Abortion ‘informed consent’ should include physical, psychological effects

CHAPEL HILL — Before women undergo induced abortions, doctors should — as part of the informed consent process — offer them information about the subsequent small but apparently real increased risk of pre-term delivery and depression, researchers say.

Clinicians also should mention the unproven possibility that their chance of developing breast cancer could climb slightly later in life.

Those are conclusions a team of doctors reached after completing a review of the best studies of the long-term physical and psychological health effects of intentional abortions.

A report on their findings and recommendations appears in the January issue of Obstetrical and Gynecological Survey, a professional journal.

Authors are Drs. John M. Thorp Jr., Mcallister distinguished professor of obstetrics and gynecology, and Katherine E. Hartmann, assistant professor of epidemiology and obstetrics and gynecology, at the University of North Carolina at Chapel Hill schools of medicine and public health. Dr. Elizabeth Shadigian, associate professor of obstetrics & gynecology at the University of Michigan School of Medicine, also helped with the work.

Following legalization of abortion in most western nations by the late 1960s and early 1970s, more women than expected chose induced abortion than doctors and others predicted, the authors wrote.

“Initially, research focused on early complications, immediate maternal mortality and optimization of abortion technique,” they wrote. “Subsequent interest in the potential long-term health consequences entered scientific discussion later, not primarily driven by specific hypotheses, but rather by those with conflicting viewpoints (about) the moral status of the embryo or fetus, and the desire to either limit or expand access to abortion.”

While interest in potential long-term health effects from the common procedure remained strong among scientists and clinicians, no definitive studies were undertaken to answer lingering health questions, the three said.

“Despite strong recommendations for substantive research, and the clear need for women to have accurate information as they execute their autonomy, current data remain sparse, studies are small and methodologically flawed and the conclusions are often intertwined with the political agendas of their authors and publishers,” the authors wrote.

In their new study, the team scoured the MEDLINE database for all English-language scientific publications containing the words “abortion” and “abortion complications” in their headings. They then reviewed the resulting abstracts to see whether the studies met their selection criteria, which included having at least 100 subjects with two months or more of medical follow-up. Finally, they analyzed and compared the remaining studies.

Thorp and colleagues concluded that the long-term health effects of elective abortion were difficult to study and poorly understood for numerous reasons. One is that randomized trials of the effects of abortion cannot be done for ethical and other reasons. Another is that it is not clear which group of women would be an appropriate comparison group for the observational studies that are possible. A third is the high cost of the research, and another is the small size of possible risks associated with competently performed abortions.

And because ending a pregnancy often is an emotionally troubling choice, women might not tell the whole truth about their reproductive histories, Thorp said. Politics of the issue also cloud results with anti-abortion groups sometimes exaggerating claims about ill effects and pro-choice groups minimizing them.

Still, “elective abortion must be studied?with vigor, given the frequency with which women choose to terminate a pregnancy and the important and prevalent health conditions that some of the data gathered heretofore have linked to abortion (such as) preterm birth and breast cancer,” he said.

“We find little evidence to support the claims that elective abortions increase the risk of subsequent sub-fertility, ectopic pregnancy and spontaneous abortion,” the authors conclude. “Of more concern are the possibility of links to preterm birth, placenta previa (a condition of varying severity in which the placenta implants low in the uterus), breast cancer and serious mental health problems.”

Some evidence exits for links between induced abortion and the latter disorders, especially preterm births and mental health problems such as depression, they said. The one study that combined results from other research on breast cancer suggested a small increase in that cancer because of abortion, but the finding remains controversial and unconfirmed.

“We think that given the undisputed protective effect of a full-term delivery early in one’s reproductive life on subsequent breast cancer development that a young woman can and should be informed of the loss of that protection that would derive from a decision to terminate her pregnancy and delay having a baby,” the authors wrote.