Beyond Regret

For several months I've had a worry, one of those that at first seems mad but won't, over time, go away: Sometime in the foreseeable future, anti-abortion forces will make another run at the surgeon general, seeking a warning that abortion is hazardous to women's health. Abortion-rights supporters will be horrified. It is, we will say, not true; science matters, and the science to support the warning is not there. Besides, the anti-abortionists already tried this and lost.

But as evident as it seems that legal abortion, given its 35-year history, is safe, it is not safe to avoid this fight and hope that facts alone will carry the day. Given recent events in the courts and the states, and with a new surgeon general on the horizon, it's time to start getting the science out there -- in forms people want to hear.

In 1988 Ronald Reagan directed his surgeon general, C. Everett Koop, to study the safety of abortion for women. Koop found the research biased, and refused to rule, writing in his memoir that the president had embraced the "silly idea" that "the evidence of adverse health effects (presumably mental) of abortion on women that the Surgeon General could pull together would be sufficient to overturn Roe v. Wade."

How times have changed. For the past two decades, anti-abortion activists have worked to prove that abortion causes all sorts of problems, from psychological traumas aggregated into a mythical "post-abortion syndrome" (PAS), to breast cancer, to future fertility problems.

The research they've produced is weak. Much of it confuses correlation with causation. Much of it is also produced by a handful of pseudo-scholars with dubious qualifications. And almost all of it was started with a premise (abortion is bad for women) and then sought data to prove it -- hardly the scientific method.

Decades of scientific research, on the other hand, has proven no sound basis for these claims. Neither the American Psychological Association nor the American Psychiatric Association has recognized PAS. And in a 2006 report, the Guttmacher Institute found that "the preponderance of evidence from well-designed and well-executed studies indicates that abortion … carries little or no risk of fertility-related problems, cancer or psychological illnesses."

The ongoing threat to choice isn't just that the anti-abortion forces are pushing their research aggressively, but also that the assumption behind this research -- that women will regret their abortions -- seems to be irresistible to some state legislatures and courts. In his Carhart decision this spring, Justice Kennedy acknowledged that there is "no reliable data" about the potential harms of abortion to women, but went on to say that it "seems unexceptionable to conclude" that some women may suffer "severe depression and loss of esteem" as a result of "regret" over their abortions. "The state," he concluded, "has an interest in ensuring so grave a choice is well informed." In other words, women should be informed of the risks -- even though there is "no reliable data" to support the existence of these risks.

Kennedy may get his way. Many state legislative sessions are finished for the year, but Planned Parenthood expects an uptick in bills mandating "counseling" about abortion's risks next year. And once findings of fact about the supposed harm to women get into state-legislative and lower-court materials, higher courts will pay them significant deference.

Answering the claims that abortion hurts women isn't easy. Pro-choicers offer statistics on the significant relief that many women report after their abortions, but they don't often address the women who also have negative reactions. They need to. They need to show that the numbers of women whose abortions cause acute and long-term problems are statistically insignificant. Then they need to target liberal legislatures and liberal courts, making sure that research on the safety of abortion ends up in official findings there, so that when, ultimately, Kennedy or the surgeon general gives the data its day, there's ample official record on the other side to which they must defer.

But statistics alone won't help. What's compelling about the post-abortion-syndrome argument is that many people want to believe that a woman who aborts also regrets. Pro-choicers need to craft an emotional counter-narrative that rings true for -- and about -- women. That narrative may even acknowledge regret -- but it must also suggest that The Choice was the best choice among the options. If we don't move toward this message, a few generations hence we could see another surgeon general's warning, one that we already know to be true: that illegal abortion may be hazardous to your health.