Monday 16 September 2019

Vote No and safeguard women's mental health

Abortion is never easy or desirable for women whatever their circumstances, writes Dr Anne Doherty

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Anne Doherty

As a doctor and especially as a psychiatrist, I am anticipating this referendum with grave concern. This is a confusing debate. While many describe abortion as a healthcare initiative, there is no justification for describing it as a mental healthcare initiative.

I am a doctor who wishes to care for women in a genuinely compassionate way. In my day-to-day work, I want to respond to women in distress with care, compassion and professionalism, without judgment. In my work, I have met many women who have had terminations of pregnancy, some in very difficult and painful circumstances.

For some, it was part of a difficult time in their past; for others it has been the source of pain and suffering. I have not met any woman for whom it was an easy or desirable choice. All doctors, regardless of our personal views on abortion, treat women in distress or with mental health problems with care and consideration, and regardless of the outcome of the referendum, I will continue to do so.

In terms of the referendum itself, we are being asked to vote on repealing the Eighth Amendment, removing all recognition of the human rights of the unborn, facilitating legislation for providing for termination. Much of the campaigning from the Yes side has focused on the 'hard cases' - women whose lives may be at risk, women with pregnancies following rape, and babies with life-limiting conditions. These situations account for less than 4pc of UK abortions. My sympathies are with the women in these hard cases. From my clinical experience, I understand the pain that difficulties bring, and that these are complex and nuanced circumstances. Despite my sympathies and my clinical commitment to these women, I have concerns about meeting their suffering with procedures and courses of action which are not proven to benefit women's mental health.

If the Eighth is repealed, the Government is proposing legislation to allow unrestricted abortion up to 12 weeks, and up to 24 weeks or viability if the mother's health is at risk, which may be due to physical or mental illness. The proposed legislation allows for abortion on more liberal grounds than the UK, where the signatures of two doctors are required even for early term abortion.

In the UK, 96pc of abortions are carried out on mental health grounds. As a psychiatrist, someone who treats serious mental illness, and has done so in the UK, it is not easy to believe that more than 180,000 women in England and Wales are seriously mentally ill (96pc of 190,416: 2016 figures).

Abortion on 'mental health' grounds is a retrograde step, using mental health problems as a reason for abortion rather than an indication for treatment.

Distress should be acknowledged and addressed in a truly caring way with supports and evidence-based treatments. The mental health of women deserves real respect and real interventions, but not at the expense of the life of the unborn.

So, let's consider the evidence. It may seem at first that terminations must be beneficial, but the evidence does not support the idea that terminations are in any way favourable for women's mental health, and even pro-choice researchers and activists will concede this.

There is some evidence that they may cause harm. This is a hotly debated area, and the research in this area is really quite mixed, due to the nature of the research which can be conducted. To determine harm conclusively, a study would need to randomise pregnant women to receive either a termination or to proceed to birth, and this is obviously not ethical.

There have been a number of systematic reviews of the literature - large studies which examine all of the available or published evidence.

There most balanced of these reviews is from the Academy of Medical Royal Colleges, which acknowledged that there is an association between abortion and mental health problems. However, it found similar rates of mental health problems among women with an unwanted pregnancy who had abortion and those who gave birth, a group with an established high risk of mental health problems. It concluded that the "most reliable predictor of post-abortion mental health problems was having a history of mental health problems before the abortion".

Dr Anne Doherty, consultant liaison psychiatrist, Galway University Hospitals

Sunday Independent

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