CTOP AMENDMENT BILL 2007

Submission on Behalf of the Consultation of Christian Churches

Monday, 05 November 2007

Our submission is that the scope of the 1996 Act should not be enlarged in terms of more facilities and more staff unless the widespread abuses of the present legislation are addressed at the same time. Accordingly we respectfully submit that the following clauses (drafted by counsel with Parliamentary drafting experience) should be added to the Amendment Bill:

 

1.   Counselling

Add the following section:

Before a medical practitioner, or registered midwife or nurse, performs an abortion he or she shall ensure that the woman is counselled in a manner which provides a full opportunity for discussion and questions, and such counselling shall in every case include:

(a)     Sufficient information, imparted either by electronic pictures or coloured diagrams and photographs, to enable the woman to understand the existing stage of development of the unborn child in her womb.

(b)     A discussion of the extent of the risks involved in continuing the pregnancy, as set against the risks involved in having an abortion. The latter must be explained in the light of the latest medical science available at the time, and must include explanation of the following risks:

(i)         The increased risk of breast cancer following an abortion.

(ii)        The risk of depression and associated symptoms after a period of years.

(iii)      The risk of difficulties in conceiving, and bearing children in the future.

(c)     The available alternatives to abortion, and in particular the ways in which the State and other agencies will support the mother and child, particularly in the event of the child being born disabled.

 

Why is this addition proposed?

Section 4 of the 1996 Act provides that "The State shall promote the provision of non-mandatory and non-directive counselling before and after the termination of a pregnancy."  The difficulty caused by this section is:

1.       that practitioners take the view that the onus of providing counselling is on the State and not on them;

2.       that "non mandatory" is taken to mean there is no duty on the practitioner, whereas Parliament almost certainly intended it to mean that a woman cannot be forced to listen to counselling;

3.       and "non directive" opens the door even wider for the practitioner to assume that if a woman asks for an abortion any mention of the risks involved might be construed as "directive."

The drafting of section 4 of the 1996 Act is therefore uncertain and equivocal.  By contrast, the regulations relating to counselling of persons receiving HIV testing are extensive, specific and unambiguous.[1]

It is true that the regulations made under the 1996 Act are more specific as to the content of the counselling but they add nothing as to who must do the counselling.  Regulation 7 requires that counselling should include:

1.       The available alternatives to TOP (i.e., adoption, fostering, parenting)

2.       The procedure and associated risks of the TOP (it is submitted this must require the use of graphic material for most women, and must have regard to the current state of medical knowledge which today recognizes at least 3 areas of risk – increased prevalence of breast cancer, the 5-7 year depression syndrome, and difficulties relating to pregnancies in the future.

3.       Contraceptive measures for the future.

 

Not only is it vital that legislation should specify who is responsible for ensuring that counselling is done, but furthermore, there can be little doubt that any abortion performed without such counselling will be illegal in the civil courts and give rise to an action for damages because, without counselling, informed consent required by section 5 cannot be obtained.

 

2.   Informed Consent – Substitution of section 5 of the Principal Act

The following section is hereby substituted for section 5 of the Principal Act:

(a)     Save as provided for by subsections 2 and 3 of this section, the informed consent of the woman shall be required  in every case before a termination of pregnancy is performed and shall in every case consist of the three ingredients of knowledge, appreciation and consent:

(i)         Knowledge means that the woman must be fully informed, in a manner appropriate to her standard of education, of the nature and extent of the risks involved.

(ii)        Appreciation means that she must not merely receive the information but understand it as applicable to her particular situation.

(iii)      Consent means that she must subjectively consent to each step in the procedure and all its consequences.

(b)     In the case of a pregnant minor a termination of pregnancy shall only be performed by a medical practitioner who shall counsel her in accordance with section (aforesaid section) of this Act, and thereafter proceed as follows:

(i)         If, following the counselling procedure, the medical practitioner is satisfied that the minor is able to give her informed consent, and she still wishes to proceed with the termination, he shall then direct her to consult with one or both of her parents or guardians, and advise her to consult with any other person she may have confidence in, and then, if she wishes to proceed, to return after a minimum of 7 days with the written consent of at least one parent or guardian. If appropriate, he must explain that a judge can be asked to give consent in accordance with section 5 of this Act if it not possible to obtain the consent of one parent or guardian.

(ii)        If, following the counselling procedure, the medical practitioner is not satisfied that the minor is able to give her informed consent, and he is still of the opinion, after further consultation with a second medical practitioner, that a termination of the pregnancy is in her best interests, he shall contact the parents or guardians and repeat the counselling procedure as set out in section ( ) (as above) of this Act with the minor and in the presence of at least one parent or guardian. The medical practitioner may then proceed with the termination provided he is satisfied he has the consent of the minor and the informed consent of at least one parent or guardian, or a judge.

(c)     Only a medical practitioner may perform a termination of pregnancy on a woman who appears to be disabled mentally or who appears to be unconscious. In the case of a mentally disabled woman who in the opinion of the medical practitioner is not capable of giving her informed consent, or in the case of a woman who has suffered a continuous state of unconsciousness for a period of at least 14 days and in the view of at least two medical practitioners is unlikely to recover consciousness in the foreseeable future, the pregnancy may be terminated without the informed consent of the woman, provided the informed consent of her natural guardian, spouse or legal guardian (or, if such persons cannot be found  her curator personae) is obtained.

(d)     In order to provide for the situations envisaged in section ( ) (the above para) of this Act, where the consent of a parent or guardian is not available, the Minister shall make Regulations enabling a minor or medical practitioner to apply to a Judge of the High Court in chambers with expedition, without employing a legal representative, and without court fees.

 

Why is this substitution proposed?

Mandatory informed consent is required by section 5 of the 1996 Act.  This requirement of the law was reiterated and explained in detail by Judge Mojapelo in what is known as the second Christian Lawyers Association challenge to the legislation.[2]

The judgment contains this passage:

The courts have often endorsed the following statements by Innes, CJ in Waring & Giitow v Sherborne 1904 TS 340 at 144 to found a defence of consent:

"It must be clearly shown that the risk was known, that it was realised, that it was voluntarily undertaken.  Knowledge, appreciation, consent - these are the essential elements; but knowledge does not invariably imply appreciation, and both together are not necessarily equivalent to consent"

The requirement of "knowledge" means that the woman who consents to the termination of a pregnancy must have full knowledge "of the nature and extent of the harm or risk". See Castell v De Greef (supra) at 425. Neething Potgieter & Visser (op cit) at 100-101 and Neethling (op cit) at 121-122.

The requirement of "appreciation" implies more than mere knowledge.  The woman who gives consent to the termination of her pregnancy "must also comprehend and understand the nature and extent of the harm or risk."  See Castell v De Greef (supra at 425); Neethling Potgieter & Visser (op cit) at 101 and Neethling (op cit) at 122.

The last requirement of "consent" means that the woman must "in fact subjectively consent" to the harm or risk associated with the termination of her pregnancy and her consent "must be comprehensive" in that it must "extend to the entire transaction, inclusive of its sequences". Castell v De Greef (supra), at 425, Neethling Potgieter & Visser, (op cit) at 120 and Neethling (op cit) at 122.

 

It is surely a matter of common sense that no nurse, midwife or doctor can possibly be sure of these matters without taking at least twenty minutes to explain the state of the unborn child in the woman’s womb, the procedure he is offering, the risks involved, and the alternatives open to her; he must then be prepared to answer her questions however long it takes. An exception perhaps would be a gynaecologist who wanted an abortion – in such a case it might be reasonable to assume "informed consent".

We believe therefore that it has been proved necessary to set out in the Act itself, not merely in Regulations often not known to practitioners, both what is required and of whom it is required.

 

3.   Age of consent

It is our concern that the principal Act does not adequately address some issues with respect to obtaining informed consent from a minor.  Section 5 of the principal Act deals with mandatory informed consent.  Informed consent stands on three pillars: knowledge, appreciation and consent.  We therefore have the following concerns regarding this section:

1.              it is highly doubtful that a minor below the age of 16 (or even 18, for that matter) will be able to grasp the knowledge of what risks a termination of pregnancy entails, not only the termination itself, but also the long-term effects;

2.              even if a minor should be able to grasp the knowledge, she most certainly does not have the maturity to appreciate the long-term consequences of her action;  and

3.              the ability of a minor to have a termination without any parent or guardian's knowledge or consent has medico-legal implications in cases where the minor's health is damaged, maybe even irreparably, which implications are not addressed by the principal Act;

 

Suggestion

 

It is suggested that Section 5 be rewritten to allow a minor to have a termination only:

1.              after two counseling sessions at least seven days apart'

2.              which counseling sessions include a visual presentation of the termination and the gestational age of the foetus; 

3.              which counseling sessions shall be at least 20 minutes in duration each; 

4.              which counseling sessions shall reflect the latest scientific knowledge on the effects of a termination of pregnancy; and

5.              with the permission of at least one adult, whether a relative or an official, such as a judge or a hospital superintendent.

 

Rationale

 

Credible, scientific studies worldwide are finding that the risks of psychological damage, substance abuse, homicide (mainly due to risk-seeking behaviour) and suicide increase dramatically after a minor has had a termination of pregnancy, compared to (1) the general population and (2) those who had live births.  This information needs to be clearly spelled out to the minor seeking a termination, in order for the consent to be fully informed and the practitioner being protected from later medico-legal action.  It also highlights the importance of pre and post-termination counselling.  It is my wish that the Act will be amended to further protect minors from taking an uninformed or poorly informed decision.

 

4.   Gestational Age

It is our concern that the principal Act allows for terminations to take place quite late in pregnancy.  With modern technology, babies born as young as 21 weeks can be saved, which indicates their viability as human beings.  Section 2 (c) (iii) allows for a termination of pregnancy after the 20th week of gestation in cases where the continued pregnancy "would pose a risk of injury to the foetus."  This is an extraordinary contradiction, since the paragraph implies that a termination of the pregnancy will not cause injury to the foetus. 

 

Suggestion

 

It is suggested that Section 2 (c) (iii) be scrapped altogether.

 

Rationale

 

In the light of obstetric advances, the medically expedient solution in such a case as envisaged by section 2 (c) (iii) would be to evacuate the foetus from the womb via caesarean section, to prevent injury from a continued pregnancy.

 

5.   Conscientious Objection

Add the following clause:

Save in a situation where it is necessary to act immediately to save life, no person shall be under any duty, whether by contract or by any statutory or other legal requirement, to participate in any treatment authorized by the Principal Act or the Amendment Act (including any treatment relating to surgical evacuation of the womb which may follow medical treatment) to which he or she has a conscientious objection on the ground of religion, conscience or belief, provided that the burden of proof of conscientious objection shall rest on the person seeking to rely on it.

 

Why is this clause proposed?

This clause is necessary because so many thousands of health workers find themselves under pressure to perform terminations of pregnancy contrary to their consciences and religious beliefs. Ten years of TOP history has proved that the Constitution does not provide sufficient protection for such persons without an express clause in the CTOP legislation.

 

On June 22, 2007 the Labour Court of Appeal (3 judges) handed down a judgement which stressed the need for the Minister to provide certainty in this area of the law. (Charles and others vs Gauteng Health Department and others).

 

NB:  The above clause is based upon the conscientious objection clause contained in the Abortion Act, 1967 in the UK which has worked without problems for 30 years.

 

6.   Keeping of Records

The following amendment of section 7(1) of the Principal Act is recommended:

Section 7(1) of the Choice on Termination of Pregnancy Act, 1996 is hereby amended by the addition of "or (c)" after "(b)" in line three.

 

Why is this addition proposed?

This clause is necessary because the present law does not require any records to be kept of third trimester abortions.

 

5.   Offences and Penalties – Substitution of section 10(1) of the Principal Act          

The following section is hereby substituted for section 10(1) of the Principal Act.:

Any person who:

(a)     terminates a pregnancy otherwise than in accordance with the Principal Act, the Amendment Act and this Act, or at a facility not approved in terms of the Acts, or without ensuring that the requirements of the Acts relating to counselling and informed consent have been complied with, shall be guilty of an offence and liable on conviction to a fine or to imprisonment for a period not exceeding 10 years.

(b)     wilfully prevents a woman attending a facility approved for terminations of pregnancy, or in any physical manner wilfully prevents the lawful termination of a pregnancy shall be guilty of an offence and liable on conviction to a fine or to imprisonment not exceeding 2 years.

 

Why is this clause necessary?

Sub-clause (1) makes it a criminal offence for any person, including a doctor, to carry out an illegal abortion.  Currently there is no prohibition against a medical practitioner who carries out an abortion contrary to section 2(1) (a) of the Principal Act. It also gives teeth to the requirements relating to counselling and informed consent.

Sub-clause (2) clarifies the current provision which some try to construe as applicable to health workers who decline to do an abortion on the ground of conscientious objection.  The intention of Parliament was to penalize demonstrators who blockade clinics and other forcible behaviour, not those who have conscientious objection.

 

7.   Obstruction / Referral

Concern

 

Section 10 (1) (c) states that any person who "prevents the lawful termination of a pregnancy or obstructs access to a facility for the termination of a pregnancy" is guilty of an offence.  It is our understanding that this clause addresses those who might forcibly prevent women from exercising their decision to terminate a pregnancy.  However, in practice, this clause is often read (also by some legal experts) in such a way that an obligation is placed on the medical practitioner or registered midwife to perform a termination when so requested. 

 

Suggestion

 

It is suggested that the quoted Section 10 (1) (c) be replaced with: "wilfully prevents a woman attending a facility approved for terminations of pregnancy, or in any physical manner wilfully prevents the lawful termination of a pregnancy …"

 

It is further recommended that a Conscientious Objection clause be added to the Act, to further prevent any potential misunderstanding.

 

Rationale

 

The constitutional right to conscientious objection should clearly be upheld by the Act, without thereby endangering the health of the woman seeking an abortion.

 

9.   Penalties and Offences

Concern

 

1.       Section 10 (1) (c) states that any person who "prevents the lawful termination of a pregnancy or obstructs access to a facility for the termination of a pregnancy" is guilty of an offence.  It is our understanding that this clause addresses those who might forcibly prevent women from exercising their decision to terminate a pregnancy.  However, in practice, this clause is often read (also by some legal experts) in such a way that an obligation is placed on the medical practitioner or registered midwife to perform a termination when so requested. 

2.       The Principal Act specifically does not criminalise medical practitioners or registered midwives who act outside the scope of the Act. 

3.       Section 6 (1) (d) of the Amendment Act criminalises the termination of a pregnancy at a facility other than those designated in Section 2 of the Amendment Act.  However, the reality is that many medical practitioners are prescribing misoprostol to induce a termination, whereafter the patient then has to attend a clinic for a manual evacuation.  In such a case, would the termination be illegal in terms of Section 6 (1) (d)?  And if the patient inserts the misoprostol tablets at home, is this regarded as illegal in terms of Section 6 (1) (d)?

4.       The widespread use of misoprostol to induce a termination is a cause of great concern, for the following reasons:  (1) misoprostol is not registered with the Medicines' Control Council (MCC) for such use and a medical practitioner is thus medico-legally liable should anything go wrong;  (2) in later stage of pregnancy, the woman undergoing termination may bleed excessively before seeking an evacuation, which could lead to severe harm or even death;  (3) in late pregnancy, termination by misoprostol may cause irreparable damage to the cervix, leading to inability to maintain a pregnancy.

 

Suggestion

 

1.       It is suggested that the quoted Section 10 (1) (c) be replaced with: "wilfully prevents a woman attending a facility approved for terminations of pregnancy, or in any physical manner wilfully prevents the lawful termination of a pregnancy …"  It is further recommended that a Conscientious Objection clause be added to the Act, to further prevent any potential misunderstanding.

2.       Though Section 2 of the Amendment Act partially addresses the problem of medical practitioners, registered midwives or trained nurses who trespass the Act, it is not sufficient.  A clause specifically criminalizing illegal activity by these parties (such as performing a termination contrary to or outside of the stipulations contemplated in Section 2 (1) of the principal Act).

3.       Section 6 (1) (d) of the Amendment Act should specifically state that a termination shall be deemed to have been initiated at the moment when medication is administered with the intention of causing the termination of a pregnancy.

4.       The use of drugs not registered to induce a termination should be expressly prohibited, especially after 12 weeks gestation.  Not doing so leaves the door wide open for abuse by unscrupulous practitioners, at the expense of and to the detriment of the woman seeking a termination.

 

Rationale

 

1.       The constitutional right to conscientious objection should be clearly upheld by the Act, without thereby endangering the health of the woman seeking an abortion.

2.       The present silence in both Acts regarding illegal activity by medical practitioners, registered midwives and suitably trained nurses, leaves the door open to abuse by such parties, for personal gain.

3.       If the place where a termination is deemed to have taken place is not clearly defined, Section 2 of the Amendment Act is largely an academic exercise and the widespread abuse of misoprostol will continue in unauthorised venues.

4.       A dangerous precedent with far-reaching legal implications is being created if it is allowed situ-situ that medications are used outside their field of registration, especially if the person using these medications does not have the capacity to handle the effects or side-effects of the medication.


Addendum 1: http://www.afterabortion.info/news/Fergusson.htm

Abortion Causes Mental Disorders: New Zealand Study May Require Doctors to Do Fewer Abortions 

Pro-Choice Researcher Says Some Journals Rejected Politically Volatile Findings

Springfield, IL (Feb. 9, 2005) -- A study in New Zealand that tracked approximately 500 women from birth to 25 years of age has confirmed that young women who have abortions subsequently experience elevated rates of suicidal behaviors, depression, substance abuse, anxiety, and other mental problems.  

Most significantly, the researchers – led by Professor David M. Fergusson, who is the director of the longitudinal Christchurch Health and Development Study – found that the higher rate of subsequent mental problems could not be explained by any pre-pregnancy differences in mental health, which had been regularly evaluated over the course of the 25-year study.


Findings Surprise Pro-Choice Researchers

According to Fergusson, the researchers had undertaken the study anticipating that they would be able to confirm the view that any problems found after abortion would be traceable to mental health problems that had existed before the abortion.  At first glance, it appeared that their data would confirm this hypothesis.  The data showed that women who became pregnant before age 25 were more likely to have experienced family dysfunction and adjustment problems, were more likely to have left home at a young age, and were more likely to have entered a cohabiting relationship.

However, when these and many other factors were taken into account, the findings showed that women who had abortions were still significantly more likely to experience mental health problems.  Thus, the data contradicted the hypothesis that prior mental illness or other “pre-disposing” factors could explain the differences.

“We know what people were like before they became pregnant,” Fergusson told The New Zealand Herald.  “We take into account their social background, education, ethnicity, previous mental health, exposure to sexual abuse, and a whole mass of factors."

The data  persistently pointed toward the politically unwelcome conclusion that abortion may itself be the cause of subsequent mental health problems.  So Fergusson presented his results to New Zealand’s Abortion Supervisory Committee, which is charged with ensuring that abortions in that country are conducted in accordance with all the legal requirements.  According to The New Zealand Herald, the committee told Fergusson that it would be “undesirable to publish the results in their ‘unclarified’ state.”

Despite his own pro-choice political beliefs, Fergusson responded to the committee with a letter stating that it would be “scientifically irresponsible” to suppress the findings simply because they touched on an explosive political issue.

In an interview about the findings with an Australian radio host, Fergusson stated: “I remain pro-choice. I am not religious. I am an atheist and a rationalist. The findings did surprise me, but the results appear to be very robust because they persist across a series of disorders and a series of ages. . . . Abortion is a traumatic life event; that is, it involves loss, it involves grief, it involves difficulties. And the trauma may, in fact, predispose people to having mental illness.”

 

Journals Reject the Politically Incorrect Results

 The research team of the Christchurch Health and Development Study is used to having its studies on health and human development accepted by the top medical journals on first submission.  After all, the collection of data from birth to adulthood of 1,265 children born in Christchurch is one of the most long-running and valuable longitudinal studies in the world.  But this study was the first from the experienced research team that touched on the contentious issue of abortion.

Ferguson said the team “went to four journals, which is very unusual for us – we normally get accepted the first time.”  Finally, the fourth journal accepted the study for publication.

Although he still holds a pro-choice view, Fergusson believes women and doctors should not blindly accept the unsupported claim that abortion is generally harmless or beneficial to women.  He appears particularly upset by the false assurances of abortion’s safety given by the American Psychological Association (APA). 

In a 2005 statement, the APA claimed that “well-designed studies” have found that “the risk of psychological harm is low.”  In the discussion of their results, Fergusson and his team note that the APA’s position paper ignored many key studies showing evidence of abortion’s harm and looked only at a selective sample of studies that have serious methodological flaws.

Fergusson told reporters that “it verges on scandalous that a surgical procedure that is performed on over one in 10 women has been so poorly researched and evaluated, given the debates about the psychological consequences of abortion.” 

Following Fergusson’s complaints about the selective and misleading nature of the 2005 APA statement, the APA removed the page from their Internet site.  The statement can still be found through a web archive service, however.


Study May Have Profound Influence on Medicine, Law, and Politics

The reaction to the publication of the Christchurch study is heating up the political debate in the United States.  The study was introduced into the official record at the senate confirmation hearings for Supreme Court Justice Samuel Alito.  Also, a U.S. congressional subcommittee chaired by Representative Mark Souder (R-IN) has asked the National Institutes of Health (NIH) to report on what efforts the NIH is undertaking to confirm or refute Fergusson’s findings. 

The impact of the study in other countries may be even more profound. According to The New Zealand Herald, the Christchurch study may require doctors in New Zealand to certify far fewer abortions.  Approximately 98 percent of abortions in New Zealand are done under a provision in the law that only allows abortion when “the continuance of the pregnancy would result in serious danger (not being danger normally attendant upon childbirth) to the life, or to the physical or mental health, of the woman or girl.”

Doctors performing abortions in Great Britain face a similar legal problem.  Indeed, the requirement to justify an abortion is even higher in British law.  Doctors there are only supposed to perform abortions when the risks of physical or psychological injury from allowing the pregnancy to continue are “greater than if the pregnancy was terminated.”  

According to researcher Dr. David Reardon, who has published more than a dozen studies investigating abortion’s impact on women, Fergusson’s study reinforces a growing body of literature showing that doctors in New Zealand, Britain and elsewhere face legal and ethical obligations to discourage or refuse contraindicated abortions.

“Fergusson’s study underscores that fact that evidence-based medicine does not support the conjecture that abortion will protect women from ‘serious danger’ to their mental health,” said Reardon.  “Instead, the best evidence indicates that abortion is more likely to increase the risk of mental health problems.  Physicians who ignore this study may no longer be able to argue that they are acting in good faith and may therefore be in violation of the law.”

“Record-based studies in Finland and the United States have conclusively proven that the risk of women dying in the year following an abortion is significantly higher than the risk of death if the pregnancy is allowed to continue to term,” said Reardon, who directs the Elliot Institute, a research organization based in Springfield, Illinois.  “So the hypothesis that the physical risks of childbirth surpass the risks associated with abortion is no longer tenable.  That means most abortion providers have had to look to mental health advantages to justify abortion over childbirth.”

But Reardon now believes that alternative for recommending abortion no longer passes scientific muster, either. 

“This New Zealand study, with its unsurpassed controls for possible alternative explanations, confirms the findings of several recent studies linking abortion to higher rates of psychiatric hospitalization. depression, generalized anxiety disorder, substance abuse, suicidal tendencies, poor bonding with and parenting of later children, and sleep disorders,” he said.  “It should inevitably lead to a change in the standard of care offered to women facing problem pregnancies.”


Some Women May Be At Greater Risk

Reardon, a biomedical ethicist, is an advocate of “evidence-based medicine”—a movement in medical training that encourages the questioning of “routine, accepted practices” which have not been proven to be helpful in scientific trials.  If one uses the standards applied in evidence-based medicine, Reardon says, one can only conclude that there is insufficient evidence to support the view that abortion is generally beneficial to women.  Instead, the opposite appears to be more likely. 

“It is true that the practice of medicine is both an art and a science,” Reardon said. “But given the current research, doctors who do an abortion in the hope that it will produce more good than harm for an individual woman can only justify their decisions by reference to the art of medicine, not the science.”

According to Reardon, the best available medical evidence shows that it is easier for a woman to adjust to the birth of an unintended child than it is to adjust to the emotional turmoil caused by an abortion.

“We are social beings, so it is easier for people to adjust to having a new relationship in one’s life than to adjust to the loss of a relationship,” he said.  “In the context of abortion, adjusting to the loss is especially difficult if there any unresolved feelings of attachment, grief, or guilt.”

By using known risk factors, the women who are at greatest risk of severe reactions to abortion could be easily identified, according to Reardon.  If this were done, some women who are at highest risk of negative reactions might opt for childbirth instead of abortion.

In a recent article published in The Journal of Contemporary Health Law and Policy, Reardon identified approximately 35 studies that had identified statistically validated risk factors that most reliably predict which women are most likely to report negative reactions.

“Risk factors for maladjustment were first identified in a 1973 study published by Planned Parenthood,” Reardon said.  “Since that time, numerous other researchers have further advanced our knowledge of the risk factors which should be used to screen women at highest risk.  These researchers have routinely recommended that the risk factors should be used by doctors to identify women who would benefit from more counseling, either so they can avoid contraindicated abortions or so they can receive better follow up care to help treat negative reactions.”

Feeling pressured by others to consent to the abortion, having moral beliefs that abortion is wrong, or having already developed a strong maternal attachment to the baby are three of the most common risk factors, Reardon says.

While screening makes sense, Reardon says that in practice, screening for risk factors is rare for two reasons. 

“First, there are aberrations in the law that shields abortion providers from any liability for emotional complications following an abortion,” he said.  “This loophole means that abortion clinics can save time and money by substituting one-size-fits-all counseling for individualized screening.

“The second obstacle in the way of screening is ideological. Many abortion providers insist that it is not their job to try to figure out whether an abortion is more likely to hurt than help a particular woman. They see their role as to ensure that any woman who wants an abortion is provided one.”

“This ‘buyer beware’ mentality is actually inconsistent with medical ethics,” Reardon said. “Actually, the ethic governing most abortion providers’ services is no different than that of the abortionists: ‘If you have the money, we’ll do the abortion.’  Women deserve better.  They deserve to have doctors who act like doctors. That means doctors who will give good medical advice based on the best available evidence as applied to each patient’s individual risk profile.”

Fergusson also believes that the same rules that apply to other medical treatments should apply to abortion. “If we were talking about an antibiotic or an asthma risk, and someone reported adverse reactions, people would be advocating further research to evaluate risk,” he said in the New Zealand Herald. “I can see no good reason why the same rules don't apply to abortion.”

# # #

Sources:

David M. Fergusson, L. John Horwood, and Elizabeth M. Ridder, “Abortion in young women and subsequent mental health,” Journal of Child Psychology and Psychiatry 47(1): 16-24, 2006.

Tom Iggulden, “Abortion increases mental health risk: study”  AM transcript. http://www.abc.net.au/am/content/2006/s1540914.htm

Nick Grimm “Higher risk of mental health problems after abortion: report” Australian Broadcasting Corporation. 03/01/2006 http://www.abc.net.au/7.30/content/2006/s1541543.htm

Ruth Hill, “Abortion Researcher Confounded by Study” New Zealand Herald 1/5/06, http://www.nzherald.co.nz

APA Briefing Paper on The Impact of Abortion on Women, http://web.archive.org  of http://www.apa.org/ppo/issues/womenabortfacts.html

Reardon DC. "The Duty to Screen: Clinical, Legal and Ethical Implications of Predictive Risk Factors of Post-Abortion Maladjustment." The Journal of Contemporary Health Law & Policy. 2003 Winter; 20(1):33-114.

 



[1] See Minister of Health’s Directive in terms of section 2 of the National Policy for Health Act 116 of 1990 which defines “informed consent”, "pre-test counseling" and "post-test-counseling".  Six different matters are specified as mandatory topics for pre-test counseling discussions.

[2] Christian Lawyers Association vs Minister of Health (no 2) 2005 1 SA 509