Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 80-99)


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.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2007
Prepared 15 November 2007