Bipolar and pregnant

Thank you to guest blogger Zoe for allowing us to share her thoughts on the recently reported case of a woman who was granted legal access to abortion following a challenge to her ability to consent. This is cross-posted on Zoe's own blog 'The Fementalists'.

Today a woman, identified only as “SB”, won her High Court battle to be allowed to have an abortion. This fact may seem strange to many readers as since the Abortion Act was passed in 1967 legal abortion has been mostly accessible to women in England, Scotland, and Wales . However, the woman at the centre of this case has bipolar disorder and it was argued by doctors and her family that she lacked mental capacity to consent to the procedure. Lawyers representing the health authority told the judge “she is believed to lack the capacity to make a decision regarding the termination of her pregnancy due to her mental disorder.'' Fortunately, the judge disagreed with this assessment, stating that it would be "a total affront" to her autonomy to decide that she was unable to have an abortion.

I have been following this case closely as I also have bipolar disorder and as a young woman with a male partner I worry a lot about the possibility of an unplanned pregnancy, to say nothing of worrying about what my future holds in terms of planned pregnancy. It was stated in the Court that the woman in this case had stopped taking her medication and thus relapsed, culminating with her being detained under the Mental Health Act. However, many medications for bipolar are not suitable to take when pregnant as they can cause birth defects such as neural tube defects, heart defects, and developmental delay or neurobehavioural problems. Thus many people have to stop taking their medication if they wish to continue with their pregnancies. This is believed to be what happened in the “SB” case. While this may seem like a relatively minor thing, the consequences of this can be devastating. Rates of relapse into bipolar mania and psychosis are estimated at 50% to 75% respectively and WebMD states that “Pregnant women or new mothers with bipolar disorder have seven times the risk of hospital admissions than pregnant women who do not have bipolar disorder.” So clearly the risk of being detained under the Mental Health Act also greatly increases during pregnancy because of the additional problems caused by stopping medication.

For me, this represents the nightmare scenario. Finding myself pregnant with a wanted foetus only to stop my medication, relapse and be detained under the Mental Health Act, and to then decide that for my own health I would like a termination and be denied it because it is argued that I lacked capacity. It is truly a terrifying prospect to find yourself unable to control your own body because you have a mental illness. Much more needs to be done to provide perinatal care for women with severe and enduring mental illness to ensure that a situation like this never arises again. Fortunately in this case the judge has made the right decision and SB is expected to have an abortion in the following days. Arguably, this situation should never have arisen in the first place.

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Myth-Busting Monday: ‘Abortion causes mental health problems’

In light of the recent Systematic Review of Induced Abortion and Women’s Mental Health it’s time to put to rest any myths about abortion increasing risk of mental health problems.

The comprehensive review stated that:
•    The rates of mental health problems for women with an unwanted pregnancy were the same whether they had an abortion or gave birth
• An unwanted pregnancy was associated with an increased risk of mental health problems.
• The most reliable predictor of post-abortion mental health problems was having a history of mental health problems before the abortion.
• The factors associated with increased rates of mental health problems for women in the general population following birth and following abortion were similar.
• There were some additional factors associated with an increased risk of mental health problems specifically related to abortion, such as pressure from a partner to have an abortion and negative attitudes towards abortions in general and towards a woman’s personal experience of the abortion.

The recommendation is that ‘future practice and research should focus on the mental health needs associated with an unwanted pregnancy, rather than on the resolution of the pregnancy’. So let’s make sure that rather than invent or inflate risks to mental health we focus on trying to prevent unwanted pregnancies and ensuring women have the support they need during the decision-making process when they are pregnant. Jennie Bristow has a thoughtful piece on this in the Huffington Post.

Myth Busting Monday – ‘Nearly 10% of all mental health problems are directly attributable to abortion’

A recent study claiming a causal link between abortion and mental health problems has been cited by a number of anti-abortion groups, keen to support the notion that abortion is ‘bad for women’.

The study makes some bold claims, these quotes are from The Telegraph coverage:

“Overall, the results revealed that women who had undergone an abortion experienced an 81% increased risk of mental health problems, and nearly 10% of the incidence of mental health problems were shown to be directly attributable to abortion.”

“The study said that abortion was linked with a 34% greater chance of anxiety disorders, and 37% higher possibility of depression, a more than double risk of alcohol abuse – 110% – a three times greater risk of cannabis use – at 220% – and 155% greater risk of trying to commit suicide.”

Since its publication the study has been attacked by a number of prominent scientists. Responses to the article in the British Journal of Psychiatry draw attention to the flawed methodology and apparent bias of the authors:

“Priscilla Coleman presents her conclusions as "an unbiased, quantitative analysis of the best available evidence" concerning the adverse mental health consequences of abortion. Huge numbers of papers by respectable researchers that have not found negative mental health consequences are ignored without comment. Not surprisingly, over 50% of the "acceptable" studies she uses as her "evidence" are those done by her and her colleagues Cougle and Reardon. The work of this group has been soundly critiqued not just by us but by many others as being logically inconsistent and substantially inflated by faulty methodologies. As noted by the Royal Society of Obstetricians and Gynaecologists , the authors consistently fail to differentiate between an association and a causal relationship and repeatedly fail to control for pre-existing mental health problems...The "unbiased nature" of most of the studies Coleman has used in her analysis and the Declaration of Interest stated as being "none" must be taken with a large grain of salt. Reardon, the leader of this group, has clearly expressed his new rhetorical strategy as "we can convince many of those who do not see abortion to be a "serious moral evil" that they should support anti-abortion policies that protect women and reduce abortion rates" . He has stated that "I do argue that because abortion is evil, we can expect, and can even know, that it will harm those who participate in it. Nothing good comes from evil."

Reputable research from around the world disputes a causal relationship between abortion and significant mental health problems. Where women do feel sadness or regret following abortion, it may come from the circumstances of the pregnancy rather than the abortion itself.  Those women who are at greatest risk of regret are those who feel ambivalent about the decision, or have been coerced or forced into having an abortion against their will, or have had previous experience of psychiatric problems. For more on this see the RCOG’s ‘The Care of Women Requesting Induced Abortion’.


For further critique of Coleman's work see The Ministry of Truth blog.

Myth Busting Monday: 'Post Abortion Syndrome is a recognised medical condition'

In light of this recent story about a nurse distributing an anti-abortion booklet to colleagues we thought it was important to address one particular myth being bandied about in the media regarding abortion and mental health. The myth of ‘post-abortion syndrome’.

The booklet in question is produced by an organisation called Forsaken. Their website states that:

‘This book is about the reality of Post Abortion Syndrome (also known as "Post Abortion Stress", "Post Abortion Trauma" or "Post Abortion Stress Syndrome").

The book features ‘five true stories written by women from Taunton who have gone through post abortion, some of whom have found healing and release.’

EFC believes that information about abortion and services for women following abortion should acknowledge their wide range of responses to abortion: from satisfaction and relief, to sadness or regret. Now this blog isn’t about denying individual women’s experiences of their own abortion or their beliefs and feelings about abortion in general. However, as there is no evidence that women generally experience trauma following abortion EFC cannot support Forsaken’s claims about Post-Abortion Syndrome. That it causes women who have had abortions to suffer this long list of problems, or that it exists as a medical condition at all.

As the American Psychological Association makes clear in its comprehensive report on abortion and mental health, the study on which the case for ‘PAS’ is based is extremely unreliable:

‘Speckhard and Rue (1992; Rue, 1991, 1995) posited that the traumatic experience of abortion can lead to serious mental health problems for which they coined the term postabortion syndrome (PAS). They conceptualized PAS as a specific form of posttraumatic stress disorder (PTSD) comparable to the symptoms experienced by Vietnam veterans, including symptoms of trauma, such as flashbacks and denial, and symptoms such as depression, grief, anger, shame, survivor guilt,and substance abuse. Speckhard (1985,1987) developed the rationale for PAS in her doctoral dissertation in which she interviewed 30 women specifically recruited because they deemed a prior abortion experience (occurring from 1 to 25 years previously) to have been “highly stressful.” Forty-six percent of the women in her sample had second-trimester abortions, and 4% had third-trimester abortions; some had abortions when it was illegal. As noted above, this self-selected sample is not typical of U.S. women who obtain abortions. PAS is not recognized as a diagnosis in the Diagnostic and Statistical Manual of the American Psychiatric Association.'

Ellie Lee of the University of Southampton has written about the myth of ‘post-abortion syndrome’ in the UK:

‘In the light of the substantial amount of evidence against the existence of Post Abortion Syndrome, it is perhaps surprising that the claim for PAS retains any credibility...Evidence from the research literature suggests that, in the aggregate, legal abortion of an unwanted pregnancy does not pose a psychological hazard for most women. They tend to cope successfully and go on with their lives. There is no credible evidence for the existence of a Post Abortion Syndrome’.

Yes, women should be given information on pregnancy options, including all possible risks to their physical or mental health following childbirth and abortion. But this information needs to be evidence-based and scientifically sound if we want them to make confident, informed decisions. Deliberately misinforming women about risks to further an ideological agenda is profoundly unethical.