Members will hear testimony on the emotional and physical impact of abortion. Senator Brownback will preside.
Witness Panel 1
Reverend Dr. Roselyn Smith-Withers
Thank you for the opportunity to present testimony today on the important issue of the impact of abortion on women. I am Reverend Dr. Roselyn Smith-Withers, Co-Convener of the Clergy Advisory Committee of the Religious Coalition for Reproductive Choice (RCRC) and founder and pastor of The Pavilion of God in Washington DC. The Religious Coalition for Reproductive Choice (RCRC), founded in 1973, is a national non-profit education and advocacy organization whose members are national bodies from 15 denominations and faith traditions with official positions in support of reproductive choice, including the Episcopal Church, Presbyterian Church (USA), United Church of Christ, United Methodist Church, Unitarian Universalist Association, and Reform and Conservative Judaism. As an ordained clergyperson and clergy counselor trained in the RCRC model of counseling called All Options Clergy Counseling, I have counseled many women over the last 15 years. Some women have spiritual and religious concerns as they consider their options. My goal in counseling is to help women discern what is right and best for them and their family and to help them come to an understanding that they believe is consistent with their faith and conscience. Women with an unintended or unplanned pregnancy have many different feelings and concerns as they consider their options and after they have decided on a course of action and taken that action. I tell women that there are no easy answers as to what to do, that they must weigh everything involved in this decision—whether they are prepared for parenthood, have the family and financial support they need, are physically and emotionally able to handle the challenges, and many other considerations that they know best. I assure them that, while a problem or unintended pregnancy can be devastating, it can also mark the beginning of a more mature life because it requires that they take charge of their own future. In my experience, women become stronger when they are able to make these most personal, morally complex decisions for themselves, without fear and without coercion. No woman chooses to be in a situation in which she must consider an abortion, but if that is the decision a woman has to make, I believe firmly that God is with her in that moment. Women, both unmarried and married, become pregnant unintentionally for various reasons, including rape and date rape, failed birth control, and lack of information about contraception and sexuality. Many of these women experience a point of low esteem, some even wanting to die. Later, they can come to understand that they can heal and that their faith can be part of that healing. Research has shown that, while some women may experience sensations of regret, sadness or guilt after an abortion, the overwhelming responses are relief and a feeling of having coped successfully with a difficult situation. Yet the idea persists that women must be guilt-ridden by an abortion and that the decision will haunt them for the rest of their lives. There is an unfounded and unexamined presumption that a woman’s conscience guides her not to have an abortion. In my experience as a counselor, I have more often seen women who are guided by their conscience and their sense of responsibility to have an abortion. Because abortion is so stigmatized, they do not express their true feelings and desires. The stigmatization of unplanned pregnancy and abortion can have a coercive effect, causing some women to continue a pregnancy that they prefer to terminate, with lifelong consequences to the woman and her family. Clergy who are trained in the All Options counseling model and who counsel women before and after abortions know that most women believe they have made a responsible decision. Research studies support what women know in their hearts: that women's emotional responses to legal abortion are largely positive. In 1989, the American Psychological Association (APA) convened a panel of psychologists with extensive experience in this field to review the data. They reported that the studies with the most scientifically rigorous research designs consistently found no trace of "post-abortion syndrome" and furthermore, that no such syndrome was scientifically or medically recognized. The panel concluded that "research with diverse samples, different measures of response, and different times of assessment have come to similar conclusions. The time of greatest distress is likely to be before the abortion. Severe negative reactions after abortions are rare and can best be understood in the framework of coping with normal life stress." Adler pointed out that despite the millions of women who have undergone the procedure since 1973, there has been no accompanying rise in mental illness. “If severe reactions were common, there would be an epidemic of women seeking treatment,” she said. In May 1990, a panel at the American Psychiatric Association conference argued that government restrictions on abortion are far more likely to cause women lasting harm than the procedure itself. To insist, as do groups that oppose abortion in all cases, that women who have an abortion are devastated as a result simplifies the complex nature of each woman's feelings. Even worse, such pronouncements induce and nurture guilt, undermine women's self-respect, and convince women they must be forgiven for a sin, even though abortion might be the most responsible, moral decision. Religious women who have had abortions have very different feelings from those described by groups that oppose abortion. The book Abortion, My Choice, God's Grace, by Anne Eggebroten , tells the stories of women who have had abortions. Elise Randall, an evangelical Christian and graduate of Wheaton College, who had an unwanted pregnancy, said, "I was filled with resentment and afraid that I might take out my frustrations on the child in ways that would do lasting damage." She and her husband concluded that abortion "was the most responsible alternative for us at this time. The immediate result was an overwhelming sense of relief. Now we were free to deal with the existing problems in our lives instead of being crushed by new ones... Only God knows what might have been, but I like to think that our decision was ...based on responsibility and discipleship." Christine Wilson, an active member of a Presbyterian church in suburban Baltimore and attorney, wife and mother of two grown children, became pregnant when she was 16 after having sex for the first time with her boyfriend. At first naïve and then later embarrassed and afraid, she did not tell her parents until she was five months pregnant. Because abortion was illegal at that time, her father took her to England for the abortion. For many years she suffered in silence from guilt and emotional turmoil. Now, she says, "If I had (legal) access in 1969, I know it would not have taken 25 years to attain the peace of mind I have today." The attempt to stigmatize abortion and the women who have had abortions is so far-ranging that it can be considered a campaign. Medical groups calling themselves pro-life, whose purpose is to promote misinformation about abortion, are active and growing; these groups use the professional credibility of doctors to promote a political agenda that includes opposition to emergency contraception and insurance coverage of contraceptives . The campaign is also strong in some Christian denominations, in which groups or caucuses have formed to reverse traditional church policies that support reproductive choice as an act of conscience. The website of the National Organization of Episcopalians for Life (NOEL) , for example, which calls itself a “para-church organization within the Anglican tradition,” states that the group seeks to change “the growing ‘culture of death’ in America and the Episcopal Church,” in contrast to the resolution adopted by the church’s 1994 General Convention that “Human life, therefore, should be initiated only advisedly and in full accord with this understanding of the power to conceive and give birth that is bestowed by God.” The National Silent No More Awareness Campaign of NOEL and Priests for Life works to make abortion “unthinkable” while the Episcopal Church, in another statement adopted by its official body, urges there be “special care to see that individual conscience is respected and that the responsibility of individuals to reach informed decisions in this matter is acknowledged and honored.” It is important and heartening to all who care about women’s health and lives to know that the consensus in the medical and scientific communities is that most women who have abortions experience little or no psychological harm. The claim that abortion is harmful is not borne out by the scientific literature or by personal experiences of those who counsel women in non-judgmental, supportive modalities such as All Options Clergy Counseling. In fact, scientific data shows that the risk for severe psychological problems after abortion is low and comparable to that of giving birth. Yet while there is extensive political and media discussion of the supposed harm caused by abortion, the negative effects of unintended childbearing are basically ignored. Yet they have enormous consequences for women, children and families, and society at large. A recent study documents the negative effects of unintended childbearing on both the mother and her family. Women who have had unwanted births sustain lower quality relationship with all of their children, affecting the children’s development, self-esteem, personality, educational and occupational attainment, and mental health and future marital relationships. Mothers with unwanted births are substantially more depressed and less happy than mothers with wanted births. The negative effects of unintended and unwanted childbearing persist across the course of life, with mothers with unwanted births having lower quality relationships with their children from late adolescence throughout early adulthood. In conclusion, as a clergy counselor I believe that women such as Elise Randall and Christine Wilson, whose stories were recounted in Eggebroten’s book, deserve respect for making a complex decision. As their experiences indicate, it is not the abortion that can cause harm but the negative attitudes of others, including those who oppose abortion for personal, political, ideological or other reasons. Women who have an unintended pregnancy and decide to have an abortion need our compassion and support. To help women and families, we should work together to reduce unintended pregnancies through increased access to family planning and emergency contraception, comprehensive sexuality education, quality health care, and compassionate counseling.
Mrs. Georgette Forney
Mr. Chairman, good afternoon, my name is Georgette Forney, I am the President of the NOEL, a life-affirming ministry in the worldwide Anglican Communion and I live in Sewickley, Pennsylvania. I am humbled to come before you and share my testimony. As I prepared my remarks, I realized that if I had been invited to speak ten years ago, I would have done so in support of a woman's right to choose. However, some things have happened that have changed my opinion. I would like to tell you what they are. First you need to know on October 4th, 1976, when I was sixteen-years-old, I had an abortion in Detroit, Michigan. Afterwards, I went to my sister’s house to recover because my parents didn’t know about my pregnancy. That night as I lay in bed, I cried until I fell asleep. As I dressed the next morning, I was struggling to make sense of the day before, and it hit me ‘I’ll pretend yesterday never happened.’ And that’s how I lived for nineteen years, in total denial. Then, in 1994, I was with a small group of women, and we were sharing our struggles with one another. One young woman expressed how she had been struggling to bond with her newborn son. She said she had an abortion in college and felt it was why she couldn't bond with her baby. She said she was going through abortion recovery counseling. I told her I had an abortion when I was 16, and it was no big deal. I said she simply needed to get over it. About six months later something strange happened, which forced me to recall that conversation. I was in my basement cleaning out boxes, and I found my yearbook from my junior year in high school. I picked it up and thought I'd take a quick stroll down memory lane. But something strange happened. Instead of opening the book and seeing the kids’ faces, I felt my baby in my arms. I knew instantly it was my child that I had aborted. I knew she was a little girl. I could feel her little bum in my right hand and her back and neck in my left. And I knew that I had missed out on parenting a wonderful person, who would have brought a lot of joy into my life. For the first time in nineteen years, as I felt my baby’s presence in my arms I realized the full impact of my abortion. And I began to weep. As I wept I remembered the conversation from six months earlier and I immediately called that woman. I was crying, and I said I needed help. She came over immediately and sat with me while I wept and began grieving for my aborted baby. That day I started a journey that has changed my life. Like my friend, I too attended an abortion recovery program. As I went through the program I began to understand what forgiveness and repentance is all about. For the first time I knew that God loved me and that through Jesus’ death and resurrection, He forgave me, and I was able to forgive myself. I also understood that my child was in Heaven with God, and she forgave me too. During the abortion recovery program, they encourage you to recall different aspects of the abortion experience to help you heal. One of the strongest memories I have is of driving to the clinic and thinking: “This feels wrong, but because it's legal it must be okay.” I share this with you because it’s important for you to know that millions of people, especially young people trust you to make laws that protect us—sometimes even from ourselves. A second thing that caused me to change my opinion about abortion was having to explain to my eight-year-daughter what abortion was. I had written out my story after going through the counseling, and I put a copy of it in my Bible. Not long after that my daughter was playing church and went to my Bible for some Scripture references. She found my testimony and read it. The next night we were at a restaurant having dinner and she asked me if I was married when I was 16. I said, “No, why?” She asked if I was pregnant when I was 16? I put down my fork, said a prayer and replied, “Yes.” She then asked, “Where is the baby?” Trying to explain to an 8-year-old what abortion is and why I had one was extremely difficult. After some discussion, I said it was bed time, and she said, “Okay, but let me make sure I understand. You were pregnant when you were 16, and you killed your baby?” I had to look her in the eye and answer, “Yes.” The look of fear and disappointment in her eyes is something I will never forget. After my daughter learned of my abortion, I started sharing my story publicly—and took the job as Executive Director of NOEL. Early in my tenure, I was asked to do on-line counseling for women who had had abortions. I began getting emails from women and girls who wrote hours after their abortions, or years later. Each email expressed pain, and regret. Over the course of the three years I did it, I received over a thousand emails. I’ll never forget the first email I received from a girl who was 16. She had had the abortion on Saturday and Sunday night she emailed saying “I can’t go to school tomorrow and pretend everything is fine, I feel like dying.” Others wrote things like: “I just saw a diaper commercial and I can’t stop crying.” I got emails from women worldwide who shared their abortion pain and how their lives were a mess. They wanted help; they wanted to know they weren’t the only one hurting. They always expressed relief to know help was available and they weren’t alone in their pain. And that is why I have so radically changed my opinion about abortion and a woman’s right to choose. What I have learned from personal experience—and from thousands of other women—is that abortion does not solve problems; abortion just creates different problems. I cannot tell you how many women I have sat with as they cry and mourn for their babies. As their pain is released, they begin to see how it has affected their lives. It is so sad. And it is why I say: Women may have the right to choose abortion, but I know with everything in me, abortion is not right for women. These experiences made me realize while abortion is wrong because of our babies die, abortion is also wrong for women. And I knew that women who have been there, and done that, needed to speak up and share the truth about abortion. To help the public understand that abortion hurts women more than it helps them, and to let women who are hurting know that help is available. So, I co-founded the National Silent No More Awareness Campaign in partnership with Janet Morana from Priests for Life to do just that. Since developing the campaign, I have learned even more about abortion. There are a few things I’d like to quickly point out: First, many women are forced or coerced into have an abortion. Jennifer O’Neill, the Silent No More Awareness Celebrity Spokeswoman, and well-known actress, who starred in the movie “Summer of ’42,” was forced by her fiancé to abort the baby she wanted. He told her that he would sue for custody of her older daughter if she didn’t abort their child. Recently, a woman emailed me and shared her story, which included the fact that her boyfriend took her at gunpoint to the clinic for the abortion. Coercion is a common theme heard in women’s testimonies. Second, many women experience physical complications after abortion, and women still die from legal abortion. In 1998 Denise Doe (not her real name) left a Louisiana clinic with a 2-inch gash across her cervix and an infection so severe it sent her into a coma for 14 days. For the next six months, she could not even use the bathroom—she had to rely on a colostomy bag. An emergency hysterectomy at a nearby hospital ultimately saved her life. Lou Anne Herron wasn't so lucky. Her 1998 abortion in Phoenix left her bleeding and unattended in a recovery room while Dr. John Biskind ate his lunch. Dr. Biskind then left the clinic while Ms. Herron screamed for help. When an administrator finally called 911—three hours later—the administrator asked emergency workers not to use their sirens and to come in through a side entrance. They did—but Ms. Herron had bled to death already. She left behind two children. In February 2002, 25 year-old Diana Lopez died at a Los Angeles clinic because the staff failed to follow established protocols before and after the abortion. If they had followed protocols, they would have realized she was not a good candidate for abortion because of blood pressure problems, and afterwards when her uterus was punctured during the abortion they should have called for an ambulance. In September 2003, Holly Peterson died from using RU-486. Third, please know I am not claiming that every woman will express regret her abortion—as I said at the beginning of my story, for 19 years I denied my abortion and therefore denied any feelings about it. Many women are where I was but what I have found since getting involved is that there is a sub-culture in our society that is dealing with the pain of abortion. There are 15 books published on this issue and at least twenty-one national abortion recovery programs. Those who support abortion will say that at the most, 5-10% of women have emotional problems after abortion (which equals about 75,000-130,000 women a year). So I ask, would it not make sense to develop some sort of screening procedure to identify women who may have severe reactions to abortion and protect them? Last year when we started the Silent No More Awareness Campaign, a pro-abortion professor from a California college wrote an article about the campaign. She cited research that disproves any claim that women suffer emotionally after abortion and suggested that: “Ms. Forney was probably un-stable before her abortion.” As I read the article—I was amazed that this professor would write such a thing—she didn’t even know me. It was my daughter’s response that put the issue into perspective for me. She said, “Mom, while they are talking about research that says women aren’t hurting, you’re working seven days a week counseling the women they say don’t exist.” Finally, I would note that the Alan Guttmacher Institute believes 43% of women under the age of 45 have had abortions. Therefore, we are all around you. We are everywhere, and our pain affects your lives. I would like to close with some quotes from women who have spoken at the campaign events here in Washington to help you see how our pain affects us and spills out to those around us. Joyce said, “I was a crazy woman with a mask on. To everyone I looked like I had it together. My husband will tell you differently, my children will tell you differently. The warning label of abortion should read ‘caution: abortion can result in years of grief, physical and emotional pain, mood swings, eating disorders, low self-esteem, health and relationship problems with your spouse and children.’” Jennifer said, “I knew in my heart of hearts that I had done something radically wrong. That I had left a piece of me on that table.” Olivia said, “I was never told about the pain that I would feel when the vacuum machine was turned on as it sucked my baby from my body.” Ann said, “I became emotionally numb, I tried to kill myself three times.” Janine said, “I represent everyone that thinks ‘I’m fine.’ But every time that you hear something about abortion your stomach turns just a little bit to let you know that you’re not fine.” Sylvia said, “Feeling my baby burning in my womb—cannot be forgotten. I don’t know exactly how long it took for my baby to burn to death or how long labor lasted. The memory for me is not in hours and days but in sounds and feelings frozen in time. The haunting screams of the others in the room, crying out for release as they labored to give birth to death. The panicked cries of my own body as my baby was delivered dead, as planned. The tears I cried as I lay with my baby are the tears that have continued for 28 years.” Karen said, “Immediately after the abortion, nothing mattered to me, school, my life. I had very low self-esteem. It was nine years after that first abortion just three years after the second, that I began to realize that all the years of substance abuse, low self esteem, suicidal tendencies, and self hatred began after that first abortion.” For 31 years we’ve debated the humanity of the baby versus a women’s right to choose—but I believe it’s time to quit with the politics of abortion and admit that we have conducted a 31-year experiment on women. Did you know that one of the most common medical procedures done on women every year has never been properly researched or studied? Why not? Why can we not agree women’s health issues are more important than the politics of abortion? Why can we not fund an in-depth, long-term study on the impact of abortion on women? States are not even required to report the number of abortions performed annually. Let us at least make that a requirement. Since December 2001, there have been 6 articles published in leading medical journals that indicate a significant correlation between abortion and later emotional distress. These studies and articles should support the need for more discussion and further research about the emotional aftermath of abortion. 1. Higher Rates of Long Term Clinical Depression - "Depression and unintended pregnancy in the National Longitudinal Survey of Youth: a cohort study," British Medical Journal, 324: 151-152. This study from December 2001 indicates that women who abort a first pregnancy are at greater risk of subsequent long term clinical depression compared to women who carry an unintended first pregnancy to term. An average of eight years after abortion, married women were 138 percent more likely to be at high risk of clinical depression compared to similar women who carried their unintended first pregnancies to term. 2. More Mental Health Problems - "State-funded abortions vs. deliveries: A comparison of outpatient mental health claims over five years." American Journal of Orthopsychiatry, 2002, Vol. 72, No. 1, 141–152. In this record-based study of 173,000 California women, women were 63 percent more likely to receive mental care within 90 days of an abortion compared to delivery. In addition, significantly higher rates of subsequent mental health treatment persisted over the entire four years of data examined. Abortion was most strongly associated with subsequent treatments for neurotic depression, bipolar disorder, adjustment reactions, and schizophrenic disorders. 3. Increased Substance Abuse - "History of induced abortion in relation to substance use during pregnancies carried to term." American Journal of Obstetrics and Gynecology. December 2002; 187(5). This study indicates that women with a prior history of abortion are twice as likely to use alcohol, five times more likely to use illicit drugs, and ten times more likely to use marijuana during the first pregnancy they carry to term compared to other women delivering their first pregnancies. 4. Problem Bonding with Future Children - "The quality of care giving environment and child development outcomes associated with maternal history of abortion using the NLSY data." Journal of Child Psychology and Psychiatry. 2002; 43(6):743-757. “The results of our study showed that among first-born children, maternal history of abortion was associated with lower emotional support in the home among children ages one to four, and more behavioral problems among five- to nine-year-olds,” said Dr. Priscilla Coleman, a professor at Bowling Green State University and the lead author of the study. “This held true even after controlling for maternal age, education, family income, the number of children in the home and maternal depression.” 5. Higher Risk of Depression - An article published in the Medical Science Monitor, May 2003 noted the author’s summary as follows; “After controlling for several socio-demographic factors, women whose first pregnancies ended in abortion were 65% more likely to score in the ‘high-risk’ range for clinical depression than women whose first pregnancies resulted in a birth.” 6. Need for Psychiatric Hospitalization - The Canadian Medical Association Journal also published an article in May 2003, which explored the link between abortion and increased rates of psychiatric hospitalization. It found that women who abort a pregnancy are 2.6 times more likely to require psychiatric hospitalization in the year after abortion than women who experience and unexpected pregnancy and carried to term. Women have been at the center of a 31-year social experiment, and we should unapologetically insist on mandatory reporting of abortion complications for the sake of women’s health, and in the interest of preventing a public health crisis. I realize this hearing is informative in nature, but as you consider what you have heard today, please set aside any pre-conceived notions and ask yourself this: Is abortion a choice I want a woman that I care about to make? Do I want my daughters dealing with the grief that I have heard about today? Do I want my nieces dealing with the mourning that Georgette went through? Do I want my employees dealing with the shame and the pain that I have learned about? And if abortion is not good enough for the women you care about, then it is not good enough for any woman. I believe Women Deserve Better than abortion because abortion hurts women. Thank you.
Ms. Michaelene Jenkins
Mr. Chairman, good afternoon; my name is Michaelene Jenkins, I am Executive Director of the Life Resource Network, and I live in San Diego, California. I thank you for the opportunity to testify before this Committee today. Women’s issues, women’s rights and human rights have always been a passion of mine. As a teenager I assumed that legalized abortion was necessary for women to attain their educational and career goals. So, it’s not surprising that when I became pregnant at 18 I thought about having an abortion. I also considered adoption, but when I told my boyfriend, he said he would kick me out if I didn’t have an abortion. I turned to my employer for advice. She agreed that abortion was the only logical option and offered to arrange one for me. My experience at the abortion clinic was painful and humiliating. Although the young women awaiting their abortions were anxious and tearful, the clinic staff was cold and aloof. I met briefly with a “counselor” who characterized my 8-week pregnancy as a “couple of cells” and the “products of conception.” When the abortion provider entered my procedure room, I began to have second thoughts and asked her assistant if I could have a few minutes. The doctor yelled “shut her up” and started the suction machine. It was not an empowering experience. I felt violated and betrayed. The promised solution—really the only option presented to me—wasn’t the end of my nightmare, but only the beginning. I was completely unprepared for the emotional fallout after the abortion. I soon found myself in a cycle of self-destructive behavior that included an eating disorder. Desperate for a fresh start, I broke up with my boyfriend, quit my job, and moved from Minnesota to Hawaii. While living in Hawaii I educated myself about fetal development. I was shocked to learn that an 8-week embryo is at least a half-inch long with a head, arms and legs, a beating heart and functioning brain. I sank even deeper into depression and self-hatred as I realized that I had destroyed my own child. This continued for the next few years until I sought assistance when suicidal thoughts began to overwhelm me. With the help of counselors and supportive friends the time of self-condemnation and self-punishment came to an end allowing me to enter into a healthy grieving process. In addition to grieving the loss of my child, I slowly became aware of the impact my choice had on other members of my family. Although I have repeatedly assured my parents that I never doubted their support and assistance if I had decided to carry the baby to term, they continue to believe that somehow they failed me and that they are partly responsible for the death of their grandchild. When I first told my sister she cried and said she wished she didn’t know about the niece or nephew that is missing. My oldest son found out quite young and still struggles with the loss of a sibling and the reality that his mother was the cause of the loss. My youngest son who is 8 hasn’t been told yet, and it breaks my heart that he will have to deal with a loss that I inflicted. In addition to coping with the fallout the abortion has caused in my family there are still times that are painful for me. After all, healing doesn’t mean forgetting. Mother’s Day is particularly difficult. As motherhood is celebrated I experience great joy in regard to my living children at the same time aching for the child that I destroyed. At one time I thought that my abortion experience was unique, but over the years I have found that it is not. There is mounting evidence—both anecdotal and in published studies—that women suffer emotionally after an abortion. But since abortion is held hostage to politics and special interest groups there are too few reliable studies that have been done. Abortion continues to be an unchecked and unstudied experiment on American women. It has been nineteen years since my abortion. Although much has changed in nineteen years, not much has changed for women experiencing an untimely pregnancy. They still face unsupportive partners and employers and are often unaware of the community resources available to them. They undergo abortion not so much out of choice, but out of desperation or as a last resort. Although some women are able to move on from their abortion, many are left with physical or emotional scars that negatively affect their lives for years and sometimes decades. In all the noise surrounding abortion, women are often forgotten. It is time to stop the noise and start listening to women who have experienced abortion. I am grateful that you have taken the time to listen and I urge you to continue to take steps to understand the impact abortion has on women.
Witness Panel 2
Dr. Nada L. Stotland
Good afternoon, Senators. Thank you for allowing me to appear before you today. Introduction My name is Dr. Nada L. Stotland. I hold Doctor of Medicine and Master of Public Health degrees, and have been a practicing psychiatrist for more than 25 years. Currently I have a private clinical practice and am also Professor of Psychiatry and Professor of Obstetrics and Gynecology at Rush Medical College. I have devoted most of my career to the psychiatric aspects of women’s reproductive health and health care. I have served in a number of leadership positions within the American Psychiatric Association, the major medical organization with more than 35,000 psychiatrists members in the United States and internationally. I spent seven years as Chair of the Committee on Women’s Issues and currently serving as the elected Secretary. The official position of the American Psychiatric Association, the oldest and fourth largest specialty medical society in the United States, is that the right to terminate a pregnancy is important for women’s mental health. My primary professional interest is in the psychology of pregnancy, labor, and childbirth. I gave birth to four wonderful daughters, now adults, and I was determined that their births be as safe as possible. I studied methods of prepared childbirth, used them, and became the Vice President of the national Lamaze prepared childbirth organization. I first became involved with the abortion issue during my specialty training. As a young resident in 1969, I was one day assigned a new patient who announced that she was pregnant and that she would kill herself if she were not allowed to have an abortion. As a practicing psychiatrist, I have seen a fifteen-year-old girl who was pregnant as a result of being raped by a family friend, her grades falling and depression descending as she and her mother desperately sought funds to pay for an abortion to avoid compounding on the trauma of the assault. I have seen a young woman who had an abortion in her teens without support from family or friends, and who did not have the opportunity to talk about her feelings until entering psychotherapy for other reasons later in her life. There, she concluded that the decision had been painful but correct, and went on to have several healthy children. I worked with a woman who had an abortion early in her life and had to come to grips, decades later, with the fact that she might never have a child, and in the process reaffirmed that she had made the right decision when she was younger. My professional experiences reflect the scientific findings; women do best when they can decide for themselves whether to take on the responsibility of motherhood at a particular time, and when their decisions are supported. No one can make the decision better than the woman concerned. Mental illness can increase the risk of unwanted pregnancy, but abortion does not cause mental illness. After I completed my training, President Ronald Reagan appointed Dr. C. Everett Koop as the Surgeon General of the United States and asked him to produce a report on the effects of abortion on women in America. Dr. Koop was known to be opposed to abortion, but he insisted upon hearing from experts on all sides of the issue. The American Psychiatric Association assigned me to present the psychiatric data to Dr. Koop. I reviewed the literature and gave my testimony. Later I went on to publish two books and a number of articles based upon the scientific literature. My expertise and interest in the topic later led me to be recruited by an education and advocacy organization for physicians, and I am now a board member of Physicians for Reproductive Choice and Health®. Dr. Koop, though personally opposed to abortion, testified that “the psychological effects of abortion are miniscule from a public health perspective.” It is the public health perspective which with we are concerned in this hearing, and Dr. Koop’s conclusion still holds true today. History Prior to the historic Roe v. Wade decision in 1973 legalizing abortion, many women were maimed or killed by illegal abortions. Abortion is still a major cause of maternal mortality around the world in countries where women lack access to safe and legal procedures. The fact is that throughout history, and all over the world, women who are desperate to terminate a pregnancy are willing to undergo, and do undergo, illicit, terrifying abortions, often without anesthesia, risking their health, their fertility, and their lives to do so. Millions of women become desperately ill, or die, in the process. According to the World Health Organization, 80 000 women die each year from complications following unsafe abortions. We can outlaw safe abortion, we can make it difficult to access a safe abortion, but we cannot keep abortions from happening. Prior to the Roe v. Wade decision, psychiatrists were often asked to certify that abortions were justified on psychiatric grounds. Today the mental health aspects of abortion have become central in anti-abortion literature and in debates about legislation limiting access to abortion. All too often legislative decisions have been based on inaccurate information. In some states, physicians have even been required by law to misinform their patients. The purpose of my testimony today is to provide accurate scientific information about mental health aspects of abortion and to inform the subcommittee about common errors in the methodology of some of the published studies. Abortion and Mental Health Despite the challenges inherent in studying a medical procedure about which randomized clinical trials cannot be performed, and despite the powerful and varying effects of the social milieu on psychological state, the data from the most rigorous, objective studies are clear. Abortions are not a significant cause of mental illness. Unfortunately, there are active and somewhat successful attempts to convince state and national legislatures, members of the judiciary, the public, and women considering abortion of the negative psychiatric and physical consequences for which there is no good evidence. The vast majority of women have abortions without psychiatric sequelae, or secondary consequences. A study of a national sample of more than 5,000 women in the U.S. followed for eight years concluded that the experience of abortion did not have an independent relationship to women’s well-being. The most powerful predictor of a woman’s mental state after an abortion is her mental state before the abortion. The psychological outcome of abortion is optimized when women are able to make decisions on the basis of their own values, beliefs, and circumstances, free from pressure or coercion, and to have those decisions, whether to terminate or continue a pregnancy, supported by their families, friends, and society in general. I have submitted with my testimony some of the excellent scientific articles, published in the world’s most prestigious medical journals, upon which I base my professional conclusions. These articles speak for themselves. I would like to address the very serious methodological errors in some literature claiming that abortion does cause psychological harm. Some articles, and statements aimed at the public, have gone so far as to claim the existence of an “abortion trauma syndrome.” We are all familiar with post-traumatic stress disorder, or PTSD, a condition tragically brought to public attention by the horrific events of September 11, 2001. Unlike PTSD, “abortion trauma syndrome” does not exist in the psychiatric literature and is not recognized as a psychiatric diagnosis. On the other hand, an article I authored, “The Myth of the Abortion Trauma Syndrome,” has been published by the Journal of the American Medical Association. The fact that there is no psychiatric syndrome following abortion, and that the vast majority of women suffer no ill effects, does not mean that there are no women who are deeply distressed about having had abortions. Some are members of communities that strongly disapproved of abortion and some were unaware of or unable to access other options. Some had to terminate their pregnancies illegally and dangerously, or in facilities where the staff blamed them for their situations. It was difficult in the past for some of these women to discuss their negative feelings. Some now actively organized to affirm and underscore those feelings, and to publish and publicize their accounts. These accounts, however, are not scientific studies, which cannot rely on self-selected populations, or those specifically recruited because of negative feelings. Public policy must not be based on bad science. Scientific Findings The scientific findings are clear. Some women report feeling sad or guilty after having had an abortion. The most prominent response is relief. There is no evidence that induced abortion is a significant cause of mental illness. I have referenced in my written testimony the articles by exacting, renowned scientists who have come to that conclusion. There are some articles that come to other conclusions. Let me explain why: § They confuse emotions with psychiatric illnesses. The term “depression” can be used for both a passing mood and a disease. Sadness, grief, and regret follow some abortions, for very understandable reasons which I will mention shortly. These are not diseases. There is no evidence that women regret deciding to have abortions more than they regret making other decisions, including having and raising children, or allowing their babies to be adopted by others. We have a 50% divorce rate in this country. One might conclude that many or most of those 50% regret having gotten married, but, as a nation, we are working to promote marriage, not to make it difficult. § They do not distinguish women who terminate unwanted pregnancies from those who have to terminate wanted pregnancies because of threats to their own health or serious malformations in their fetuses. Those circumstances can cause terrible disappointment, a sense of failure, and concern over the possibility of future pregnancies, all of which are stressors independent of the abortion itself. § They overlook an obvious reality: only pregnant women have abortions. They fail to compare the aftereffects of abortion with the aftereffects of pregnancy, labor, and childbirth. Full-term pregnancy is associated with considerably greater medical and psychiatric risk than is abortion. The incidence of psychiatric illness after abortion is the same or less after birth. One study reports that for each 1,000 women in the population, 1.7 were admitted to a psychiatric inpatient unit for psychosis after childbirth, and 0.3 were admitted after an abortion. More than 10% of women who have babies in the United States develop post-partum depression, which is a diagnosable, potentially serious but luckily treatable, mental illness. In fact, 10% of women of childbearing age experience clinical depression. A much smaller, but real, percentage of women develop postpartum psychosis. I am sure you are familiar with the tragedies that disease can cause. Some of these unfortunate women kill their children and/or themselves. A far lower percentage of women have clinical depression following abortion, and most of these women were depressed before their abortions. Complications of pregnancy or delivery increase the risk of psychiatric illness. Even perfectly normal deliveries make women into mothers. Being a mother, a seven day a week, twenty four hour a day task, is under the best circumstances the greatest joy, but even then, perhaps, the most challenging and stressful responsibility anyone can undertake. § They fail to account for the reasons women become pregnant when not intending to have babies, and the reasons pregnant women decide to have abortions. Pre-existing depression and other mental illnesses can make it more difficult for women to obtain and use contraception, to refuse sex with exploitative or abusive partners, and to insist that sexual partners use condoms. Poverty, past and current abuse, incest, rape, lack of education, abandonment by partners, and other ongoing overwhelming responsibilities are in themselves stressors that increase the risk of mental illness and increase the risk of unintended pregnancy. § They fail to take into account the mental health of the woman before she has an abortion. Pre-existing mental state is the single most powerful predictor of post-abortion mental state. As we all learned in school, association does not mean causation. It may be the women most seriously affected by mental illness at a given time who decide that it would not be appropriate to become mothers at that time. § They do not distinguish decisions made by women, on the basis of their own situations, religious beliefs, and values, from abortions into which women are coerced by parents or partners who view their pregnancies as inconvenient or shameful. The scientific literature indicates that the best mental health outcomes prevail when women can make their own decisions and receive support from loved ones and society whether they decide to continue or terminate a pregnancy. § They do not address the literature demonstrating that children born when their mothers are refused abortions fare poorly, and are more likely to fail in school and come into conflict with the penal system, as compared with those born to mothers who wanted to have them. § They assume that all women who have abortions require mental health intervention. There is no evidence that women seeking abortions need counseling or psychological help any more than people facing other medical procedures. Standard medical practice demands that patients be informed of the nature of a proposed medical procedure, its risks, benefits, and alternatives, and that they be allowed to make their own decisions. Of course this applies to abortion as well. Because the circumstances and decision can be stressful, most facilities where abortions are performed make formal counseling a routine part of patient care. Close to 30%of women in the United States of reproductive years have abortions at some time in their lives, and very few of these seek or need psychiatric help related to the procedure, either before or after. Our role, as mental health professionals, when patients do seek our consultation under those circumstances, is to help each patient review her own experiences, situation, plan, values, and beliefs, and make her own decision. Sometimes we see patients in acute mental health crises, or whose psychiatric illnesses make it more difficult to assert themselves effectively with sexual partners, to “say no,” or obtain and use contraception effectively. Sometimes we see patients who are in abusive relationships where refusal to comply with sexual demands can result in physical harm or death, not only for themselves, but for their children. We need, under those circumstances, to make sure that our patients are fully informed about contraception and abortion. There are now a number of institutions that forbid us to do so. We also see women who have taken powerful psychotropic medications before becoming aware that they are pregnant, and women who are at grave danger of recurrence of serious psychiatric illness if they discontinue psychotropic medication, but do not wish to expose an embryo or fetus to the possible effects of these medications. § They do not address the impact of barriers to abortion, social pressure, and misinformation on the mental health of women who have abortions. Imagine being in a social milieu where your pregnancy is stigmatized and abortion is frowned upon, having to make excuses for your absence from home, work, or school, travel a great distance to have the procedure, endure a waiting period, perhaps without funds for food or shelter. Imagine having to face and go through a crowd of demonstrators in order to enter a medical facility. Finally, imagine being told that the medical procedure you are about to undergo is very likely to cause mental and physical health problems---although this is not true. Any stress or trauma caused by these external factors should not be confused with reactions to the abortion itself. § They state or imply that women who become pregnant before the age of legal majority are incapable of making decisions about their pregnancies, and recommend that young women who decide it is best to terminate their pregnancies be forced to notify their parents or obtain their parents’ consent. Laws such as these run counter to the recommendations of the American Academy of Pediatrics and to the evidence published in several recent scientific studies. There is no evidence that they improve family relationships or support for young women. In addition, these laws contradict common sense. A pregnant young woman who is not permitted to have an abortion will become a mother. In the United States, adolescents who are pregnant are entitled to make the decision to carry their pregnancies to term, and then to make decisions regarding their prenatal, labor, and delivery care. Once they deliver, they are entitled to make the decision to keep their infants or choose to release them for adoption. If they choose to keep their infants, they are completely legally responsible and entitled to make all parental decisions, including those regarding major medical interventions. Requiring parental consent means that we entrust the care and protection of a helpless infant to a woman we have deemed too immature to decide whether to become a mother or not. “Pregnancy among school-age youth can reduce their completed level of education, their employment opportunities, and their marital stability, and it can increase their welfare dependency.” One study involved adolescents who had negative pregnancy tests with those who were pregnant and carried to term and those who were pregnant and had terminated the pregnancy. All three groups had higher levels of anxiety than they showed one or two years later. But the interesting result was that two years later, the adolescents who had abortions had better life outcomes—including school, income, and mental health—and had a significantly more positive psychological profile, meaning lower anxiety, higher self-esteem, and a greater sense of internal control than those who delivered and those were not pregnant. It is already an accepted part of medical practice to help a young woman think through her situation realistically and involve her parents if she then decides that it would be a good idea to do so. Usually that is exactly what she decides. § They assume that adoption is a benign option. We are often reminded that pregnant women who do not wish to become mothers have the option of delivering their babies and allowing other families to adopt them. Those who do so may feel that they have offered the babies a good life and made another family happy. However, the real data on the impact of giving up babies for adoption is very limited. Women whose babies have been adopted often do not wish to be followed up in studies of their emotional adjustment. Much of the literature on this topic is based on self-selected subjects. Many of them report long-standing distress as a result of giving up their babies. The few studies on more randomly selected populations seem to demonstrate that the psychological sequelae of adoption for biological mothers are more intense than those affecting women who choose to abort. § They make incorrect assertions about medical sequelae of abortion. Breast cancer is a good example. “The relationship between induced and spontaneous abortion and breast cancer risk has been the subject of extensive research beginning in the late 1950s. Until the mid-1990s, the evidence was inconsistent . . . Since then, better-designed studies have been conducted. These newer studies examined large numbers of women, collected data before breast cancer was found, and gathered medical history information from medical records rather than simply from self-reports, thereby generating more reliable findings. The new studies consistently showed no association between induced and spontaneous abortions and breast cancer risk.” The most highly regarded and methodologically sound study on the purported link between abortion and breast cancer indicates that there is no relationship between induced abortion and breast cancer. In contrast with most of the studies in this area, this study contains a large study sample (1.5 million women) and relies on actual medical records rather than women’s recollection, which can be influenced by fear and the attitudes of their community. In February 2003, the National Cancer Institute, a part of the U.S. Department of Health and Human Services, brought together more than 100 of the world’s leading experts on pregnancy and breast cancer risk. Workshop participants reviewed existing population-based, clinical, and animal studies on the relationship between pregnancy and breast cancer risk, which included studies of induced and spontaneous abortions. This workshop “concluded that having an abortion does not increase a woman’s subsequent risk of developing breast cancer.” The World Health Organization, which conducted its own review of the subject, came to the same conclusion. In plain language, there is no medical basis for the claim that abortion increases the risk of breast cancer. This position, shared by the National Cancer Institute and the American Cancer Society is based on a thorough review of the relevant body of research. Among studies that show abortion to be associated with a higher incidence of breast cancer, most are unreliable due to recall bias and other methodological flaws. By contrast, studies that were designed to avoid such biases show no relationship. It is irresponsible for politicians to develop public policy that is based upon false medical allegations. § They don’t remember the past. They fail to acknowledge that abortion has existed and been practiced in every known society, throughout history. When I was in medical school, there were emergency rooms and hospital wards literally filled with direly ill and dying women who had risked their health, their future fertility, and their lives to have abortions under unsanitary conditions, often without anesthesia of any kind. More fortunate women were insulated from these horrific experiences. They could find sympathetic physicians willing to risk their careers to provide abortion services, or go to countries where abortion was safe and legal. Globally one in eight pregnancy-related deaths, an estimated 13%, are due to an unsafe abortion. Psychiatric and other medical rationales for legal barriers to abortion are spurious and injurious to women’s mental and physical health. Our patients look to us, their physicians, to provide sound scientific information to help them make informed decisions about health issues. The allegation that legal abortions, performed under safe medical conditions, cause significant severe and lasting psychological or physical damage is not born out by the facts. , , We can have wanted children and safe and legal abortions, or we can have maimed women and families without their daughters, sisters, wives, and mothers. As a mother, grandmother, practicing physician, scientific expert, and citizen, I hope and pray we will opt for the former. Thank you again for the opportunity to speak with you today.
Dr. Elizabeth Shadigian
Most of the medical literature since induced abortion was legalized has focused on short-term surgical complications, surgical technique improvement, and abortion provider training. Long-term complications had not been well studied as a whole, until now, due to politics – specifically, the belief that such studies would be used either to limit or expand access to abortion. The two commissioned studies that attempted to summarize the long-term consequences of induced abortion concluded that future work should be undertaken to research long-term effects. The political agenda of every researcher studying induced abortion is questioned more than in any other field of medical research. Conclusions are feared to be easily influenced by the author’s beliefs about women’s reproductive autonomy and the moral status of the unborn. Against this backdrop of politics is also a serious epidemiological concern: researchers can only observe the effects of women’s reproductive choices, since women are not exposed to induced abortion by chance. Because investigators are deprived of the powerful tool of randomization to minimize bias in their findings, research must depend on such well-done observational studies. These studies depend on information from many countries and include legally mandated registers, hospital administrative data and clinic statistics, as well as voluntary reporting (or surveys) by abortion providers. Approximately 25% of all pregnancies (between 1.2-1.6 million per year) are terminated in the United States, so that if there is a small positive or negative effect of induced abortion on subsequent health, many women will be affected. A recent systematic review article critically assesses the epidemiological problems in studying the long-term consequences of abortion in more detail. It should be kept in mind that: 1) limitations exist with observational research; 2) potential bias in reporting by women with medical conditions has been raised and refuted; 3) an assumption has been made that abortion is a distinct biological event; 4) inconsistencies in choosing appropriate comparison groups exist; and 5) other possible confounding variables of studying abortion’s effects over time also exist. Nonetheless, given the above caveats, my research, which included individual studies with no less than 100 subjects each, concluded that a history of induced abortion is associated with an increased long-term (manifesting more than two months after the procedure) risk of: 1) breast cancer 2) placenta previa 3) preterm birth and 4) maternal suicide. Outcomes Not Associated with Induced Abortion Induced abortion has been studied in relation to subsequent spontaneous abortion (miscarriage), ectopic pregnancy, and infertility. No studies have shown an association between induced abortion and later spontaneous abortion. An increase in ectopic or tubal pregnancies was seen in only two out of nine international studies on the topic, while only two out of seven articles addressing possible subsequent infertility showed any increased risk with induced abortion. Outcomes Associated with Induced Abortion 1. Breast Cancer Based upon a review of the four previously published systematic reviews of the literature and relying on two independent meta-analyses, (one published and one unpublished ), induced abortion causes an increased risk of breast cancer in two different ways. First, there is the loss of the protective effect of a first full-term pregnancy (“fftp”), due to the increased risk from delaying the fftp to a later time in a woman’s life. Second, there is also an independent effect of increased breast cancer risk apart from the delay of fftp. The medical literature since the 1970s has shown that a full-term delivery early in one’s reproductive life reduces the chance of subsequent breast cancer development. This is called “the protective effect of a first full term pregnancy (fftp).” This is illustrated in Figure 1 which uses the “Gail Equation” to predict the risk of breast cancer for an 18 year-old within a five-year period and also within a lifetime. The Gail Equation is used to help women in decision-making regarding breast cancer prevention measures. In the first scenario, the 18 year-old decides to terminate the pregnancy and has her fftp at age 32, as compared to the 18 year-old in the second example who delivers at term. The individual risk of these women is then assessed when the risk of breast cancer peaks. As figure 1 shows, having an abortion instead of a full-term pregnancy at age 18 can almost double her five-year and lifetime risk of breast cancer at age 50, regardless of race. An independent effect of increased breast cancer risk apart from the delay of first full-term pregnancy has been controversial. Four published review articles have been written. Two of the reviews found no association between induced abortion and breast cancer, while one paper found a “small to non-significant effect.” The sole published meta-analysis reported an odds-ratio (“OR”) for breast cancer of 1.3 (or 95% CI=1.2, 1.4) in women with a previous induced abortion. One yet unpublished independent meta-analysis found the OR=1.21 (95% CI=1.00, 1.45). Brind et al. used older studies and translated non-English ones. He did not exclude any studies and used a different statistical approach. The unpublished study used exclusion criteria and only English language studies. Another finding was that breast cancer is increased if the abortion is performed before a first full term pregnancy. Brind found an OR=1.4 (95% CI=1.2, 1.6), while the unpublished study showed an OR=1.27 (95% CI=1.09-1.47). The two meta-analyses used different methodologies, but reported nearly equivalent results, which are statistically significant, and do show that induced abortion is a independent risk factor for breast cancer. Some other findings from individual research papers included in my review concluded that the risk of breast cancer increases with induced abortion when: (a) the induced abortion precedes a first full term pregnancy; (b) the woman is a teen; (c) the woman is over the age of 30; (d) the pregnancy is terminated at more than 12 weeks gestation; or (e) the woman has a family history of breast cancer. One researcher (Daling) also reported, in her study, that all pregnant teens with a family history of breast cancer who aborted their first pregnancy developed breast cancer. 2. Placenta Previa “Placenta previa” is a medical condition of pregnancy where the placenta covers the cervix, making a cesarean section medically necessary to deliver the child. In general, this condition puts women at higher risk, not just because surgery (the c-section) is necessary, but also because blood loss is higher, and blood transfusions may be necessary. There is also a higher risk of hysterectomy (the loss of the uterus), and therefore the need for more extensive surgery. Three studies with over 100 subjects each were found examining induced abortion and placenta previa, as well as one meta-analysis. The three studies found a positive association, as did the meta-analysis. Induced abortion increased the risk of placenta previa by approximately 50%. 3. Pre-Term Birth (“PTB”) Twenty-four studies explored associations between abortion and pre-term birth or low birth weight (a surrogate marker for pre-term birth). Twelve studies found an association which almost doubled the risk of preterm birth. Moreover, seven of the twelve identified a “dose response effect” which means a higher risk for pre-term birth for women who have had more abortions. “Also notable is the increased risk of very early deliveries at 20-30 weeks (full-term is 40 weeks) after induced abortion, first noted by Wright, Campbell, and Beazley in 1972. Seven subsequent papers displayed this phenomenon of mid-pregnancy PTB associated with induced abortion. This is especially relevant as these infants are at high risk of death shortly after birth (morbidity and mortality), and society expends many resources to care for them in the intensive care unit as well as for their long-term disabilities. Of particular note are the three large cohort studies done in the 1990s, 20 to 30 years after abortion’s legalization. Each shows elevated risk and a dose response effect. Because these studies were done so long after legalization, one would assume that the stigma of abortion that might contribute to under-reporting would have waned.” 4. Suicide Two studies have shown increased rates of suicide after induced abortion, one from Finland and one from the United States. The Finnish study (by Gissler et al.) reported an OR=3.1 (95%CI=1.6,6.0) when women choosing induced abortion were compared to women in the general population. The odds ratio increased to 6.0 when women choosing induced abortion were compared to women completing a pregnancy. The American study (by Reardon et al.) reported recently that suicide RR=2.5 (95%CI=1.1, 5.7) was more common after induced abortion and that deaths from all causes were also increased RR=1.6 (95%CI= 1.3, 7.0). In addition, self-harm is more common in women with induced abortion. In England psychiatric hospital admissions because of suicide attempts are three times more likely for women after induced abortion, but not before. Maternal Mortality There is no mandatory reporting of abortion complications in the U.S., including maternal death. The Centers for Disease Control (CDC) began abortion surveillance in 1969. However, the time lag in CDC notification is greater than 12 months for half of all maternal deaths. Maternal deaths are grossly underreported, with 19 previously unreported deaths associated with abortions having been identified from 1979-1986. The CDC quotes approximately one maternal death for every 100,000 abortions officially, which is death between the time of the procedure and 42 days later. Therefore, statements made regarding the physical safety of abortion are based upon incomplete and inaccurate data. Many women are at much higher risk of death immediately after an induced abortion: for example, black women and minorities have 2.5 times the chance of dying, and abortions performed at greater than 16 weeks gestation have 15 times the risk of maternal mortality as compared to abortions at less than 12 weeks. Also, women over 40 years old, as compared to teens, have three times the chance of dying. Late maternal mortality, which includes deaths occurring after the first 42 days following abortion are not reflected in CDC numbers, nor are data from all 50 states, because reporting is not currently mandatory. To accurately account for late maternal mortality, maternal suicides and homicides, breast cancer deaths and increased caesarian section deaths from placenta previa and pre-term birth would also be included with other abortion –related mortality. Informed Consent Health care providers are obliged by law to inform patients of the benefits and risks of the treatment being pondered before a medical decision is made. In the case of a woman deciding to terminate a pregnancy, or undergoing any surgery or significant medical intervention, informed consent should be as accurate as possible. Induced abortion is associated with an increase in breast cancer, placenta previa, pre-term birth and maternal suicide. Maternal deaths from induced abortion are currently underreported to the Centers for Disease Control. These risks should appear on consent forms for induced abortion, but currently are not. American College of Obstetricians and Gynecologists (ACOG) In the most recent edition of medical opinions set forth by the American College of Obstetricians and Gynecologists (Compendium of Selected Publications, 2004, Practice Bulletin #26), ACOG inexplicably states: “Long-term risks sometimes attributed to surgical abortion include potential effects on reproductive functions, cancer incidence, and psychological sequelae. However, the medical literature, when carefully evaluated, clearly demonstrates no significant negative impact on any of these factors with surgical abortion.” (Italics added for emphasis) I am a proud member and fellow of ACOG. Because of groups like ACOG American women enjoy some of the best health, and health care, in the world. However, I am deeply troubled that ACOG makes assurances to their membership, and to women everywhere, claiming a lack of long-term health consequences of induced abortion. Instead, ACOG should be insisting that these long-term health consequences appear on abortion consent forms. Why doesn’t ACOG insist that long-term health consequences of induced abortion be included? ACOG seems to claim that they have adequately evaluated the medical literature, but they do not consider our study nor the many older studies we evaluated. This situation is akin to the early studies that indicated that cigarette smoking was linked to heart disease and lung cancer in the 1950’s and 1960’s. Eventually, larger, improved studies were funded that could thoroughly assess the health effects of smoking. We are at a similar crossroads for women today – just as we were regarding smoking and long-term health effects in the 1950’s and 1960’s. Conclusion A clear and overwhelming need exists to study a large group of women with unintended pregnancies who choose - and do not choose - abortion. If done properly, a dramatic advance in knowledge will be afforded to women and their health care providers - regardless of the study’s outcome. A commitment to such long-term research concerning the health effects of abortion including maternal mortality would seem to be the morally neutral common ground upon which both sides of the abortion/choice debate could agree. In the meantime, there is enough medical evidence to inform women about the long-term health consequences of induced abortion, specifically breast cancer, placenta previa, pre-term birth, and maternal suicide. They should also be informed of the inadequate manner in which maternal death is reported to the government, thus grossly underestimating the risk of death from abortion. I applaud this subcommittee for taking on such a politically difficult topic in an effort to show women the respect they deserve by supplying them with accurate medical information. * * * . Figure 1 SCENARIO: ALL FOUR WOMEN ARE PREGNANT AT AGE 18; #1 & #3 abort their first pregnancy and deliver at 40 weeks in their next pregnancy at age 32. #2 and #4 continue their first pregnancy and deliver at 40 weeks at age 18. Gail Variable #1 #2 #3 #4 Race Caucasian, Non-Black Caucasian,Non-Black Black Black Age 50 50 50 50 Menarche 12 12 12 12 Age 1st live birth 32 18 32 18 Number of first-degreerelatives with breast cancer 0 0 0 0 Number of previous breast biopsies 0 0 0 0 5-year breast cancer risk 1.3% 0.7% 0.8% 0.4% Lifetime breast cancer risk 12.1% 6.5% 6.7% 3.6%