an After abortion

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Saturday, February 7, 2004

One more thought on what medical research shows about the connection between abortion and later psychiatric problems. In July 2003, the Canadian Medical Association Journal took the unusual step of running an editorial, Unwanted results: the ethics of controversial research defending their decision to publish the article cited first below in May 2003 that shows a statistical correlation between abortion and increased rates of psychiatric hospitalization.

They write in part:

The recent publication of a study on psychiatric admission rates among low-income women after abortion and childbirth has elicited a barrage of letters to CMAJ of a pitch that we do not frequently encounter. We are chided for publishing flawed research and told that we should be ashamed of publishing the "opinions" of self-evidently biased researchers. We are accused of doing a disservice to women, medicine and the Journal, of failing to conduct proper peer review, and of not adequately scrutinizing the credentials of the authors.

The abortion debate is so highly charged that a state of respectful listening on either side is almost impossible to achieve. This debate is conducted publicly in religious, ideological and political terms: forms of discourse in which detachment is rare. But we do seem to have the idea in medicine that science offers us a more dispassionate means of analysis. To consider abortion as a health issue, indeed as a medical "procedure," is to remove it from metaphysical and moral argument and to place it in a pragmatic realm where one deals in terms such as safety, equity of access, outcomes and risk–benefit ratios, and where the prevailing ethical discourse, when it is evoked, uses secular words like autonomy and patient choice.

Hence, perhaps the thing that is most offensive to some of our correspondents is the apparent co-opting of the medical view by persons they believe to be unqualified — or disqualified. The attack in our letters column is largely an ad hominem objection to the authors' ideological biases and credentials

The answer to the first must be that opinion can of course cloud analysis. In light of the passion surrounding the subject of abortion we subjected this paper to especially cautious review and revision. We also recognized that research in this field is difficult to execute. Randomized trials are out of the question, and so one must rely on observational data, with all the difficulties of controlling for confounding variables. But the hypothesis that abortion (or childbirth) might have a psychological impact is not unreasonable, and to desist from posing a question because one may obtain an unwanted answer is hardly scientific.

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