In a decided and dangerous victory of politics over science, the 8th Circuit Court of Appeals on July 24 upheld a 2005 South Dakota law requiring physicians to advise women seeking abortions that they face an increased risk of suicide and suicidal thoughts if they obtain the procedure. Not only is this requirement unsupported by the evidence, it also continues and validates a deeply troubling trend under which states have enacted a range of misleading counseling requirements on the supposed physical and mental health risks of abortion designed to dissuade women from obtaining an abortion. Although these measures are labeled "informed consent" laws, they in fact undermine the fundamental ethical principle of informed consent by requiring health care providers to provide misinformation to their patients.

The court decision on the South Dakota law requiring that women be informed of their increased suicide risk should they obtain an abortion is contradicted by the overwhelming weight of the highest quality scientific evidence available:

• In December 2011, a systematic review commissioned and published by the Academy of Medical Royal Colleges (funded by the UK Department of Health, and carried out by the National Collaborating Centre for Mental Health at the Royal College of Psychiatrists) concluded that "rates of mental health problems for women with an unwanted pregnancy were the same whether they had an abortion or gave birth," that an "unwanted pregnancy was associated with an increased risk of mental health problems" and that the "most reliable predictor of post-abortion mental health problems was having a history of mental health problems before the abortion."
• An August 2008 report by the American Psychological Association (APA) Task Force on Mental Health and Abortion concluded that "the best scientific evidence indicates that the relative risk of mental health problems among adult women who have an unplanned pregnancy is no greater if they have an elective first-trimester abortion than if they deliver the pregnancy."
• A comprehensive review of the scientific literature, conducted in 2008 by researchers at Johns Hopkins University, likewise found that "the highest-quality research available does not support the hypothesis that abortion leads to long-term mental health problems." The Johns Hopkins review also found a "clear trend" by which "the highest quality studies had findings that were mostly neutral, suggesting few, if any, differences between women who had abortions and their respective comparison groups in terms of mental health sequelae. Conversely, studies with the most flawed methodology found negative mental health sequelae of abortion."

The court decision on the South Dakota law appears to rely heavily on the work of Priscilla Coleman, a professor of human development and family studies at Bowling Green University. However, Coleman's work has repeatedly come under strong criticism by respected members of the scientific community:

• In March 2012, researchers at the University of California, San Francisco and the Guttmacher Institute determined that a 2009 study by Coleman and colleagues purporting to show a causal link between abortion and subsequent mental health problems has fundamental analytical errors that render its conclusions invalid. Most egregiously, the study did not distinguish between mental health outcomes that occurred before abortions and those that occurred afterward, but still claimed to show a causal link between abortion and mental health disorders. Significantly, the editor of the journal in which the study was published, as well as the director of the data set used in the study, concluded in a journal commentary that "the Steinberg-Finer critique has considerable merit," that the Coleman paper utilized a "flawed" methodology and that "the Coleman et al. (2009) analysis does not support [the authors'] assertions."
• Similarly, a meta-analysis by Coleman and colleagues, published in 2011 in the British Journal of Psychiatry (BJP) has been strongly criticized for violating several established guidelines for conducting meta-analyses, failing to evaluate the quality of included studies, not adhering to its own exclusion and inclusion criteria, and including studies that did not adjust for prepregnancy mental health. "We strongly question the quality of this meta-analysis and its conclusions," researchers from the University of California, San Francisco, and Princeton University wrote in one such critique. "Here we detail seven errors of this meta-analysis and three significant shortcomings of the included studies because policy, practice and the public have been misinformed. These errors and shortcomings render the meta-analysis' conclusions invalid."

Laws such as South Dakota's, which are grounded in spurious research rather than the best-available scientific evidence, not only represent a gross intrusion into the doctor-patient relationship, they also endanger the health and rights of women, by intentionally misinforming them on important medical matters. It is highly unfortunate that, even when widely recognized as such within the scientific community, discredited studies can have far-reaching consequences.

For more information:

Study purporting to show link between abortion and mental health outcomes decisively debunked

How mandatory counseling laws turn the principle of informed consent on its head

State mandatory counseling requirements for abortion