Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 100-119)


15 OCTOBER 2007

  Q100  Chairman: The Royal College of Obstetricians and Gynaecologists is a fairly respectable body. Do we agree on that?

  Professor Norman: Yes.

  Professor Casey: Provided they obtain psychiatric information about it and I have read the RCOG submission.

  Q101  Chairman: Apart from you, Dr Casey, who does not feel they are a respectable body

  Professor Casey: I do. This is quite serious, Chairman. Anybody commenting on—

  Q102  Chairman: Can I just ask a question and then perhaps you will give me an answer?

  Professor Casey: Yes.

  Q103  Chairman: The bit I do not understand is that the Royal College of Obstetricians and Gynaecologists in their evidence to us say that the incidence of seeing negative reaction to abortion is low. In other words, they do not believe that there is a strong correlation between abortion and mental illness. Why have they got it so wrong?

  Dr Richards: They agree on association. The question is: is it causal? These new studies are very good studies. Statisticians and psychiatrists are in agreement that these are gold standard studies, particularly that of Fergusson but there are others. There is a question about why suicide is much more common after abortion. The studies show clearly it is. The question is: is it causal?

  Q104  Chairman: It can also show us that road accidents are more.

  Dr Richards: There is six times the rate of suicide in the year following induced abortion in the Finnish paper. Someone looked at the rates of presentation of attempted suicide in Glamorgan in this country and found a very striking effect, which was that the time before and after the suicide or the birth, in those who had just had a birth, the suicide rate fell or stayed very steady, but comparing before and after abortion it rose very substantially in some age groups.

  Q105  Dr Harris: I was late into the private meeting where we declare our interests and for the record I need to declare my interest as a member of the British Medical Association's Medical Ethics Committee and say that my partner works in this field in policy. While we are on that subject, Professor Casey, you said that you were absolutely convinced that there was a causal association between abortion and mental illness.

  Professor Casey: Yes.

  Q106  Dr Harris: You are a professor of psychiatry. I just wanted to clarify where you are coming from and what is your perspective to give you that certainty. You have done reviews of this but you have not done research on this yourself. You are not a research active psychiatrist in this particular field, but you have reviewed the work?

  Professor Casey: I am not a research active psychiatrist in the area of abortion because it is impossible to do that in Ireland for obvious reasons, but I have treated many women who have had abortions. I am a clinician as well.

  Dr Harris: This is in no way a criticism of you. I want to make that clear, but you have not declared any particular associations with the anti-abortion movement. Would you say that you are anti-abortion? Are you opposed to abortion being legal in Ireland?

  Dr Spink: Chairman, we have not asked any particular questions of any witnesses. Are we going to ask all witnesses, because—

  Dr Harris: I would like to know, when we are having a scientific evidence session, whether an assertion that the witness is convinced that there is a causal association between abortion and mental health—and indeed Chris Richards said between abortion and suicide, which is even stronger than Professor Casey said in her paper; Dr Richards has declared his interests in this area—and I wanted to ask that question if I may. It is usual practice in select committees.

  Q107  Chairman: I understand the question but I think Dr Casey has made the point that she has formed that view on reviewing the evidence that was before her.

  Professor Casey: Yes.

  Q108  Dr Harris: Can I remind you what you wrote in a paper in Ireland just last year on 9 July 2006? "It is sad that the state is being asked to declare as a non-human a voiceless group within the human community. If it succeeds it will truly be an oppression since it will prevent the full potential of these tiny humans from being realised by casting them aside at this early point in their development." You go on at length to give a pro-life position. Would it be fair to say that you are pro-life but that has not influenced your judgment on whether abortion causes mental health problems?

  Professor Casey: Yes, I am pro-life and I am glad that you accept that being pro-life does not necessarily affect my brain's ability to assimilate scientific information.

  Q109  Dr Harris: On that basis, can you explain why you left out the Gilchrist study of 1995 in the evidence you submitted? I know it falls before 2000 which is a round number.

  Professor Casey: The Gilchrist study is a very weak study that involved over 1,000 general practitioners in this country. There was no quality assurance that they were all trained to identify psychiatric illness in the same way. I have been involved in a big European study of depression and we have regular meetings for quality assurance purposes to make sure that everybody does the same thing all the time. There was no quality assurance.

  Q110  Dr Harris: I understand you think it is a poor study.

  Professor Casey: Yes, I do.

  Q111  Dr Harris: What about the confidential inquiry into maternal death 2002, which attempts to measure every single death in this country? That has failed to show in their published report any causal association between abortion and suicide. You did not even in passing mention that in your evidence and other people I have spoken to say that it is astonishing that your review of the evidence around abortion and suicide would not mention that.

  Professor Casey: I did not mention the confidential inquiry into homicide and suicide because it is not scientific in the sense that there is not a particular research design around it. It is basically number crunching based on the numbers available. It is not in peer reviewed journals. I specified I wanted to use peer reviewed papers.

  Q112  Dr Harris: Dr Richards, you felt the Gilchrist study was good enough to cite in your own evidence when there was a part of it that you felt backed up your conclusions. Could you explain to us and Professor Casey why you think the Gilchrist study is good enough quality to cite in your evidence?

  Dr Richards: I cannot and I cannot recall that. I would like to address your question about the confidentiality inquiry into maternal death because that is important. It is raised as the gold standard for maternal death in this country. It is not the way we are going to find out whether induced abortion causes death in women in this country. There is a number of reasons why that is the case and I outline those in my paper.

  Q113  Dr Harris: I have now found the reference, xi, and you should have your evidence before you which is in paragraph 5.2. You said, "A further study"—you do not say it is a poor study—"found levels of deliberate self-harm to be almost 3 times more frequent in those with unplanned pregnancy and who had no history of psychiatric illness, but went on to have an induced abortion, as compared to those who kept their baby." I know you are not a psychiatrist and you have declared your interest as a member of the Christian Medical Fellowship and a director of the organisation that produces materials from a Christian perspective for schools. I am just wondering why you think that bit of the study was good enough but Patricia Casey thinks the rest of it was lousy. Was it selective?

  Dr Richards: I was not trying to be selective. I was trying to look at these studies. There are vast numbers of them and many of them support an association between suicidal ideation, depression, mental disorders and having had an induced abortion. That is one part of that paper that shows that.

  Chairman: To be fair, Dr Richards has not in fact rubbished that particular piece of evidence. I want to leave that at that point.

  Q114  Mrs Dorries: Dr Richards, you have made quite clear your belief that there is a link between abortion and later suicidal and mental health, as has Professor Casey. It is back to the RCOG guidelines again, I am afraid. Should a woman not be informed, when she goes to seek a termination from a doctor, of the fact that she may suffer later in life—or what the statistical evidence is—mental health problems as a result of this termination? Should the RCOG guidelines be updated so that a woman is fully informed when she requests a termination?

  Dr Richards: I am sure they should be amended. Certainly at the moment they do not reflect that. They suggest that if there is a low mood after abortion it is transient and not necessarily associated with the abortion itself. I am sure these new studies that have come out show an unanswerable case that we must be warning women of a significant risk of depression and suicide following abortion.

  Q115  Chairman: Would you agree?

  Dr Richards: Yes, I do agree.

  Q116  Chairman: To balance the argument, the Royal College should review the evidence before it gives guidance?

  Dr Richards: Yes. I would like their guidance to be evidence based. There is now strong evidence that—

  Q117  Chairman: It is not for them to decide whether that evidence is strong or not.

  Dr Richards: It is also up to this Committee to see—

  Q118  Chairman: I am accepting the point but I am saying they ought to do that.

  Professor Norman: I have in front of me what the RCOG advises doctors to tell women about abortion and there is a list of issues. Number nine is that they suggest we advise—this seems to me to be reasonable—that some studies suggest that rates for psychiatric illness or self-harm are higher among women who have had an abortion. It goes on to say, "It must be borne in mind that these findings do not imply a causal association." I think that is a reasonable interpretation of the literature as it is and I think that is sensible advice for doctors to give.

  Q119  Mrs Dorries: I would say it plays it down, considering the issue of suicide.

  Dr Richards: It says it is on the wane immediately after abortion and that is not the case. These studies show that there is prolonged low mood in these women who have had abortions. It continues for some months or years after the event of the induced abortion.

  Mrs Dorries: Which is why the guidelines play the situation down. Dr Lee, I am interested in the comment that you made about women and the reasons why they present. You said that some women present because of difficulties with a partner. This is probably a slightly emotive question but I still want to ask it anyway. On the previous panel we heard particularly from Professor Wyatt that in his unit at UCL 42% of babies born at 23 weeks live and that gives up to 60 something per cent at 24 weeks. It is even higher in the States. Who do you think has the greater right? The woman who comes to you at 23 weeks because she wants a termination because she is having difficulties with her partner, which is one of the reasons you have cited—

  Chairman: I am sorry. With due respect, this is not for this inquiry. I am trying to get evidence which comes out of our experts in terms of evidence that they can put rather than their personal opinions.

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