Maria Miller, Abortion and ‘Common Sense’.

The current upper limit for legal elective abortions (24 weeks gestation) is back in the news, yet again, courtesy of an article by Channel 4’s Cathy Newman at the Papal Telegraph’s new ‘Wonder Woman’ blog section – and, no, having looked over the section there’s not of hint of blue hot pants or a stars and stripes bodice to be found anywhere… yet.

The spark for this latest bout of piss-poor argumentation is brief interview with the Tories new Minister for Women and Equalities, Maria Miller, who voted to reduce the upper limit to 20 weeks back in 2008 and now states, unapologetically, that she’d ‘absolutely’ do so again, given the chance.

Fair enough, she’s entitled to her opinion and, fortunately, her main cabinet role is as Secretary of State at the Department of Culture, Media and Sport, so she has no direct involvement in determining health policy, so my immediate inclination is to think ‘what of it?’. This is, after, the Telegraph, which has become so obviously Roman Catholic in its orientation since it was taken over by the Barclay brothers that one half expects to see them launch a Latin edition in the not too distant future.

However, as Miller’s argument appears to based primarily on the suggestion that it is only ‘common sense’ to lower the current upper limit, due to advances in medical technology, I’ve decided that its worth giving this a bit more attention, even at the risk of revisiting issues and arguments that I wrote about, at some length, more than four years ago. There is also the added bonus of a commentary on Miller’s comments by Cristina Odone, the Telegraph’s reigning High Priestess of the First Church of Sanctimonious Flapdoodle, to play with, so without further ado let’s get on with the show by way of the section of Newman’s article that cover’s Miller’s remarks in full:

Having voted in 2008 to reduce the legal limit for abortions from 24 weeks to 20 weeks, there was a fair bit of comment that this must mean she wasn’t very feminist. So when I spoke to her about the issue, a few weeks after she got the brief in Cameron’s first reshuffle, I half expected her to fudge it, or be slightly reluctant to answer questions.

Not a bit of it. To give her credit, she is clearly a woman who knows her own mind. Would she, I asked, vote that way again? “Absolutely.” I must admit I was slightly taken aback by her candour. “You have got to look at these matters in a very common sense way,” she expanded. “I looked at it from the really important stance of the impact on women and children.”

This, in truth, is the Nadine Dorries school of thought – the belief that the pro-choicers who want to keep the limit at 24 weeks are, as Ms Dorries put it to me, ignoring “the number of women who are traumatised and vulnerable during the abortion process”. Ms Dorries says a 20 week cut-off makes her “more of a feminist”, standing up for women.

And Ms Miller – who describes herself as “a very modern feminist” – clearly agrees, saying she’s “driven by that very practical impact that late term abortion has on women…What we are trying to do here is not to put obstacles in people’s way but to reflect the way medical science has moved on.”

Right from the off, I want to give Miller the benefit of the doubt and break Newman’s suggested link to the ‘Nadine Dorries school of thought’. Putting the words ‘Dorries’ and ‘thought’ in the same sentence in pretty implausible to start with, adding ‘school’ as well takes off into the realms of unicorns and fairies at the bottom of the garden.

But, being serious for a moment – well, several moments – the real issue with Dorries is not, and never has been, simply her advocacy of a reduction in the upper limit for elective abortions from 24 to 20 weeks. Its the abject dishonesty of both her position and her arguments coupled with her close association with fundamentalist Christian organisations whose real objective is the outright prohibition of abortion in any and all circumstances, including rape, serious foetal abnormality and even where the life of a pregnant woman would be placed at serious risk by the continuation of a pregnancy.

Dorries was put up, originally,to serve as a ‘cleanskin’ in a debate in which any kind of known religious affiliation or motivation was – and still is – viewed with a considerable degree of distrust by a majority of the British public. In poll after poll, public support for the generality of abortion rights, legal action to safe abortions within a framework set out in law, runs consistently at or above 60%, while support outright, or near outright, prohibition has been scraping along at or around 9-10%.

The anti-abortion lobby has long since lost the basic moral argument in terms of public opinion, if only because a solid majority of the general public understand, perfectly well, that the alternative to safe, legal, abortion services isn’t an end to the need/demand for abortions but rather a return, at least for the poor, to the days of unsafe backstreet abortion – the illegality of abortion in all but very limited circumstances, prior to the 1967 Abortion Act, was, of course, no great impediment to those who were wealthy enough to find themselves a suitably discrete and accommodating private clinic. If we look past the UK’s own experience to the global picture what we find, today, that almost half of all abortions carried out, worldwide, are unsafe, with the overwhelming majority of these abortions (98%) occurring in the developing world, largely in countries with severely prohibitive abortion laws. In global terms, legal access to safe abortions on broad terms is associated with an overall reduction in the abortion rate – legalisation of abortion typically goes hand-in-hand with the legalisation/broadening of access to effective contraception and, naturally enough, to marked reduction in abortion-related complications, in including mortalities.

Recognition of the ‘impossibility of all or nothing approach’ – the exact phrase used by one of Dorries’ associates, Dr Peter Saunders, in a 2007 presentation to members of the Lawyer’s Christian Fellowship – has, in recent years prompted the anti-abortion lobby to switch tack, de-emphasise its religious/moral stance on abortion (at least in public) and focus instead on trying to win over both the public, and legislators, to the side of incremental restrictions in abortion rights using ‘scientific’ arguments to go with their usual diet of scaremongering, shaming and slanderous assaults on the personal and professional integrity of abortion service providers. The essence of this strategy is set out in another slide from Saunders’ presentation:

Bringing about legal change

Broad coalitions (Alive and Kicking).

Prime focus on changing public opinion.

Specific legal interventions (upper limit for handicap, separating psych and physical indications, accurate recording of complications).

Changing medical opinion – guidance of RCOG and RCPsych on psychological effects of abortion and resuscitation guidelines.

Although, before anyone gets taken in by the apparent reasonableness of this approach, its also worth noting that this same presentation also includes slides such as this one (below) which shows Saunders marshalling his arguments for the absolute prohibition of abortion where conception occurred as result of rape:

What about abortion for rape?

Rape is an extremely serious crime but…

Pregnancy following rape is extremely rare and far less than 1% of abortions are performed following alleged rape.

Rape sacrifices a second innocent victim (Should the baby die for the crime of its father?).

In the only major study of pregnant rape victims ever done, 75 to 85% chose against abortion.

Saunders’ claim that the ‘only major study of pregnant rape victims ever done, 75 to 85% chose against abortion is, by the way, a steaming pile of crap. The study he’s referring to here, which was carried out by Dr. Sandra Makhorn in the late 1970’s, is anything but major – the data comes from all of 37 women – nor was published in a peer reviewed scientific journal, although it has been published twice, with some revisions, as a chapter in books edited by known anti-abortion authors Thomas W Hilgers, David Mall and Dennis J Horan. It also anything but the only study to look at pregnancy outcomes in rape victims – Saunders is, here, ignoring completely the existence of peer reviewed papers by Holmes et al. (1996) and Wilcox et al. (2001), both of which were discussed here by Kate Clancy in article published earlier this year by Scientific American.

What this illustrates, rather neatly, is the fundamental problem that the anti-abortion lobby has had in trying to argue the science. On pretty much every issue they’ve sought raise, from mental health risks to alleged links between abortion and breast cancer, the best current evidence fails to support either their general position or their specific arguments – hence their abject failure to either ‘change medical opinion’ or effect any substantive changes to the guidance issued by RCOG and RCPsych on the psychological effects of abortion – leaving them with no option but to resort to dishonest argumentation, blatant misrepresentation, such as the example given above, and even dishonest ‘science’ (by all means feel free to use the search facility here to look up Priscilla Coleman and David Reardon – you’ll very quickly see exactly what I mean).

Somewhat ironically, given that her main, indeed only, role in all this has been to serve as the anti-abortion lobby’s Parliamentary Sockpuppet-in-Chief, the anti-abortion lobby’s general approach to science and the scientific evidence relating to abortion has nowhere been better summed up than by Nadine Dorries who, rather infamously, offered up what RationalWiki has politely referred to as a ‘unique take on epistemology and the nature of science’.

At the foot of this report there are links to others and there are plenty more where they came from. But it’s all about science. Which is about the definition of fact. Which facts are indisputable and which are not. There are as many ‘facts’ as you wish to choose from on both sides of the argument.

I have chosen the ‘fact’ I wish to believe. It’s up to those who don’t believe a foetus in the womb can feel pain to test their facts and prove that it can’t and that is the issue, it cannot be proven. Science is about testing until the facts are indisputable and absolute. There is enough evidence to suggest a baby could feel pain, pretty compelling actually, for me to be of the opinion that if there is any element of doubt, shouldn’t the decision whether or not to abort at 20 weeks be a value based decision? If the scientific evidence either way cannot be proven 100% we have to ask what kind of society are we?

Perhaps the only thing one can agree with here it that values should play an important role in decisions as to whether or not to terminate a pregnancy at 20 weeks gestation. However, the question is ‘who’s values?’, to which the obvious, indeed only reasonable answer, is ‘Not your’s, Nadine.”

Bringing this all the way back to Maria Miller, after a fairly lengthy digression, not only is suggestion that Nadine Dorries has a ‘school of thought’ nothing short of laughable, in objective terms, but it really is rather harsh and not a little unfair of Newman to draw any kind of parallels between Miller and Dorries given, on the strength of an admittedly cursory bit of background checking, the dearth of evidence linking Miller with either Dorries’ known puppet-masters or with their particular brand of dishonest argumentation. To be scrupulously fair here, at least until evidence to the contrary presents itself, we need afford Miller the benefit of the doubt and take the view that she is genuinely sincere in her belief that the medical and scientific evidence on neonatal viability and the psychological effect of late-term abortion supports her view that a reduction in the current upper limit for legal elective abortions to 20 weeks gestation is matter of ‘common sense’.

She’s wrong – of course – but it has to be conceded that the arguments and evidence from which she is likely to have derived her position on abortion do possess a superficial, if rather narrow, degree of plausibility, one that can be readily, if not frequently, be mistaken for ‘common sense’ and, as such, I would be doing Miller a great and unjustified disservice were I to blindly assume her own position to be as vacuous and intellectual dishonest as that espoused by Nadine Dorries on those very rare occasions that she manages to stick to her own, carefully fabricated, message and not drop bollocks left, right and centre.

So where should we begin with Miller?

Perhaps the best place to start is with the observation than any claims linking science to ‘common sense’ should always be treated with caution, if not outright suspicion, given that the historical development of science and scientific knowledge has so often been a matter of scientific observation and experimental overturning idea that were, at one time, believed so widely to be true that they were considered to be nothing more than ‘common sense’.

Four hundred years ago, for example, the eminent intellectuals of the day firmly believed that humans developed in the womb from tiny, perfectly-formed, homunculi (a doctrine called preformationism) and the only matter of serious dispute was whether or not these homunculi originated in the body of the father but would grow only after implantation in the mother during sexual intercourse (spermism) or whether they were held in the mother’s body awaiting the transmission of the ‘spark of life’ (ovism) which, of course, was also thought to occurred during sexual intercourse when the male ejaculated. It wasn’t until the publication of William Harvey’s seminal work on embryology, ‘On the Generation of Animals’, in 1651, that the ‘common sense’ notion of preformationism – which, like so many other prominent pre-scientific ideas, could be traced back to Aristotle – was seriously challenged and it was only with the invention of the microscope and the subsequent discovery of spermatozoa in 1677, by the Dutch microscopist Antonie van Leeuwenhoek, that the performationist theory gave way to the epigenist theory, laying the foundations of modern embryology.

The basic dictionary definition of ‘common sense’ is ‘plain ordinary good judgement’ and, of course, what makes a particular judgement both plain and ordinary is the fact that it accords with something that the vast majority of people know, or at least believe, to be true. And so it was that, less than 50 years before the publication of Harvey’s work on animal embryology, what everyone, other than a few heretical intellectuals knew for certain was that the earth was the centre of the universe, at least until an inquisitive Italian by the name of Galileo Galilei pointed a telescope at the plant Jupiter and discovered that it, like the Earth, had its own moon, or rather moons as Galileo discovered four satellites in total; Io, Europa, Ganymede, and Callisto, moons that are collectively referred to as the Gallilean moons in his honour.

A little over 150 years ago, what the vast majority people in Europe and North and South America knew was that the universe and everything in it, including us, has been created, ex-nihilo, in a matter of six days, and many were of the view that this singular event has occurred within the last 6,000 years. What most of these people also knew was that terrible diseases such as cholera and typhoid were spread through the air by noxious fumes called ‘miasmas’ and some of the people who knew this were even called doctors.  Today there are still some people out there who profess to know that the universe was created in six days or that diseases are caused by miasmas, the difference being that the ‘common sense’ view of such beliefs has moved on to the point that these beliefs, which were once the ‘common sense’ of their time, are now widely – quite rightly – considered to be entirely delusional.

And only a little under a century ago, even knew that we lived in a stable, orderly universe that ran like clockwork according to mathematically straightforward physical laws, even Einstein who fudged his own figures by introducing a cosmological constant into his General Theory of Relativity in order to ensure that his calculations coincided with the known view of the universe. Einstein was, of course, wrong, as was fairly quickly demonstrated by Edwin Hubble, and science once again overturned the ‘common sense’ view of the nature of the universe. So know we know that the universe is a much stranger and more complicated place than anyone had previously imagine before the 20th century’s scientific revolutions in cosmology and quantum mechanics, too complicated, in fact, for anyone to seriously consider it to be matter of simple common sense.

Science is not about common sense, it’s about evidence and, more often than not, what the evidence tells us is something very different to the prevailing ‘common sense’ view of particular issue, which is why appeals to common sense are properly considered to be a logical fallacy; the Argumentum ad populum or Bandwagon fallacy.

On that basis, I think we can reasonably discard the notion of approaching this issue in terms of ‘common sense’ and look, instead, at the scientific evidence and the arguments that stem from it and ask ourselves whether this genuinely does underpin Miller’s position.

For once, luckily, we’re not dealing with Nadine Dorries, so there is no need to wade through the usual Gish Gallop of fabrications, blatant misrepresentations and fallacious reasoning. We don’t need to choose the facts we wish to consider because Miller has already helpfully narrowed her position down to two key arguments, the argument from viability, which holds that we should prohibit abortion once a foetus reaches a gestational age at which it would have some prospect of surviving outside the womb (give or take a few caveats about serious disability).

The popularity of the argument from viability is not that difficult to understand. Superficially, at least, it appears to provide a relatively straightforward solution to a complex ethical question that lies at the heart of the abortion debate, that of when a foetus could reasonably be said to have acquired certain rights, specifically, the right to life, independently of its maternal host. Its for this reason, primarily, that the argument from viability has played a key role in shaping our current abortion laws, because it appears to offer legislators a degree of certainty on an issue that is otherwise littered with complex ethical uncertainties. Scratch the surface of the argument from viability, however, and the apparent certainties it may appear to offer quickly start to unravel.

So, what does science have to say about foetal viability?

Well, the best current evidence suggests at the current upper limit for legal elective abortions, 24 weeks gestation, we are very close to the absolute limits of foetal viability, even allowing for improvements in neonatal care over the last 20-30 years. 24 weeks gestation appears to be a critical boundary as the data from the best available studies shows marked improvements in long-term survival rate in several premature neonate born at or shortly after 24 weeks gestation but no real improvement in survival rates before 24 weeks, a fact which is reflected in current clinical practice where clinicians will, if the risks justify it, make every effort to delay the delivery of a neonate, if the mother begins to go into labour before 24 weeks, until it gets past the 24 week boundary in the knowledge that this will improve its survival prospects.

At 23 weeks gestation, 26% of neonates that survive long enough to admitted to a neonatal intensive care unit will go on to survive until at least their first birthday. At 24 weeks gestation, the survival rate increases to 47% and by 25 weeks gestation it rises to 67%. (figures from Epicure 2). That is, however, far from being the whole story, because if we start our analysis from the point at which labour begins and consider the fate of foetuses that are alive at that stage in proceedings, what we quickly find is that at 23 weeks gestation, 20% of those foetuses die during labour itself and are stillborn, while a further 40% survive the birth only to die in the labour ward with a matter of minutes, before they can be admitted to a neonatal ICU. So what the Epicure 2 figures are actually telling us is not that neonate born at 23 weeks gestation has around a 1 in 4 chance of survival but rather that it has about a 1 in 10 chance (25% of the 40% admitted to an NICU) once we take into account those that are stillborn or die before admission to intensive care.

Survival is not the only issue here.

From the first Epicure study, 219 of the 307 children who were born before 26 weeks gestation and survived to reach the age of 11 underwent neurodevelopmental assessments at the age of 11 alongside a control group of 153 other children of the same age. Of these, 40% were found to have serious cognitive impairments, compared to just 1.3% in the control group. 17% had cerebral palsy, 10% a moderate to severe impairment in neuromotor function while the rates of sensory impairments were 9% (visual) and 2% (hearing). Overall, 45% of the children born before 26 weeks gestation had a serious functional disability, compared to just 1% of the control group, with the highest risk of serious disability being found in children born at 23-24 weeks gestation (1.8 time higher than for children born at 25 weeks gestation).

In a separate study using the same children, but with a slightly lower response rate (182 of 219 children were assessed) rates of chest deformities and respiratory symptoms in the extreme pre-term birth group were significantly higher than in the control group with diagnosed rates of asthma in the pre-term group being almost double those of the control group (25% against 13%). Overall, 56% of the pre-term group were found to have some degree of impaired lung function although only half of these were being treated with medication.

And, again, the same group were also assessed for the prevalence of psychiatric disorders at the age of 11 and, unsurprisingly, were found to be around three times more likely to have psychiatric disorder (e.g. ADHD, Autistic Spectrum Disorder, serious emotional/behavioural problems) than children in the control group. As you might well expect the prevalence of psychiatric disorders in the pre-term group was significantly associated with the presence of neurodevelopmental impairments (OR = 3.5; CI = 1.8 to 6.4).

So, what the scientific evidence has to say about the viability of a foetus at 23 weeks gestation is that, with access to the best available care, it has only a 1 in 10 chance or surviving and that even those who beat the odds have a 50% chance of serious disability, one sufficient, in law, to allow for a pregnancy to be terminated at any point prior to the birth – and one has to recall that the law is framed in such a way as to permit a pregnancy to be terminated if there is simply a ‘substantial risk’ of serious disability. not an absolutely certainty. A 1 in 2 chance is certainly substantial by any reasonable measure.

This all presupposes. of course, that one actually access to the best available neonatal care, which is, of course, highly likely in the UK with its universal, publicly funded, healthcare system, but much less likely to be true in countries where the quality of care one can obtain is largely or wholly dependant on one’s ability to pay one’s own treatment costs and not true at all in countries, and whole regions, that lack both the facilities and medical expertise necessary to provide neonatal care comparable to that we rather take for granted in the UK. To be absolutely clear, in the absence of high quality neonatal care, the chance that a neonate born at 23 weeks gestation will survive to see even its first birthday in zero. At that age neither the neonates brain nor, crucially, its lungs have developed sufficiently to allow it to survive outside the maternal host for more than a few hours.

Far from offering a straightforward solution to the question of when a foetus could be argued to have acquired a right to life independently of its mother, the argument from viability, when considered properly, merely introduces its own set of complex ethical questions into the debate.

Are we genuinely licensed to define the viability of a foetus in terms of what is possible given the availability of a particular (high) standard of medical care?

Most people would, I think, argue that we are but in that case, what account should we take of the availability of that level of care when we come to apply this notion of viability to the framing of abortion laws? Do we accept that it would be entirely reasonable for a country in sub-Saharan Africa to have a different – higher – abortion limit to the UK simply because it cannot provide the vast majority its citizens, all but the very wealthiest, with the same standards of neonatal care that we rather take for granted in the UK? And lest we think that this is merely another developed v developing world argument, what of countries like the United States where the standard of healthcare one receives is determined, at the very least, by what one can afford in terms of healthcare insurance. Should the US have a different abortion limit for women who cannot afford the kind of insurance that would cover the crippling costs of admitting a severely premature neonate to a high quality intensive care unit for anything up to nine to twelve months?

If the argument is that viability confers on the foetus/neonate a deontological right to life then how do we square that right with the fact that parents are accorded the right to refuse invasive medical treatment for their child, even if the consequences of such a refusal result in the death of the child?

Yes, that right is by no means absolute. It can be rescinded by a court if it take the view that the parents are seeking to exercise that right unreasonably, negligently or neglectfully in a manner contrary to the best interests of their child but courts deal with such issues, when they arise, as a question of fact and it is highly unlikely that court would choose to intervene in the case of a neonate born at just 23 weeks gestation, given that is has just a 1 in 10 chance of survival and a 1 in2 chance of having a serious disability if it does survive, not least because current abortion law would allow a foetus with the same survival odds and risk of disability to be aborted at any point up to its birth if it were subject to those odds due to a congenital abnormality.

In reality, of course, the chances of a court even being asked to rule on the legality of a ‘no treatment’ instruction given in respect of a neonate born at 23 weeks gestation is vanishingly small, unless the instruction is given substantially in advance of the birth. Doctors are ethically bound to observe such instructions, if given by the parents, at least until a court tells them otherwise and the short-term survival prospects of a neonate born at that gestational age are, in the absence of invasive medical care, so low that the neonate will die before the matter gets anywhere close to a court – it’s any issue that is only ever likely to reach a court in circumstance in which a doctor has taken it upon themselves the parents’ instructions and is being sued for medical negligence as a result.

All this is not to say that the argument from viability is necessarily wrong – there are no absolutely right or wrong answers here – but rather to point out that what is wrong here is the proposition that the argument from viability provides a ‘common sense’ answer to the question of when a foetus can be said to have acquired certain rights, including, critically, the right to life. It doesn’t, not unless one treats the argument from viability in narrow and wholly superficial manner – and that’s even without taking into consideration the complex questions that arise as a consequence of women, as independent moral agents, having an entirely legitimate claim to the rights of self-determination and bodily autonomy.

So, the first plank of Miller’s ‘common sense’ argument turns out to be anything but a matter of common sense, but what of the second, that of the risks associated with late-term abortion?

In the first instance, its not entirely clear what kind of risks Miller is taking about the ‘impact’ of abortion on women and children. In referring, in the article, to women who are (allegedly) ‘traumatised and vulnerable during the abortion process’, Newman is quoting Nadine Dorries and, therefore, making the assumption that Miller is approaching things from much the same direction as Dorries, even if it isn’t clear from Miller’s own comments that this is what she’s actually driving at.

In purely physical terms, late-term abortions are associated with a greater risk of complications associated with the procedure than early abortions. These risks are known, readily quantified from current research and easily explained to women when they are considering whether or not to have an abortion, putting abortion in the same category an any other invasive clinical procedure, i.e. as an matter to be dealt with within the normal doctor-patient relationship.

That leaves us to consider women’s emotional reactions to abortion and any subsequent risk of mental health problems, an arena in which the best guide to the scientific evidence is to be found in last year’s NCCMH/RCPsych systematic review of the evidence on induced abortion and mental health.

As regular visitors to the Ministry will already know, what the review found, after controlling for prior mental health and other confounding factor, is that ‘when a woman has an unwanted pregnancy, rates of mental health problems will be largely unaffected whether she has an abortion or goes on to give birth.” and so, as interesting as Cathy Newman’s account of her own experience of abortion might be, the circumstances in which she had that abortion (due to a foetal abnormality) significantly lessens its relevance to the issues that we’re actually debating here. Terminating a pregnancy that you intended to carry to term because, unfortunately, its found the foetus has a serious abnormality is not the same as terminating a pregnancy that you just don’t want to carry to term, even if, to some people, ‘common sense’ might suggest otherwise.

Beyond that key finding, evidence contained in the NCCMH/RCPsych review picks up two further issues that are relevant to the mental health argument. In regards to the factors that that did show some association with poor mental health outcome after an induced abortion, the review states that:

– The most reliable predictor of post-abortion mental health problems is having a history of mental health problems prior to the abortion.

– A range of other factors produced more mixed results, although there is some suggestion that life events, pressure from a partner to have an abortion, and negative attitudes towards abortions in general and towards a woman’s personal experience of the abortion, may have a negative impact on mental health.

– Women who show a negative emotional reaction immediately following an abortion are likely to have a poorer mental health outcome.

– There was an overlap in the risk factors associated with mental health problems following an abortion and those factors associated with mental health problems following a live birth, and factors associated with mental health problems for women in general.

What this evidence points to is the existence of a small sub-group of women who, even after controlling for prior mental health and other confounding factors, do exhibit significantly higher rates of post-abortion mental health problems than other women who have also had an abortion. If you look at the evidence relating to this particular sub-group, which appears to account for at most 2-3% of all women who terminate a pregnancy then what you quickly find is that what we’re looking are women who tend to exhibit a significant degree of ambivalence or uncertainty about their decision to have an abortion and who then go on to experience a significant, negative, emotional reaction immediately following the termination. As the NCCMH/RCPsych also notes, there is also some evidence to suggest that factors ranging from life events through pressure to have an abortion from a partner or family members to having strong moral/religious views against abortion have also been linked to this particular group of women, a group which, ultimately, tends to report, retrospectively, that they fell that they made entirely the wrong decision is choosing to terminate a pregnancy.

The common thread that runs through the evidence relating to this sub-group is choice, specifically the fact that these women feel, very strongly, that they made the wrong choice for them and, therefore, didn’t get the pregnancy outcome that, deep down, they really wanted.

Why, you might ask, would a woman choose to terminate a pregnancy when it really wasn’t what they wanted?

Well, in common with Cathy Newman’s account of her own experience, much of the evidence here suggests would have felt, at the time they made the decision, that an abortion was the only option open to them, even if it wasn’t what they really wanted, because they perceived that their freedom to choose the outcome of their pregnancy was being heavily constrained by external factors over which they had little or no control; all of which suggests that choice – and particularly freedom of choice – is, itself, an independent mediating factor that has a direct influence on women’s post-abortion risk of developing mental health problems.

Now if this is true of women who feel that they made the wrong choice, i.e. the choose to terminate a pregnancy that wasn’t genuinely unwanted, then its perfectly reasonably for us to infer that it will similarly be true for women who genuinely wish to terminate an unwanted pregnancy but who are, for whatever reason, denied that choice even in the absence of any data relating direct to that situation. We don’t have any evidence of the impact of denying women the option of terminating a pregnancy because all the data included in the NCCMH/RCPsych review necessarily comes from countries, including the UK, where abortion is legal within broad terms, even if the precise basis on which abortions can, and cannot, be obtained varies to some degree from country to country.

From that inference it follows, logically, that were we to begin to deny significant number of women the choice of terminating an unwanted by, for example, lowering the upper time limit for legal elective abortions by a significant amount, if not to the 20 week limit favoured by Maria Miller then certainly to the 12 week limit that Jeremy Hunt would prefer – and, frankly, the less said about Hunt’s intervention the better – then we should fully expect to see evidence merge that showed a significantly higher incidence and, by extension, risk of post-abortion mental health problems in women who were denied the option of terminating an unwanted pregnancy, even allowing for the fact that the impact of such a change will inevitably be mediated , to some degree, by a rise in outward ‘abortion tourism’ from the UK to other EU countries with less restrictive abortion laws in much the same way that the UK has, since abortion was legalised, seen a significant inflow of women from Northern Ireland and the Irish Republic for much the same reason. In such circumstances, those women who can afford to go overseas to have an abortion will while, of those that can’t, its likely that at least some will find a ‘backstreet’ route to the outcome they want. Whether that will mean the return of the backstreet abortionist or simply an increase in the number of women using the internet to obtain abortifactant drugs is anyone’s guess at this point in the debate.

The one issue that we haven’t looked at, thus far, is whether or not there is evidence to support the suggestion that the risk of post-abortion mental health problems is greater for women who have late-term abortions than for women who terminate a pregnancy at a much earlier stage, this being a distinction implied by Miller’s apparent support for a reduction in the upper limit to 20 weeks.

In the NCCMH/RCPsych review, only four studies looked specifically at the timing of the termination in relation to subsequent mental health outcomes, although all of them looked only for an association with Post-Traumatic Stress Disorder and not with other, much more common, mental health problems. Of these four studies, only one was rated above ‘very poor’ for study quality, so straight away, the evidence we have to play with is extremely limited and very weak even before we note that these four studies produced contradictory outcomes – two found a clear association between the timing of an abortion, i.e. either first or second trimester, one partially validated that association and one found no evidence of an association, so a far reflection of the current state of play on this question would be ‘inconclusive – needs more, and better quality, research’.

However, there are a couple of important caveats to add here. First, when one looks at the two studies that did find a clear association between late-term abortion and PTSD one find a number of very familiar names cited as co-authors including Vincent Rue, the ‘inventor’ of so-called ‘post abortion syndrome’, which proposes a (hotly disputed) trauma-based link between abortion and subsequent mental health, and an old ‘friend’ of the Ministry, Priscilla Coleman who can, if I’m being really charitable, can best be described as someone who frequently operates at the very borders of research misconduct. So the strongest, if still very clearly weak, evidence for Miller’s position comes from studies conducted by authors who are best known for their extremely dubious research methods and obvious, if frequently undisclosed, ideological biases and direct involvement in anti-abortion activism.

Second, the only study to deal directly with the prevalence of PTSD in women who had terminated a pregnancy, compared to women who carried a pregnancy to term – and one of very few studies rated ‘very good’ for its overall quality – failed to find any clear evidence that rates of PTSD were higher in women who had aborted their first pregnancy, even after controlling for multiple abortions.

As with the findings for social anxiety and GAD reported above, STEINBERG2008study2 found no clear evidence that the odds of having PTSD were greater in women who aborted their first pregnancy compared with those who gave birth (OR = 1.35; 95% CI, 0.67 to 2.73, p = 0.43). When controlling for additional covariates women who had either one or multiple abortions were no more likely to experience PTSD at the time of follow-up than those women who delivered their first pregnancy (1 versus 0 abortions: OR = 0.98; 95% CI, 0.54 to 1.78, p = 0.94; 2 versus 0 abortions: OR = 1.29; 95% CI, 0.43 to 3.84. p = 0.64).

The trauma model proposed by Rue, and supported by Coleman and other anti-abortion activists, is not supported by any credible evidence nor is ‘post-abortion syndrome’ recognised either scientifically or medically for that reason.

Once again, Miller’s ‘common sense’ reading of the evidence appears to have let her down very badly here, given that the evidence quite clearly fails to accord with her apparent views on late-term abortion. Perhaps that is an indication that Miller has adopted, at least to some degree, Nadine Dorries’ unusual view of epistemology and is, here, choosing the ‘facts’ she wishes to believe or maybe she just isn’t very good at interpreting evidence – she may have a Bachelor of Science degree but the ‘science’ in question is economics which mean that she is operating, here, well outside the field in which she was educated. Either way, the evidence doesn’t support her position at all.

To finish up with Maria Miller, it would be most remiss of me if I didn’t point out, yet again, the existence of a small but fairly solid body of quantitative and qualitative evidence which indicates that the anti-abortion lobby’s preferred alternative to abortion, for women who genuinely don’t want to bring up an unwanted child – adoption – is far from being a risk-free alternative:

A number of studies of relinquishing birthmothers have found that having a child adopted is an experience of loss and grief that persists beyond the immediate aftermath of the parting, and in many cases is long term. Winkler and Van Keppel (1984) studied 213 women who had all relinquished a child for adoption when they were young and single. A great sense of loss was a key feature of many women’s stories and the greater the sense of loss reported by the women, the worse was their adjustment. For many women this sense of loss did not diminish with time, in fact 48% of the sample reported that it had intensified and was worse at particular times such as birthdays and Mother’s Day. For some women a strong sense of loss had persisted for up to 30 years. Well over half of respondents rated the adoption of their child as the most stressful experience of their life. The psychological functioning of the birthmothers was also measured and was found to be significantly worse than a matched sample of women who had not had a child adopted. This research clearly shows that it is unrealistic to make the assumption that women whose children are adopted will quickly ‘get over’ this experience. In many cases the negative consequences are serious and long lasting. Many similar findings have been outlined by other researchers both in this country (e.g. Bouchier et al, 1991; Howe et al, 1992; Hughes and Logan, 1993; Logan, 1996; Wells, 1994) and abroad (e.g. Condon, 1986; Deykin et al, 1984; Rockel and Ryburn, 1988) and key themes are obvious in biographical accounts (e.g. Powell and Warren, 1997).

Neil, E. (2004) “Supporting the birth relatives of adopted children: A review of relevant literature”

One simply cannot make a credible argument for a reduction in the current upper limit for elective abortion on the basis of risk without taking into account the fact that there are risks associated with many of the potential alternatives to a late-term abortion, risks that are, in some cases, built on rather better evidentiary foundations than those upon which the argument for a reduction in the time limit to 20 weeks has been constructed.

Again, what we may have here is yet another failure of ‘common sense’ . The default assumption that many people seem to hold is that because a woman voluntarily gives an unwanted child up for adoption the actual act of relinquishing that child is likely to be free of any harmful consequences. For some women that may well be true, however the evidence suggests that for many women it isn’t and the negative consequences of relinquishing a child are, as Neil points out, serious and long-lasting.

At long last – sorry for the delay but I did say that I’d give Miller the benefit of the doubt and treat arguments as being sincerely held opinions rather than the usual blinkered nonsense one gets from the usual dishonest prohibitionists – we come to Cristina Odone efforts to promote Miller’s position as an example of ‘modern feminism’:

Maria Miller, the new minister for women and Secretary of State for Culture, Media and Sport, has said the unsayable. No, I don’t mean her call for changing the abortion limit from 24 weeks to 20, citing advances in medical science. Ms Miller has broken another taboo: as she takes her stand, she does so not as a conservative or as a Christian but as a self-described “modern feminist”.

Ms Miller is brave. In one bound she has liberated those of us who care about promoting women yet want the debate on abortion reopened – and unleashed the furies of the pro-abortion lobby who think they alone are modern feminists.

For too long the debate over the abortion limit has been framed by fallacies: supporters of the present 24 week limit are feminists, while those who want to reduce the limit must be misogynists and religious cranks. Thanks to Ms Miller, these fallacies have been exposed. Now, those of us who have worried about the impact of late-term abortions on women and our moral culture can reclaim the feminist label. It isn’t a vote against women to wish them free of the trauma of late abortions; nor is it a sign of anti-feminism to want a culture that values life. “Life-affirming” is praise, not criticism.

That Miller choose to describe herself as a ‘modern feminist’ doesn’t automatically make it true, people cab be just as mistaken about the labels they use to describe themselves as anything else and so the question of whether or not Miller deserves to accorded such a label is, at least for the moment, open to question.

To be honest, my immediate reaction whenever anyone starts throwing around labels such as ‘feminist’ and ‘feminism’ is usually to ask them to define exactly what they think those labels mean. As I’ve grown older and become – hopefully – a little wiser I’ve become much less enamoured of the whole business of ideological labelling, and much less inclined to identify myself with particular labels, even those that I was content to espouse only a few years ago.

Part of this stems from a feeling that life is far too short to waste time wrestling with other people’s package deal fallacies of their inability to get their head around the ‘No True Scotsman’ fallacy but mostly its because experience has taught me that ideological labels are, more often than not, largely devoid of any concrete meaning, as Orwell noted in ‘Politics and the English Language’:

MEANINGLESS WORDS. In certain kinds of writing, particularly in art criticism and literary criticism, it is normal to come across long passages which are almost completely lacking in meaning. Words like romantic, plastic, values, human, dead, sentimental, natural, vitality, as used in art criticism, are strictly meaningless, in the sense that they not only do not point to any discoverable object, but are hardly ever expected to do so by the reader. When one critic writes, ‘The outstanding feature of Mr. X’s work is its living quality’, while another writes, ‘The immediately striking thing about Mr. X’s work is its peculiar deadness’, the reader accepts this as a simple difference opinion. If words like black and white were involved, instead of the jargon words dead and living, he would see at once that language was being used in an improper way. Many political words are similarly abused. The word Fascism has now no meaning except in so far as it signifies ‘something not desirable’. The words democracy, socialism, freedom, patriotic, realistic, justice have each of them several different meanings which cannot be reconciled with one another. In the case of a word like democracy, not only is there no agreed definition, but the attempt to make one is resisted from all sides. It is almost universally felt that when we call a country democratic we are praising it: consequently the defenders of every kind of regime claim that it is a democracy, and fear that they might have to stop using that word if it were tied down to any one meaning. Words of this kind are often used in a consciously dishonest way. That is, the person who uses them has his own private definition, but allows his hearer to think he means something quite different. Statements like Marshal Petain was a true patriot, The Soviet press is the freest in the world, The Catholic Church is opposed to persecution, are almost always made with intent to deceive. Other words used in variable meanings, in most cases more or less dishonestly, are: class, totalitarian, science, progressive, reactionary, bourgeois, equality.

‘Feminism’ has, in some quarters, quite obviously lapsed into much the same state of non-meaning as ‘Fascism’ hence the existence of the portmanteau term ‘Feminazi’. In other circles it also has come to share much the same characteristics that Orwell ascribes to democracy, socialism, freedom, etc. and has certainly become a term which is used in a consciously dishonest way by parts of religious and political right in the United States in an effort on abortion, marriage and the family that are unmistakeable paternalistic and authoritarian in their intent.

One could, therefore, take the view that the validity of Odone’s claim to the label ‘modern feminism’ is nigh on impossible to adjudicate as one cannot define what, exactly, modern feminism is with sufficient clarity to determine whether or not Odone’s (and Miller’s) position lies within its boundaries – except…

This is purely a personal view but, if pushed to try and pin down something concrete to say about contemporary feminism then I would have to argue that its one, genuine defining characteristic, would lie in a fundamental respect for the intellectual, moral, emotional and, of course, bodily autonomy of individual women even more so than a commitment to equality, if only because equality is yet another much abused word with several irreconcilable meanings. This view, to a certain degree, places contemporary feminism rather at odds with some of the strands of Marxist-influenced feminist thought that developed during the 1960s and, particularly, 1970s, which tend to emphasise, if not over-emphasise the importance of the common or collective good over individual personal agency in a manner that always stuck me as being incongruously paternalistic in a purely Marxist setting and downright anachronistic when applied to feminism.

I’ll leave that observation there as I really don’t want to get into writing a sub-essay on the interplay between Marxism and Feminism when the point I’m actually trying to get to is that, when you strip back Odone’s argument to its core what you’re left with is the proposition that one can reasonably parley concerns about the possible risks associated with abortion into a policy decision that limits the scope of women’s personal agency purely on the paternalistic basis that you are somehow doing it for their own. Even if it were true that there were substantial mental health risks associated with late-term abortion sufficient to justify placing abortion under a more restrictive legal framework for purely utilitarian reasons that still wouldn’t wouldn’t bring Odone’s position with the scope of modern/contemporary feminism as it would impose legal constraints on women’s personal agency in circumstances in which women are perfectly capable or assessing and evaluating the risks for themselves – and it is precisely that aspect of Odone’s argument that makes a complete mockery of her attempt to lay claim to the term ‘modern feminist’, never mind the absurd suggestion that Miller has somehow succeeding in reconciling the terms ‘modern feminist’ and ‘common sense’.

Whether  this amounts to the kind of ‘conscious dishonesty’ that Orwell referred to in his essay is open to question although, personally, I’ve long been of the view that one should never underestimate some people’s capacity for self deception to the extent that Hanlon’s Razor* may provide an equally, if not more, plausible explanation for Odone’s claim.

*’Never attribute to malice that which is adequately explained by stupidity.’

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