Sir, – Prof Veronica O’Keane et al (November 22nd) alluded to the 2011 report from the National Collaborative Centre for Mental Health (NCCMH). The main conclusion of that report is: “The rates of mental health problems for women with an unwanted pregnancy were the same whether they had an abortion or gave birth”. The NCCMH report is not, itself, based on a statistical study, but is rather a systematic review of other studies in this area.
While many such studies were examined for the review, the main conclusion quoted above was based on only a small number of studies. To qualify for inclusion in the report, various criteria had to be met, including: mental health outcomes had to be measured at least 90 days after birth or abortion; the study had to control for whether the pregnancy was wanted or unwanted; and the study had to control for previous mental health problems. Adoption of these criteria had the effect of excluding all studies which had found a link between abortion and poor mental health.
However, the NCCMH also reports as follows: 1. The factors associated with poor mental health post-birth and post-abortion were “similar”. 2. There were additional risk factors associated with abortion, including “negative attitudes ...towards a woman’s personal experience of the abortion”.
The second of these findings should not surprise any of the countless women who unequivocally attribute subsequent mental health problems directly to the abortion itself.
I am having problems reconciling these two findings with the report’s main finding that (controlling for various other variables) there is no evidence of a link between abortion and poor mental health. My problem is not with the main finding itself which, if anything, undermines pro-choice arguments based on maternal mental health. No, my problem is a logical one.
If the NCCMH main conclusion is based on statistical studies which successfully controlled for all important variables, and if there are additional risk factors specifically associated with abortion, then surely the abortion variable should have emerged from the NCCMH review as statistically significant? While the NCCMH report is a fine document, perhaps its inclusion criteria should be looked at again. – Yours, etc,
A chara, – No one can ignore the international dimension of Savita Halappanavar’s death and her husband’s public denunciation of her treatment. Comment from all round the world reflects the instant globalisation of news, and has been far more intense than in previous chapters in Ireland’s abortion debate.
In the need to secure a less misogynistic legal and ethical framework for Irish women, let us not forget the other international dimension to Ireland’s anti-abortion stance, namely its indirect effect on women in developing countries.
Ireland’s anti-abortion lobby has often expressed pride in the way Ireland acted as a “beacon” to the world in passing the constitutional amendment in 1983. In pioneering anti-abortion legislation at this level, Irish legislators must share responsibility for encouraging the anti-abortion climate and legislation that pertains across large parts of Africa, Asia and Latin America. For women in countries where not only is abortion banned, but there is no access to neighbouring medical services such as those which Irish women can avail of in the UK, the effects can be disastrous.
The 2009 Guttmacher Institute report estimated deaths from unsafe abortion across the world at 70,000 a year. This figure is much lower than estimates prevalent in the 1980s and 1990s, but would still give around two million women as having died, unnecessarily, from unsafe abortions over the period since 1983. The same report said that nearly half of the world’s 41 million annual abortions are unsafe, revealing a stark gap between rich and poor countries.
It is time that we in Ireland set an example that could serve as a different kind of beacon to the world – one that would acknowledge the reality that abortion figures vary little between countries with restrictive or liberal legislation. What lowers maternal deaths from abortions is providing safe facilities. Irish legislation can no longer be seen as isolated from the global context of which it forms part. – Is mise,