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FactCheck: What do HSE guidelines actually say about the effects of abortion?

The Pro Life Campaign’s Sinead Slattery made a bold claim on Tonight With Alison O’Connor this week. Does it hold up?

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ABORTION AND REPEAL of the Eighth Amendment are never far from the top of the news agenda at the moment.

On Tuesday, TV3′s Tonight With Alison O’Connor hosted a debate on the issue, during which the Pro Life Campaign’s Sinead Slattery made an interesting claim.

According to her, the HSE’s recently published maternal bereavement guidelines had said that “abortion actually causes more distress” than carrying a pregnancy to term.

Is that actually what they say?

Gerry Edwards, Chairperson of Leanbh Mo Chroí, a charity for families affected by pregnancies with a diagnosis of a fatal foetal abnormality, got in touch with us.

(Remember, if you hear a dodgy claim, email factcheck@thejournal.ie or tweet @TJ_FactCheck).

Claim: HSE guidelines state that abortion causes more distress than carrying a pregnancy to term
Verdict: FALSE

  • The HSE guidelines do not say what Slattery claimed they say
  • She has since clarified that she was not quoting from anything, but rather paraphrasing two documents cited in the HSE guidelines
  • Among the guidelines’ 260 references are a study on the psychological effects of a second-third term abortion after a diagnosis of foetal abnormalities, and a literature review on grief after perinatal loss
  • Both articles are far more nuanced and limited in their findings, and don’t support the summary presented by Slattery
  • The claim, as stated on Tonight With Alison O’Connor, is inaccurate and a serious misrepresentation of the facts.

What was said:

Source: TheJournal.ie/YouTube

You can watch the exchange from Tuesday’s show above.

This is the section of Sinead Slattery’s comments that we’re most interested in:

…If you look at the HSE, who recently published bereavement guidelines for parents and for mothers who are carrying children with life-limiting conditions, and I quote, they say that abortion actually causes more emotional distress in the long term and in the short term than actually carrying through with a pregnancy.

The Facts

You can read the recent HSE guidelines in full, here.

Let’s get this out of the way – the HSE guidelines do not say what Sinead Slattery said they say.

They don’t state or even quote any comparison of the psychological effects of terminating a pregnancy with those of carrying a pregnancy to term.

The HSE told FactCheck: “As far as the HSE is concerned the quote referenced did not originate with us”.

We asked Sinéad Slattery to provide the exact quote alluded to in her remarks, and its source.

In response, she told us she was, in fact, “paraphrasing” two studies cited in the HSE guidelines, which she said “totally debunk” the claim that, where there is a diagnosis of foetal abnormalities, abortion is “in the mother’s best interest, emotionally and psychologically”.

Regarding the use of the word “say” referring to the HSE, perhaps it would have been better if I had used the word “cites” but I think it was clear that I was referring to peer-reviewed research and the guidelines themselves obviously are not a research document and it was not my intention to present them as such.

There’s no wording in her statement on Tonight With Alison O’Connor which would indicate she was referring specifically to research cited in the guidelines, rather than, as she actually said, the guidelines themselves.

However, she has since clarified to FactCheck that she was not, in fact, quoting from anything, but rather paraphrasing the two studies she mentioned.

Let’s look at those studies, to see whether their citation in the guidelines could reasonably be understood as an endorsement of the position that “abortion actually causes more emotional distress in the long term and in the short term than actually carrying through with a pregnancy”.

We won’t be evaluating that claim itself, but rather whether or not the two documents highlighted by Slattery (and cited in the HSE guidelines) lend support to her contention.

Citation 1

Screen Shot 2016-08-26 at 12.33.30 PM

The first is entitled Complicated Grief After Traumatic Loss: A 14-month follow up study, and was published by two German researchers in 2007.

The study compared the psychiatric test results of two groups of women, at various time intervals after a particular event.

That is: two weeks, six months, and 14 months after 1) the termination of a pregnancy (second or third trimester) due to foetal anomalies, 2) the birth of a healthy child.

Perhaps not surprisingly, it found consistently higher levels of trauma, stress, anxiety and “complicated grief” in the first group than in the second group, at every time interval, although the vast majority of women in both groups did not show these symptoms at any time.

Crucially, this study did not compare the psychological test results of women who chose to terminate their pregnancy after a foetal abnormality diagnosis, with those of women who chose not to do so, after similar diagnoses, or “carry through” with the pregnancy, in Slattery’s words.

The use of women who spontaneously delivered a healthy child as a control group was intended to illustrate the psychological symptoms following from an abortion after a diagnosis of foetal abnormalities.

Naturally, this type of information would be of use to practitioners dealing with parents who have been bereaved after this type of loss.

Furthermore, the study did not test, nor make any findings for, the psychological symptoms following any abortion, for any reason, at any stage.

It very specifically related to second or third-trimester abortions (on average 20 weeks in), in cases of foetal abnormalities.

It does not support Sinead Slattery’s contention, because it doesn’t involve the salient comparison.

Citation 2

shutterstock_296153609 Source: Shutterstock/megaflopp

The second document, Complicated Grief After Perinatal Loss, is by the same lead author as the first, Dr Anette Kersting from the University of Leipzig.

It is not a study, as claimed by Sinead Slattery, but rather a literature review (a summary of what’s already been written on the subject). It was published in 2012 and can be read in full here.

The review describes what existing scientific studies say about patterns of grief surrounding perinatal loss (the death of a child at or around the time of birth) as a whole.

It’s not focused on pregnancy termination, although it includes a section on it. The authors mention two studies (one of which we’ve described above) which essentially show, as they put it:

…The loss of an unborn child after discovery during pregnancy of fetal malformation or severe chromosomal disorders can be considered as a traumatic life event with high psychological impact.

And the Conclusion states: “Pathological grief was found to be particularly high in women after termination of an abnormal pregnancy”.

However, they also note the finding in another study that: “In spite of changes in mental state following termination…only 2.7% of the participants regretted their decision”.

Note, once again, that there is no comparison here between grief or trauma among women who choose to terminate after a diagnosis of foetal abnormality, and women who choose not to, which is the salient comparison.

And again, the authors refer only to grief and trauma after abortions in the case of foetal abnormalities, and not abortions at any stage, or for any reason.

There may be other research out there which supports or refutes Sinead Slattery’s contention about the comparative psychological effects of abortion, but the purpose of this exercise is to see whether the documents she pointed to give that support.

They don’t.

A third citation

shutterstock_268616597 Source: Shutterstock/BLUR LIFE 1975

Although this wasn’t pointed to by Sinead Slattery in her response to FactCheck, there is a section in a draft version of the HSE guidelines, from 2015, which states:

It is acknowledged that women, who for whatever reason opt to have a termination of pregnancy, experience more intense emotional distress in the short and long term as compared with women after preterm birth or normal birth. [Emphasis added].

This section cites a third journal article written by Dr Anette Kersting, which is referenced in the finalised guidelines, although the section itself was cut.

Although Slattery did not refer to it in her response to FactCheck, it closely resembles her claim on Tonight With Alison O’Connor, that abortion causes “more emotional distress in the long term and in the short term”.

It also appears to be reflected in comments made recently by Jennifer Kehoe of One Day More, a support group for parents who receive what they describe as “poor pre-natal prognoses for their babies”.

In a press release in response to the publication of the HSE guidelines, Kehoe said:

Significantly, the guidelines also draw attention to the research in this area showing that women who opt for termination of pregnancy, for whatever reason, experience more intense emotional distress in both the short and long term. [Emphasis added].

The press release also contained a footnote referring explicitly to the 2009 research by Anette Kersting.

That study compared the psychological test results of three groups of women after a specific event.

That is: two weeks, six months, and 14 months after 1) the termination of a late pregnancy (second or third trimester) due to foetal anomalies, 2) a preterm (premature) birth of a VLBW (very low birth-weight) child, and 3) the birth of a healthy child.

It found that the rate of diagnosis of a psychiatric disorder was consistently higher among the first group, at every time interval, although the vast majority of women in all three groups did not have such diagnoses.

Once again, the paper does not compare between women choosing to terminate a pregnancy after a diagnosis of foetal abnormalities, and women choosing not to terminate a pregnancy after a diagnosis of foetal abnormalities.

The second group in the study was composed of women who gave birth to a very low birth-weight child (on average at 29 weeks), and not women who chose to continue with a pregnancy after a diagnosis of foetal abnormalities.

And finally, the study did not analyse the psychological effects of terminating a pregnancy in general (i.e. for any reason, at any time) as opposed to carrying a pregnancy to term, in general.

So the use of the phrase “for whatever reason”, in the draft HSE guidelines (and later by Jennifer Kehoe) is a significant misrepresentation of what the 2009 study actually found.

In her statement, Kehoe also left out the crucial point of comparison included in the study (i.e. terminations compared to preterm and healthy births, as opposed to non-terminations).

And finally, this section of the draft guidelines was cut from the final version, anyway. Referring to the 2015 draft, the HSE told us:

The literature review was composed of science-based evidence from research conducted by national and international researchers.  The findings did not represent an opinion originating from the HSE.

Conclusion

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  • The HSE guidelines do not say what Sinead Slattery quoted them as saying, nor do they make any similarly-worded statement.

In response to FactCheck, Slattery clarified that she was not, in fact, quoting from anything, but rather was paraphrasing two documents cited in the guidelines.

  • That study and literature review had findings and conclusions that were far more nuanced than, and different to, the summary Slattery presented. This is not merely a technicality or a semantical point.
  • Furthermore, even if those documents did contain the quote presented by Slattery (which they don’t), or support her contention about the comparative psychological effects of termination (which they don’t), there is crucial context to be borne in mind here.

The HSE guidelines, which are 84 pages long, contain 260 references – 211 of which are peer-reviewed journal articles such as the ones outlined in this FactCheck and highlighted by Sinead Slattery.

If the HSE guidelines “say” what’s contained in one or two of those articles, it would have to logically follow that the HSE guidelines also “say” everything that’s contained in all 260 books, reports, statutes, and articles it references.

Or if it’s somehow especially significant that the HSE guidelines cite one or two of those articles, it would have to logically follow that it’s equally significant that the HSE guidelines cite each of those 260 references.

Sinead Slattery’s claim, as articulated on Tonight With Alison O’Connor, is entirely inaccurate.

Her subsequent clarification – that she was actually paraphrasing two documents cited in the guidelines – misrepresents those documents and is not supported by the facts.

We rate her claim FALSE.

Send your FactCheck requests to factcheck@thejournal.ie

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