by Joyce Arthur
Pro-Choice Press, Autumn/Winter 2003

The May 13 issue of the Canadian Medical Association Journal (CMAJ) featured a research article[1] by lead author David Reardon and five other anti-choice activists. The article subtly implies that abortions are dangerous because statistics show that women who abort have more psychiatric admissions than women who deliver to term. However, to conclude from this statistic that abortion causes mental problems is unwarranted and spurious. In fact, the study is essentially meaningless. It's important to explain why, because the media can easily misinterpret such data, and anti-choice groups exploit these studies to support their political agenda against abortion.

To the journal's credit, it did publish in the same issue an excellent refutation[2] of Reardon's research by Dr. Brenda Major, who has a Ph.D in Social Psychology from Purdue University and is a professor and researcher in the Department of Psychology at the University of California in Santa Barbara.

As Dr. Major explains in her rebuttal, "It is a fundamental tenet of science that one cannot infer cause from a correlation between two variables. Consider, for example, the strong correlation that exists between the number of bars in a city and the number of churches in a city. How can we explain this finding? Some may conclude that religion drives people to drink. Others may conclude that drinking drives people to religion. The most likely explanation, however, is that the correlation is spurious, caused by a third unmeasured variable that is associated both with the number of churches and the number of bars in a city—such as city size."

Or, the causality could be in the opposite direction. Major says, "Although it is possible that abortion leads to psychiatric problems, it is just as plausible that the direction of causality is reversed, namely, that psychiatric problems cause women who become pregnant to feel less capable of raising a child and to terminate their pregnancy." Reardon's study tried to adjust for this by omitting women who had been admitted for psychiatric care in the year before the pregnancy. However, Major notes that the authors did not look at psychiatric admissions prior to that year, nor did they look at other mental health indicators that might have led women to choose an abortion.

The most plausible explanation for the observed association between abortion and mental health problems, according to Major, "is that it is spurious: it reflects unmeasured differences that existed before the target pregnancy between the women in the delivery and the abortion samples." In other words, the life circumstances of women who continue a pregnancy probably differ significantly from those of women who abort a pregnancy, and this can impact mental health. Abortion providers and clinics are everyday witnesses to the fact that women who seek abortions are, on average, more likely to be younger, single, have relationship problems, suffer from health problems, have drug or alcohol abuse problems, or be going through a difficult or dysfunctional time in their lives, compared to women who carry to term. For example, pregnant women in abusive relationships are more likely to have an abortion than pregnant women who are happily married. It's reasonable to infer that the former are also more likely to seek psychiatric help—but the reasons probably relate to their abusive relationship, not the abortion.

Further, Reardon's study did not take into account the marital status of women who abort versus those who carry to term. Major points out, "In contrast to women who deliver, women who terminate a pregnancy are less likely to be married or in an intimate relationship with their partner. Both of these social factors are associated with poorer mental health."

Reardon also compared apples to oranges by not taking into account the "wantedness" of the pregnancy. When selecting comparison groups for studies, subjects should face similar predicaments with similar risk factors. But about half of all pregnancies brought to term are planned and wanted, while almost all abortions result from unintended pregnancies. Women who choose to deliver are more likely to feel emotionally and financially capable of raising a child, and be in a positive frame of mind about it. In contrast, experiencing an unintended pregnancy is often a traumatic experience, usually far more upsetting than the abortion itself, which actually relieves most women. Aside from that, women who experience unintended pregnancy are more likely to be disadvantaged in some way compared to women who planned their pregnancies—e.g., they may be less resourceful, less content, less self-assured, less in control of their lives for whatever reason. Such factors could explain why they got accidentally pregnant in the first place, and, they could also lead to a higher rate of psychiatric admissions later on. Again, it is the specific disadvantage that may be causing the psychiatric problem, not the abortion.

Reardon's findings are also inconsistent with some well-designed earlier studies that compared the psychological reactions of women who gave birth to those of women who aborted unplanned pregnancies. These studies concluded that the emotional well-being of women who abort an unplanned pregnancy does not differ from that of women who carry a pregnancy to term. Major says, "Reardon and colleagues cite none of these studies." She also notes that their research conflicts with that of the American Psychological Association, which concluded that first trimester abortion is "psychologically benign" for most women.

Serious research articles should at least acknowledge opposing evidence, instead of ignoring it. Plus, knowing the difference between correlation and causation is such a fundamental principle in science that Reardon's failure to clearly acknowledge it can only be attributed to a strong political bias against abortion. In fact, every one of the study's co-authors is a staunch anti-abortionist. Only one appears to be a working scientist with the proper credentials in psychology—Dr Priscilla K. Coleman—although one of her main research focuses is women's responses to induced abortion, including death and suicide. It's fair to ask whether such a strong bias on the part of all six authors is appropriate for a research article in a leading medical science journal.

Lead author David Reardon's only apparent vocation is running an anti-abortion propaganda mill out of Illinois (The Elliot Institute, www.afterabortion.org) since 1988, although he does have a Ph.D in Social Sciences. The other co-authors include a psychiatrist and a Family Relations Ph.D, both of whom specialize in exposing the "dangers" of abortion; a graduate student in psychology; and a medical doctor. The latter's affiliation was cited as the "John Bosco Institute." However, an Internet search revealed that this lofty-sounding place is actually the St. John Bosco Catechital Institute, a Catholic divinity school. Not only does such an affiliation have zero relevance to medical research, the omission of key words indicates a deliberate attempt to cloak its real nature.

At any rate, the real danger in research articles such as these is the potential for misinterpretation by the media and misuse by anti-choice groups. Although the study data may be accurate by itself, it's the conclusions leapt to that are the problem. Reardon's Elliot Institute is notorious for publishing research that suggests abortion is bad for women—but this conclusion does not flow from the data because of the same biased assumption that "correlation equals causation".

In subsequent issues, the CMAJ published only one short protest letter from a pro-choice medical student, but printed several lengthy anti-choice letters that attacked Major's critique and praised Reardon's article. This did not reflect the outrage and disappointment of those in the Canadian pro-choice community, many of whom complained to the CMAJ because they felt betrayed by what they saw as a breach of medical ethics by the journal. The purpose of a medical journal is to advance medicine, not to stir controversy and increase readership—and in the process impugn abortion practice and harm women.