A Poor Attempt in a High Profile Journal to Deny the Abortion Suicide Link

By Priscilla K. Coleman, PhD, Bowling Green State University and WECARE

The Lancet recently published a study by Julia Steinberg and colleagues titled, “The Association Between First Abortion and First-Time Non-Fatal Suicide Attempt: A Longitudinal Cohort Study of Danish Population Registries” [https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30400-6/fulltext]

The researchers reported they found that

“women who had abortions had a higher risk of non-fatal suicide attempts compared with women who did not have an abortion. However, because the increased risk was the same both the year before and after the abortion, it is not attributable to the abortion.”

There are a number of egregious shortcomings associated with the methodology employed and with the conclusions. The public should be aware that the results of this study are not reliable and should not inform policy.

The most salient issues are described below.

First, the researchers only examined a small segment of the population of women undergoing abortions. Not considered in this study were the following groups: 1) women who had more than one suicide attempt, 2) women who completed suicide, 3) women who had a first suicide attempt before the rather arbitrary beginning point of data analysis (one year before the abortion), and 4) women who had more than one abortion.

Women who have had multiple abortions are known to experience greater risk for post-abortion-mental health problems. Moreover, the most serious cases of suicidal behavior were not captured in the data (repeated attempts and completed attempts).

Second, the researchers failed to control for numerous variables shown previously to be associated with the choice to abort and/or mental health problems, including suicide. Among the variables not controlled for are marital status, history of other perinatal losses, childhood history of abuse, intimate partner violence, substance abuse, and pregnancy intention, among others.

Third, the measure of non-fatal suicide attempts inappropriately collapsed data pertaining to suicide attempts, self-harm with intention to hurt oneself, and self-harm without intention to die. The researchers reported that in supplemental analyses they examined only the outcomes of suicide attempts and intentional self-harm and found similar results.

However, the intention to harm oneself is not synonymous with attempting suicide and they do not report any results that focused exclusively on non-fatal suicide attempts.

Finally, the researchers draw causal conclusions which are not permissible from correlational data. They stated at the close of their paper

“Our findings do not support the notion that abortion causes or increases women’s risk of suicide attempts. In fact, our findings support the conclusion that heightened suicide attempts are not caused by abortion, but by differences in other risk factors for suicide attempts. Consequently, policies based on the notion that abortion increases women’s risk of suicide attempts are misinformed.”

The table below contains synopses of five studies pertaining to abortion and suicidal behavior and several others are available in the professional literature. The best evidence reveals that abortion is a consistent and strong risk factor for suicidal behavior.

The studies are all large scale, prospective in nature, and they incorporate a variety of different types of comparison groups as well as additional control techniques, effectively fortifying the level of confidence in the results derived.

Study Focusing on Suicidal Behavior Outcomes
1.) Fergusson, D. M., Horwood, J., & Ridder, E. M. (2006). Abortion in young women and subsequent mental health. Journal of Child Psychology and Psychiatry, 47, 16-24.

Results
27% of women who aborted reported experiencing suicidal ideation This effect was significant at the >.001 level, meaning there was only a 1 in 1000 chance that the result was due to chance. The risk was 4 times greater for women who aborted compared to never pregnant women and more than 3 times greater than women who for women who delivered.

Study Focusing on Suicidal Behavior Outcomes
2.) Gilchrist, A. C. et al (1995). Termination of pregnancy and psychiatric morbidity. British Journal of Psychiatry 167:243-

Results
Among women with no history of psychiatric illness, the rate of deliberate self-harm was significantly higher (70%) after abortion than childbirth.

Study Focusing on Suicidal Behavior Outcomes
3.) Gissler, M., et al. (1996). Suicides after pregnancy in Finland, 1987-94: Register linkage study. British Medical Journal, 313, 1431-4

Results
Suicide rate was nearly 6 times greater among women who aborted compared to women who gave birth.

Study Focusing on Suicidal Behavior Outcomes
4.) Gissler, M., et al. (2005). Injury deaths, suicides and homicides associated with pregnancy, Finland 1987-2000. European Journal of Public Health, 15, 459-463.

Results
Abortion was associated with a 6 times higher risk for suicide compared to birth.

Study Focusing on Suicidal Behavior Outcomes
5.) Reardon, D. C., et al. (2002). Deaths associated with delivery and abortion among California Medicaid patients: A record linkage study. Southern Medical Journal, 95, 834-841

Results
Suicide risk was 154% higher among women who aborted compared to those who delivered

Study Focusing on Suicidal Behavior Outcomes
6.) Gissler, M., Karalis, E., & Ulander, V.M. (2015). Decreased suicide rate after induced abortion, after the Current Care Guidelines in Finland 1987-2012. Scand J Public Health, 43(1), 99-101.

Results
Studied suicide trends after induced abortion in 1987 – 2012 in Finland. Women with a recent induced abortion still have a 2-fold suicide risk even after current care guidelines include a 2-3 week follow-up session with abortion patients to monitor for mental health disorders.

For all these reasons and more, The Lancet study is at odds with the documented conclusion that a woman’s risk of suicide is increased after an induced abortion.