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.
PRE-TERM
DELIVERY
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 (www.jpands.org)
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).
BREAST CANCER
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.
MENTAL HEALTH
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.
REFERENCES
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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