A study in Norway compared a group of 40 women who suffered a miscarriage with 80 who chose to have an abortion, questioning them ten days, six months, two years and five years after the event.Great, I thought. Just what we need. Of course, I’m an anthropologist both by training and by nature, and so I had a few questions about this study. So I took a look at it and noticed a couple of things that might be of interest. For a start, the researchers set out with a hypothesis that women who abort will experience more mental distress than women who miscarry:
The team found that women who had a miscarriage suffered more mental distress up to six months after losing their babies compared with those who had an abortion. But women who had an abortion experienced more mental distress long afterwards compared with the miscarriage group.
Pro-life campaigners said the research confirmed the emotional consequences of having an abortion could be massive.
The process of deciding to have an abortion can be difficult, and the reason for electing to have an abortion can affect the psychological responses after the event. Thus, the social, moral and psychological context of an induced abortion may be more complicated than that of a miscarriage, and may result in different psychological responses. We hypothesized that women who undergo an induced abortion will have a more protracted course of mental disturbance than women who experience a miscarriage. (p6)I don’t have a problem with the hypothesis in and of itself, but I do have a big stinking problem with the fact that, even after noting abortion can have a more complicated context than a miscarriage, the study itself seems to have made no attempt whatsoever to control for the contributions of external pressures as a control for any distress experiences by its participants, particularly as they did control for other “possible confounders,” including marital status, number of children, vocational activity, and former psychiatric health. And in fact, when scores for the mental health outcomes of the two groups were compared with those of the controls, “differences in IES avoidance [at the first two benchmarks] were no longer statistically significant.” So, couldn’t it be that the scores for women who had abortions and “had significantly more guilt [at the last three benchmarks], and more shame at all interviews” would no longer be “statistically significant” if external factors—such as religiosity, family influence, societal pressure, etc.—were taken into consideration? Unfortunately, we don’t know, because the authors of the study didn’t bother to find out.
The preexisting mental health of the study’s participants before the abortion or miscarriage is another issue that runs throughout the study.
[T]he mental health of aborting women was poorer (almost statistically significantly) than that of miscarrying women prior to the pregnancy termination event. Therefore, we cannot infer that induced abortion caused the elevated anxiety of the induced abortion group relative to that of the miscarriage group. (p18)So the mental health of the participating women who sought an abortion was almost statistically significantly poorer than the participating women who had a miscarriage, and the complexity of the abortion issue may account for discrepancies. That’s the problem with poor controls; you can end up with a study that has a completely meaningless conclusion. And yet here it goes—out into the world, reported as fact. Women who get abortions are more highly traumatized than women who have miscarriages. Even though it may be the women who got abortions and participated in the study were more inclined toward mental distress irrespective of their abortions, or that societal views of abortion—and specifically, women who get abortions—may facilitate feelings of shame and guilt.
Other mental health outcomes, such as depression, trauma responses, quality of life and feelings, may likewise be poorer for women in the induced abortion group because of their mental health status before the abortion. (p19)
The responses of women in the miscarriage group were similar to those expected after a traumatic and sad life event. However, the women in the induced abortion group had more atypical responses. This may be because the mental health of the aborting women was somewhat poorer than that of the miscarrying women before the pregnancy termination event. The more complex nature of the induced abortion event may also account for differences in the course of psychological responses between the two groups.(p22-23)
An explanation for the unusual and divergent courses of the IES scores in the induced abortion group is not obvious, but may result from the characteristics of the abortion event. (p19)It sure may. Maybe something worth finding out before the study is published, though.
The elevated scores for guilt, shame and IES avoidance for women who had had an induced abortion may require more attention. … It is possible that feelings of guilt and shame associated with the induced abortion contribute to a slower improvement in mental health. (p20-21)Yep, that’s possible. Or it’s possible that preexisting mental distress unrelated to the abortion could be to blame. Or that the underlying causes of the guilt and shame might not be the actual abortion, and therefore aren’t ameliorated by the passage of time. Lots of things are possible.
Also missing from the reporting on this study is the fact that, along with grief, loss, guilt, shame, and anger, researchers also tracked relief.
Women who had had an induced abortion had significantly more relief at all interviews than women who had had a miscarriage. (p16)We certainly wouldn’t want to broadcast the relief women feel at having aborted an wanted pregnancy. It might undermine the message that they ought to be suffering from guilt and shame.
The authors conclude that “Women in both groups should be given information about common psychological responses to pregnancy termination,” but without any depth of understanding of the driving forces behind those psychological responses, I’m curious as to what, exactly, they believe that information should be.