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• Gap in Analysis Misses Benefits of Laws Regulating Pre-Abortion Screening and Counseling
  David Reardon
  Published on: 4 March 2022

• Published on: 4 March 2022

  Gap in Analysis Misses Benefits of Laws Regulating Pre-Abortion Screening and Counseling

  • David Reardon, Researcher Elliot Institute

  Dear Editor,

  I am extremely puzzled by the lack of any response regarding my proposed comments regarding this article. I've submitted my comments twice, but they have not been published. I cannot imagine why. It appears to be a discretionary censorship, which is of course contrary to BMJ's published editorial policies which generally favor respectful discourse. I would greatly appreciate an explanation and an appeal to a larger panel of BMJ editors.

  To repeat...for the third time,... regarding this article:

  There is a growing interest in developing evidenced based standards for public health policy initiatives.[1] In response to this effort, Burris et al have put forward their own initial effort to identify the potential effects of laws regulating abortion on women’s health.[2] Unfortunately, they apparently failed to include in their research team anyone with familiarity with the literature regarding the negative physical and psychological effects of coerced and unnecessary abortions. This is not a minor oversight.

  Regarding the issue of women’s autonomy, increasing legal access to abortion is a double-edged sword. Easier access makes it easier for women to choose abortion for their own self-interests, but it also makes it easier for those pressuring women into unwanted abortions to abuse women’s rights.[3]

  Coerced abortions are especially common among women enslaved in sex trafficking.[4,5] But it is also common within...

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  Dear Editor,

  I am extremely puzzled by the lack of any response regarding my proposed comments regarding this article. I've submitted my comments twice, but they have not been published. I cannot imagine why. It appears to be a discretionary censorship, which is of course contrary to BMJ's published editorial policies which generally favor respectful discourse. I would greatly appreciate an explanation and an appeal to a larger panel of BMJ editors.

  To repeat...for the third time,... regarding this article:

  There is a growing interest in developing evidenced based standards for public health policy initiatives.[1] In response to this effort, Burris et al have put forward their own initial effort to identify the potential effects of laws regulating abortion on women’s health.[2] Unfortunately, they apparently failed to include in their research team anyone with familiarity with the literature regarding the negative physical and psychological effects of coerced and unnecessary abortions. This is not a minor oversight.

  Regarding the issue of women’s autonomy, increasing legal access to abortion is a double-edged sword. Easier access makes it easier for women to choose abortion for their own self-interests, but it also makes it easier for those pressuring women into unwanted abortions to abuse women’s rights.[3]

  Coerced abortions are especially common among women enslaved in sex trafficking.[4,5] But it is also common within households precisely because every pregnancy impacts not just the pregnant woman, but also male partners, parents, employers, and society at large . . . as evidenced by advocates of population control who have sought and implemented public policies that discourage birth.[3]

  As many as 64% of American women acknowledging a history of abortion report having felt pressured to abort by others.[6] Similarly, a 2021 study of women seeking abortion found that only 42% described their pregnancy as never wanted.[7] The pressure to abort a pregnancy that might otherwise be welcomed typically comes from their male partners, parents, employers and social services officials.[8]

  As might be imagined, negative psychological reactions to abortion are more common when women feel pressured into an abortion or have other conflicting maternal interests and moral beliefs.[6,9] These are just a few of the 15 risk factors identified by the APA for negative psychological reactions. They include: terminating a pregnancy that is wanted or meaningful; perceived pressure from others to terminate a pregnancy; perceived opposition to the abortion from partners, family, and/or friends; lack of perceived social support from others; various personality traits (e.g., low self-esteem, a pessimistic outlook, low-perceived control over life); a history of mental health problems prior to the pregnancy; feelings of stigma; perceived need for secrecy; exposure to antiabortion picketing; use of avoidance and denial coping strategies; feelings of commitment to the pregnancy; ambivalence about the abortion decision; low perceived ability to cope with the abortion; history of prior abortion; and late term abortion.[9] The best evidence indicates that the vast majority of women undergoing abortion have one or more of these risk factors.[9]

  Even assuming that the negative psychological associated with abortion, including increased risk of substance abuse,[9] postpartum psychiatric risks,[10] sleep disorders,[11] posttraumatic stress disorder,[9] and suicidal ideation and other risk taking behaviors[9] are entirely due to coerced and unwanted abortions, the importance of laws intended to prevent unwanted abortions should not be ignored…but that is precisely what Burris et al have done.

  For example, one of the reasons for laws requiring parental involvement or notification are to help prevent a minor from undergoing a coerced abortion at the behest of the male partner or his family. They are also intended to prevent a minor from fearfully consenting to an otherwise unwanted or unnecessary abortion because of a mistaken fear that the minor’s parents will reject her because of her sexual activity and will not support her desire to keep the pregnancy.

  But in Table 1, the benefit of “prevention of unwanted, unnecessary or unsafe legal abortions” is not identified in the list of “plausibly related outcomes” for any of the types of laws considered. Nor is there any consideration of “saved costs” and in regard to fewer treatments for the negative health effects associated with unwanted abortion.[9]

  Numerous studies have also found a strong link between induced abortion and subsequent pre-mature and low-birth weight deliveries.[12] In the context of the United States, the increased medical costs in treating subsequently pre-maturely born children just to the point of hospital discharge apportions out to approximately $100,000 per 100,000 abortions. Therefore, any reduction in abortion rates that may result from laws that reduce the risk of coerced and unwanted abortions would produce significant health care savings, would reduce the risk of lifelong health complications associated with premature and low birth weight deliveries, and would save numerous lives among later planned pregnancies. But again, none of these benefits appear in Table 1.

  Moreover, literally every record linkage study (eleven in total) examining reproductive outcomes associated with mortality has shown that abortion is associated with an increased risk of premature death among women exposed to abortion.[13] There is even a dose effect, with each abortion increasing the risk of an early death by approximately 50 percent.[13] At least a part of this increased risk is due to the increased risk of within a year of an abortion.[14,15] But even if we again assume that all these risks attach only to unwanted abortions (presuming that if a woman truly wants an abortion according to her own guiding lights, she will experience no psychological harm), the fact remains that any law which may help to reduce the rate of unwanted abortions is likely to reduce mortality rates and thereby increase work productivity and gross national product. But, yet again, the positive plausible outcomes have been omitted from Table 1

  Notably, “unintended childbirth” is one plausible outcome that Burris et al have associated with every type of law identified in Table 1. But that outcome is poorly defined. When, and how often, is “unintended childbirth” a benefit to women and when is it a harm? Countless women report great satisfaction and blessing from their subsequent delivery of unplanned pregnancies. In fact, the Turnaway Study found that among all the women who were denied a late term abortion, 60% reported being happy about continuing their pregnancies, and by the time the child was born, only 12% still wished they could have had the abortion.[16] The bottom line is that many “unintended” and even “unwanted” pregnancies are associated with a mix of feelings, a mix that in the long run often result in a “welcomed” child, one that is valued not because the child was planned but simply it is the woman’s and her family’s child. Given that Burris et al are arguing for better research to support policy decisions, the importance of better research to identify when and how often unintended pregnancies result in a welcomed child should be a priority, as well as research to identify public policies that can help to make it easier for families to welcome unintended children.

  Finally, Burris et al have failed to identify in the list of potential legal interventions laws governing informed consent, risk disclosure and pre-abortion screening for risk factors identifying women who may be at greater risk of being coerced or may feel pressured by social circumstance to agree to an abortion contrary to their moral beliefs and/or maternal desired.

  In short, Burris et al’s analysis has failed to fully describe or analyze the plausible effects of statutes and public policies intended to protect women from unwanted, unnecessary and unsafe legal abortions. Simply declaring abortion legal does not necessarily render them safe and effective for all women in any and all circumstances of an “unintended” pregnancy.

  Unfortunately, “unintended” pregnancies are often more unwanted by others (including population control activists) than they are by the pregnant themselves. In many cases, women are resiliently willing to embrace their unintended pregnancies as a welcomed-children. Often, it is only the hostility of others, and the accompanying pressure to submit to unwanted abortions, that is the true attack on women’s rights and autonomy.

  Laws designed to identify and alleviate the pressures on women to undergo unwanted and unnecessary abortion should be pursued and implemented to save lives, reduce costs, and increase the well-being of both women and their children.

  Competing Interest
  David Reardon is the Director the Elliot Institute which sponsors peer reviewed medical research, promotes post-abortion healing programs, and advocates for laws requiring pre-abortion screening for coercion and other risk factors associated with negative outcomes for women.

  References

  1. Rehfuess EA, Stratil JM, Scheel IB, Portela A, Norris SL, Baltussen R. The WHO-INTEGRATE evidence to decision framework version 1.0: integrating WHO norms and values and a complexity perspective. BMJ Glob Heal [Internet]. 2019 Jan 1 [cited 2022 Jan 13];4(Suppl 1):e000844. Available from: https://gh.bmj.com/content/4/Suppl_1/e000844
  2. Burris S, Ghorashi AR, Cloud LF, Rebouché R, Skuster P, Lavelanet A. Identifying data for the empirical assessment of law (IDEAL): A realist approach to research gaps on the health effects of abortion law. BMJ Glob Heal [Internet]. 2021 Jun 1 [cited 2022 Jan 13];6(6):e005120. Available from: https://gh.bmj.com/content/6/6/e005120
  3. Reardon DC. Abortion decisions and the duty to screen: clinical, ethical, and legal implications of predictive risk factors of post-abortion maladjustment. J Contemp Health Law Policy. 2003;20(1):33–114.
  4. Coyle C. Sex Trafficking. In: MacNair RM, editor. Peace Psychology Perspectives on Abortion. Kansas City. MO: Feminism & Nonviolence Studies Association; 2016.
  5. Lederer L, Wetzel C. The Health Consequences of Sex Trafficking and Their Implications for Identifying Victims in Healthcare Facilities. Ann Heal Law. 2014;23(1):61.
  6. Rue VM, Coleman PK, Rue JJ, Reardon DC. Induced abortion and traumatic stress: A preliminary comparison of American and Russian women. Med Sci Monit. 2004;10(10):SR5–16.
  7. Biggs MA, Neilands TB, Kaller S, Wingo E, Ralph LJ. Developing and validating the Psychosocial Burden among people Seeking Abortion Scale (PB-SAS). Vaingankar JA, editor. PLoS One [Internet]. 2020 Dec 10 [cited 2021 Feb 8];15(12 December):e0242463. Available from: https://dx.plos.org/10.1371/journal.pone.0242463
  8. Elliot Institute. Forced Abortion in America: A Special Report [Internet]. Springfield IL; 2004. Available from: https://afterabortion.org/new-elliot-institute-report-exposed-americas-f...
  9. Reardon DC. The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities. SAGE Open Med [Internet]. 2018;6:205031211880762. Available from: http://journals.sagepub.com/doi/10.1177/2050312118807624
  10. Reardon DC, Craver C. Effects of pregnancy loss on subsequent postpartum mental health: A prospective longitudinal cohort study. Int J Environ Res Public Health [Internet]. 2021 Feb 2 [cited 2021 Mar 17];18(4):1–11. Available from: https://pubmed.ncbi.nlm.nih.gov/33672236/
  11. Reardon DC, Coleman PK. Relative treatment rates for sleep disorders and sleep disturbances following abortion and childbirth: a prospective record-based study. Sleep. 2006;29(1):105–6.
  12. Calhoun BC, Shadigian E, Rooney B. Cost consequences of induced abortion as an attributable risk for preterm birth and impact on informed consent. J Reprod Med. 2007;52(10):929–37.
  13. Reardon DC, Thorp JM. Pregnancy associated death in record linkage studies relative to delivery, termination of pregnancy, and natural losses: A systematic review with a narrative synthesis and meta-analysis. SAGE Open Med [Internet]. 2017 Dec 13 [cited 2018 Aug 15];5:205031211774049. Available from: http://journals.sagepub.com/doi/10.1177/2050312117740490
  14. Gissler M, Berg C, Bouvier-Colle M-H, Buekens P. Injury deaths, suicides and homicides associated with pregnancy, Finland 1987-2000. Eur J Public Health. 2005 Oct;15(5):459–63.
  15. Reardon D, Strahan T, Thorp … J. Deaths Associated with Abortion Compared to Childbirth-A Review of New and Old Data and the Medical and Legal Implications [Internet]. J. Contemp. Health …. 2003. Available from: http://heinonlinebackup.com/hol-cgi-bin/get_pdf.cgi?handle=hein.journals...
  16. Foster DG. The Turnaway Study: ten years, a thousand women, and the consequences of having--or being denied--an abortion. New York, NY: Scribner; 2020. p. 360.

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  Conflict of Interest:
  David Reardon is the Director the Elliot Institute which sponsors peer reviewed medical research, promotes post-abortion healing programs, and advocates for laws requiring pre-abortion screening for coercion and other risk factors associated with negative outcomes for women.

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