by Martha Shuping
June 8, 2018
A study published recently in the American Journal of Psychiatry online claims that abortion does not increase the risk of suicide. If only that were true. The study by M. Antonia Biggs and colleagues (which I will refer to as “the Biggs study”) used data from the University of California San Francisco’s Turnaway Study. But the results are very questionable because they are inconsistent with many other studies, and the final results of this study are based on only 18 percent of the original sample.
The Turnaway Study was intended to provide a comparison between women who aborted and those unable to obtain an abortion due to waiting to come to the clinic until the pregnancy was too advanced (past the limits for the clinic chosen, or for their state). But only 38 percent of eligible women consented to participate in the research, with 15 percent of those dropping out before the first interview (see study). With further dropouts over the five years of the study, only 18 percent of the original sample remained—even though women received a $50 gift certificate for each telephone interview (see study).
The low participation rate and the additional dropouts make the results questionable, because it is well known that the most distressed individuals are more likely to avoid participating. This has been reported in research on abortion and other reproductive losses, and in more general trauma research.*
The Biggs study concluded that rates of suicidal ideation were comparably low in women who obtained abortions and those who were refused abortions. The authors further conclude that their results show that state laws requiring informed consent about suicide risk should be scrapped as unnecessary. But we lack information on 82 percent of the women who either declined to participate or dropped out. The results may be meaningless if those women included those who were most distressed.
In addition, the Biggs study contradicts a large body of research on suicide and abortion. A study from Finland published in the British Medical Journal linked medical records to death certificates, showing that women having abortions had a 650 percent increased risk of suicide compared to women who gave birth.
One of the highest quality studies of abortion and mental health was done by Donald Sullins of the Catholic University of America in 2016 using data from The National Longitudinal Study of Adolescent to Adult Health (“Add Health”) which was funded by 18 different federal agencies and which provided a nationally representative sample of 8,005 women, with 81 percent of the sample completing this 13-year longitudinal study. In his analysis, Sullins controlled for 13 different potential confounders, and showed increased suicidal ideation in the women who had abortions compared to those who completed pregnancies. In addition, Sullins showed that women having abortions had increased risk for a total of seven different mental health outcomes. The results were statistically significant.
The Biggs study is an outlier, giving results that are very different from the results of a number of high quality studies of suicide risk and abortion. The truth is, we have the words of actual women who have attempted or completed suicide. The British artist Emma Beck said in her 2007 suicide note: “I told everyone I didn’t want to do it, even at the hospital … now it is too late … I want to be with my babies.” The authors of the Biggs study show their political bias in their conclusion that women like Beck have no need to be warned about suicide risk before their abortion.
Martha Shuping, M.D., is a practicing psychiatrist who lives in Winston-Salem, N.C.
*Broen, A.N., Moum, T., Bødtker, A.S., & Ekeberg, Ø. (2005). The course of mental health after miscarriage and induced abortion: a longitudinal, five-year follow-up study. BMC Medicine, 3,18. doi: 10.1186/1741-7015-3-18. Retrieved from http://www.biomedcentral.com/1741-7015/3/18
Shuping, M. (2016). Counterpoint: Long-lasting distress after abortion. In R. MacNair (Ed.), Peace Psychology Perspectives on Abortion. Kansas City: Feminism and Nonviolence Studies Association.
Weisaeth, L. (1989). Importance of high response rates in traumatic stress research. Acta Psychiatrica Scandinavica Supplementum, 355, 131-137.