One of the most common methodological flaws in abortion research involves the use of poor comparison groups. A good comparison group will match the abortion group as closely as possible, controlling for a number of other factors - age, income, education, and so on. One of the most important factors to control for is the wantedness of the pregnancy. When studying the psychological effects of aborting an unwanted pregnancy, the only adequate comparison groups will be composed of women who carried an unwanted pregnancy to term.

Skewing the results against abortion is as easy as choosing an inadequate comparison group. Examples of this include:

• Women who have never been pregnant.
• Women who carried a wanted pregnancy to term.

An example:

A 2006 study by Fergusson, Horwood, and Ridder concluded that women who aborted were at an increased risk of mental health problems. The "pregnant - no abortion" comparison group was not controlled for pregnancy wantedness or intendedness - there is no way to know how many of these women were actively trying to get pregnant and viewed the pregnancy positively. Furthermore, this study was conducted in New Zealand, where abortion access is extremely limited:

Firstly, women must approach their doctor and are then referred to specialist consultants. Two certifying consultants must then agree: 1) that the pregnancy would seriously harm the life, physical or mental health of the woman or baby; or 2) that the pregnancy is the result of incest; or 3) that the woman is severely mentally handicapped. An abortion will also be considered on the basis of age, or when the pregnancy is the result of rape. (p. 17)

The "pregnant - abortion" group and the "pregnant - no abortion" group are composed of two very different sets of people. The first includes only women requiring abortion for medical/psychological reasons (some of whom may have been deeply emotionally invested in their pregnancies), rape/incest victims, very young girls, and mentally handicapped women. The latter includes women who wanted their pregnancies and women who were forced to carry their unwanted pregnancies to term due to legal restrictions on abortion. It's impossible to know how many of the participants fall into each of these categories within the two groups.

This obviously casts a great deal of doubt on the validity of the results. The failure to control for pregnancy wantedness and extremely traumatic events - such as rape or the termination of a wanted pregnancy due to severe medical complications - makes it seem absurd to draw conclusions about the abortion procedure as a primary cause of mental illness in the participants. In a section titled "the role of contextual factors," the authors weakly identify (and mostly skirt around) this serious problem with their research:

It is clear that the decision to seek (or not seek) an abortion following pregnancy is likely to follow a complex process relating to: a) the extent to which the pregnancy is seen as wanted; b) the extent of family and partner support for seeking or not seeking an abortion; c) the woman's experiences in seeking and obtaining an abortion. It is possible, therefore, that the apparent associations between abortion and mental health found in this study may not reflect the traumatic effects of abortion per se but rather other factors which are associated with the process of seeking and obtaining an abortion. For example, it could be proposed that our results reflect the effects of unwanted pregnancy on mental health rather than the effects of abortion per se on mental health. The data available in this study was not sufficient to explore these options.

I'll give you a moment to place your bets on how anti-abortion groups portrayed the results.

Done? Okay.

LifeNews reported that several medical journals rejected the study, but in nearly 500 words failed to find the space to even mention the methodological problems that might've led to the decision.

"We went to four journals, which is very unusual for us — we normally get accepted the first time," he said.

Fergusson told the Herald he knew of the "circus" that could result from the study but he said it would be "scientifically irresponsible" to not publish the results even though they are controversial.

Hear that? It's the world's smallest violin, and it's playing just for you.

In an article titled "How Abortion Harms Women's Health," the Family Research Council included this blurb:

A "pro-choice" research team in New Zealand, analyzing data from a 25-year period and controlling for multiple factors both pre- and post-abortion, found conclusively that abortion in young women is associated with increased risks of major depression, anxiety disorder, suicidal behaviors, and substance dependence. This is the most comprehensive, long-term study ever conducted on the issue.

Right. Well, except for the fact that the authors admitted that there were other plausible explanations for their findings, and that the editors of a number of peer-reviewed journals felt that the research was too weak to warrant publishing it. I really do hope that this isn't "the most comprehensive" study "ever conducted" on the topic.

Right to Life of Northeast Ohio, Voice for Life, and The National Right to Life Committee (NRLC) also commented on the study. None of them mentioned the flawed comparison groups. The NRLC claimed that the study "brought to light the professional bias" against results that "challenge the pro-abortion political agenda."

It seems that Fergusson had no trouble shoving the weaknesses in his work under the rug - and unfortunately, there are even more subtle ways of manipulating comparison groups to dramatically alter results. One popular method involves excluding participants with a history of multiple abortions from the delivery group but not the abortion group. The result? Women who have had no abortion are compared with women who've had any number of abortions. It might seem unlikely that this would significantly impact results, but (for reasons mentioned below) it can actually make a big difference.

In fact, a 2005 study by Schmiege and Russo found that attempting to mitigate this effect by excluding participants who'd had abortions subsequent to their first pregnancy from both the delivery group and the abortion group had a profound effect on the results. Women who delivered were significantly more likely to be depressed (determined by exceeding the cut-off score for Center for the Epidemiologic Studies Depression Scale, or CES-D) than women who had an abortion (APA Task Force on Mental Health and Abortion, p. 38-41). When women who'd had subsequent abortions were included in both groups, there was no significant difference in depression rates between the two.

Compare this to studies that do differentially exclude women with subsequent abortions from the delivery group (but not the abortion group!) and you'll find that almost all of them show higher levels of mental illness in the abortion group.

In other words, something as simple as removing women with subsequent abortions from the delivery group without doing the same for the abortion group can dramatically bias the direction and significance of the results. This is a very nuanced way to bend science, and if you don't know to look for it, it's easy to miss.

The likely explanation for this effect is actually quite simple: lower levels of education and higher rates of poverty correlate with repeated unwanted pregnancies (APA, p. 33). Additionally, pregnancy coercion and contraceptive sabotage correlate with a higher risk of both intimate partner violence and unwanted pregnancy (Miller, Decker, McCauley, Tancredi, Levenson, Waldman, Schoenwald, & Silverman, 2010). As the APA Task Force notes in its overview, "positive associations observed between multiple abortions and poorer mental health may be linked to co-occurring risks to both multiple unwanted pregnancies and mental health problems."

To summarize: comparison groups should always be as closely matched to abortion groups as possible. If researchers can't provide a very compelling reason for manipulating their comparison group(s) in ways that subvert their similarities with the abortion group, doing so presents a serious threat to the validity of their research.

If this post has piqued your interest in the methodological flaws that taint most abortion research, I can't encourage you enough to read the Report of the APA Task Force on Mental Health and Abortion in full.

This is the first post in what will (hopefully) become a series on the tools used by anti-abortion activists to bend science. My hope is that this information will be used by pro-choice advocates to critically evaluate and counter the massive quantity of bad research produced by anti-abortion interests.

Today's post covers the use of biased participant groups.

Perhaps the most classic example of this trick is a 1994 study that found that 94% of the participants had, at some point, regretted the decision to abort. The big problem here is that all of the participants in this study were women who had made contact with Women Exploited By Abortion (WEBA), Victims of Choice, or Last Harvest Ministries. Furthermore, some of the participants had already been "counseled" by these groups. The only conclusion supported by this research is that 94% of women who contact anti-abortion groups for post-abortion counseling have at some point regretted the decision to abort. Not exactly a shocker.

(Note that support groups exist for mothers struggling with the decision to parent or give up a child for adoption, and one could easily follow a similar procedure to get equally distorted results with these groups.)

Even the author admits that his findings aren't applicable to post-abortive women in general:

Because this is a self-selected sample of the those who had a "bad experience" these findings should not be interpreted as representative of a random sample of all women who have had abortions.

However, when this study is cited by anti-abortion organizations, any mention of the biased sample completely vanishes. As you can see below, these groups are blatantly lying about the implications of the research.

Sozo Life Clinic (Family Life Ministries):

A Survey of Post-Abortive Women Found That:

28% attempted suicide
31% experienced suicidal feelings
60% commented that the decision to abort made their lives worse
94% regretted the decision to abort

Hope for Families:

...what your mother may not realize is that 94% of women who have had an abortion regret their decision.

Twin Falls Pregnancy Crisis Center:

Most women regret abortions. In fact, when Dr. David Reardon, Ph.D., surveyed 260 women who’d had abortions, he found that:

94 percent had regrets about their abortion
28 percent attempted suicide
58 percent lost pleasure from intercourse
63 percent had flashbacks of their abortion

As this example shows, it is extremely important to read about the participants when evaluating research. There are countless ways to manipulate the participant pool to get more favorable results. Off the top of my head, I can think of several:

• Select women from a conservative church who attend multiple services.
• Select women who are having to abort a wanted pregnancy.
• Select impoverished or homeless women.
• Select women who are currently being treated for depression or anxiety.

Note that there's nothing inherently dishonest about studying abortion outcomes in these groups - the problem lies in extrapolating conclusions about the general population of women from information about smaller, specialized samples. I think it would be very useful to know more about how abortion affects the homeless and conservative church-goers - but it doesn't say anything about women who don't fall into those specific categories.

Finally: when you're quoted statistics that seem wildly inaccurate, demand the source. If someone can't provide any credible information about their data, chances are that something is being skewed - either in the research itself, or in its interpretation. Beyond that, hold a high standard for the information you pass on. A lot of journal articles and research reports are just one Google search away!

The Pitch has a nice little post on Missouri's recently-enacted SB-793, which essentially requires doctors to lie to women seeking abortion about the kind of aid offered to them if they continue their pregnancies. The "Alternatives to Abortion Services Fact Sheet" - which abortion doctors must provide to their patients - suggests that medical/prenatal care, food, childcare, housing and utilities, transportation, clothing, pregnancy supplies, and job training/placement are all available to women in need. The only problem? It's not really true.

So the state of Missouri will help new mothers afford parenthood, huh? Not according to the stats from the Mid-America Research Council's Metropolitan Council on Early Learning. According to the "policy issues" page on its website, Missouri is ranked 49th in the nation in childcare assistance funding.

"Once a baby is born, women are pretty much on their own," says Ruth Ehresman, the director of health and budget policy for the Missouri Budget Project. Unemployed moms can be eligible for Temporary Assistance to Needy Families (aka "welfare"), which equals $292 a month for a family of three. If the mother or her spouse works, that amount is reduced. There's a five-year lifetime limit on this support, so it maxes out quickly. As Ehresman puts it, "It is negligible support."

If the state of Missouri won't provide the services it promises, how does it expect women to access them? The answer is disappointing, to say the least. Doctors must hand out lengthy lists of crisis pregnancy centers (CPCs) and other religious organizations, billing them as "Pregnancy Assistance Information Providers" and "Missouri Alternatives to Abortion Program Providers." These groups give aid at their own discretion; they're not required to provide any of the services promised by the state of Missouri, even to the women with the greatest need. The stated goal of many of these groups is to prevent women from aborting and "educate" them about Christianity, not to help them afford their babies.

But wait, there's more.

The law also requires that women seeking abortion be presented with color photographs of "the developing unborn child" at two-week gestational increments, all the way up to full term. Descriptions of the anatomy and heart/brain functions of the fetus must accompany the photos. And then there's this:

The printed materials shall prominently display the following statement: "The life of each human being begins at conception. Abortion will terminate the life of a separate, unique, living human being."

Never mind that this definition requires a very narrow reading of the terms "separate" and "unique," or that a person isn't generally considered alive by medical professionals unless he or she sustains a certain level of brain functioning, which certainly isn't present at conception. Missouri legislators had to get as close to "you're killing your baby" as they possibly could. And unfortunately, that's not even the worst of it.

Women seeking abortion after 22 weeks must be told that the fetus may feel pain. The doctor must describe the steps of the abortion procedure in detail, and make note of "which steps... could be painful to the unborn child." No one is exempt. Even women carrying wanted pregnancies with severe complications are required to sit through this - and there's no opportunity to opt out.

In case you're thinking "no way, I could never put someone through that if she asked me to stop," there's this: to violate any of the bill's provisions is a Class B Felony, carrying a prison sentence of 5-15 years. Doctors' hands are tied. Not only must they be complicit in the aid bait-and-switch, they must also make a difficult decision even more painful for their most vulnerable patients.

Fuck Missouri.

In the not-too-distant past, American women were typically relegated to being support staff in their own lives. The sexual revolution and the advent of widely-accessible birth control and safe, legal abortion had an immense impact on the American woman, and whether or not you see that as a good thing depends largely on whether you consider yourself a liberal or a conservative.

The rift could not be more apparent when you look at social phenomena like the widely-publicized Duggar family. The Duggars are essentially living the ultra-conservative "good life," with lots of contraceptive-free sex subsequently resulting in 19 children (so far). The older kids are "assigned" a younger sibling to look after, and mom stays home to supervise.

Never mind that most people don't have the will or the wealth to handle over a dozen children and a $3000/month grocery bill. The question isn't what you want for your life, or even if you can afford that life you don't want. If you're good to God, God provides.

If you don't believe in the prosperity gospel (essentially: the rich are rich because God likes them), or don't believe the fundamentalist Christian interpretation of a deity, the idea of dropping all your little plans for your own life and donning a financial blindfold might seem a bit rash. Which is probably why 98% of U.S. women who've had sex have, at some point, used contraceptives.

The point I'm getting at is NOT that the Duggers are bad people, or that they shouldn't be able to live the lifestyle they've chosen (as long as their children are sufficiently cared for), but that it's not a life many of us would choose. Virtually every vocal pro-choicer has been called "selfish" for their beliefs about contraception and abortion, which essentially amount to the belief that women should be at the helm of their own lives, deciding if, when, and with whom they want to become parents.

Let's be frank: refusing to be a doormat in the face of someone else's perceived ideological authority isn't selfish. Personal liberty is at the heart of every precious freedom we have. I refuse to ignore the incredible sense of entitlement that necessarily accompanies the belief that you know how other people should live their lives and form their families.

I'm not a perfect person. I can be selfish far more often than I'd like to be. But my belief in personal liberty for all human beings, including my belief in freedom of choice, is one of the least selfish things about me.

Vanguard (a documentary series) recently did an episode on sexual abuse in Native American communities, with a focus on the Rosebud Reservation in South Dakota. According to the filmmakers, Native Americans make up only 9% of the state's population, but account for 40% of its sexual assault cases. One in three Native American women will be raped in her lifetime.



(Click here to watch the full episode - "Rape on the Reservation" - on Hulu.)

Here's a transcript of the conversations between the reporter and several high school students in Rosebud:

Male Student: My dad broke his woman's jaw before within just two seconds, he just reached sideways, just a quick snap, and she was done. And uh, she didn't even go to the cops. She was scared. But um, seeing that I guess made me realize on... how I can have control over my house. You know, the rough way. The man way, I guess. That's the way my dad put it. Be a man. Hit somebody.

Reporter: Do you see any problem in hitting, beating women?

Male Student: I don't wanna say it's OK, but if you're gonna have dominant power in your relationship, then yeah.

Reporter: And how do you guys feel when you hear that?

Female Student: Well I don't think it's okay, but like, no one can stop them.

According to NOW:

When we consider race, we see that African-American women face higher rates of domestic violence than white women, and American-Indian women are victimized at a rate more than double that of women of other races.

The Vanguard episode addresses some of the barriers that Native American women face when trying to seek justice after their assault: victim-blaming, stigma, racism, and fear of retribution from the perpetrator's family being just a few.

Male Student: Say uh, if I had raped somebody and then she wanted to go forward and press charges on me, and I got tossed in jail. See, my brother gets pissed off and goes knocking on her door - he's gonna hit her. Damn right, she gets hit. And then say he goes to jail for hitting her, well I've got another brother. And after that brother, I've got another friend. After that friend, he's got an older brother.

Blogged by Amanda at Pandagon via RH Reality Check, the National Association of Evangelicals has extended some degree of support for contraception as a means of reducing abortion rates.

It's a small victory (contraception was mentioned just once in the press release), but it may be an important one. The propagation of abstinence-only "education" has taken its toll, and many forms of birth control are still cost-prohibitive for many Americans. Thanks to the Affordable Care Act, preventative services will soon be offered for free by many insurers, and Planned Parenthood is pushing hard (if quietly) to make sure that birth control makes the list.

To me, this seems like common sense. Birth control prevents pregnancy, which is in fact a medical condition. The problem is that most conservatives believe, either in actuality or for the sake of argument, that pregnancy is not a medical condition. This allows them to make the case that neither birth control nor abortion fit the bill for "health care," which subsequently results in female reproductive care getting held back while improvements are made elsewhere*. We've seen this before, and sadly, I think we're going to see a lot more of it.

Which is why small victories, like the NAE offering a token of support for contraception, matter. Admitting that contraception access is a good thing is a subtle way of admitting that unwanted pregnancy - not just abortion - is a bad thing. It's a step toward reality-based abortion prevention: the sort that works by helping women prevent pregnancies they don't want, rather than finding ways to manipulate them after they've become pregnant. Parental consent, waiting periods, and unreasonable counseling requirements all fall into the latter category, and they're all still condoned by the NAE. However frustrating they may be, small steps are sometimes the only way forward.

* An example of the delegitimization of women's reproductive care: an opinion piece in the Washington Examiner yesterday titled "Obamacare: Get ready to pay for young slackers’ sex-lives."