Select Committee on Science and Technology Written Evidence

Memorandum 56

Supplementary evidence from Dr Sam Rowlands

Supplementary evidence on pre-term delivery, breast cancer and mental health in relation to abortion

  Oral evidence having been completed and having had the chance to review the transcript of the session I participated in on 15 October, I would request that members of the Committee take into account the following points when preparing the report to Parliament.


  First of all I would like to acknowledge that my literature search failed to pick up the EUROPOP study.1 So since the publication of the RCOG guideline, in addition to EPIPAGE, there is another case-control study showing a significant but small association between abortion and pre-term birth. As we know, case-control studies are the least reliable form of observational study.

  My conclusion on abortion and pre-term delivery would be unchanged. It is still the case that the more reliable cohort methodology has shown no association in some cases. And as I stated in my submission there is the very large Finnish record linkage study published last year showing no association between previous abortion and pre-term delivery.2 This study used a population-based database including 26,976 singleton pregnancies.

  The evidence is still contradictory, but women should be aware of the potential risk to future pregnancies. In my opinion, the wording in the RCOG guideline (recommendation 16.8) does not need to be strengthened.

  I would like to point out to the Committee that the written evidence from Professor Wyatt contained reference 309 by Rooney & Calhoun from the Journal of American Physicians & Surgeons. I was unable to find this journal on either MEDLINE or PubMed databases. Looking at the journal's website ( I see that there are many articles published on anti-vaccine and anti-water fluoridation themes and several articles promoting the false link between abortion and breast cancer. I hope the Committee would agree that evidence from this journal is inadmissible. Dr Evan Harris did raise the status of this journal in the oral evidence session (Q137), but at that time I was not aware of it.

  I have now looked at the written evidence again and find that the submission by Professor Calhoun refers to his own co-authored paper in the Journal of American Physicians & Surgeons. I note that neither Professor Wyatt or Professor Calhoun cite the 2006 Finnish study.

  This paper in the Journal of American Physicians & Surgeons is again cited by Brind (his reference 16).


  Further to my oral evidence in which I noted the selective citations by Brind in response to Q134 and Dr Gardner's reference to the Breast Cancer Prevention Institute website (Q136) I would also invite the Committee to look carefully at the written evidence from the Christian Medical Fellowship. They cite Dr Gardner writing in the Triple Helix, the CMF's in-house magazine, which needless to say is not listed in MEDLINE or PubMed and in my view is inadmissible.


  As I said in my written submission, I relied heavily on reviews by Thorp et al,3 Dagg4 and Zolese and Blacker.5 There is a 1984 review by Del Campo6 but this fails to cite studies by Pare & Raven 1970, Beazley 1971, McCance 1973 and Blomberg 1980. So in terms of a review of abortion denied I would say the Committee should prefer the much more comprehensive 1991 review by Dagg.

  I would like to draw the Committee's attention to the concluding remarks by Thorp et al. The authors state "a major question remains unanswered because of the lack of a proper control group. Are the observed phenomena (suicide, psychiatric admission, deliberate self harm etc) a correlate of the circumstance that may lead to a crisis or unintended pregnancy regardless of a woman's decision to choose abortion, or is this a function of both? Until that question can be answered, it will be hard to inform women as to what, if any, additional risk a decision to terminate will produce". A separate supplementary written submission is coming to you from Professor James Trussell et al which gives a clear exposition on why the methodology of studies submitted by Professor Casey is fatally flawed.

  A final point I would like to make is that there are some papers7; 8 which deal with how wanted a pregnancy is and subsequent maternal-child bonding and child development. I would not want the Committee to be misled into thinking that these studies could be taken as representing the same order of magnitude of unwantedness that pertains with women requesting abortion. The populations used in these studies are women who continued their pregnancy to term and kept the baby. These women, even if expressing a degree of unintendedness of their pregnancy, are not the same as women who request abortion.


1.  Ancel P, Lelong N, Papiernik E, Saurel-Cubizolles M, Kaminski M. History of induced abortion as a risk factor for preterm birth in European countries: results of the EUROPOP study. Hum Repro 2004; 19: 734-740.

2.  Raatikainen K, Heiskanen N, Heinonen S. Induced abortion: not an independent risk factor for pregnancy outcome. Annals of Epidemiology 2006; 16: 587-592.

3.  Thorp JM, Hartmann KE, Shadigian E. Long-term physical and psychological health consequences of induced abortion: review of the evidence. Obstet Gynecol Surv 2002; 58: 67-79.

4.  Dagg PKB. The psychological sequelae of therapeutic abortion—denied and completed. American Journal of Psychiatry 1991; 148: 578-585.

5.  Zolese G, Blacker CVR. The psychological complications of therapeutic abortion. British Journal of Psychiatry 1992; 160: 742-749.

6.  Del Campo C. Abortion denied—outcome of mothers and babies. Can Med Assoc J 1984; 130: 361-366.

7.  Joyce TJ, Kaestner R, Korenman S. The effect of pregnancy intention on child development. Demography 2000; 37: 83-94.

8.  Miller WB, Sable MR, Csizmadia A. Pregnancy wantedness and child attachment security: is there a relationship? Maternal and Child Health J Electronic journal 20/07/2007.

October 2007

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