Document Reviewed work(s): Source: Family Planning Perspectives, Vol. 22, No. 1 (Jan. - Feb., 1990), pp.

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Document

Moreon Koop's StudyofAbortion

In 1987-1988,SurgeonGeneralC. Ever- Koop's staff impact abortion very of is negative, compiled reviewed and more logical others that is]usually say [it ettKoopconducted study themedical than250 articles a of from scientific more the litera- whereas thancarrying unwanted an positive child. and psychological of on ture. impact abortion The draft women. The report theSurgeon that GenIn January report also emphasizedthe 1989, Koop metwiththe Dr. eralhadbeenexpected makewas never Secretary Healthand HumanServices, goal of "eliminat[ing] need foraborto the of released,butsome information made Dr. OtisBowen, was by prevention programs, and a decision eduwas made tion" strong aboutpregnancy contraception, and via to public a letter Koopwrote President nottoreleasetheabortion report. Instead, cation Ronald Reagansummarizing findings.1theSurgeon his incentives alternafor a General wrote letter Presi- and strengthening to As partofthe House of Representative'sdentReagan,datedJanuary 1989,that tives;theseissueswerenotraisedin the 9, roleto review government activities, but the concludedthat "the available scientific letter, Dr. Koop supported in them his Human Resourcesand Intergovernmental beforethe Human Resources evidence aboutthepsychological sequelae testimony Subcommittee obtained copyofthe re- of abortion a Relations Subcomsimply cannotsupport either and Intergovernmental port,and then conductedhearingsinto thepreconceived beliefs those of prolife or mittee.9 to whatSubcommittee Chairman Weiss those Ted Reagan,the Dr. prochoice."5 Koopalsoconcluded In his letter President (D.-New York) werediscrepancies felt be- that,"for the physicalsituation," General recommended HHS that such Surgeon $10 tweenthe report and information to the made problems infertility, miscarriage, spendatleast million study longas later impactof pregnancy, including The and low-birth-weight can occurto term the public.The subcommittee's report, babies FederalRole in Determining Medical women the Such research would whohavehad abortions those impactof abortion. and and Psychological aboutthe of on who havenot, and aretherefore Impact Abortion "difficult also providemoreinformation impact childbirth givof or Women, was releasedinNovember 1989 to proveas abortion In sequelae."6 sum- psychological adoption, and is excerpted below. whichwould Dr. that"I regret, inga childup for mary, Koop concluded comparisonto Mr. President, in spiteof a diligent provide an appropriate that The Subcommittee Hearings whohavehadabortions. reviewon thepartof manyin thePublic women Although ... The idea of a Surgeon General's report HealthService in and in theprivate sector, the studywas mentioned the report, on thehealtheffects abortionon women thescientific the of levelnorthedetails of studiesdo notprovidecon- neither funding witha 26-year-old WhiteHouse clusive data about the healtheffects weredescribed.... originated of thestudy editorofthe abortion women."7 aide, Dinesh D'Souza, former on Dartmouth Review,who thoughtthat the Roe v. Wade, SupremeCourtdeci- The Medical Impact of Abortion the for report could be used to reverse Roe v. sionthat 1972, madeabortion inevery legal state, Mortality-Since theCenters Disto Wade.2 Accordingto the Surgeon General, was partly based on themedical (CDC) hasattempted idenevidence ease Control and ... the decision to request a report also that first-trimester every abortion-related abortionswere less tify investigate States.10 served as the "final bone that [President dangerous thanpregnancy. Surgeon deathin theUnited to According The of professor obstetrics Reagan] threw to the Pro-Life people," General's are studyand report therefore Dr. David Grimes, and medicine who were angry about the ousting of an relevant future to legaldecisions leg- and gynecology preventive and antiabortionactivistfromher position as islativedecision-making of California abor- at the University Southern regarding and former chief theAbortion of Surveildirector the Office Population Affairs tion.... of of at HHS [the Department of Health and at In contrast the SurgeonGeneral's lanceBranch CDC, since legalization the to in Human Services].3 Roe letter President to following v. Wade 1973, January 1989, 9, Reagan, ofabortion abortion dehas On July at stated thephysical that 30,1987,in remarks a briefing which risks abor- "the riskof deathfrom of to of Right-to-Life leaders, PresidentReagan tionare unclear, final the draft theSur- creasedmore thanfivefold less than of which directedthe Surgeon General to prepare a geon General's procedures, datedJanuary report, 17, one deathper 100,000 of the an on comprehensive report thehealtheffects 1989,concludedthatabortion does not is lessthan risk deathfrom injecDr. of as served a of abortion on women. In response, Dr. pose a physical riskto themother.8 Both tion penicillin.""1 Grimes to and General his and letter thereport that concluded the consultant theSurgeon Koop or his staffmet privatelywith 27 the in of effects abortion un- staff their of preparation theabortion are groups that had "philosophical, social, psychological medical or otherprofessionalinterests in clear.According the report, to some re- report. the abortion issue."4.. In addition, Dr. searchers of haveconcluded thepsycho- Dr. Carol Hogue,Director theDivithat
36 FamilyPlanningPerspectives

sionofReproductive Health theCenters ing a comparison of groupof womenwho many yearslater whenshereached to out for has Disease Control, published articles continued unwanted pregnancies term hold herfirst to and grandchild felt terrible in medical journals concluding child- and thefact that that there no wayofknow- guilt is and depression.24. .. birth seventimes is more likely result to in ingwhether women the whogetabortions Inresponse these to concerns, Amerithe maternal deaththan abortion.12 Hogue are different, Dr. psychologically fromother can Psychological Association concluded served a consultant theSurgeon as to Gen- women even beforethe abortion.16 For that millions womenwho havehad the of eralandhisstaff theSurgeon for General's example, womenwho have unwanted abortions if would have already in resulted abortion report....Anarticle published in pregnancies to be less well adjusted, a significant tend if mental health epidemic this the American JournalPublic of Health 1987, less capableoftaking in careofthemselves, was a problem even amonga smallperusing more data were and so on,they comprehensive than would probably continue centofwomenwho had abortions the in previously available, concluded preg- to have thoseproblems that whether not 1970s or earlier.25 or For example, they nancyand childbirth 25 timesmore they are obtained abortion. an out if pointed that 10percent thewomen of in likely result thedeathofthemother In their to reviewpaper presented the obtaining to had abortions severeproblems thanan abortion.3.. Despitethereview SurgeonGeneral, American . the Psycho- as a result, there wouldbe 100,000 women ofthese articles theSurgeon General or logical by Association concluded that, despite needing mental health careevery yearto hisstaff, Koopdidnotmention Dr. mortal- theflawsin theresearch, there so little deal withtheirabortions. is Dr. Although ityrelated abortion pregnancy the evidenceof psychiatric to or in problems follow- Koop testified he believesthataborthat report letter.... or ingabortion, so muchevidence re- tion can cause long-term and of psychological Other HealthEffect. . . Because of the lief, therefore that abortion does notcause problems somewomen, admitted for in he flawsof the research medical more indicating than psychiatric problems unwanted histestimony this nota public that is health from the problems resulting abortion, Sur- pregnancy.17 Theyalso arguedthatgiven problem.26.. . draft concluded that thelargenumber abortions, signifi- In one ofhislastprivate of geonGeneral's report any meetings with abortion has no medicaldisadvantages. cant psychiatric problemswould have consultants theabortion to with report, an that Thereport concluded mis- becomevery infertility, obviousto themental health "ad hoc groupof distinguished psychialow in carriage, birth weightand otherre- system thelast15years.8. . . trists" September 1988,Dr. Koop on 15, productive problems"are no more fre- The two researchers representing the expressed doubtsabouttheexistence a of quent among women who experienced National Right-to-Life Committee meet- Postabortion in Stress Syndrome,saying thanthey amongthegeneral ingswiththeSurgeon abortion are General, who testi- ". . . thepeople who would like to see a refiedbefore subcommittee, the population of women. ". . . based their portthat health the effects abortion of are Health vs. Impact Legal Illegal of Abortion- conclusions interviews on with women so devastating that abortionshould be ... In early draftsof the abortion report, who havehad abortions are now un- stopped, and use as one oftheir weaponsthe theSurgeon General his staff or included happy about theirdecision.19 Those re- fact there sucha thing a postaborthat is as to references the comparative of searchers safety quoted womenwho said that tionsyndrome....As we have talkedto but had nightmares, legal abortion, thesewereeliminated they of at- various feelings guilt, there nodoubt there is groups, that in thefinal and draft to report letter Presi- tempted suicideand other feel- arepeoplewho experience postabortion negative a a dentReagan.For example, section was ingsthattheywere unableto confide in syndrome, there peoplewho have but are that "What eliminated stated: wouldhap- others, ... including therapists.20Dr.Koop a post-death-of-my-child syndrome, if weremadeille- described pen tomorrow abortion similarsituations his testi- post-death-of-my-mother in syndrome, in and in hismeetings gal?There withadvocates post-lost-my-job maybe a decrease thenum- mony syndrome."27 berofabortions eachyear, for but also In his privatemeetings maybe one- in preparation the report, by withRight-tothird.... The worstresult would be that stated that anecdotal information was Lifeadvocates, Koop expressed Dr. conto somewouldbe forced resort unsafe, unscientific therefore sufficientcernsabout the poor qualityof their to and not reMaternal and proof.21. . . illegalabortions. morbidity searchevidenceand told themthatthey would becomea seriousprobmortality wouldhavetoprovide better if proof they lem.To makeabortions illegal wouldonly Findings and Conclusions a wanted Surgeon General's consisreport "14 continue national the TheSurgeon struggle. General child- tent with their agreed... that of point view.... InhispubIn thefinaldraft the report, onlymen- birth muchmorelikely result the lic statements, talkedabouthow PHS is in to he tionof theseissues is that90 percent of deathofthemother thanan abortion.22. . [Public Health Service] scientists . were abortions now in the "saferfirst are tri- When asked why mortality statistics asked to reviewthe major articlesand In mester." theletter President to in to Reagan, werenotincluded hisletter President found them to be flawed; fact, all in howtheonly is referencea sentence that Reagan or in the report, Dr. Koop re- ever, stating written reviews wereonlyrequested the of however, incidence physi- sponded that those comparisons were for National the Committee's Right-to-Life "[c]learly, cal injury greater instances is in where well-known, thatthe subjectof the "white but paper"[The Psychological Aftermath abortions performed attempted are or and letter were long-term health ofAbortion]. reviewswere requested by report No thosenot qualified do themor under effects, mortality.23. to not .. for articles the that abortion was showing lessthansterile conditions." In his testimony, Koop dismissed psychologically thanchildbirth.28 Dr. safer Mental of literature [the] on Dr. Koop has repeatedly Health-Regardless theirposi- most of the research statedthathe mentalhealthexperts psychological tion on abortion, an impactof abortion, and saying wanted unbiased report, at several much theresearch psycho- that didnotinclude of on it agreethat long-term withadvocates, Koop Dr. follow-up ofhis meetings 5 logical impact is flawed.1WThey cite of womenwho have had abortions, and expressed concern his thatthereport not problems that included measuresof therefore flawed. gavean example embarrass "office thetitleof the was He ..,. the and mental health arenotobjective, that sample of a womanhe knewwho had no prob- Surgeon General" and that wanted"to he sizes that small, difficulty find- lems resulting are fromher abortionuntil leave itas pristine the of whenI go as I found it
Volume Number January/February 22, 1, 1990 37

Moreon Koop's StudyofAbortion

to womenwith than there whenI came."29 the otherhand,Dr. linespertaining pregnant werea fewyears ago.ThelongOn termcosts include a largernumberof Koop admittedthat his personal bias AIDS.39 TheCDC's rolecontinues be restricted unwantedpregnancies, to againstabortion some of which remains,30 thisbias and considerations. than More may explainwhy the letter President bypolitical to five translate largefinancial to outlays fosfor Reagan, which was released welfare and of payments a variety instead the yearsago, the CDC stoppedcomparing tercare, of and of report, notconsistent theweight is and with care,education socialservices. of the mortality morbidity women health withwomencarrying Froma scientific pointofview,long-term evidenceor withthe SurgeonGeneral's who had abortions to This own testimony in of regarding physical the or thepregnancy term.40 is an impor- costsincludea shortage researchers tant change becausethecomparisons have thefield; mental health with money effects abortion.... of less scienavailable, thatwomenare between seven tists in TheSurgeon pursuecareers other areas where General testified "most indicated that more likely diefrom child- research to funding more is abortions wouldnottakeplaceifpregnan- and25 times readily available. than legalabortion. When asked As a result, possibilities newcontracies were notunplanned the of and unwanted. birth from was made,CDC officials ceptive Therefore, seemsthatefforts it developments beencurtailed have shouldbe whythischange but stated that for directed towardwhatever to meanswould had no explanation, merely years come. like comparisons thosemade in Stablefunding research contraminimize number unwantedand "[d]irect the for of on can at years be easilymadewithdata ception, thelevelsavailablein theearly unplanned Dr. pregnancies."'31 Koop cited earlier by 1980s, willenablethefederal "expansion research reproduction supplied CDC."'41 of government into Other types of researchon abortion to supportthe mostpromising and maleand female contraception" an research as important wouldbe extremely for focus suchefforts.32. useful federal of poli- andtoencourage .. researchers stay the to in For in increaseswould Despitetheresearch evidence support- cymakers. example, the 1970sand field.More substantial the ingtheneedfor the of attract 1980s, CDC studied impact moreresearchers. contraceptive Such increased research and early on for funding educational the wouldbe cost-effectivesociety for programs regarding cor- legalrestrictions Medicaidfunding rect ofcontraceptives, federal on use infant mor- and thefederal the gov- abortion accesstoabortion, government. and and ernment morbidity mortal- TheSurgeon General concluded ... for tality maternal that providesverylittle funding could be used to help the inappropriate of contraceptives suchefforts. year, Last use NICHD [National ity.Such research the government aboutthe contributes the number unwanted to Institute ChildHealthand HumanDe- inform federal of of of in and velopment] spent$9.5 million contra- results theHydeAmendment simi- pregnancies theUnited States. on However, thesetypesofstudies the Department Health and Human of ceptivedevelopment.33 represents lar laws. However, This a .. conducted published.42. Serviceshas not played a majorrole in or reduction almost50 percent of compared arenolonger Researchon abortionis occasionally determining to improvecontracepto the$12 million how spent FY 1980, in when by but and inflation taken account.34 is into According published CDC scientists, thequan- tiveuse,evenamongthoseteenagers and has to the NICHD, contraceptive funding tity typeofsucharticles changed adultswho are alreadyusingcontracepFor CDC scientists tives. could drop as low as $5 million FY substantially. example, for 29 on in In thesamewaysthatdeveloping which a new 1990, wouldrepresentcutofmore published articles abortion 1980 the was than70 percent to contraceptives could proveto be cost-efwhen inflation taken and24 in1981; number reduced is fourin 1986,two in 1987 and seven in fective, into how account.35... the determining to improve Whereasthe publications the correct ofavailable in use According Dr. David Grimes,...in 1988.43 to contraceptives also use 1983,the WhiteHouse insisted thatDr. early 1980sincludedpolicyinformationcould be a cost-effective of modest Willard in research dollars. Cates, whowas then charge such as theimpactof theHyde Amend- federal Jr., which restricted Medicaidcoverage of the Reproductive Abortion one of the mostcommon is Health Division at ment, or in of CDC and had publishedmanyscientific ofabortions, therelative safety differ- medicalprocedures the UnitedStates the and yettheDepartment Health articles abortion, fired transferredentabortion on procedures, vastmajority today, be or of recent because of what was perceivedby the ofthemost are publications merely and HumanServices restricts all severely such WhiteHouse advisersto be a prochoice statistical information, as theannual scientific researchwhich could lead to of deaths nationwide. improved or wouldcompare Dr. safety which advocacyand bias.36 Cates was de- number abortion and transferreda position the thephysical and mental healtheffects of moted at to Division Sexually abortion with effects other the of Transmitted of available Diseases, Recommendations all wouldwelcome alternatives. a and was later Relatedissues, such as the to promoted hiscurrent po- Virtually Americans reduction the numberof unwanted risksassociatedwithpregnant in sition director that AIDS paas of division. which wouldalso reducethe tients, Dr. Grimes have similarly and other beenignored the at colleagues the pregnancies, by of The SurgeonGen- Public Health Service nonscientific for Abortion reaSurveillance Branch left also their number abortions. few way to sons. jobs duringthe following yearsbe- eral concludedthatan effective of is It is crucialthatresearchers cause of limitations employed placed on theirre- reducethenumber abortions to imAnd the search publications.37. and . . Similarly, Dr. provecontraceptives. yet, federal by the CentersforDisease Controland has Grimes testified the1981annualCDC government cut its fundsforcontra- elsewhere theU.S.Department Health that in of abortion surveillance halfsince andHumanServices permitted mainreport, whichpro- ceptive be development almost by to and at thesametime, vidednational worldwide tain theirobjectivity to conductthe and statistics mortality on and FY 1989, for was delayed for two years, publicand private needed to evaluatehealthprofunding contracep- research morbidity, apparentlyfor political reasons.38 had and policiesand thusimprove Dr. tive development been cut substan- grams the healthof all Americans. Thiscan bestbe Grimestestified thateven policydocu- tially. Lackofresearch funds contraceptiveaccomplished eliminating for by ments other in areas of healthcare were censorship has meant that thereare and minmizingbias in biomedical. influenced CDC's decision to omit development by reavailable search. mention abortion, example, guide- fewertypes of contraceptives of for in
38 FamilyPlanningPerspectives

References 1. "A Measured Response: Koop on Abortion," Family Planning Perspectives, 21:31,1989. 2. Transcript Dr. C. Everett of Koop's meetingwithan ad hoc group of distinguishedpsychiatrists, Sept. 15, 1988,p. 2. 3. Transcript meeting of held withtheAmericanCouncil on Science and Health,Feb. 4, 1988,p. 2; and HearingbeforetheHuman Resourcesand Intergovernmental Relations Subcommittee, Medical and Psychological Impact of Abortion, Mar. 16, 1989,testimony Dr. of C. Everett Koop, p. 247. 4. Hearing, op. cit.(see reference letter from Dr. C. 3), Everett Koop to PresidentReagan, Jan.9, 1989,p. 68. 5. Ibid., p. 69. 6. Ibid., p. 70. 7. Ibid., p. 71. 8. Ibid; and Hearing,op. cit.(see reference reportof 3), Dr. C. Everett Koop, Jan.17, 1989,p. 219. 9. , op. cit. (see reference3), pp. 215, 217 and 223-224. 10. , op. cit. (see reference3), testimonyof Dr. David Grimes,p. 64. 11. Ibid. 12. Hearing,op. cit.(see reference testimony Dr. 3), of Jaroslav Hulka, University NorthCarolina,Chapel F. of Hill, p. 86. 13. M. J.Rosenberg and S. M. Rosenthal,"Reproductive Mortality the United States:RecentTrends and in Methodologic Considerations," AmericanJournalof PublicHealth, 77:833,1987. 14. This draft documentis available in thesubcommittee files. 15. Hearing,op. cit.(see reference testimony Dr. 3), of

Wanda Franz,National Right-to-Life testiCommittee, fying behalfofthe AssociationforInterdisciplinary on Research in Values and Social Change, p. 110, and of testimony Dr. Nancy Adler,University California of at San Francisco,on behalf of the American Psychological Association,p. 133. 16. , op. cit. (see reference 3), testimonyof Dr. HenryDavid, Transnational FamilyResearchInstitute, on behalf of the AmericanPublic Health Association, p. 143; and , op. cit.(see reference testimony 3), of Dr. Nancy Adler,pp. 138-140. 17. "Testimony thePsychologicalSequelae ofAboron tion," on behalf of the Public InterestDirectorateof the American Psychological Association, presented to the Officeof the U.S. Surgeon General,Dec. 2, 1987, pp. 25 and 29, document available in subcommittee files. 18. Ibid., p. 3. 19. Hearing, op. cit.(see reference testimony Dr. 3), of Anne Speckhard,psychotherapist, 175. p. 20. , op. cit. (see reference3), testimonyof Dr. Wanda Franz,p. 111. 21. -, op. cit. (see reference testimony Dr. C. 3), of EverettKoop, p. 232. 22. , op. cit. (see reference3), testimonyof Dr. Carol Hogue and Dr. C. EverettKoop, p. 223. 23. , op. cit. (see reference testimony Dr. C. 3), of EverettKoop, p. 223. 24. Ibid., p. 211. 25. " Testimony thePsychological on Sequelae ofAbortion,"op. cit.,1987 (see reference p. 3. 17), 26. Hearing,op. cit.(see reference testimony Dr. 3), of C. EverettKoop, p. 211. 27. TransciptofDr. C. Everett Koop's meetingwithan

ad hoc group of distinguishedpsychiatrists, Sept. 15, 1988,p. 5 in subcommittee files. 28. Hearing, op. cit. (see reference discussion,pp. 3), 232-235. 29. -, op. cit. (see reference testimony Dr. C. 3), of EverettKoop, p. 194; and transcript meetingheld of with the National Youth Pro-LifeCoalition, May 25, 1988,pp. 9-10. 30. -, op. cit. (see reference testimony Dr. C. 3), of EverettKoop, p. 243. 31. Ibid., p. 195. 32. Ibid. 33. Hearing, op. cit.(see reference testimony Dr. of 3), Duane Alexander,National Instituteof Child Health and Human Development,p. 273. 34. Lisa Kaeser, The Alan Guttmacher Institute, letter to Representative Ted Weiss, Nov. 2, 1989,available in subcommittee files;theinflation estimate was provided by the Congressional Budget Officeand is also available in subcommittee files. 35. Ibid. 36. Hearing, op. cit.(see reference testimony Dr. of 3), David Grimes,p. 87. 37. Ibid., p. 94. 38. Ibid. 39. Ibid., p. 88. 40. Hearing,op. cit.(see reference testimony Dr. of 3), Carol Hogue, p. 248. 41. , op. cit. (see ref.3), information supplied for the recordby the CentersforDisease Control,p. 248. 42. Ibid., pp. 254-272. 43. Ibid.

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