Abortion and Suicide: A Spurious Link

In South Dakota, it is now legal to require doctors to tell women seeking abortions that they are putting themselves at risk for suicide.

This move is brilliant from a PR standpoint. Unlike banning certain types of abortions entirely or, say, forcing women to undergo invasive screenings that are medically unnecessary, this seems completely apolitical when you first look at it. Don’t people deserve to be informed if they may be increasing their risk for suicide? Don’t we all agree that suicide is a Bad Thing?

However, something tells me that this is actually another attempt to scare women out of (what should be) a normal, socially acceptable medical procedure.

First of all, the inconvenient truth here is that credible research consistently shows little or no link between abortion and poor mental health. One 2008 study reviewed the literature and found that the only studies that seemed to show such a link had very flawed methodology, whereas the studies that were well-designed showed no links. (Damn liberal academics!) And here’s another study that showed no such links. And here’s a thorough debunking of a study that did claim such links:

Most egregiously, the study, by Priscilla Coleman and colleagues, did not distinguish between mental health outcomes that occurred before abortions and those that occurred afterward, but still claimed to show a causal link between abortion and mental disorders.

In other words, that study actually tried to use mental health pre-abortion to confirm a hypothesis about mental health post-abortion. This is simply not how you do science. And it’s especially bad here, because according to the American Psychological Association, guess what the best predictor of mental health post-abortion is?

Across studies, prior mental health emerged as the strongest predictor of postabortion mental health. Many of these same factors also predict negative psychological reactions to other types of stressful life events, including childbirth, and, hence, are not uniquely predictive of psychological responses following abortion.

That’s right. Shockingly enough, the best predictor of mental health is, well, past mental health. And poor mental health predicts poor response to all sorts of stressful events, of which abortion is only one example. Another one being, for instance, childbirth!

Compounding the bad science here is that, unlike physical side effects,suicide isn’t something that just happens to you suddenly and without warning. People don’t just suddenly wake up one morning and decide to kill themselves. Suicidality is a complex process that involves factors like genetics, family history, environment, social support, mental illness, and life circumstances. For instance, here are some things that, according to research, actually increase one’s statistical risk for suicide:

As you can probably surmise, not all of these correlations are also causations. While mental illness and drug addiction can actually cause suicidal behavior, being intelligent and being LGBT probably cannot. In the latter case, the causative culprit seems to be (surprise surprise) institutionalized discrimination and homophobia. Before I get too off-topic, let me point out the irony in the fact that, despite this well-known risk faced by LGBT youth, I don’t see any of these pro-lifers advocating for an end to homophobia.

That’s why something tells me that nothing about this court ruling actually has anything to do with suicide prevention.

Although the court’s ruling does at least acknowledge that abortion probably doesn’t cause suicide, it nevertheless states that “conclusive proof of causation is not required in order for the identification of a medical risk.” This is probably true, but it only makes sense from a physical health standpoint. If studies show that people who get a certain elective medical procedure are much more likely to, say, experience headaches or nausea or numbness, you don’t necessarily need a causative study to conclude that there’s a reasonable chance that these symptoms were caused by the procedure (assuming, of course, that there was no illness present that might be causing them). Furthermore, there’s a difference between saying “This procedure may cause you to experience cramps and headaches” and saying “This procedure may cause you to kill yourself.”

The truth is, mental health doesn’t work that way. A person who gets an abortion might experience mental side effects because of the stress of having gotten pregnant accidentally and been forced to decide what to do, perhaps without the support of a partner or family. Furthermore, any invasive medical procedure can be stressful and worrying for many people–especially one like abortion, which is consistently portrayed as more painful and dangerous than it really is.

And this is all made even more complicated by the fact that the faulty studies in question were actually studying mental health before the abortion. Perhaps a person with poor mental health is more likely to seek an abortion in the first place–say, if they feel that they aren’t mentally capable of raising a child at the moment.

Ultimately, decisions about what to tell a patient should be left up to the people who know most: doctors (with, of course, a reasonable amount of regulation to prevent malpractice). If a doctor can tell that a person seeking an abortion is going through a lot of mental distress, then that doctor may want to gently recommend counseling and perhaps give out some hotline numbers–and training doctors to recognize signs of mental health troubles is always a good thing.

But doctors should not be mandated to fearmonger to their patients. They should especially not be mandated to serve a pro-life agenda.

A Sacrifice They're Willing to Make: Mississippi's War on Abortion

The last remaining abortion clinic in Mississippi is perilously close to shutting down thanks to a new proposed law, Mississippi House Bill 1390. The law would require that all doctors performing abortions be board-certified in obstetrics and gynecology (reasonable), and that they also have admitting privileges at a local hospital (not so reasonable).

The reason that’s not so reasonable is because Jackson, Mississippi, home of the besieged abortion clinic, has two hospitals with Christian affiliations, and any hospital can refuse to grant admitting privileges to a physician for any ol’ reason, such as that said physician is a godless heathen who wants to help women murder their unborn fetuses babies.

To make it even better, the law would give the clinic’s physicians (all of whom are board-certified OB/GYNs but only one of whom has admitting privileges) less than two months to acquire them. As Evan McMurry writes at PoliticOlogy, “This is part of the pro-life’s recent death-by-a-thousand cuts tactic: if they can’t overturn Roe v Wade outright, they’ll make accessing and performing abortions so onerous that the practice will be effectively impossible.”

But of course, as it usually is with these laws, things get even more ridiculous. From the HuffPo article:

The State Senate voted to pass the bill Wednesday, but it was held for further debate on Thursday, when lawmakers had an odd exchange over the bill on the Senate floor. Sen. Kenny Wayne Jones (D-Canton) asked Sen. Dean Kirby (R-Pearl), who chairs the Senate Public Health Committee, whether ending abortions in the state would force women to resort to dangerous, back-alley abortions.

“That’s what we’re trying to stop here, the coat-hanger abortions,” Kirby replied, in reference to the abortions provided at the clinic in Jackson. “The purpose of this bill is to stop back-room abortions.”

Okay, first of all. No reputable doctor performs abortions with a coat hanger. In fact, I’m just going to go out on a limb and amend my statement to say, No doctor performs abortions with a coat hanger.

All of the physicians in question are board-certified in obstetrics and gynecology–a certification that I’m pretty sure Senator Dean Kirby does not have.

Incidentally, you know when dangerous abortions do actually happen? When abortion is made illegal. Research invariably shows this. (I know, I know, Republicans don’t believe in science anyway, but it was worth a shot.)

The truth is that making something illegal, especially if that thing is considered absolutely necessary by many people, does not mean it won’t happen anymore. It just means that it’ll happen out of sight, and therefore without regulation. This is why countries that are more progressive than ours are starting to experiment with drug decriminalization, but that’s a whole other topic.

Drug policy is a different ballgame because, while there are many psychological and societal factors that may lead people to become addicted to drugs, most of us can agree that nobody needs illegal drugs in order to have a decent life. Abortion is another matter, however. Unless conservative lawmakers are willing to provide comprehensive sex education and low-cost (or free) birth control (not to mention end sexual assault), there may not be a way to eliminate the need for abortion. For instance, from a comment on the HuffPo article I linked to:

I live in Mississippi. Yesterday I taught classes in the poorest part of the Delta to pregnant or parenting teens on parenting skills. I would much rather teach classes to teens about safe, effective birth control. The state won’t let me. It doesn’t matter how many facts or statistics I roll out…nobody listens. I am frustrated beyond belief.

So that’s what we’ve got.

Anyway, because politicians in states like Mississippi refuse to provide the resources to prevent abortion from becoming necessary, they must face the fact that women are going to get them whether they’re legal or not. But they don’t face this fact.

In the quote from Senator Kirby, which I provided above, he states that his purpose in making abortion unattainable in Mississippi is to prevent women from having dangerous abortions. So basically, his argument is this: we’re going to restrict women’s access to a safe, standard medical procedure in order to prevent them from obtaining the potentially dangerous, unregulated version of that procedure, despite the fact that restricting the safe thing actually leads to an increase in the use of the dangerous thing.

Kirby’s reasoning makes such a mockery of logic and common sense that I had to read the original quote several times before I understood it.

Mississippi’s Republican governor, Phil Bryant, had this to say about the proposed law: “This legislation is an important step in strengthening abortion regulations and protecting the health and safety of women. As governor, I will continue to work to make Mississippi abortion-free.”

Wait a minute. First he wants to merely “strengthen” abortion regulations. But then he says he wants to “make Mississippi abortion-free.” That should convince anyone who wasn’t already convinced that this law has absolutely nothing to do with making sure that abortions are performed safely. Rather, it has everything to do with making Mississippi “abortion-free.”

That’s right, he didn’t even try to pretend this was about women’s safety.

In my opinion, the fact that criminalizing abortion leads to dangerous back-alley abortions is the strongest argument for keeping abortion legal. It’s the strongest argument because it doesn’t lean on emotion or ideology. We can argue left and right about when life begins and when fetuses feel pain and whether or not women have the right to choose what to do with their bodies (hint: yes), but we cannot argue with the preponderance of evidence that shows that criminalizing abortion does not prevent abortion. It merely makes it dangerous.

Pro-lifers’ continued refusal to accept this argument says one or both of these things about them:

1. They are unwilling or incapable of accepting and understanding basic facts about economics and decision-making. That is, despite all the evidence showing the negative consequences of the criminalization of abortion, these politicians (and voters) continue to believe that banning abortion would plunge us all into Fun Happy No-Killing-Babies Land.

2. They understand these facts, but just don’t care. This is undoubtedly the worse alternative, because it means that the pain, injury, and even potential death that will come to women who try to obtain illegal abortions are, to borrow from Shrek‘s Lord Farquad, a sacrifice that Republicans are willing to make.

So, ignorance or malice? Take your pick.