New Scientist, 14 June, 2008
OP-ED: America's abortion scandal; When it comes to abortion and contraception in the US, beware insidious governmental pressures on doctors and researchers
By Pratima Gupta, MD
AS AN obstetrician-gynaecologist trained to rely on the best scientific evidence to diagnose and treat my patients, and as a professional who performs abortions, I've witnessed many examples of personal moral beliefs trumping scientific evidence. But these days, individuals' personal beliefs are also being trumped - by the ideologies of powerful institutions. These pressures can produce abuses of science and self-censorship, even among doctors and scientists.
One of the most insidious examples of scientific abuse is the belief that abortion is psychologically damaging. A proposed law in South Dakota would ban most abortions on the grounds that "an abortion subjects the pregnant woman to significant psychological and physical health risks". Anti-abortion advocates argue for a diagnosis of "post-abortion stress syndrome" despite the absence of evidence. The women to whom I offer abortion care feel a range of emotions - relief, sadness, even happiness - but their emotions confirm the scientific evidence that the best predictor of a woman's mental health after an abortion is her mental health before it.
Yet in Gonzales vs Carhart (a Supreme Court case last year which upheld a law supported by the Bush administration, banning a specific abortion procedure), Justice Anthony Kennedy noted: "While we find no reliable data to measure the phenomenon, it seems unexceptionable to conclude some women come to regret their choice to abort." Kennedy's personal opinions have legitimised an idea that has no basis in medical fact. Already this year, politicians in 11 states have introduced laws mirroring aspects of the ruling.
The controversial nature of reproductive healthcare also extends to "benign" areas such as birth control. My colleagues and I discuss birth control with every woman we see. Since most women spend decades sexually active but trying not to get pregnant, and only a few years pregnant or trying to be, contraception is a big issue.
Sadly, a systemic lack of education and training for doctors prevents them from providing good contraceptive counselling. This is especially true of the intrauterine device (IUD) - an effective, long-term birth control method with an undeservedly bad reputation dating from the 1970s and early 1980s. Many colleagues tell of placing IUDs in their patients, only to have other doctors remove them because they mistakenly believe there is a high risk of infection and infertility. The lack of training leaves too many doctors open to old controversies and misconceptions which they pass on to their patients and students.
While these are troubling examples of ideology and misinformation preventing doctors from providing the best care, self-censorship worries me more. Take the case of a loan scheme offered by the National Institutes of Health to medical researchers. The money comes with a catch: the research cannot involve abortion. Several colleagues have abandoned their primary interest in abortion because they need funds. As one of the most common procedures in the US today, abortion should be widely researched, not bypassed for lack of funds. The resulting dearth of research leaves doctors less informed, and compromises women's care.
Another example happened in April. The Popline database on sexual and reproductive health is run from the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. After government officials questioned the inclusion of several articles on abortion in the database which they felt had crossed a line into advocacy, database administrators eliminated "abortion" as a valid search term. A medical librarian in California noted the change - confirmed via email by database administrators - and forwarded their message to listservs and blogs for medical librarians. News of the change ignited an online storm, and within a day the Bloomberg School's dean restored "abortion" as a search term and launched an inquiry.
While the search term was restored promptly, it is unsettling that concerns over government funds apparently overrode Popline's mission to provide the most comprehensive information on reproductive health. The administrators were not told to censor "abortion", but did so after a few articles were challenged. Doctors and researchers depend on Popline. We should not have to resort to the Orwellian search term suggested by its administrators - using "fertility control, post-conception" - to find information about a medical procedure 1 in 3 women in the US will undergo.
Most of my colleagues recognise blatant attempts to suppress research or spread misinformation on abortion and contraception. But the process can also be subtle, eroding the practice of evidence-based medicine. To ensure the best care, we demand funds for research, training in reproductive healthcare, and information that is freely shared. It's the only way to avoid a Bermuda triangle of censorship, ideology and ignorance.
Pratima Gupta, an obstetrician-gynaecologist, is a board member of the US pro-choice doctors' network Physicians for Reproductive Choice and Health