Abortion Suicide Warning Law (obvs. Abort Ment)

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Alissa_Sal's picture
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Abortion Suicide Warning Law (obvs. Abort Ment)

http://slatest.slate.com/posts/2012/07/24/court_upholds_s_d_mandated_suicide_warning_to_women_seeking_abortions.html?from=rss/&wpisrc=newsletter_slatest

A federal appeals court on Tuesday upheld a South Dakota law mandating that doctors must warn women seeking abortions that they?ll face a higher risk of suicide and suicidal thoughts if they go through with the procedure.

The St. Louis-based 8th Circuit upheld the 2005 law, 7-4. Planned Parenthood of Minnesota, North Dakota, and South Dakota filed an appeal in September asking the court to toss the mandated warning, arguing that it infringes on both the abortion rights of the patient and on the free speech rights of the doctor.

The court's ruling, the Associated Press explains, ultimately came down to a "battle of medical studies." The AP:

Statistics show that women who have had abortions have higher rates of suicide compared with women who've given birth, but the sides don't agree that there's a causal link between abortion and suicide.

The defenders of the law cited research they said asserts a statistically significant correlation between abortion and suicide. The law's opponents, meanwhile, argued such findings overlook exterior factors such as domestic abuse or mental health, which other studies say may predispose women to both unwanted pregnancy and suicide.

What do you think of a law that mandates doctors to warn women seeking abortions that they face a higher risk of suicide and suicidal thoughts? Good warning to help women make informed decisions, or politically motivated scare tactics?

ClairesMommy's picture
Joined: 08/15/06
Posts: 2299

I'm okay with it, only if causation can be proven. I think sometimes we have to take a look at the topic a bit more objectively and not think that every move by the courts is to infringe upon a woman's rights. There are many medications that have warnings about increased suicidal thoughts and tendencies. Yes, granted it's the medication increasing that risk, not like with an abortion where the woman actively chooses termination, so it's a bit more of a passive example, but I don't see a warning like this scaring emotionally fragile women into keeping their babies because of the possibility they may have an increase in suicidal thoughts and behaviour. It's a health warning, and I don't think it's an anti-abortion message.

GloriaInTX's picture
Joined: 07/29/08
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I think I would put more faith in studies published in peer-reviewed medical journals than in a study supported by Planned Parenthood who has a stake in abortions since that is how they make their money. I don't understand how it hurts anyone to get the warning?

The four dissenting judges said that multiple studies cited failed to take into account factors such as pre-existing mental health issues, domestic violence and a young age at the time of pregnancy.

"The most reliable evidence in the record shows that abortion does not have a causal relationship to the risk of suicide and that South Dakota's mandated advisory is not truthful, but actually misleading," Circuit Judge Diana Murphy wrote for the dissenting side.

The state, in supporting the law passed seven years ago, disagreed, submitting several studies published in peer-reviewed medical journals to demonstrate a "statistically significant correlation between abortion and suicide." Planned Parenthood, however, relied on another study to argue its belief that certain underlying factors, such as mental health issues, predispose women to have both unwanted pregnancies and suicidal tendencies.

http://www.google.com/hostednews/ap/article/ALeqM5iDvk75U6jEi3rwhW6DrnTvCACFQg?docId=a8ce5cddc2fc4f008e56414d3a0dfd51

AlyssaEimers's picture
Joined: 08/22/06
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I think it is a good thing for a doctor to talk to their patient about any potential consequences of their actions. My doctor tells me that if I do not loose weight, I could become a diabetic. Not a scare tactic. Just fact. I do not see how this is different.

Alissa_Sal's picture
Joined: 06/29/06
Posts: 6427

My problem with it is that correlation is not causation, and it makes me worry that politicians are focusing on abortion (and yes, I do think this is a political issue, since we're talking about a law here) rather than exploring the risk factors may lead to BOTH abortion AND suicide, such as domestic violence, substance abuse issues, and poverty. For example, lowered SES (socioecomic status) is a risk factor for both abortion, and suicide.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2818047/

SES—including higher levels of educational attainment, employment, and higher income—is associated with better health and lower risks of all-cause mortality (Adler et al., 1994; Feinstein, 1993; Rogers, Hummer, and Nam, 2000). These factors are associated with suicide at the aggregate (Kubrin, Wadsworth, and DiPietro, 2006; Stockard and O’Brien, 2002; Wadsworth and Kubrin, 2007) and individual (Stack, 2000a) levels. Although education, employment, and income are clearly related to each other, it is important to investigate their separate relationships with the risk of suicide. For example, Kposowa and colleagues (1995) found a bivariate relationship between income and suicide that was explained away in multivariate models.

Higher SES may reduce suicide risk in several ways. Higher incomes may reduce suicide risk by allowing individuals to access help from mental health professionals or paying for goods or services that ease their lives. Employment provides income, but may also foster social integration by providing meaning and organization to the routines of daily life, offering opportunities to make friends, and encouraging responsibility to co-workers by fulfilling job requirements (Kasl and Jones, 2000; Theorell, 2000). Work is associated with lower risks of overall mortality (Rogers, Hummer, and Nam, 2000), and employed persons have lower risk of suicide mortality (Stack, 2000a), although there are some exceptions among specific occupational groups (Stack, 2001).

High levels of education may reduce the risk of suicide by providing individuals with a greater sense of self-control and access to tightly knit pro-social groups that promote marriage, employment, and improved social capital (Kawachi and Berkman, 2000; Mirowsky and Ross, 2003; Waite, 2006). Education may also facilitate strategies for managing stressful social environments (Krueger and Chang, 2008; Lantz et al., 2005).

A lot of what they wrote about the relationship between SES and suicide could easily apply to abortion as well as suicide, for example, access to health care services, social support, et cetera.

Point being, I don't believe that it's as simple as "Abortion causes suicide." I think a lot of factors interplay in suicide, abortion, and the places where the two meet, and I would prefer to see public policy that explores this rather than slapping a warning label on abortion and calling it a day.

AlyssaEimers's picture
Joined: 08/22/06
Posts: 6561

People experience depression after giving birth. Granted, I am not a doctor, but it would stand to reason if you A. give birth, B. have a miscarriage, or C. have an abortion there will be a substantial change in hormones. It would be irresponsible for a doctor to not tell their patients that it is normal to have emotional trauma after such an experience. Social pressures aside, abortion is a big deal. It is bound to affect people in different ways. Telling someone, if you have thoughts of suicide call your doctor is not against abortion. It is just common sense. I can think of several TV commercials advertising medicines that say the exact same thing. It also does not hurt to tell a young woman in a difficult situation to make sure they are thinking things through. It is not like you can go back and change their mind after the fact.

Joined: 08/17/04
Posts: 2226

Well as Alissa said, correlation is not causation and until they prove that suicide after abortion is linked to the abortion and not other factors then I would be okay with them presenting this information.

Now, if they wanted to present that you can experience the same hormonal changes and possibly a depression then I am on board with that. Just like the tell you after a baby you can experience PPD. Not everyone does and those that do don't always commit suicide or hurt their babies. The PPD can cause this but having a baby doesn't cause this.

I'm tired and hope that makes sense.

Spacers's picture
Joined: 12/29/03
Posts: 4100

Do they disclose the risk of suicide for women who have a baby they can't afford? Do they disclose the risk of suicide for women locked into an abusive relationship with someone they don't like but are tied to for life through a child? Do they disclose the risk of suicide for women who feel forced into giving their child up for adoption because they see no other alternative? There are risks to everything. Ending a pregnancy causes a major hormone shift no matter how it happens, and women do need to be aware of that, but just to say, there's an increased risk of suicide if you have an abortion, with nothing else, is just wrong.

GloriaInTX's picture
Joined: 07/29/08
Posts: 4116

Women who had undergone an abortion experienced an 81% increased risk of mental health problems, and nearly 10% of the incidence of mental health problems was shown to be attributable to abortion. The strongest subgroup estimates of increased risk occurred when abortion was compared with term pregnancy and when the outcomes pertained to substance use and suicidal behaviour.

Conclusions This review offers the largest quantitative estimate of mental health risks associated with abortion available in the world literature. Calling into question the conclusions from traditional reviews, the results revealed a moderate to highly increased risk of mental health problems after abortion. Consistent with the tenets of evidence-based medicine, this information should inform the delivery of abortion services.

http://bjp.rcpsych.org/content/199/3/180

Spacers's picture
Joined: 12/29/03
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Coleman Article Should be Retracted, Not Debated in a Subsequent Issue of BJP

  • [EMAIL=jcoyne@mail.med.upenn.edu]James C Coyne[/EMAIL], Professor

University Of Pennsylvania School of Medicine
Serious flaws in the reporting and conduct of the Coleman review should have been identified in pre-publication review and not left for readers of BJP to sort through subsequently. The article should be retracted and should not given the dignity of post-publication debate in a subsequent issue of the journal.
The review lacks the fundamental transparency that is expected of systematic reviews and meta-analyses and needed to allow readers to independently evaluate its conduct and
More... Serious flaws in the reporting and conduct of the Coleman review should have been identified in pre-publication review and not left for readers of BJP to sort through subsequently. The article should be retracted and should not given the dignity of post-publication debate in a subsequent issue of the journal.
The review lacks the fundamental transparency that is expected of systematic reviews and meta-analyses and needed to allow readers to independently evaluate its conduct and interpretation of results without having first to go back to the original studies. Search strategies are not even provided in sufficient detail for readers to ascertain the adequacy and completeness of the retrieval of relevant studies.
Results for 36 effects obtained from 22 studies that are integrated into a single effect size represent highly diverse outcomes ranging from smoking of marijuana to suicide. The overall effect size that is calculated does not generalize back to the individual outcomes in any meaningful way. This aspect of the meta-analysis recalls a photo often incorporated into workshops on meta-analysis. The photo depicts the famous road sign for New Cuyama, California in which a total of 4663 is indicated for a population of 562, an elevation of 2150 feet, and a date of establishment of 1951. The calculation of an estimate of the heterogeneity of the effect size reported by Coleman is missing, in violation of standards for reporting a meta-analysis.
Multiple effects sizes are obtained from individual studies are integrated in a way that violates basic assumptions of independence of individual effect sizes that are required for a meaningful meta analysis. The 22 studies include 13 from Coleman's author group, and so the meta analysis violates usual expectations that a meta analysis be independent of the author group who generated the original studies. David Reardon who is a co-author of Coleman on a number of these studies has declared his strategy [1]:
"For the purpose of passing restrictive laws to protect women from unwanted and/or dangerous abortions, it does not matter if people have a pro-life view...In some cases, it is not even necessary to convince people of abortion's dangers. It is sufficient to simply raise enough doubts about abortion that they will refuse to actively oppose the proposed anti- abortion initiative. In other words, if we can convince many of those who do not see abortion to be a "serious moral evil" that they should support anti-abortion policies that protect women and reduce abortion rates, that is a sufficiently good end to justify NRS efforts. Converting these people to a pro-life view, where they respect life rather than simply fear abortion, is a second step. The latter is another good goal, but it is not necessary to the accomplishment of other good goals, such as the passage of laws that protect women from dangerous abortions and thereby dramatically reduce abortion rates."
Many of the studies included in the Coleman meta-analysis, including most of the studies conducted by her group, are strongly criticized by other researchers and excluded from consideration in other systematic reviews, including a forthcoming report by the National Collaborating Centre for Mental Health (NCCMH) at the Royal College of Psychiatrists (RCPsych). One can only speculate on the timing of the BJP's publishing of Coleman's review relative to the impending release of the RCPsych report. Results of some of the original Coleman studies are not replicated in subsequent re-analyses of the same data sets by others. Coleman integrates results from studies without controlling for measures of mental health outcomes obtained prior to an abortion and in a number of instances, the mental health outcomes entered into her meta analysis were obtained before the abortion. In other instances, the effects reflect differences between women who obtained an abortion for an unwanted pregnancy versus women who delivered a wanted baby, a grossly inappropriate comparison if the intention is to obtain a valid estimate of the effects of abortion on mental health.
It is a mater of technical details, but important to evaluating Coleman's meta analysis that she used the wrong formula to calculate population-attributable risk and violated basic assumptions for such a calculation.
These serious flaws were apparent in a cursory reading of Coleman's article. I am confident that a closer read and a retrieval of the original studies and others that were ignored by Coleman would have yielded still more problems. But I think this analysis reaches the threshold for demonstrating the necessity of retracting the Coleman article and it begs an explanation for the nature of the peer review that led to the article being accepted.
The Coleman article is not a contribution to scientific literature but rather represents the revenge of Coleman and her offer group on the scientific community which has held their work to basic objective scientific standards, criticized its poor quality, and excluded from integration into systematic reviews on the basis of objective criteria.
1. Reardon DC (2002). A defense of the neglected rhetorical strategy (NRS). Ethics Med 18 (2): 23-32.

http://bjp.rcpsych.org/content/199/3/180/reply#bjprcpsych_el_33923

Emphases are mine. The bolded areas point out flaws with this study itself. The red highlights the fact that the co-author of many of the studies in this analysis is a pro-life activist whose primary goal is to restrict access to abortions. Nice source, yes, let's base our decision-making on this flawed piece of **** article.

AlyssaEimers's picture
Joined: 08/22/06
Posts: 6561

I quick Google search found several articles saying that the suicide rates are higher among people who have had an abortion. I have no idea if they are accurate or not.

http://afterabortion.org/2001/suicide-rate-higher-after-abortion-study-shows/
http://www.lifenews.com/2004/03/02/nat-359/

I do think it stands to reason that if someone is desperate enough to have an abortion, then there is an increased chance of suicide. I could be wrong, but I do not think that the majority of people having abortions are people who are in happy, stable, healthy relationships with a huge support system. Support and counselling at the time of the abortion is a reasonable accommodation.

GloriaInTX's picture
Joined: 07/29/08
Posts: 4116

There are other studies out there, that is just the first one I came across. I don't know what studies were used to make the decision but it said they were peer reviewed. Otherwise the judges wouldn't have made the decision they did.

Spacers's picture
Joined: 12/29/03
Posts: 4100

"AlyssaEimers" wrote:

I quick Google search found several articles saying that the suicide rates are higher among people who have had an abortion. I have no idea if they are accurate or not.

http://afterabortion.org/2001/suicide-rate-higher-after-abortion-study-shows/
http://www.lifenews.com/2004/03/02/nat-359/

I do think it stands to reason that if someone is desperate enough to have an abortion, then there is an increased chance of suicide. I could be wrong, but I do not think that the majority of people having abortions are people who are in happy, stable, healthy relationships with a huge support system. Support and counselling at the time of the abortion is a reasonable accommodation.

How about looking at sources that aren't so blatantly pro-life? You might get a better picture of the reality of the situation. The fact is that most abortions are performed on married women, and a majority of women who have an abortion already have at least one child. Why should someone have to undergo counseling if they are already perfectly content with the decision they've made? Perhaps the real reason for the risk of suicide is because so many people feel the need to criticize what should be a private, personal decision. Let's stop stigmatizing abortion and maybe the suicide rate will go down.

Joined: 08/17/04
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"Spacers" wrote:

How about looking at sources that aren't so blatantly pro-life? You might get a better picture of the reality of the situation. The fact is that most abortions are performed on married women, and a majority of women who have an abortion already have at least one child. Why should someone have to undergo counseling if they are already perfectly content with the decision they've made? Perhaps the real reason for the risk of suicide is because so many people feel the need to criticize what should be a private, personal decision. Let's stop stigmatizing abortion and maybe the suicide rate will go down

:clappy:

AlyssaEimers's picture
Joined: 08/22/06
Posts: 6561

"Spacers" wrote:

Let's stop stigmatizing abortion and maybe the suicide rate will go down.

This thought process really shocks me. I can accept you saying not to stigmatize gay people or drinking because that really only affects the person doing it, and when it comes right down to it, I don't care that much. Let's think about what is happening when someone has an abortion. A tiny life is being terminated and even though it is currently legal, that is still something the woman should think long and hard about first. It should not (Nor do I think it most often is) be made on a wim. I can not believe it does not affect a person to once carry a life, terminate it and at the very least not feel sad about what has happened.

AlyssaEimers's picture
Joined: 08/22/06
Posts: 6561

I do not believe this website to be pro-life.

http://www.prochoice.org/about_abortion/facts/women_who.html

Marital Status
Most women getting abortions (83%) are unmarried; 67% have never married, and 16% are separated, divorced, or widowed.4 Married women are significantly less likely than unmarried women to resolve unintended pregnancies through abortion.6

Joined: 08/17/04
Posts: 2226

"AlyssaEimers" wrote:

This thought process really shocks me. I can accept you saying not to stigmatize gay people or drinking because that really only affects the person doing it, and when it comes right down to it, I don't care that much. Let's think about what is happening when someone has an abortion. A tiny life is being terminated and even though it is currently legal, that is still something the woman should think long and hard about first. It should not (Nor do I think it most often is) be made on a wim. I can not believe it does not affect a person to once carry a life, terminate it and at the very least not feel sad about what has happened.

Of all the people I know who have had an abortion it was a well thought decision and not made on a whim. Being told that you are you awful, a sinner, dirty, a tramp etc because you are going to have one or have had one is the stigma.

Joined: 03/14/09
Posts: 624

"AlyssaEimers" wrote:

I think it is a good thing for a doctor to talk to their patient about any potential consequences of their actions. My doctor tells me that if I do not loose weight, I could become a diabetic. Not a scare tactic. Just fact. I do not see how this is different.

Does your doctor also mention that weight loss has very scary consequences for your health, including decreasing the length of your life, increasing your chance of diabetes, heart problems, and many others? There are a number of studies on it. But doctors are just as susceptible to cultural bias as anyone else.

For me to believe that *abortion* is a cause of higher suicide rates, I would have to see a study performed in a country without stigmatization. I would hazard a guess that it is not abortion, but religious treatment of the topic. I'd like to see a study comparing suicide rates of women who have had abortions who are not religious (actually, Christian) and were not raised religious (Christian), compared with those in religious communities that demonize abortions, and those in countries where Christianity is not present to see if the same results occur. I doubt they would.

AlyssaEimers's picture
Joined: 08/22/06
Posts: 6561

"Jessica80" wrote:

Being told that you are you awful, a sinner, dirty, a tramp etc because you are going to have one or have had one is the stigma.

I believe abortion is a horrible thing that should never have become legal. That said, someone who has received an abortion has suffered a great loss and should be treated with love and kindness. They should receive good medical care (Not waiting hours to go to the hospital), and a good support system. Someone should be making sure they are ok and understand what they are doing.

AlyssaEimers's picture
Joined: 08/22/06
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"blather" wrote:

For me to believe that *abortion* is a cause of higher suicide rates, I would have to see a study performed in a country without stigmatization. I would hazard a guess that it is not abortion, but religious treatment of the topic. I'd like to see a study comparing suicide rates of women who have had abortions who are not religious (actually, Christian) and were not raised religious (Christian), compared with those in religious communities that demonize abortions, and those in countries where Christianity is not present to see if the same results occur. I doubt they would.

Is it possible that the reason the suicide rate could be higher for people who have had an abortion is that while yes, some people who have had an abortion are married with other kids and happy with their choice, there are others who felt they did not have a choice? Alone, pregnant, with no one to turn to. Feeling like they had no choice but to abort their baby. It is only logical (and unfortunate) that it could depress some people enough to commit suicide and there for the numbers would be higher for those people.

Joined: 03/14/09
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"AlyssaEimers" wrote:

Is it possible that the reason the suicide rate could be higher for people who have had an abortion is that while yes, some people who have had an abortion are married with other kids and happy with their choice, there are others who felt they did not have a choice? Alone, pregnant, with no one to turn to. Feeling like they had no choice but to abort their baby. It is only logical (and unfortunate) that it could depress some people enough to commit suicide and there for the numbers would be higher for those people.

Sure. Just like the woman could be depressed from a rape that induced the pregnancy or the stress of wanting an abortion but living in a US country where the procedure is not offered. Lots of reasons. But I haven't even seen an acceptable study showing that women who abort do attempt or commit suicide at higher rates, so it's not really something I can speculate on.

Joined: 05/23/12
Posts: 680

I believe that women should be informed as part of standard protocol just like during the times when I've given birth or during my prenatal appointments they sometimes assess with a survey etc.. I don't think she should be scared or warned - just informed, during an informational session in some sort of counseling session before the abortion is preformed. I think this would be much more empowering so at least the woman would know to possibly look out for any symptoms of depression or suicidal ideation etc and where she can go in case she feels anything concerning. That's it.. nothing scary but yes informative.

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"AlyssaEimers" wrote:

. . . someone who has received an abortion has suffered a great loss and should be treated with love and kindness. They should receive good medical care (Not waiting hours to go to the hospital), and a good support system. Someone should be making sure they are ok and understand what they are doing.

I agree with this. (I had to cut off the first part because I don't agree it shouldn't be legal, but I do think it's a terrible thing.) I don't think they should be warned that "going through with the procedure" increases a suicide risk, the logic behind that one seems spotty at best. But they should be warned that they are likely to have emotional/psychological repercussions they may not be expecting, and they should be offered support, counseling, etc. if they want it. I have known several women who've gone through it and it was easy for none of them. Some were married, some weren't, some had kids before & after, some didn't. All were devastated even when they felt it was the right choice for them.

So I like the idea of counseling & support and acknowledgment of the effects, but not the suicide scare tactics. I think telling someone who has come in to get an abortion that going through with it will make her suicidal is incorrect and reeks of an agenda.

mom3girls's picture
Joined: 01/09/07
Posts: 1535

I believe they should be told the statistics and data that show the higher suicide rate, doctors have a responsibility for their patients. Woman can choose to still receive the procedure, but if even 1 woman is monitoring her mental health more closely after her abortion then it is worth it.