Changes

''Critique of the APA Task Force on Abortion and Mental Health''

=''Critique of the APA Task Force on Abortion and Mental Health''=

Priscilla K. Coleman, Ph.D.

Priscilla K. Coleman, Ph.D.

==1) The conclusion (in italics below) DOES NOT follow from the literature reviewed==

==The conclusion (in italics below) DOES NOT follow from the literature reviewed==

''"The best scientific evidence published indicates that among adult women who have an unplanned pregnancy the relative risk of mental health problems is no greater if they have a single elective first-trimester abortion than if they deliver that pregnancy."''

''"The best scientific evidence published indicates that among adult women who have an unplanned pregnancy the relative risk of mental health problems is no greater if they have a single elective first-trimester abortion than if they deliver that pregnancy."''

==2) When comparing reviews of the literature there is selective reporting==

==When comparing reviews of the literature there is selective reporting==

A review of Bradshaw and Slade (2003) in the report ignores this statement from the abstract: "Following discovery of pregnancy and prior to abortion, 40-45% of women experience significant levels of anxiety and around 20% experience significant levels of depressive symptoms. Distress reduces following abortion, but up to around 30% of women are still experiencing emotional problem after a month."

A review of Bradshaw and Slade (2003) in the report ignores this statement from the abstract: "Following discovery of pregnancy and prior to abortion, 40-45% of women experience significant levels of anxiety and around 20% experience significant levels of depressive symptoms. Distress reduces following abortion, but up to around 30% of women are still experiencing emotional problem after a month."

==3) Avoidance of quantification ==

==Avoidance of quantification ==

The authors of this report avoid quantification of the numbers of women likely to be adversely affected by abortion. This seems like an odd omission of potentially very useful, summary information. There is consensus among most social and medical science scholars that a minimum of 10 to 30% of women who abort suffer from serious, prolonged negative psychological consequences (Adler et al., 1992; Bradshaw & Slade, 2003; Major & Cozzarelli, 1992; Zolese & Blacker, 1992). With nearly 1.3 million U.S. abortions each year in the U.S. (Boonstra, et al., 2006), the conservative 10% figure yields approximately 130,000 new cases of mental health problems each year.   

The authors of this report avoid quantification of the numbers of women likely to be adversely affected by abortion. This seems like an odd omission of potentially very useful, summary information. There is consensus among most social and medical science scholars that a minimum of 10 to 30% of women who abort suffer from serious, prolonged negative psychological consequences (Adler et al., 1992; Bradshaw & Slade, 2003; Major & Cozzarelli, 1992; Zolese & Blacker, 1992). With nearly 1.3 million U.S. abortions each year in the U.S. (Boonstra, et al., 2006), the conservative 10% figure yields approximately 130,000 new cases of mental health problems each year.   

==4) Biased selection of Task Force members and reviewers==

==Biased selection of Task Force members and reviewers==

No information whatsoever is provided in the report regarding how the Task Force members were selected. What was done to assure that the representatives do not all hold similar ideological biases? What was the process for selecting and securing reviewers? How many were offered the opportunity? Did any decline? How was reviewer feedback incorporated into revising the document?...very minimally from this reviewer's vantage point. Disclosure of this information is vital for credibility and accountability purposes.

No information whatsoever is provided in the report regarding how the Task Force members were selected. What was done to assure that the representatives do not all hold similar ideological biases? What was the process for selecting and securing reviewers? How many were offered the opportunity? Did any decline? How was reviewer feedback incorporated into revising the document?...very minimally from this reviewer's vantage point. Disclosure of this information is vital for credibility and accountability purposes.

==5) Power attributed to cultural stigmatization in women's abortion-related stress is unsupported==

==Power attributed to cultural stigmatization in women's abortion-related stress is unsupported==

There are few well-designed studies that have been conducted to support this claim. In fact, many studies indicate that internalized beliefs regarding the humanity of the fetus, moral, religious, and ethical objections to abortion, and feelings of bereavement/loss often distinguish between those who suffer and those who do not (see Coleman et al., 2005 for a review).  

There are few well-designed studies that have been conducted to support this claim. In fact, many studies indicate that internalized beliefs regarding the humanity of the fetus, moral, religious, and ethical objections to abortion, and feelings of bereavement/loss often distinguish between those who suffer and those who do not (see Coleman et al., 2005 for a review).  

==6) Selection criteria resulted in dozens of studies indicating negative effects being ignored==

==Selection criteria resulted in dozens of studies indicating negative effects being ignored==

According to the report "The TFMHA evaluated all empirical studies published in English in peer-reviewed journals post-1989 that compared the mental health of women who had an induced abortion to the mental health of comparison groups of women (N=50) or that examined factors that predict mental health among women who have had an elective abortion in the United States (N=23)."  

According to the report "The TFMHA evaluated all empirical studies published in English in peer-reviewed journals post-1989 that compared the mental health of women who had an induced abortion to the mental health of comparison groups of women (N=50) or that examined factors that predict mental health among women who have had an elective abortion in the United States (N=23)."  

== 7) Methodologically based selection criteria as opposed to geographic locale should have been employed and consistently applied.==

==Methodologically based selection criteria as opposed to geographic locale should have been employed and consistently applied.==

   

   

   

   

If the Task Force members were interested in providing an evaluation of the strongest evidence, why weren't more stringent criteria employed than simply publication of empirical data related to induced abortion, with at least one mental health measure in peer-reviewed journals in English on U.S. and non-U.S. samples (for one type of study)? Employment of methodological criteria in selection would certainly have simplified the task of evaluation as well. Sample size/characteristics/representativeness, type of design, employment of control techniques, discipline published in, etc. are logical places to begin. I am shocked to not see the development of criteria that reflect knowledge of this literature.

If the Task Force members were interested in providing an evaluation of the strongest evidence, why weren't more stringent criteria employed than simply publication of empirical data related to induced abortion, with at least one mental health measure in peer-reviewed journals in English on U.S. and non-U.S. samples (for one type of study)? Employment of methodological criteria in selection would certainly have simplified the task of evaluation as well. Sample size/characteristics/representativeness, type of design, employment of control techniques, discipline published in, etc. are logical places to begin. I am shocked to not see the development of criteria that reflect knowledge of this literature.

==8) Shifting standards of evaluation of studies presented based on the conclusion's fit with a pro-choice agenda==

==Shifting standards of evaluation of studies presented based on the conclusion's fit with a pro-choice agenda==

   

   

There are numerous examples of studies with results suggesting no negative effects of abortion being reviewed less extensively and stringently than studies indicating adverse effects. Further the positive features of the studies suggesting abortion is a benign experience for most women are highlighted while the positive features of the studies revealing adverse outcomes are downplayed or ignored. All the studies showing adverse effects were published in peer-reviewed journals, many in very prestigious journals with low acceptance rates. Clearly then, the studies have many strengths, which outweigh the limitations.  

There are numerous examples of studies with results suggesting no negative effects of abortion being reviewed less extensively and stringently than studies indicating adverse effects. Further the positive features of the studies suggesting abortion is a benign experience for most women are highlighted while the positive features of the studies revealing adverse outcomes are downplayed or ignored. All the studies showing adverse effects were published in peer-reviewed journals, many in very prestigious journals with low acceptance rates. Clearly then, the studies have many strengths, which outweigh the limitations.