Abortion and Mental Health Effects: What Will the APA Say?

This week in Boston, the American Psychological Association Council of Representatives will vote to accept or reject a report from its Task Force on Mental Health and Abortion. Convened quietly in April 2006, the committee was asked by the APA Board of Directors to conduct an updated review of the published scientific literature on the impact of abortion on women’s mental health. Since 1989, the APA has held that the risk of psychological harm from abortion is low. However, recent studies have cast some doubt on this sunny position and led to the new analysis.

Pro-life groups who might be expected to welcome the re-examination have expressed concerns. One such group, Consistent Life, contacted the APA with questions about perceptions of bias in the composition of the committee. In one letter to APA President Alan Kazdin, the president of Consistent Life, Bill Samuel, wrote:

APA has held a position of abortion as being a civil right for women since 1969, and therefore has a clear political stand. Yet the Task Force on Mental Health and Abortion had no call for nominations … and the final make-up of the task force had half the members as strong public advocates of the pro-choice view. Advocates of the view that abortion is violence to both unborn children and to women, which could balance such biases, are ominously absent. There are several well-qualified researchers who would have been pleased to serve on the panel, had the panel been selected with balance in mind.

Consider also that the report of this task force is scheduled to come out during an election year, 2008. The APA position is in accord with that of one of the major political parties, and in opposition to that of the other … Surely critics and observers will highlight the fact that members of such a task force were unbalanced in favor of those whose views matched the political position of the organization … We hope you will pause to reflect upon how partisan this will appear.

APA President Kazdin wrote back to defend the task force and say that the APA report “must be grounded in the strongest, peer-reviewed science available.” This, of course, is the answer one would expect, and I believe he is sincere. However, I think Mr. Samuel raised valid points of concern which have not been addressed. Is there any evidence that the pre-existing views presage the final outcome?

I could be wrong, but I believe the APA has telegraphed the answer. In the June 2008 APA monthly publication, Monitor on Psychology, Rebecca Clay authored an article titled, “Science vs. Ideology: Psychologists fight back against the misuse of research.” Clay interviewed abortion researcher Nancy Adler regarding how anti-abortion psychologists are seeking legitimacy for their perspective by (shudder) doing research and reporting in peer-reviewed journals. Will the task force see things much differently than Dr. Adler? Clay writes:

In other issue areas, special-interest groups have assumed the trappings of science to bolster ideology-driven claims. One example is so-called “post-abortion syndrome,” a scientific-sounding name for something most researchers say doesn’t exist.

Nancy E. Adler, PhD, a professor of medical psychology at the University of California, San Francisco, is one of them. She has found that the rate of distress among women who’ve had abortions is the same as that of women who’ve given birth. Adler and other experts reviewed the literature in the late 1980s as part of an APA panel and found no evidence of a post-abortion syndrome. Even the anti-abortion Surgeon General C. Everett Koop, MD, refused to issue a report on abortion’s supposed psychological impact when President Ronald Reagan asked him to, citing the lack of evidence of harm.

Since then, says Adler, anti-abortion advocates have become more world-wise. “They’re using scientific terminology,” she points out. They’re also gaining credibility by getting published in mainstream journals.

But such research often has methodological problems, Adler claims: “Women are not randomly assigned to have abortions. Women who are having abortions are having them in the context of an unwanted pregnancy, which usually has some other very stressful aspects. Their partners may have left them. They may have been raped.”

In addition, says Adler, proponents of the syndrome don’t mention the base rate of depression and other psychological problems in society as a whole. And they always attribute such problems to abortion rather than other possible causes.

A new APA Task Force on Mental Health and Abortion will examine such issues in a report later this year.

I think this probably signals how the APA’s task force report will turn out. The good guys use good methods and the bad guys use the “trappings of science” and are being “world-wise” by “getting published in mainstream journals.” As described in their official publication, the APA’s way of evaluating good vs. bad research is not the quality of peer-reviewed work but the ideology of the researcher. What I gather from Clay’s article is this: When an APA-approved policy position is supported, it is science; otherwise, it is ideology.