News Abortion

Study: Having An Abortion Does Not Increase Risk of Mental Health Problems, Unwanted Pregnancy Does

Jodi Jacobson

The world's largest, most comprehensive and systematic review of mental health outcomes and abortion care shows abortion does not increase the risk of mental health problems, but unwanted pregnancy does. The results led to a British medical journal calling for reversal of the recent HHS decision to deny young women access to emergency contraception.

See all our coverage of the Administration’s 2011 Emergency Contraception Reversal here.

Last week, the UK Academy of Medical Royal Colleges (AMRC), published the world’s largest, most comprehensive and systematic review of mental health outcomes and abortion care. The review included 44 high-quality studies done in developed countries and published between 1990 and 2011.

The conclusion? Having an abortion does not increase the risk of mental health problems. “The best current evidence,” according to the Academy, “suggests that it makes no difference to a woman’s mental health whether she chooses to have an abortion or to continue with the pregnancy.”

A commentary on the study published in the December 17th of the British Medical Journal, The Lancet notes:  “Past studies on the effect of an induced abortion on mental health have been mixed in terms of their quality, findings, and interpretation. Some have shown no harm while others have found associations with mental disorders.”

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Last week, the world’s largest, on mental health outcomes of abortion was published by the UK Academy of Medical Royal Colleges (AMRC). The review claimed to provide a definitive answer: having an abortion does not increase the risk of mental health problems.

According to the Academy’s own statement, the review’s Steering Group and the National Collaborating Centre for Mental Health (NCCMH) at the Royal College of Psychiatrists (NCCMH) “carried out a systematic and comprehensive search of the literature and identified 180 potentially relevant studies published between 1990 and 2011.”

The Steering Group was careful to ensure only the best quality evidence was used, so all studies were subject to multiple quality assessments. In total, 44 papers were included in the review.

 On the basis of the best evidence available, the Steering Group concluded that:

  • Having an unwanted pregnancy is associated with an increased risk of mental health problems. However, the rates of mental health problems for women with an unwanted pregnancy are the same, whether they have an abortion or give birth.
  • The most reliable predictor of post-abortion mental health problems is having a history of mental health problems. In other words, women who have had mental health problems before the abortion are at greater risk of mental health problems after the abortion.
  • Some other factors may be associated with increased rates of post-abortion mental health problems, such as a woman having a negative attitude towards abortions in general, being under pressure from her partner to have an abortion, or experiencing other stressful life events.

The Steering Group recommends that future practice and research should focus on supporting all women who have an unwanted pregnancy.

These results, said The Lancet, “should guide care and advice for women with unwanted pregnancies who need mental health support whatever the resolution of their pregnancy.”

Prevention of unwanted pregnancies is also crucial through education and the provision of contraception. But women still face barriers to accessing these services.

Last week, continued The Lancet, “US Health and Human Services Secretary Kathleen Sebelius vetoed the Food and Drug Administration’s recommendation to make the emergency contraceptive pill, Plan B, available without prescription to all women of childbearing age in the USA. Plan B will not be available without prescription to girls 16 years or younger under the ruling.”

The AMRC’s findings show that Sebelius’s decision is an assault on the mental health of women as well as their reproductive rights. It should be reversed.

We could not agree more.

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Follow Jodi Jacobson on Twitter:  @jljacobson

News Human Rights

ACLU Report: California Jails Denying Reproductive Health Care

Nicole Knight

Interviews with one jail administrator indicated that jail staff would encourage women with multiple children or those with chemical dependencies to have an abortion.

Incarcerated California women are denied abortion services, prenatal care, and even menstrual pads, according to a scathing American Civil Liberties Union (ACLU) of California report released Tuesday that finds some county jails deny, delay, and ignore prisoners’ reproductive health care.

The 36-page report—the product of jailhouse interviews, a review of complaints and jail policies, and public records requests at five county jails—issues a sweeping call for reform of practices that the organization says jeopardize the reproductive health of incarcerated people.

“Jails are putting people’s health at risk by denying, delaying, and ignoring crucial reproductive health care,” Melissa Goodman, one of the report’s authors and director of the LGBTQ, Gender & Reproductive Justice Project at the ACLU of Southern California, told Rewire in an interview. A jail has “a legal obligation to provide medical care to the people it incarcerates, but sadly that often ignores reproductive health,” Goodman continued.

Two years in the making, the report identifies coercive practices, such as forced pregnancy tests, and wide-ranging problems in timely, lawful access to reproductive health care, including:

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  • Delayed and denied abortion access: Some county jails draw inappropriate distinctions between “elective” and “medically necessary” abortions, and others even have illegal policies against “elective” termination procedures. One county’s policy required a mental health clearance before a woman could obtain an abortion. One woman interviewed by the ACLU had to wait two months for an abortion, despite repeated requests. The jail told her she had to prove she could pay for the procedure before she could get it, she said, which is illegal.
  • Influencing abortion access: Interviews with one jail administrator indicated that jail staff would encourage certain women—those with multiple children or those with chemical dependencies—to have an abortion.
  • Dangerous conditions for pregnant inmates: Pregnant inmates were denied prenatal and emergency visits with medical staff and were shackled while pregnant, a practice California outlawed in 2012. One pregnant woman, suffering intense abdominal pain, was seen at a jail clinic, where nurses failed to find a fetal heartbeat. The woman, who was sent back to her cell because an OB-GYN wasn’t available to perform an ultrasound, said, “I was really scared because I didn’t know what was going on and I started getting more depressed as time went by because I didn’t know if my baby was alive or dead.”
  • Lack of accommodations for nursing inmates: Most lactating parents were unable to pump breast milk or provide it to their child. One nursing woman reported that her infant developed bronchitis because the jail wouldn’t let her pump milk for the child. Lactation is subject to a confusing mishmash of policies. One county assessed in the report allows postpartum women with less than two weeks on their sentence to pump milk in order to maintain lactation, but women with more than two weeks left on their sentence are not allowed to pump. These women are instead taught to “suppress lactation” and given a tight bra to minimize discomfort from engorged breasts.
  • Shortage of menstrual supplies: Many jails’ supplies of menstrual pads are insufficient. One former inmate reported that in one jail’s solitary confinement, people were not given any sanitary products and were forced to bleed on the floor.
  • Lack of safeguards for LGBTQ people: The vast majority of transgender women are still automatically placed in male housing locations despite the serious safety risks, violence, and increased isolation they encounter there.
  • Poor tracking of sexual assault: Two of the five counties surveyed did not track the number of people who had experienced sexual assault in custody.

The report calls for a variety of reforms, such as new reproductive health care and sexual assault policies based on medical best practices, and ones that address the transgender community.

The report urges the abolition of jailhouse policies that limit reproductive health care to cisgender women, or women whose gender identity matches their biological sex at birth. Other recommendations include addressing the fact that incarcerated transgender women are at a heightened risk for sexual assault, and providing menstruation pads to all people who need them, regardless of gender identity or whether the person is housed in a men’s or women’s jail.

To accompany the report, Goodman said the ACLU has released a tool, which includes model policy language, to help jails enact and follow policies in keeping with state law and medical standards.

“At the end of the day, the message we have for jails is reform is important, legally necessary, and feasible,” Goodman said, citing reforms enacted in Los Angeles County jails following a 2012 analysis by the ACLU. She said these jails made widespread reforms and now allow family members to pick up pumped breast milk, and are considering a doula program.

Commentary Law and Policy

The New McCarthyites: Lists, Lies, and the GOP’s Attacks on Women’s Health Care

Jodi Jacobson

McCarthyism is defined in the dictionary as the practice of making accusations unsupported by proof or based on slight, doubtful, or irrelevant evidence, and the practice of making unfair allegations or using unfair investigative techniques especially in order to restrict dissent or political criticism. I'd say today's radicalized GOP has them both down pat.

Watching last Tuesday’s congressional hearing on Planned Parenthood by the House of Representatives Oversight and Government Reform Committee felt less like viewing a bona fide hearing in the sense of fact-finding or rational questioning by capable public servants on issues of public import than it did, variously, like witnessing an inquisition, a series of performances in theater of the absurd, and raising Joe McCarthy from the dead.

Ostensibly, these hearings were called to investigate claims by an anti-choice group known as the Center for Medical Progress (CMP) that Planned Parenthood was profiting from the sale of fetal tissue. This in turn gave House Republicans a reason to call for “defunding” Planned Parenthood. But there has never been any actual evidence offered by CMP or anyone else to support the charges of profits from the sale of fetal tissue, which is widely used in critical health research and has long been regulated under federal law. No evidence was offered at the hearing either. None of the congresspeople had seen the full, unedited versions of these videos, which have yet to be publicly released by CMP, though they’d had months to ask for them. In fact, that same day, Missouri became the sixth in a list of states that have wasted taxpayer money on investigations that found the claims to be baseless. (Never mind that the Missouri Planned Parenthood clinic does not even offer fetal tissue donation, but you know, let’s investigate anyway.)

The sale of fetal tissue isn’t and never really was the point of this hearing nor in fact of the videos themselves. Rather this attack is yet another salvo in a very long, large, and well-organized campaign to destroy the single largest provider of reproductive and sexual health care in the United States. As noted by CMP founder David Daleiden in an interview with Politicohis agenda is to bring down Planned Parenthood by any means possible. Because after all, why worry about the lives and health of the three million people a year who get services at Planned Parenthood clinics when you have political points to score and a reputation to make.

But hearings were of course held anyway, because if there is anything the GOP hates more than gun regulations and immigrants, it’s the ability of women to get access to health care whether it be contraception, abortion, testing and treatment for sexually transmitted infections, or breast exams.

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Cecile Richards, president of the Planned Parenthood Federation of America (PPFA), appeared at the hearing voluntarily, but that did not prevent her from having to take five hours of abuse. Watching in real time, I quickly understood there were three reasons for this hearing. One was to try as much as possible to humiliate Richards, who, apart from being a political force in her own right, is also the daughter of former Texas Democratic Gov. Ann Richards, a Democrat herself, a former chief of staff for Nancy Pelosi, and the head of both a powerful health-care provider and a powerful political action committee. Attacking Richards covers a lot of bases for right-wing hate-mongers. Several House members appeared committed to doing anything possible to trip Richards up such that she said something, anything, they could perhaps later use as fodder for campaign ads and another round of attacks.

A second reason appeared to be to further obfuscate the issue of funding for reproductive health care such that the GOP could find “better” uses for that money.

Finally, and most insidiously, taking a page right out of the playbook of Sen. Joseph McCarthy, this hearing was about taking names and getting lists of providers, of clinics, of staff people and even of organizations providing family planning services abroad for the purposes of harassing and stigmatizing them, if not more.

The most aggressive tactics apparently meant to humiliate or trap Richards were used by Congressmen Trey Gowdy (R-SC) and Jim Jordan (R-OH). As the following videos show, they each asked leading questions of Richards, and, before she could even begin to reply they interrupted, answered for her, and then twisted what she had managed to say in reply. In fact, throughout the hearing, GOP congresspersons asked convoluted questions only to cut Richards off any time she tried to respond.

Gowdy didn’t bother with questions about fetal tissue, body parts, or funding. Instead he ran off the rails with irrelevant questions about whether or not Richards understood “how some of us may at a base level disagree with you on the origin of life?” He then went on to badger her about her opinions on abortion and on so-called partial birth abortion, neither of which were relevant to the stated purposes of the hearing and the latter of which does not exist.

Jordan focused on a Planned Parenthood video featuring Richards and made in response to the first release by CMP. He badgered Richards about this video, without allowing her to reply.

The effort to confuse the public around funding for Planned Parenthood was at first raised obliquely by House committee chairman Jason Chaffetz. He opened the hearing with a tearful though disconnected story about his personal family losses from cancer. Chaffetz said:

This is an important topic. The risk of getting a little—a little personal. My wife, Julie and I have been married some 24 years. Have our 25th wedding anniversary coming up in February.  I’m proud of my wife. She… she got her degree in psychology later in life after helping to raise three kids, some are still at home. She has just started to work [with] a plastic surgeon [who is] involved in helping women who are having to have their breast removed. And my wife (inaudible) helping these women. And I’m proud of her for doing that.

My mother—she passed away when I was 28 years old. She fought cancer for more than 10 years. She had breast cancer. And I miss her.  I lost my—I lost my father to cancer as well. Cancer, in this country, kills about 1,500 people a day. A day. And yet, our federal government only spends about $5 billion to fight it. If they were shooting 1,500 people a day, if there were rockets coming—we would be fighting this with everything we have got.

Then, Chaffetz continued:

And as I said before I came to Congress and I’m saying here today, as fiscally conservative as I can possibly be, we don’t spend enough on cancer. We don’t spend enough. We need to spend more. I would quadruple the amount of money if I had my chance to fight cancer and win. And the reason I’m passionate about the hearing today is we got a lot of health care providers, who, I think, in their hearts know that they’re trying to provide good.

The question before us is, does this organization—does Planned Parenthood really need federal subsidy? Does it need federal dollars? Every time we spend a federal dollar, what we’re doing is pulling money out of somebody’s pocket and we’re giving it to somebody else. What I don’t like, what I don’t want to tolerate, what I don’t want to become numb to is wasting those taxpayer dollars.

It is not at all unusual for congresspeople to use personal stories in hearings. Normally, however, such stories are relevant to the subject of the hearing itself. Cancer research was not relevant. It is funded through the National Institutes of Health, the budget of which was cut by Republicans in March of this year.

This hearing was about the federal funds that support services delivered by Planned Parenthood, which come through two avenues, either reimbursement of services for patients who qualify for Medicaid, or through funding to support Title X family planning services. To suggest funds for cancer research have anything to do with funding for these services reveals either that Chaffetz did not know his facts, or he was playing on sympathy as a guise for suggesting there was a choice to be made between the two. In the same way that the GOP either truly does not get it or purposefully misunderstands the actual process women go through to get mammograms (first a primary caregiver provides a referral, then you go to a radiologist), they seem bent on pretending that switching funds from Planned Parenthood to other purposes is a better use of money. We’ll have to watch for these comparisons to be made later.

But what was perhaps the most insidious aspect of the hearing were the “lists.” As the hours wore on, there were repeated requests for Richards to send the committee lists of everything from the organizations to which Planned Parenthood provides funding overseas to the names and contact info for clinics and providers. In the 1950s, former Sen. Joe McCarthy touted lists he claimed proved communists had infiltrated the U.S. government. He used those purported lists (which did not actually exist) to create fear and intimidate people throughout the country, and to haul them in front of Congressional committees. He ruined many lives. And it appears his spirit lives on in the contemporary GOP now in power.

Reproductive health providers know about lists. A number of organizations in the anti-choice movement have been known to make and publish lists online, including the names of doctors and service providers of abortion care, the names and addresses of clinics, and the home addresses of those who work at clinics. These lists are used to intimidate, target, follow, and sometimes harm or murder abortion providers and staff. Some state attorneys general have tried to use their power to obtain the records of women who have had abortions, and in at least one case, that of former Kansas State Attorney General Phill Kline, information gathered by his office was shared publicly and with anti-choice groups. And now, since CMP released its videos, there have been a number of attacks on clinics throughout the country.

Chaffetz started taking names and making lists almost immediately. He began with a question about the Democratic Republic of Congo (yes, you read that right, straight from fetal tissue to the DRC):

CHAFFETZ: Ms. Richards, Planned Parenthood has sent 32-plus million dollars in grants overseas. Does any of the funds go to the Democratic Republican of the Congo?

RICHARDS: Congressman, let me…

CHAFFETZ: No, no, no. We don’t have time for a narrative. I just want to know…

(CROSSTALK)

CHAFFETZ: Yes or no.

RICHARDS: You asked me a question. Any of the money that is — Planned Parenthood raises and is given by foundations and individuals to support family planning services is in Africa and Latin America, and they go to individual organizations.

I’m happy to provide you a list of those organizations, but I did not bring them with me.

CHAFFETZ: If you could give us a list of those organizations.

Chaffetz then asked for a list of Planned Parenthood’s “ownership in foreign companies,” a somewhat strange request to a nonprofit, but…

CHAFFETZ: Does Planned Parenthood have any ownership in foreign companies?

RICHARDS: I don’t believe so. I don’t know what you mean by ownership.

CHAFFETZ: Well, in your 2013 tax return, it lists $3.3 million marked as, quote, “investment,” unquote in Central America and the Caribbean. I’m just asking if that investment was an actual investment?

RICHARDS: We don’t own anything in those countries. What…

CHAFFETZ: OK. Let me keep going. I have to keep going. I need to — I would appreciate a list. You have been very cooperative so far.

Congresswoman Cynthia Lummis (R-WY) picked up this thread by asking for a list of affiliates that “receive the majority of their revenue from abortion.” Lummis insinuated that there must be something wrong with Planned Parenthood’s data on the share of services for abortion, given revenues from abortion appear higher than those from other services. Her line of questioning was wholly misleading. Surgical abortion is more costly than other services, and those services are not reimbursable by Medicaid or other government funds, so the revenue stream is not relevant to the share of services provided. It’s like asking a dentist why she brings in more money for root canals than teeth cleanings.

Chaffetz, however, did not want to let that point go by, and so he reiterated the request when Lummis was done. “[A]s a point of clarification, Ms. Richards, I want to make sure there’s no ambiguity here. The gentlewoman from Wyoming asked for a listing of affiliates where the majority of revenue comes from abortion services. You said you’d talk to your team. Will you actually provide us that list?”

Like Joseph McCarthy, GOP members of the hearing panel then went on to suggest some sort of guilt by association with President Obama and the Department of Justice.

JORDAN: Since the videos have surfaced have you had any conversations with the President of the United States?

RICHARDS: No I have not.

JORDAN: Since the videos have surfaced have you been to the White House?

RICHARDS: No I have not.

JORDAN: How many times have you been to the White House?

RICHARDS: During what period of time?

JORDAN: Since Mr. Obama’s been president.

RICHARDS: I don’t know that’s been I think seven years, so I would have to get back to you on that.

JORDAN: Our count shows that you, your board members and senior staff have been to the White House 151 times in six and a half years. I’m just curious, that’s why I ask the question if you’ve been to the White House or you talked to the President since these videos have surfaced?

RICHARDS: And I said I have not.

JORDAN: And you’ll get back with me on if the Justice Department has contacted you since these videos have surfaced?

RICHARDS: Well I think you listed several folks, so I’m happy to work with the committee and find out what all you need to know.

JORDAN: CMS, HHS, Inspector General, Justice Department; Justice Department’s the most important.

Was President Obama featured in the CMP videos? I don’t think so either.

Chaffetz then once again stepped in and reiterated the list of lists being requested, and added a couple more.

CHAFFETZ: We are looking for the amount of revenue by affiliate for abortion services. So you have the — that should be pretty straightforward. We would like to know which affiliate provides which services.

RICHARDS: I believe you have that, but we’re happy to provide that.

CHAFFETZ: We’re still—we want to make sure we’ve it crystal. I think we have portions of it, but we don’t have all of it.

RICHARDS: OK.

CHAFFETZ: The names of organizations and the countries that Planned Parenthood gives funds to overseas. So based on the tax returns and reports, you’re sending money to overseas. Some of them have been listed as investments, so as other things, we’d like to get some details and specificity as to how much is going to which country and what those are for. Is that fair?

RICHARDS: I really have to talk to my team about that but I will.

And:

CHAFFETZ: We obviously, have some concerns about the Planned Parenthood Action Fund. So we’re trying to get to the duties performed and compensation received for all Planned Parenthood or affiliate employees. This could either by for the Planned Parenthood Action Fund or for either of the — I believe there are two, 5207 organizations. One of our concerns, is that the shared services and the sharing of employees between political actives and non-political activities and we would like to understand how broad based that is.

CHAFFETZ: [And] the cost of reimbursement for both contraception, and abortion, and abortion obviously breaks down into in clinic as well as the pill.

RICHARDS: Actually, there’s a lot of kinds of contraception too.

CHAFFETZ: Yes, contraception, I left it as broad as I could. But for the abortion services…

RICHARDS: I’m just saying, I think it’s important, I’m not sure we got into much of that conversation about how birth control—how many different kinds of birth control there are now because that’s one of our specialties.

CHAFFETZ: Help us understand and what services and money you’re allocated and what the costs of that are. There were some points that should be helping to drive down those costs and we’re just not understanding the ratio…

RICHARDS: That’s why…

CHAFFETZ: It needs clarification. I’m not asking…

RICHARDS: It was clear that folks weren’t aware of the various costs of different kind of contraceptions..

CHAFFETZ: Exactly, and that’s where we need help. Not right now, just as a follow up.

And:

CHAFFETZ: A list of political organizations, Planned Parenthood collarbones, including the names in compensation of received of shared employees.

I think I covered that in general, but I’ll keep going.

Yes, it seems they will keep going, as one means of spreading fear and intimidation.

There are two definitions of McCarthyism in the dictionary:

  • the practice of making accusations unsupported by proof or based on slight, doubtful, or irrelevant evidence.
  • the practice of making unfair allegations or using unfair investigative techniques especially in order to restrict dissent or political criticism.

I’d say today’s radicalized GOP has them both down pat.

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