Misusing Science Risks Women’s Health
Nebraska Lawmakers Manufacture Scientific Controversy to Forward an Anti-Abortion Agenda
Two weeks ago the Nebraska legislature passed two new extreme anti-abortion laws: The first bans abortions after 20 weeks of pregnancy based on the assertion that the fetus can feel pain. The second bill requires abortion providers to screen for any characteristic thought to be “associated” with poorer health outcomes after abortion. Both laws represent extraordinary new attacks on abortion rights and the science of women’s health.
The first Nebraska bill, LB1103, is deceptively called the “The Pain-Capable Unborn Child Protection Act.” The true goal of the bill is to directly challenge the Roe v. Wade decision, which extended legal protection for abortion for any reason to the point of fetal viability (approximately 24 weeks) and thereafter to protect the health or life of the pregnant woman. In making the claim that the fetus can feel pain prior to viability, abortion opponents hope to change the boundaries of legal abortion.
What is at stake in Nebraska is the foundation of the Roe v. Wade decision itself, as well as our ability to craft public health policy with legitimate science.
Those who advocate for abortion restrictions based on the notion of fetal pain make three central claims: the fetus has the physical structures for pain; the fetus withdraws from stimulation in response to pain; and anesthesia is used on similar-age fetuses during fetal surgery to prevent pain. None of these claims, however, is supported by objective science.
In 2005, a group of scientists at the University of California, San Francisco (UCSF) conducted a review of the available evidence related to the question about when a fetus is capable of feeling pain and published their findings in the Journal of the American Medical Association. They explain that while the brain circuitry responsible for relaying some types of sensory information begin developing around 23 weeks’ gestation, the circuits must be connected to the brain in specific ways for a fetus to experience pain. That connection does happen until later in the pregnancy and not sooner than 29 weeks of gestation, well into the third trimester.
The second claim, that fetal responses to stimuli are evidence of an ability to feel pain, is also without merit. Reflex responses occur independent of pain sensation, such as the “knee jerk” reflex. Thus studies demonstrating the presence of fetal movement in response to stimuli (potentially harmful or not) do not establish the existence of fetal pain.
Finally, in response to the claim about anesthesia, the authors of the UCSF study note that performing surgery on a fetus and providing an abortion are two very difference scenarios. For fetal surgery, analgesia/anesthesia is primarily used to prevent possible adverse surgical outcomes, to relax the uterus to prevent premature contractions, to immobilize the fetus, and to prevent possible long-term neurological developmental problems resulting from the hormones released during surgery. None of these objectives is applicable to an abortion.
Opponents of abortion stress the “scientific controversy” over fetal pain and highlight the few outsiders who support their agenda to make abortion illegal. This focus on doubting established science is a common tactic of the conservative right which has politicized science in areas from evolution, to climate change, to sexuality education. And journalists eager to cover a new controversy over abortion take the bait; potentially out of a desire to “balance” their coverage of abortion they suggest that the science is unresolved. The controversy, however, is resolved—fetuses cannot feel pain at 20 weeks gestation.
Accompanying LB1103 is a companion law, LB 594, requiring a woman seeking an abortion to undergo an elaborate screening process prior to obtaining an abortion. This law, deceptively named the “Women’s Health Protection Act,” perverts science in all kinds of new ways.
First it requires that abortion providers produce a screening tool that includes any risk factor shown to be associated with poor outcomes after abortion. Second, it requires that women be screened for these characteristics and then informed of their individual potential for bad outcomes. These characteristics include demographic factors (i.e. women need to be told that being divorced has been shown to be associated with higher rates of depression after abortion), mental health factors (i.e. having anxiety prior to abortion is associated with higher rates of anxiety following an abortion), and physical health factors (i.e. being obese is associated with higher rates of infection after an abortion). In the eyes of the Nebraska law, there is no difference between those factors shown to be causal and those that are just related (i.e. “associated”).
For the last two decades abortion opponents have undertaken a deliberate effort to publish studies that show a relationship between abortion and poor mental health, i.e. depression, substance use, anxiety, suicide. In these studies researchers use secondary data analysis to conclude that women who have abortions have higher rates of each of these ailments. None of these studies, however, show causality. They demonstrate only associations. Hence the reason for the term “associated” in LB594.
Reviews of the studies of abortion and poor mental health, however, find each of these studies significantly methodologically flawed.[3, 4] For example, these studies include inadequate comparison groups: women who have abortions are compared to those that that have wanted pregnancies, rather than to women with unintended pregnancies who continue their pregnancies to term or to women who wanted abortions and couldn’t get them. These studies often fail to account for preexisting conditions, i.e. women who have depression are more likely to choose abortion so we would expect more women after abortion will have depression.
Helping people understand the difference between causation and association was not a priority of the Nebraska legislature, but it is critically important as a standard for public health law. An analogy helps to explain the difference: Carrying matches is associated with having lung cancer. It is not the cause of the cancer and we don’t suggest that people stop carrying matches as a way to prevent cancer (especially if they just replace the matches with a lighter).
In the context of the Nebraska law, African American women would need to be told that being black is associated with higher rates of substance abuse after abortion. However, having the abortion does not cause the substance abuse, nor does being African American. Other women would need to be told that having relationship problems is associated with higher rates of depression after an abortion. Again, having the abortion does not cause the depression nor would carrying a pregnancy to term reduce the risk of depression.
Conducting the required screening and informing the woman of these associations is not helpful to the woman nor does it improve the care she receives. It does not reduce her chances for having a physical or psychological problem after an abortion, nor does it enhance her decision making related to the abortion. The real intent behind the law is to create a feeling that abortion is risky and to allow women to later sue abortion providers with the claim that they were not adequately warned that they might experience negative outcomes after their abortion.
Ironically what little evidence there is on poor coping after abortion suggests that abortion protesters, lack of social support, and stigma are actually causal.[5-7] Yet the Nebraska legislature is not only unwilling to do anything to reduce these known risk factors—their actions may in fact contribute to poor coping by increasing the stigma woman feel about their abortion and fanning the flames of anti-abortion hostility.
Misuse of science in the name of an anti-abortion agenda is not new. Fetal pain and claims about harms after abortion are just the latest tactics. However, what is at stake in Nebraska is the foundation of the Roe v. Wade decision itself, as well as our ability to craft public health policy with legitimate science.
Dr. Tracy Weitz, PhD, MPA, is Director of the Advancing New Standards in Reproductive Health (ANSIRH) program in the Bixby Center for Global Reproductive Health at the University of California, San Francisco (UCSF).
 Lee SJ, Ralston HJ, Drey EA, Partridge JC, Rosen MA, “Fetal pain: a systematic multidisciplinary review of the evidence,” Journal of the American Medical Association 2005;294(8):947-54.
 Mooney C., The Republican War on Science (New York: Basic Books; 2005).
 Major B, Appelbaum M, Beckman L, Dutton MA, Russo NF, West C., “Abortion and mental health: Evaluating the evidence,” American Psychologist 2009;64(9):863-90.
 Robinson GE, Stotland NL, Russo NF, Lang JA, Occhiogrosso M., “Is there an ‘abortion trauma syndrome’? Critiquing the evidence,” Harvard Review of Psychiatry 2009;17(4):268-90.
 Major B, Cozzarelli C, Sciacchitano AM, Cooper ML, Testa M, Mueller PM, “Perceived social support, self-efficacy, and adjustment to abortion,” J Pers Soc Psychol 1990;59(3):452-63.
 Cozzarelli C, Major B, Karrasch A, Fuegen K., “Women’s Experiences of and Reactions to Antiabortion Picketing,” Basic and Applied Social Psychology 2000;22(4):265 – 275.
 Major B, Gramzow RH., “Abortion as stigma: cognitive and emotional implications of concealment,” J Pers Soc Psychol 1999;77(4):735-45.
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