A while ago on the Abortion.com Facebook page I saw the following comment: “I guess pro-choice people don’t think twice about stabbing a baby in the head …  that has taken a breath! Or even twisting their heads off!” It got me thinking: how does one combat this level of ignorance? Then the deeper implication: how can there ever be real dialogue in the abortion debate when such ignorance is so commonplace? The answer, I hope, is that by injecting critical thinking and evidence into a dialogue so lacking in either, I can change that trend.

My name is Heather Cale, and I care about this topic because as a medical student, I want abortion to be treated like any other medical matter: in an evidence-based manner. I consider myself strongly pro-choice, but that alone does not determine the extent of my views. Abortion is investigated as rigorously as any other medical procedure; that means it is my responsibility as a future physician to analyze the data objectively, and not through the lens of my personal views.

So far, most relevant evidence strongly supports continued access to abortion, including that restrictive abortion laws are not associated with lower rates of abortion, but are associated with much higher maternal mortality and morbidity rates. However, not enough research has been conducted in some important areas. For instance, a widely touted JAMA systematic review on fetal pain concluded that fetuses most likely become pain-capable somewhere in the third trimester, but admitted the evidence is limited and inconclusive. Newer evidence indicates it may also incorrectly assume that requirements for pain perception are identical for fetal and adult brains.

Unfortunately, abortion has become so politicized that many on either side either completely disregard any evidence that doesn’t further their own agendas, or even manipulate evidence to fit their beliefs. This attitude is exemplified by organizations like WECARE. Most people are unaware of WECARE, but Priscilla Coleman, its Director, is the author of a large percentage of articles that purport to find negative associations with abortion even where none exist. In 2009, she published a headline-making study purporting to link abortion to “anxiety, mood, and substance abuse disorders.” The study was then thoroughly debunked by UCSF’s Julia Steinberg, who showed that Coleman’s results could not be duplicated, and her methodology, among other egregious errors, failed to control for prior mental health and violence experiences. The journal that published both the original article and its critique even offered a commentary agreeing with the merit of the latter and stating that Coleman’s paper “does not support assertions that abortions led to psychopathology.”

ImageFlawed, debunked, or superseded evidence then becomes perpetuated by professional medical organizations with definitive religiopolitical stances (like the Christian Medical & Dental Associations) in a vicious trickle-down cycle. The CMDA continues to publicize articles incorrectly linking abortion with breast cancer or mental health disorders (Coleman is the author of many) while completely ignoring any opposing evidence that defeats those stances. These studies are also perpetuated in so-called “Crisis Pregnancy Centers,” where workers routinely give pregnant women scientific misinformation in an attempt to dissuade them from choosing to abort. Finally, the spread of misinformation ends with the public and political sphere. That single debunked study by Coleman alone was, according to a piece in the New York Times, “[responsible] for ‘informed consent’ laws in at least eight states.” Is it any wonder, then, that ignorance abounds in the abortion debate? Image

Science is not liberal or conservative; it is objective or non-objective, evidence-based or not. Science doesn’t work by deciding the validity of a source based on its conclusion rather than the evidence which supports it, or by manipulating evidence to fit a decided conclusion. I can understand what cements this rigid unwillingness to consider evidence that doesn’t help one’s political cause: the fear of giving up hard-fought-for victories to a political enemy. That fear isn’t just limited to the pro-life side, either.

However, in a debate so riddled with religious fervor and emotional rhetoric, rationality must be the path forward, and that means both sides must at least be willing to recognize evidence that may not aid their “cause.” Here is where I hope to instigate some change: to see abortion treated as a medical procedure with deep-running bioethical considerations rather than a billboard slogan, to see evidence considered on its own merits rather than its political implications. In short, I hope to bring logic back to a debate overrun with emotion, religion, and politics. Wish me luck.

 

 

For the much touted 2005 JAMA review on fetal pain indicating it most likely begins in the third trimester: http://jama.jamanetwork.com/article.aspx?articleid=201429

 

For one of multiple related articles indicating that fetal brains may be capable of primitive pain sensation that does not require thalamocortical circuits related to pain perception: http://www.ncbi.nlm.nih.gov/pubmed/17905181

 

For some heavier reading detailing the connection between unsafe abortion and maternal morbidity and mortality, try the most recent edition of “Unsafe Abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008” by the World Health Organization: http://www.who.int/reproductivehealth/publications/unsafe_abortion/9789241501118/en/index.html

 

For more on how rates of abortion are estimated to be comparable in countries where it is legal and illegal, but there are much higher rates of unsafe abortion (and 97% of associated deaths) where it is illegal, see “Induced abortion: estimated rates and trends worldwide.” http://media.mcclatchydc.com/smedia/2007/10/17/13/Chang-Guttmacher_Institute_abortion_report.source.prod_affiliate.91.pdf

 

For more on the New York Times piece citing the states in which Coleman’s study was used as the basis for informed consent laws: http://takingnote.blogs.nytimes.com/2012/03/14/remember-that-study-saying-abortion-makes-you-crazy/

 

For more on Coleman’s paper in the Journal of Psychiatric Research, Steinberg’s analysis, and the journal’s commentary, see: http://healthland.time.com/2012/03/08/study-linking-abortion-to-mental-health-problems-is-flawed/