Examination of Witnesses (Questions 80-99)
PROFESSOR PATRICIA
CASEY, DR
ELLIE LEE,
PROFESSOR JANE
NORMAN, DR
CHRIS RICHARDS
AND DR
SAM ROWLANDS
15 OCTOBER 2007
Q80 Dr Turner: There is not reliable
information?
Dr Lee: If you had somebody here
from the International Planned Parenthood Federation they might
be able to tell you.
Dr Rowlands: There is evidence
from the papers that I quote in my submission where abortion was
denied and papers have quoted there that up to 40% of people definitely
obtain abortions if they are denied, even if they are denied and
then appeal, as in the Czech study that I quoted.
Q81 Dr Iddon: Professor Casey, how
can we be sure that abortion does increase the risk of mental
illness?
Professor Casey: Because of the
studies that have been done that I have quoted to you. Some of
them are done on general populations. They are not done on people
with pre-existing psychiatric illness saying, "I have had
an abortion. Is this the cause?" These are population studies
that have looked at admission rates, at outpatient attendance
rates and that have just followed through people in the general
population and related their mental health at a later point to
whether they have had an abortion or not using very complex statistical
analysis, using multiple regression analysis usually. There is
a number of those studies that I have presented. There has been
a huge surge in studies since 2000 which is why I picked 2000
as the date after which I would submit published studies. There
has been a huge explosion in studies investigating this in very
different cultures as well. The evidence is compelling that there
is an association between abortion and mental health problems
and that there is more than an association. There is a causal
link between them. I am satisfied of that from looking at the
studies. It was the case in the past that people said mental health
problems were related to prior mental health problems. If somebody
had a history of depression in the past and then had an abortion,
yes of course, they were bound to develop emotional problems subsequently.
All of the recent studies have controlled for prior history and
family vulnerability. They have controlled for those kinds of
confounders and have still found a link between mental health
problems and abortion.
Q82 Dr Iddon: Could you go into the
causal factors in a bit more detail and perhaps the confounding
factors as well?
Professor Casey: The confounding
factors are variables that would be related both to abortion and
to a mental health problem. A prior mental health problem would
be one. It might be that women with prior mental health problems
are more likely to seek abortion but having a prior mental health
problem would also be related to developing a later mental health
problem. A confounder is related to both the cause of the variable
you are interested in and to the outcome variable, so you control
for them because they muddy the waters. You want to be sure that
you are not muddying waters. That has been done in all of these
studies.
Q83 Dr Iddon: Could I turn to the
other members of the panel and ask whether in general they agree
with what Professor Casey is saying or whether there is any disagreement?
Dr Rowlands: If you go back to
basic principles, women who have an unwanted pregnancy, the studies
that Professor Casey quotes are the best that are available. They
are very good methodology but if you notice they are comparing
the women with unwanted pregnancy who have an abortion with what
you might call willing mothers and also in some cases women who
have miscarriages. If you go back to basic principles what you
would really want to do—unfortunately it is not possible—is
compare women with unwanted pregnancies who are denied abortion.
I do quote one very small study which I would not claim has any
fancy methodology but that comes from Singapore, where there is
a law. It is a lot more strict than in this country. That would
be the ideal thing but obviously it would be totally impossible
to have a proper, randomised trial. You cannot do that. All we
have are the kinds of studies that I quote which I do agree are
old but to follow people up in Prague for 35 years is quite a
feat. Those are the studies that you need to look at, the women
who have had unplanned pregnancies and had their abortions denied
and the ones where they have had an abortion. I agree it is not
possible but I am just saying this to point out that these comparators
in these high falluting, good methodology studies are not really
the best comparators.
Q84 Chris Mole: What you are saying
is that the dominant factor could be the unplanned pregnancy rather
than the termination?
Dr Rowlands: Yes. We know that
women with unplanned pregnancies, if you look at their personalities
and social circumstances, differ from the general population.
I pointed this out in my submission. They have different social
problems, drug misuse problems etc. They are different.
Q85 Dr Iddon: Professor Casey said
that the figures looked compelling to her. Would you use that
word? It sounds as if you would not and that you are a sceptic.
Dr Rowlands: I was quite reasonably
impressed with them because they are good quality but fundamentally
they are not really comparing what we want to compare with. A
woman who has planned her pregnancy, is happy to be pregnant and
has her baby is obviously very different from the people who have
abortions.
Q86 Dr Spink: Are they the best,
most professional set of figures available to us?
Dr Rowlands: Yes.
Dr Lee: There is one study of
exactly the type Sam describes for this country which is Gilchrist
and Hannaford, the Royal College of General Psychiatrists and
Royal College of General Practitioners joint study, which is the
largest study that has ever been done in the world and includes
exactly the comparator groups that Sam mentions.
Q87 Chairman: These are the women
who were denied abortion?
Dr Lee: Yes, so it compares whether
you continued with abortion or whether you were denied abortion
and two other groups of women with very clearly defined psychiatric
sequelae. I think it is widely accepted that this is probably
the best study that has ever been done in the world on this issue,
but it is a little dated. It was published in two stages. The
second stage was published in 1995 but it is widely available
and I think your submission referred to it, or one of them did.
Q88 Dr Iddon: Is the work compelling?
Dr Lee: For that study it is compelling.
I am much less convinced by the smaller scale studies. There has
been for example a lot of talk of the Fergusson study and this
has been really bigged up by certain people who want to make claims
about the negative, psychological sequelae of abortion. The Fergusson
study has reasonably good methodology but it does not, by admission
of the author, include women who are denied abortion and it does
not measure for wantedness of the pregnancy. It is also only of
young women under 25 in New Zealand. There are pros and cons for
different methodologies in the different studies Patricia cites,
but they are all limited because of their size and because of
the lack of the appropriate control group.
Dr Richards: I am aware of the
Fergusson study and it is very compelling. It shows that women
who have had induced abortion are twice as likely to have mental
health problems, three times as likely to have major depressive
illness, four times as likely to have suicidal ideation than the
comparative group who have given birth.
Dr Lee: That is just mothers.
Q89 Dr Iddon: Are you talking about
one study?
Professor Casey: No. We are talking
about a number of studies. I will go through the studies that
my colleagues have mentioned.
Q90 Chairman: You are talking about
the Fergusson study, are you not?
Dr Richards: Yes.
Q91 Mrs Dorries: Am I right that
Fergusson took 25 years?
Professor Casey: Yes. I will describe
the Fergusson study briefly for the Committee and for the audience.
It is a big study of women in the general population in Christchurch.
There are over 600 women in the study who have been followed for
25 years. It is part of a bigger study measuring a variety of
things. Because it is a longitudinal study, the authors began
at birth and it is continuing as we speak. It was able to measure
things like the presence of sexual abuse, emotional abuse and
various vulnerability factors in childhood. It was also able to
measure things like substance abuse, separation, marital breakdown
of the parents, all of the kinds of things that make people vulnerable
to psychiatric illness later in life, irrespective of what happens
to them. It then enquired about abortion as well and whether women
had or had not had abortion and it divided them into two groups
and compared the variables that distinguished the abortion group
from the non-abortion group at the 25 year follow up period. Not
only that; it then put in all of the confounders that might have
led to the mental health problems like whether there was child
abuse or whether the parents were separated. It put all of that
into the equation.
Q92 Chairman: It did not put in the
fundamental point that Dr Rowlands mentioned about those people
who requested an abortion but were denied it?
Professor Casey: Because abortion
is legal in New Zealand. They are not denied it. Dr Rowlands did
mention the Prague study. You cannot mention abortion denial any
more because it is so widely available. Can I come back to the
Prague study? The Prague study started in 1961 or 1962 and it
looked at wantedness. It found that children born to parents who
had not wanted them suffered more adverse consequences later in
life and that the differences between the wanted children and
the unwanted children diminished over time but that is one study.
There are two more recent studies from the United States and I
have them if the Committee would like them.
Q93 Chairman: We have those in your
evidence?
Professor Casey: No. I did not
put these into my evidence because I did not think wantedness
was going to come up.
Chairman: Send us details of that.
Q94 Dr Iddon: Can I ask Professor
Norman for her very important views on the question of mental
illness?
Professor Norman: I think we would
all agree there is an association between women who have abortion
and women who develop mental illness. What we would disagree with,
I suspect, is what is cause and what is effect. I have seen no
evidence that is compelling to suggest that having an abortion
causes mental illness. There is a strong association between unwanted
pregnancy and increased risk of suicide in later life but it is
not clear whether it is having the unwanted pregnancy that increases
the risk of suicide or whether it is the abortion.
Professor Casey: There is one
study looking at unwanted pregnancy.
Q95 Chairman: Can we finish with
one witness first of all?
Professor Norman: I am an obstetrician;
I am not a psychologist, but I note that the American Psychological
Association in their presentation to Congress in 2005 felt there
was no evidence that induced abortion caused psychological harm.
Q96 Chairman: It is controversial?
Professor Norman: Yes.
Professor Casey: There is a study
looking at unwanted pregnancy by Reardon and Cool that was published
in the BMJ a few years ago. In relation to the American Psychological
Association, on foot of the Fergusson study they have now removed
from their website any comments about the safety of abortion.
Dr Lee: That is not true.
Professor Casey: They have set
up an inquiry into it.
Q97 Dr Iddon: That was strong language,
Dr Lee. Could you just expand on that?
Dr Lee: Yes, I will expand on
this because maybe four or five submissions to this inquiry assert
this point about the APA. This must only be on the basis of the
authors' speculation where they put together the publication of
the Fergusson study. The fact is that the APA took down an out
of date fact sheet, put two and two together, came up with 75
and decided that one has caused the other. They obviously have
not been in touch with the APA. I have been in touch with a member
of the APA who heads up the APA's task force, who is in charge
of looking at this review of the evidence that they are now doing.
There is no relation between the two. It was an out of date fact
sheet. The APA position on abortion is still available on their
website for anyone to see. I really think if people are suggesting
that they are putting in evidence to a committee which is interested
in looking at evidence, they could even ask the APA about this
before making unfounded assertions. It is just not true.
Q98 Dr Iddon: Professor Casey, I
am a scientist and if I do a piece of work I do not expect anybody
to believe in it unless somebody else can reproduce it somewhere
else in another laboratory. I am always sceptical of a single
publication unless someone else has brought up similar evidence
somewhere else in the world.
Professor Casey: There are several
studies. I have quoted them in my paper: the Reardon study published
in the Journal of the Canadian Medical Association in 2003. That
looked at poor women giving birth or seeking abortions and looked
at their—
Q99 Dr Iddon: With respect, I do
not think we have time to go into the evidence but what you are
saying is these studies are repeatable?
Professor Casey: Yes, and they
have been repeated.
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