At the center of the latest fight over access to abortion is a federal judge

statement that quotes

concerns about the mental health of women who choose to terminate their pregnancies.

In withdrawing regulatory approval for the widely used drug mifepristone, U.S. District Judge Matthew Kacsmaryk said the Food and Drug Administration had not studied the psychological effects of its use and ruled that it should be removed from shelves while the drug agency conducts an extensive conducted an evaluation of the pills safety.

In response to his ruling, a federal appeals court issued a response late Wednesday night

maintain access to mifepristone

but only for a maximum of seven weeks of pregnancy and not by post.

Given the intense psychological trauma and post-traumatic stress women often experience from chemical abortion, Kacsmaryk wrote, the FDA’s omission will undoubtedly cause lasting harm to women who take the pill.

On a deeply personal topic like abortion, the balance of risks and benefits varies for every pregnant woman considering one. But the aggregated impact of abortions on the mental health of women who have terminated their pregnancies has been studied extensively, and the most rigorous research does not support Kacsmaryk’s claims.

Differences in study design, the limits of available data, and researchers’ political leanings have led to a range of findings that encourage cherry-picking. That, critics argue, is what Kacsmaryk did, citing a strange assortment of studies to bolster his views.

With so much excellent science on abortion and mental health, it’s a mystery to me why that research wasn’t used in the judge’s decision, said Julia R. Steinberg, a professor of family sciences at the University of Maryland who is the studies the interplay between reproductive and mental health. .

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Indeed, several of the studies Kacsmaryk highlighted have been widely criticized for flawed methodology.

Among them was a 2011 review of studies that said women who had abortions had an 81% increased risk of mental health problems, with nearly 10% directly attributable to their procedures. Since its publication in the British Journal of Psychiatry, no less than 11 published critics have questioned these findings by pointing to a slew of “fatal flaws.” They noted that half of the 22 papers included in the analysis were self-conducted by the author, a serious conflict of interest, while several relevant studies by other researchers were omitted from the analysis. Critics also pointed to statistical errors that falsely implied a causal relationship between abortion and mental health problems.

Kacsmaryk also cited a 2002 study written by David C. Reardon, an associate scholar at the Charlotte Lozier Institute, an anti-abortion organization. That study combined Medicaid records from low-income women in California and found that for eight years, suicide rates among women who had an abortion in 1989 were 2.5 times higher than among women who had babies that year.

Critics have accused such medical record studies of drawing a direct line between abortion and suicide without considering other factors that might explain the relationship. Because Medicaid records are incomplete, studies using them fail to account for the effects of poverty, domestic violence, and pre-existing mental health conditions, all of which can contribute to unwanted pregnancies and abortions. They are also all risk factors for suicide.

In addition, many such studies compare the mental health of women seeking abortions with women completing desired pregnancies in two very different populations.

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In an interview, Reardon said 11 studies have found increased short-term mortality rates in women who have had abortions. Such evidence should be reviewed by the FDA, he said.

I realize this is highly controversial, Reardon said. But he defended his findings, saying he’s not claiming abortion is the sole cause of increased death rates.

These outcomes have multiple causal factors, said Reardon, who also directs the anti-abortion Elliot Institute. But abortion is a factor.

In his 67-page statement, Kacsmaryk drew on a published “case study” of women who anonymously shared their regrets on an Internet site devoted to “abortion healing.” And he repeatedly referred to a 2001 study that found ways to reduce patient discomfort in UK abortion facilities. That report found that 56% of women who had an abortion believed they had seen the aborted fetus during the procedure, an event that can be distressing, bring out the reality of the event and affect emotional adjustment later, it said. the authors.

This observation led Kacsmaryk to warn that women who have aborted a child, especially through chemical abortion drugs that require her to see her aborted child once it has died, often experience shame, regret, anxiety, depression, substance abuse, and suicidal thoughts because of the abortion .

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Much of the research cited by Kacsmaryk was published decades ago, apparently supporting his argument that the FDA could have considered it when evaluating mifespristone. But other studies available at the time could have led the FDA to conclude that a close scrutiny of abortions

effect

on the psyche of women was not necessary.

A comprehensive review conducted by the American Psychological Ass

N.

concluded in 1989, for example, that serious adverse reactions to legal, non-restrictive first-trimester abortion are rare and best understood in the context of coping with normal life stresses. Some women experience severe anxiety or mental illness

anus

abortion, the APA team wrote, but

It

cautioned that a causal relationship was not clear.

Ten years later, an APA taskforce expanded on that conclusion. The majority of adult women who terminate a pregnancy have no mental health problems, the members wrote. Citing a 2000 study of post-abortion women’s mental health, the task force said those who experience depression, anxiety and regret are most often women with a history of depression.

Researchers at UC San Francisco have begun an effort to conduct more thorough research into women’s mental and physical health after they’ve had an abortion. Funded by grants from private philanthropies, including the David and Lucile Packard Foundation and the William and Flora Hewlett Foundation, the Turnaway Study recruited about 1,000 women who had sought care from 2008 to 2010 at 30 abortion centers in 21 states across the country.

The researchers made it a point to compare women in similar circumstances with an unwanted pregnancy, but whose trajectories were different. Some got the abortion they wanted, others were rejected because their pregnancies were too advanced to be terminated in the clinic. Some of these women had abortions elsewhere. Unless they miscarried, the rest carried their pregnancies to term.

Whatever their circumstances, the women answered questions about their physical and mental health, experiences and intentions to have children, histories of traumatic life events, and a host of other biographical details. Until 2016, those interviews were repeated every six months for five years.

The resulting wealth of data has yielded 52 published studies that allowed for direct comparisons between women who had abortions and those who gave birth.

On Ed: I wanted to terminate my pregnancy. But the anti-abortion policy filled me with self-doubt

Collectively, those studies tell a story of women undergoing abortions who were initially shocked by their ordeal but were no longer depressed or anxious five years later.

That

who completed an unwanted pregnancy. After five years, 95% of women who terminated an unwanted pregnancy felt confident that they had made the right choice. And women who had abortions were no more likely to consider suicide than those who went to term.

In fact, recent research from the Turnaway Study suggests that it is not so much whether a woman terminates or consummates an unwanted pregnancy that predicts whether she will suffer from mental health problems in the next two years. An important predictor of whether a woman seeking abortion develops depression or anxiety is whether she perceives stigma around abortion in her family and community.

We’ve long lived in an environment that shames women for wanting health care, and I worry that the current political environment will only increase people’s shame for wanting an abortion, said study leader M. Antonia Biggs, a researcher at the field of reproductive health at UC

san francisco

.

Women who fear others might think less of them may not dare to seek support, Biggs added. The isolation of hiding such a decision can last a very long time, and internalizing feelings of shame can have an impact on your mental health.