Supplementary evidence from Dr Chris Richards
1. Regarding the risk of deliberate self-harm
in the abortion group compared to the post-partum women, the risk
of "almost three times" was an error and should read
"1.7 times". I apologize to the Committee for this mistake
and ask you to amend my report accordingly.
2. You question my selection of data from
the Gilchrist paper. It is obviously important that the Committee
are presented with only the most reliable data. Reliability varies
not only between studies but sometimes within individual studies.
In this study the authors give two reasons for doubting the reliability
of the data for the abortion-denied group which do not apply to
the much more secure abortion and non-abortion data to which I
referred. Their concerns can be summarised as follows:
(a) The abortion-denied group size was much
smaller. It covered only 1,587 woman years compared to the abortion
and non-abortion groups covering 28,046 and 21,778 woman years
respectively. The authors concluded that "the study had little
power to detect important effects" in the abortion-denied
group (page 3).
(b) There was uncertainty about the accuracy
of group allocation. The authors comment that "it is possible
that the rate among women refused a termination was relatively
high because some women had actually obtained an abortion"
(page 7). Their concern was aroused by the extraordinarily high
rates of reported miscarriage in the abortion-denied group, which
may actually have been concealed abortions. Wrong assignment to
groups could obviously affect the observed risks of deliberate
self-harm substantially especially for the much smaller "abortion-denied"
group. Considering the relative ease of access to abortion in
the UK even at the time of the study in the late 1970s, I am sure
that the authors were correct to be so concerned that having been
denied an abortion by their GP, some women would have arranged
one elsewhere without their GP necessarily knowing.
The Committee will need to look elsewhere in
the literature to draw any conclusion about the outcome of abortion-denied
women. The medical literature on the outcome of this group is
very limited; with the advent of easily available abortion in
many Western countries this will remain so. The last review of
the literature appears to be in Canadian Medical Association Journal
in 1984 which concludes that there is "a comparable outcome
of pregnancy, delivery and puerperium between women who were denied
abortion and controls (who did not seek abortion); no evidence
that a continued unwanted pregnancy will endanger the mother's
health; good acceptance of the infant by the mother, especially
with the father's support; and minimal to moderate psychosocial
disadvantages for the child".
375 Del Campo C. Can Med Assoc J 1984 130;361-366. Back