Abortion, Mental Health Problems and the Politicisation of Science

Just the other day, several UK newspapers (here, here) reported about a new, ambitious study on the relationship between abortion and mental health problems. Undertaken by Priscilla Coleman, professor at the Bowling Green State University, and published in the well-renowned journal, British Journal of Psychiatry, the study is a so-called meta-analysis where data and results from many different studies in this area are brought together and analysed as a whole. The result is that evidence speaks in favor of a significant statistical correlation between abortion and elevated risks of mental health problems after abortion. Not surprisingly, this news have been ceased on by political campaigners who want to push for more restrictive abortion legislation. Coleman herself is markedly more modest, concluding only that...

Consistent with the tenets of evidence-based medicine, this information should inform the delivery of abortion services.

In the news reporting, this statement has generally been read as a call for telling abortion seeking women about the risks. Now, if you believe in individual liberty, women's right to decide over their own body or is generally oriented towards pro-choice positions on abortion, this may not appear to be very shocking. After all, abortion is a serious medical or (when undertaken in later stages of pregnancy) surgical procedure that is often undertaken in the context of a personal crisis. If there indeed is a link between undergoing this procedure and suffering mental health problems, this should be explained to women contemplating abortion, shouldn't it? However, there are several question marks surrounding Coleman's result and what conclusions can be inferred from it, both scientifically and with regard to policy.

First, neither the news reporting, nor the abstract to the actual article reveals if and to what extent Coleman's analysis has controlled for relevant so-called confounders – i.e. other factors contributing to the onset of mental health problems. In particular, it is unclear to what extent the analysis has factored in the presence of mental health problems or risk factors for such problems before abortion and, indeed, pregnancy. When I had reason, several years back, to look at research in this area undertaken in Sweden, a repeated phenomenon was that there indeed were correlations between abortion and mental health problems, but that the occurrence of this problems almost always could be linked to the presence of such problems (or risk factors for them) before abortion or even the actual pregnancy. Now, Coleman's results indeed indicate that women who undergo abortion have elevated risks compared to a substantial control group. However, in lack of controlling for the presence of problems before abortion, this may just as well support the notion that women already suffering from mental health problems or who are victims of risk factors for this are more likely to establish pregnancies that they eventually would prefer to have terminated. Indeed, such a link was suggested by a large Danish study published last year in the highly ranked journal New England Journal of Medicine. This, in turn, may depend on a lot of different things, such as being placed in a dysfunctional psycho-social context (e.g. lack of a reliable partner, poverty, disorganised housing situation, et cetera). Hopefully, time will tell what quality Coleman's study actually possess in this respect and, in the case of deficiencies, that further studies are undertaken to investigate the issue.

However, even if it turns out that Coleman's results hold up to closer scrutiny, the sort of factors just mentioned make the interpretation of Coleman's practical recommendation made in the media quite odd, if not biased – just as the one reported about the reaction of many campaigners against liberal abortion legislation. For suppose that Coleman indeed is right in the strongest sense, is the most obvious conclusion then that we should move to restrict access to legal abortion? Actually not, since there is strong scientific support for the claim that such actions lead to no good (in particular, they do not prevent abortions). How about informing about the risk then? Well this looks more sensible, although, if the underlying explanation of abortion being a risk factor is that a certain portion of abortion seeking women are already burdened by mental health problems that threaten to become more serious if they are exposed to trauma of some kind, one may doubt the efficacy of such actions.

Instead, the practical conclusion that would seem to be gaining the most support would be this: Researchers like Coleman should rapidly proceed to develop instruments to identify those at risk, and abortion services should offer these women special post-abortion care and counseling, or even preventive actions before the procedure is undertaken that may serve to decrease the risk. If such an instrument proves difficult to develop, such care and counseling should become a standard ingredient of good clinical abortion practice all across the board. I must say that I find it a bit odd and worrying that Coleman's own practical suggestion does not focus on this. After all, if women's mental health is what you care about, practical implications should focus on actions directed at promoting that aim.

The Wikileaks Cablegate Pro & Con

I have tried to avoid airing my thoughts on this subject, but the pile of rubbish from supposedly able foreign policy experts all over the place that has been made public during the week makes this impossible. So, here's my take on Wikileaks and, in particular, the "cablegate" release of about 250.000 US diplomatic cables dating from 1966 up to the beginning of 2010. A very well-structured presentation of the publication, together with analysis and commentary, has been made available by UK newspaper The Guardian.

First of all, some - unfortunately necessary - preliminaries. Although this is not as evident as it should be on the Wikileaks website, the Wikileaks operation is not the same as its founder Julian Assange. As you may be aware of, when this is written, the latter has been arrested and, by reason of probable cause, detended in his absence in my country for one count of rape, two counts of sexual assault and one count of unlawful coercion (during a time he spent in Sweden) – resulting in an Interpol wanted poster, a so-called Red Notice this wednesday. There has been a lot of conspiracy theories aired about this on blogs, forums and places like Facebook and Twitter, but the fact is that the allegations have some history, and that the Red Notice is a consequence of Assange not having made himself available to the police or the prosecutor to clear himself of what he claims to be false allegations. On some forums, I have seen the suggestion that the crimes he is accused of would not be grave enough to warrant international action of this sort and that this would be proved by the fact that Sweden seldom requests the issuing of such notices. Neither is true. Regarding the latter, the simple explanation for the lack of Swedish Red Notice requests is that the suspected perpetrator as a rule can be found in the country or apprehended in another country in simpler ways (ways which, in the case of Assange, have been tried before the notice was requested). Regarding the former, rape is a very serious crime in Swedish legislation and the level of suspicion underlying the arrest is of the higher level. That, together with Assange's apparently deliberate absence and lack of communication with the Swedish authorities is enough to warrant requesting the notice. As to the allegations themselves, it is apparently easy as a Wikileak supporter to forget that there are actual people who have made these - women who have reported to the police that they have been raped and assaulted by Assange - and that the prosecutor has found evidence enough for the court to find probable cause for a detention decision. Now, Assange may, of course, be perfectly innocent here, but as in any country, this is for a court of criminal law to establish, no matter who you happen to be and what good things you may have done.

But the point I want to make here is this: none of that has anything to do with the question about the justifiability of the actions of Wikileaks. Moreover, contrary to what this excuse for a political analyst believes, jailing or even killing Assange does not amount to punishing or, for that matter, closing down Wikileaks. Get it? Good! Over to the main show:

There is, in my view, not a shadow of a doubt that the first leak of US documents - the Iraq and Afghanistan War Logs - was morally justified. Yes, the person who leaked the documents committed a serious crime in US jurisdiction. Yes, legally he deserves to be punished within that jurisdiction. However, regarding those documents, he did the right thing, as did Wikileaks when making them public. What made the source's action right is that it is a clear case of justifiable civil disobedience. He acted against the law, as well as his legally sworn professional duty, but nevertheless, he did the right thing. Why? Because what the documents reveal and their revelation is of that level of importance. What they reveal is a stinking heap of elaborate lies and cover-ups all intended at making two bloody and senseless wars look less tasteless in the eyes of the public. That is, the very same public that is supposed to be able to make informed decisions when it is election time. This blinkering of the people is by itself reason enough. However, to this may be added the effect of the lies to make the launching of war more easy. I'm not a pacifist. I believe that war may sometimes be justified. However, war should be made only after a decision made on as correct, complete and relevant information as possible about the expected gains as well as costs of war. And voters in a democracy, should have access to all these facts in order to be able to assess the decisions of their leaders in upcoming elections. The first publication of Wikileak is of the utmost importance for making this slightly more possible in the future. The United States claims itself to be the world's leading democracy and, indeed, is constitutionally bound to the democratic ideology and values by definition. The talk about the leak being against the US "national interest" is thus, if you excuse me saying so, a load of bollocks. There has also been talk about soldiers or others being put at risk by the leak. Well, perhaps that is so, but to make a moral assessment that cost needs to be balanced against the cost of future wars that a preservation of secrecy would have made more likely and all people that would have been put at risk by those.

So, how about cablegate? It does look a bit more complicated, doesn't it? The argument above is surely not applicable here. My assessment so far is undecided. But, what I don't agree with are the many statements about the cablegate leak making the world a less safe place through undermining the prerequisites for efficient foreign policy and diplomacy in the service of peace.

It seems to me that the cablegate revelations fall into two categories. The first one is that diplomats express themselves less than nice and polite about their colleagues in other embassies and foreign dignitaries. Of course, while this was surely not very surprising, it may be used as an excuse by one or the other country to jump out of a negotiation or deal or two. But claiming this revelation to be the end of diplomacy or something close to that, as my own foreign minister did just a day or two ago, is just ridiculous. And it remains ridiculous even if we assume that states will be forced to seriously count on Wikileaks-like leaks in the future. Why? Because the cure to the supposed problem is as easily accessible to all diplomats as it is obvious: Refrain from slandering other people or calling them by less than honorable names - at least in your diplomatic cables. Put more simply: behave yourselves! I'm sure that diplomacy and world peace will survive that apparently drastic culture change in diplomatic circles.

The other category of revelations from cablegate concerns less laughable matters. Secret messages and requests between countries (such as Saudi Arabia asking the US to attack Iran), reports about proofs of various covered up actions of the US as well as other countries (China cyber-attacking Google), and actions taken within the US foreign policy hierarchy. Most sinister of all is a report belonging to this last topic and is, of course, Hillary Clinton's reported orders to US diplomats to spy on UN high-level leadership, staff and representatives. In what way, I ask, do any of these revelations threaten foreign policy and diplomacy in the service of peace? A number of arguments may be launched in response to this, but they all come down to one thing: the need for hush-hush. So, the crucial issue seems to be about this: how necessary is hush-hush for foreign policy and diplomacy in the service of peace?

This question is not an easy one to answer, since it is ambiguous. Here's one apparently sound and valid pattern of reasoning: When making foreign policy and diplomacy in the service of peace with respect to some particular chain of events or a particular topic or area, any nation must have the possibility to adapt to the fact that other players are making things secretly. If a nation cannot act in secrecy itself, it will be played for a sucker by those nations that can or, at least, it will be more difficult to reach desirable results. So, for instance, country A may approach country B with the message that it will yield on some important topic of negotiation only if country B assists country A in an action against country C that country C would react very strongly to if taken by country A. If country B cannot keep this request from A secret, there is a risk of conflict between C and A even in the lack of action from B's side. And if A can't trust its request to B being kept a secret, it will never make its offer regarding the important topic of negotiation. I assume that numerous examples of this sort, many far more complex and dirty than this generic sketch, can be given by those who know better than me. As regards spying, there are many examples through history (not least from the cold war era) of espionage intelligence being very important from the perspective of peace. Conclusion: hush-hush does seems to be a vital ingredient in foreign policy and diplomacy to secure peace. Thus, threats to hush-hush, such as Wikileaks, are  threats to peace.

Against this picture, the following, equally sound and valid, line of argument may be mounted: Suppose that, e.g., the US and the EU countries launched a policy of complete openness about foreign policy actions taken and information received regarding foreign policy. This would include refusing to keep secret any sort of clandestine request or offer, but also openly declare all intelligence or "ops" activities - such as wanting to scan the irises of Ban Ki Moon, or paying off some corrupt Afghan minister for not rocking the boat. From a democratic point of view, such a position would seem to be much more desirable than the one described in the former paragraph. Here, the voters are perfectly aware of what their elected representatives are doing in their name. The argument for this is the same as the one outlined earlier. What is more, however, the strongest powers in international politics taking up such a position would seem to cripple the chances of any other country playing them for suckers by applying a hush-hush policy themselves. This since they will then not be able to cooperate at all with US or the EU. In effect, all other countries would have a strong incentive to adapt the openness position as well! As a consequence, a situation would develop where the default premise in international politics would not be that others are lying to you and hiding things from you, but the other way around. Just as in the hush-hush dominated world, openness and honesty of a single player would lead to ruin, in the openness world, trying to hide your actions or intentions would become extremely risky. Chances are that you are discovered and, as a consequence, made a pariah in the international community. Now, the question is this: which world would the better one from the standpoint of peace - the one where nations habitually lie and cheat and expect everyone else to do likewise, or the one built on the opposite of that? The answer should be obvious and, thus, to have foreign policy and diplomacy promoting peace, hush-hush is, in fact, not essential. Even stronger, hush-hush actually diminishes the chance of foreign policy and diplomacy to deliver peace.

So bear with me being a little bit utopian here. I hereby make the following suggestion to the US, the EU, Russia and China on how they should best respond to the Wikileaks phenomenon in general and cablegate in particular. Use Wikileaks to your advantage! Stop playing the hush-hush game! Adapt the openness position and you will have secured a win-win situation that no one will be able to touch! If you do, tomorrow belongs to you!