Tag: reproductive health

How research becomes populism – Abortion debate in the Finnish Parliament

Liberal abortion legislation was introduced in Finland in 1970. Every now and then, there is discussion regarding, whether the law should be changed in any way. Some would like to see a day, when abortion is available on request (as in Sweden for instance) and others wish to make it more difficult to obtain abortions.

Recently, a few members of parliament from the Christian party, the Centre party and the True Finns party suggested that the legislation should be changed  so that medical doctors and other hospital personnel should be given a right to refuse performing abortions, if that’s against their conviction.

Last Thursday, the parliament discussed the suggestion. Quite rapidly the discussion shifted from the rights of hospital staff into whether abortions are morally justified. An MP from the True Finns party, Mika Niikko, referred to a study showing that more than 50 percent of the women, who went through a termination of pregnancy were depressed a year after the termination and that two percent suffered from severe depression. Later he tells that the study was conducted by “a researcher called Söderberg” and also mentions that there is a Finnish study by Gissler, Hemminki and Lönnqvist that found the risk of suicide being three times higher for women, who had had an abortion, compared to the women, who had a childbirth.

Given that I have worked on abortion-related topics for a while, the results of the studies seemed somewhat surprising to me and I decided to track down these papers. Since the citations are not more specific than what I’ve described above, I cannot be sure I found the right papers, but I managed to identify two, which fit the criteria (Söderberg et al.; Gissler et al.). After having looked at the results of these studies, I have to say I’m quite concerned about the relationship between academic research and policy making.

The paper by Söderberg and colleagues is a study of 854 women, who had had an abortion in Malmö, Sweden in 1989. The researchers identified a case group of 139 women that had experienced emotional distress and doubts regarding abortion decision and compared them to a control group of 114 women not having these feelings. Given that I only have access to an not-so-clearly-written abstract rather than a full text, I cannot say much about the study design, but the conclusions of the study are clear: the researchers identified risk factors of experiencing emotional distress (such as poor support from family and friends and underlying ambivalent attitude to abortion) and state “[t]he risk factors identified suggest that it may be possible to ameliorate or even prevent such distress”.

The other study compared suicides after pregnancy in Finland between 1987 and 1994. The researchers were able to identify 73 suicides within one year after the end of the 667,572 pregnancies observed during the study period. Women, whose pregnancy had ended in abortion, were six times more likely to commit a suicide than women, who had a childbirth. The researchers state clearly at the end of the paper that the study was not able to study causality between these two events, because they had no information of pre-pregnancy mental health conditions of the women. Thus, the causal relationship could go either way: suicides and abortions are caused by similar things or abortions cause mental health problems to some women. In addition, I’d bear in mind the small number of suicides observed, which adds uncertainty to any conclusions.

Had Niikko read a more recent paper from Gissler and colleagues, he would have discovered that having mental health problems is associated with a higher risk of abortion. Therefore it seems like experiencing difficult life events is associated with higher risk of abortion rather than the other way around. Also this paper ends with caution: more research is needed, before claiming causality in this complex relationship. Many previous studies have suffered from severe problems in research design and thus cannot be trusted.

So, the studies Niikko referred to were from late 1980s and early 1990s. It goes without saying that they are old and that there are more recent studies he could have referred to. Moreover, the results of the studies were clearly misinterpreted. The really sad part is that in the discussion Niikko was the only MP, who even tried to refer to academic studies to justify his point of view.

Where are the policy implications of policy relevant academic studies hiding?

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The Cruel World of Birth Lottery

Last Monday an interesting series of documentaries called  Why Poverty? started on BBC (FYI: also broadcasted by YLE in Finland). The first film was called Welcome 2 the World – 4 Born Every Second. As the title suggests, the film was about babies, their mothers in different parts of the world, and their struggle of survival in circumstances that carry the highest risk of maternal and child mortality.

The film tells a story of pregnant women living in poverty in countries such as Sierra Leone, Cambodia, the US, and UK. Even thinking about the stillborn babies, complications and suffering presented still brings tears to my eyes. This is probably one of the most depressing, and yet, one of the most interesting documentaries I’ve ever seen.

According to the UN and WHO, 800 women die annually from preventable causes related to pregnancy and childbirth, due to lack of skilled medical staff, resources, or knowledge on reproductive health. The causes of death most commonly are bleeding, infections, high blood pressure, or unsafe abortion. 99 percent of all maternal deaths occur in the developing world, mostly in Sub-Saharan Africa. There are three million infants that die annually in addition to 2.6 million stillbirths. Within countries, the poorest women and their children in rural areas carry a higher risk of death than others.

These problems still exist, since there are not enough money to organise sufficient family planning services and education in many countries. The level of the family planning funds has declined between 2000 and 2008, according to the UN, despite tho growing need for help. Although maternal mortality has dropped worldwide by almost 50 percent between 1990 and 2010, more funds are needed to help the most deprived areas.

The film brought alive the facts described above. There were two stories that struck me the most. First, there was a pregnant Cambodian mother, infected by HIV, taking care of her biological son and a younger adopted girl.Their only mean of survival was to send the son to collect garbage (instead of going to school) to get money to feed the family. Finally, she gives birth to her new baby, Ly Ly and her 12-year-old son makes a commitment to continue collecting garbage, so that his sisters could go to school and eventually have a better life. However, two months after her birthday, Ly Ly dies. This allows the mother to go work in a construction site, and thus her son gets to go to school. The brutality of the situation really struck me. The youngest member of the family had to die to allow the others to have a little bit better chance in life.

The second thing that opened my eyes was a story about 22-year-old Londoner, who was a single mom for a girl and a boy, who had different fathers. Despite the lack of help from the boy’s father, she was able to provide food, shelter and an education for her family. Despite the fact that in the UK she might be considered poor, the chances of her children to live a normal life were many times better than any of the other children in the film. She was the only mother in the film saying that she has everything she needs and that she is happy.

I’m not trying to say that inequalities do not exist in the Western world, since that would not be true. The point I’m trying to make is that despite the problems that always exist no matter what we do, inequalities can be reduced to a lot smaller level than what we experience worldwide right now. It is just a matter of political decisions and allocation of resources. We should be more willing to share. Improving the condition of young children and their families is a good place to start.

I recommend watching the film (please see the links below).

Sources

UN Millenniun Development Goal reports 2010 and 2012 (PDF)
WHO Maternal Mortality fact sheet, May 2012
WHO Trends in Maternal Mortality: 1990 to 2010 (PDF)

Links