobby, could be a significant contributory factor.

MPs will shortly vote on a proposal to reduce the upper time limit for abortions “for social reasons” from 24 weeks to 20 weeks, a move not backed by the government. A Sunday Times poll today shows 59% of women would support such a reduction, with only 28% backing the status quo. Taken together, just under half (48%) of men and women want a reduction to 20 weeks, while 35% want to retain 24 weeks.

This poll, and the three similar one’s preceding it deserve a post of their own to demonstrate how

Some MPs also want women to have a “cooling off” period in which they would be made aware of the possible consequences of the abortion, including the impact on their mental health, before they could go ahead.

And as just noted, the imposition of such a ‘cooling off period’ could easily prove counter-productive if it is the case that forcing women to dwell on their decision does contribute to the risk of subsequent mental health problems, not that the anti-abortion lobby care because their support for the introduction of cooling off periods has nothing to with concern for the interests of women seeking abortion and everything to do with trying to dissuade women from having abortions.

One of the much favoured tactics of the anti-abortion lobby in the US has been to push for mandatory referrals for ‘counselling’ on alternatives to abortion provided by anti-abortion group. There is, of course, no problem, with providing information and guidance on alternatives to abortion, but only where such counselling is carried out ethically and under  conditions in which the interests of the woman considering an abortion are paramount and, as one might expect, ‘counselling’ services provided by anti-abortion groups have a well documents, long and inglorious track record of unethical conduct.

More than 90% of the 200,000 terminations in Britain every year are believed to be carried out because doctors believe that continuing with the pregnancy would cause greater mental strain.

Hence the need to expedite the procedure at the early stages, not throw up unnecessary delays.

The Royal College of Psychiatrists recommends updating abortion information leaflets to include details of the risks of depression. “Consent cannot be informed without the provision of adequate and appropriate information,” it says.

But it doesn’t actually mention the inclusion of ‘details of the risks of depression’, what it actually says is:

The Royal College of Psychiatrists recognises that good practice in relation to abortion will include informed consent. Consent cannot be informed without the provision of adequate and appropriate information regarding the possible risks and benefits to physical and mental health. This may require the updating of patient information leaflets approved by the relevant Royal Colleges, and education and training to relevant health care professionals, in order to develop a good practice pathway.

See? No mention of depression at all.

Several studies, including research published in the Journal of Child Psychology and Psychiatry in 2006, concluded that abortion in young women might be associated with risks of mental health problems.

And you can read the study for yourself, as this is the New Zealand study included above.

The controversy intensified earlier this year when an inquest in Cornwall heard that a talented artist hanged herself because she was overcome with grief after aborting her twins. Emma Beck, 30, left a note saying: “Living is hell for me. I should never have had an abortion. I see now I would have been a good mum. I want to be with my babies; they need me, no one else does.”

A sad story, true, but as with such stories there is rather more going on that the Times reports:

In February the following year, the night before her 31st birthday, Miss Beck hanged herself at her home in Helston.

She had recently split up with her boyfriend, identified only as Ben, who was said to have “reacted badly” to her pregnancy.

The Truro inquest heard that Miss Beck’s mother later contacted the hospital, demanding to know why she was not given more support.

Sylvia Beck, 62, from Woking, Surrey, wrote: “I want to know why she was not given the opportunity to see a counsellor.

“She was only going ahead with the abortion because Ben did not want the twins. I believe this is what led Emma to take her own life, because she could not live with what she had done.”

Remember what the New Zealand study said about contextual factors?:

It is possible, therefore, that the apparent associations between abortion and mental health found in this study may not reflect the traumatic effects of abortion per se but rather other factors which are associated with the process of seeking and obtaining an abortion.

So did this unfortunate woman kill herself because she was traumatised by the abortion, or does the trauma lie in her having aborted foetuses she actually wanted at the behest of an ex-boyfriend who comes over as having been a major league arsehole?

The college’s revised stance was welcomed by Nadine Dorries, a Conservative MP campaigning for a statutory cooling-off period: “For doctors to process a woman’s request for an abortion without providing the support, information and help women need at this time of crisis I regard almost as a form of abuse,” she said.

Yes, as you might expect, the MP for Mid Narnia is hardly slow to get in on the act, this time by pitching her campaign for a mandatory ‘cooling off’ period for women seeking abortions. It remains to see exactly what form the amendment for this ‘cooling off’ period takes but, at this stage what one can say is that a delay of this kind is of no value whatsoever if all it entails is leaving women to stew, without further support, for a few days in between an initial appointment and being admitted for the procedure. On its own, a so-called ‘cooling off’ period is a worthless gesture designed to put a barrier in the hope that the delay will cause some women to reconsider. What matters is not how long a woman has to wait before getting the abortion, but what support and counselling she receives before and, critically, after having had an abortion, especially as, in many cases, the amount of professional after-care given is limited to a pre-discharge interview.

If Dorries were genuinely concerned about the well-being of women who have had abortions she’d be pushing for a statutory requirement for post-abortion counselling not a pre-abortion delay.

Dawn Primarolo, the health minister, will this week appeal to MPs to ignore attempts to reduce the time limit on abortion when new laws on fertility treatment and embryo research come before parliament.

Will she? If that is what she does, it will be on the basis of the available scientific and clinical evidence not on a stream of fabrications, smears and lies, which is what Dorries has been peddling.

Dr Peter Saunders, general secretary of the Christian Medical Fellowship, said: “How can a doctor now justify an abortion [on mental health grounds] if psychiatrists are questioning whether there is any clear evidence that continuing with the pregnancy leads to mental health problems.”

I’m not sure what Saunders’ specialism is – although there is a consultant anaesthetist of the same name at London Bridge Hospital which may be our Dr Saunders – but from that statement we can be sure that whatever it is, it isn’t psychiatry. Either that or simple could nor be bothered read what the RCoP actually said:

The Royal College of Psychiatrists is concerned to ensure that women’s mental health is protected whether they seek abortion or continue with a pregnancy.

Mental disorders can occur for some women during pregnancy and after birth.

What there isn’t clear evidence for is whether having an abortion leads to an elevated risk of mental health problems; that some women experience mental health problems during pregnancy and after giving birth is not open to question, as Dr Saunders should know perfectly well. It’s not as if we’re short of literature on post-natal depression, for starters, and the effects of that can be particularly severe, in the worst cases resulting in suicide and/or a mother harming her child.

Then again, what else would you expect from a man who writes articles about ‘miracles’, which include statements such as:

Talk of laws implies the presence of a lawgiver, and if laws are established by a supernatural agent, then they could also be modified or temporarily suspended for a purpose.

And…

If we claim to be Christians then we can neither escape nor deny the miraculous; nor should we wish to. In accepting the existence of a personal creator God who wishes to reveal himself to us, we should affirm that miracles are a natural and logical way to do this. The evidence for the resurrection of Jesus is excellent and if discussion of miracles prompts us to talk about the resurrection, we are both on certain ground and a great topic!

Saunders’ excellent ‘evidence’ for the resurrection, as you might expect, is a list of quotations from the Bible, which he uses as the basis for a stream of hilarious observations:

Some have suggested hallucinations as an alternative explanation; but hallucinations do not occur with varied groups, on multiple occasions, in different places, over a period of several weeks. Hallucinations don’t light real beach fires or eat real fish either, but Jesus did!

And Dorothy really did go to Oz – we know this for sure because it says so in the ‘Wizard of Oz’.

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Having written several previous articles on the generally poor quality of much  or what passes for health journalism in the mainstream media, I think its now time – for ease of use, if nothing else – to coin a suitable neologism for members of this ‘professional’, and after the fashion of the esteemed Dr Crippen, if a nurse (or similar) who spouts nonsense is a ‘quacktitioner’ then a journalist who does the same sort of thing must surely be a ‘hacktitioner’, making this my first fully fledged ‘hacktitioner alert’.