Reflections on “Happy mothers are willing mothers!”

Reflections on “Happy mothers are willing mothers!”

This article has been contributed via Readers’ Contribution


AWARE’s op-ed piece criticizes an unnamed organization (that provides a telephone service to assist women who face unwanted pregnancies) for providing inaccurate information and misinforming its callers. AWARE’s overall goal to dispel unscientific myths and promote accurate information is commendable and comprises a necessary check-and-balance as we aspire to be a society governed by free speech. Nevertheless, it is my opinion that the critique is undermined by certain inaccuracies and over-generalities as well as poor timing.

Given that AWARE’s purpose in its op-ed is to unmask the inaccuracies and sweeping statements of another organization, it should naturally be held to a higher standard in its own reporting, especially since it uses the results from three academic papers to lend weight to its arguments. After reviewing these studies, I think that quite ironically, AWARE’s op-ed also suffers from inaccuracies and over-generalizations, not unlike those that it accuses the unnamed organization of making.

First, the op-ed claims that the 2007 NEJM study[1] found that “a medical abortion … causes no adverse health effects on subsequent pregnancies.” I believe that this is inaccurate. The study found that medical abortions had statistically similar rates of various types of complications in subsequent pregnancies to surgical abortions, not that there are no adverse health effects associated with medical abortions. Furthermore, this study only applies to abortions in the first trimester of gestation, not to abortions in general.

Second, the op-ed claims that the 2011 NEJM study[2] “shows that having an abortion does not increase the risk of mental health problems.” This statement differs from the actual findings of the study in several respects. First, the use of “does not” in the op-ed is an overly strong assertion of what the study actually claims. By definition, such a study cannot definitely prove a negative statement. At most, it can (and does) only conclude that it failed to find the hypothesized statistical association. Second, the study only pertains to first trimester abortions, not abortions in general. Third, the study’s outcome measure is first contact with a psychiatric facility, which is a good but nevertheless imperfect proxy for “mental health problems.” For example, it does not capture severity of the mental condition, and also suffers from potential selection biases. Finally, the study is restricted to the Danish female population and it is unclear that the results can be extrapolated universally as the op-ed suggests, particularly because unlike physiological conditions, psychiatric conditions may potentially be affected different social structures and other cultural influences.

Third, the op-ed cites the results of the 2012 Ob&G study[3] to conclude that “legally induced abortion is markedly safer than childbirth, with the risk of death associated with childbirth approximately 14 times higher than [sic] with abortion.” I think this is the most accurately reported finding among the three studies. However, the op-ed fails to mention that this third study uses a very different methodology than the other two: it bases its conclusions on population statistics instead of a cohort study, and consequently does not control for individual-level covariates. Such studies are not usually considered at the same level of evidence as cohort studies because they are subject to biases from selection and inconsistency between data sources.

Personally, I think that abortion is a highly complex issue. It cuts into our core beliefs about life, mortality, and free choice. I do not think that it is as one-dimensional as some on the far ends of the pro-life / pro-choice spectrum make it out to be. Specifically, I think that it is overly simplistic to frame the issue solely as being about choice or life. In this regard, I am disappointed that AWARE chose to use the occasion of Mother’s day to vilify the other camp (I’m assuming that the organization is a pro-life group) and promote its overtly pro-choice agenda. It makes AWARE seem petty and mean-spirited, and bordering on hypocritical, as it is similarly using over-generalized findings to support its stance. In my opinion at least, it may have done more to hurt the pro-choice movement than to help it.


[1] Virk J, Zhang J, Olsen J. Medical abortion and the risk of subsequent adverse pregnancy outcomes. New England Journal of Medicine. 2007;357:648-653.

[2] Munk-Olsen T, Laursen TM, Pedersen CB, Lidegaard O, Mortensen PB. Induced first-trimester abortion and risk of mental disorder. New England Journal of Medicine. 2011; 364: 332-339.

[3] Raymond EG, Grimes DA. The comparative safety of legal induced abortion and childbirth in the United States. Obstetrics & Gynecology. 2012;119: 215-219.”