"Stop harassing women"? Study examines impact of pro-life activity outside abortion premises

Those who criticise pro-life groups for holding public acts of witness outside abortion facilities will often claim that these vigils harass, scare, and intimidate mothers who enter and leave abortion facilities.

This criticism comes from abortion "charities" like BPAS, Marie Stopes International, university and local feminist groups, mainstream media, and individuals on Twitter, Facebook, and blogs.

Groups criticised by those supporting abortion include 40 Days for Life, the Good Counsel Network, the Helpers of God's Precious Infants, Abort67, and SPUC coordinated annual pro-life chains. (This list is not intended as a SPUC endorsement of the groups listed, rather to recognise the groups who are very often criticised.) Occasionally an anonymous anecdote or a quote is presented as evidence that pro-lifers are there to harass mothers outside of abortion facilities.

However, rarely if ever is something more substantial cited, such as a study that attempts to seriously consider the experiences of mothers and pro-life vigils outside of abortion facilities. There are a few studies that are not well known.

The most recent study is by Diana Greene Foster et al, "Effect of abortion protesters on women's emotional response to abortion", Contraception 87 (2013) 81-87. Here is the abstract which briefly summarises the study:

Abstract
Background: Little is known about women's experiences with and reactions to protesters and how protesters affect women's emotional responses to abortion.

Study Design: We interviewed 956 women seeking abortion between 2008 and 2010 at 30 US abortion care facilities and informants from 27 of these facilities.

Results: Most facilities reported a regular protester presence; one third identified protesters as aggressive towards patients. Nearly half (46%) of women interviewed saw protesters; of those, 25% reported being a little upset, and 16% reported being quite a lot or extremelyy upset. Women who had difficulty deciding to abort had higher odds of reporting being upset by protesters. In multivariable models, exposure to protesters was not associated with differences in emotions 1 week after the abortion.

Conclusion: Protesters do upset some women seeking abortion services. However, exposure to protesters does not seem to have an effect on women's emotions about the abortion 1 week later.

This study notes that "although researchers and advocates have reason to believe that abortion protesters affect women's experience of abortion, little research has comprehensively documented women's experience of protester interactions". It is useful in some ways, but first let's list a few of the problems.

First, the researchers label pro-life vigils as "protests" and the people as "protesters". This is unhelpful, because in our society the word "protest" summons up images of shouting crowds marching through the street, conflict with police, arrests, aggression and so on. The use of the word "protester" can also be a biasing factor in the design of the study. Questions asked to abortion staff and mothers using the word protester can influence the way the participant views the question and affects the answer given, even to the point of giving the sort of answer they think the researchers expect to hear.

Second, the different types of pro-life vigil are labelled as passive (praying quietly at a distance), aggressive (shouting at women, attempting to hand out literature), or mixed (both passive and aggressive). It seems like a stretch of the imagination to label handing out a leaflet as an aggressive act. Is it possible that there have been times when someone who is part of a vigil shouts? Yes, peoples feelings can run high and saying something back to a passer-by who just swore at you might feel justified at the time, particularly if the person has little or no experience of how to behave at appropriately at a vigil. This is why groups like 40 Days for Life and Good Counsel Network insist that vigil participants sign a statement of peace - a short code of conduct participants should follow. Often passers-by will shout abusive comments at pro-lifers. Sometimes, but less often, banners, placards, and displays are kicked, broken and stolen by passers-by. A mother walking into an abortion facility may well mistake a passer-by and an pro-lifer having an altercation as aimed at her in someway.

Third, the study cites the American Psychological Association (APA) task force report on mental health and abortion report 2008 and the 2011 Munk-Olsen study on induced abortion and risk of mental disorder. These studies are cited to support the paper's claim that the vast majority of women report positive emotional outcomes after their abortion, and poor mental health after abortion due to poor mental health before the abortion. However, these claims and the studies used to support them cannot be taken at face value. The American Association of Pro-Life Obstetricians and Gynaecologists published an extensive critique of the APA report in September 2008. Professor David Fergusson, atheist and self-described "pro-choicer" and one of the international leading experts on abortion and mental health, criticised the APA 2008 report in August of that year.

The APA report, in fact, does draw a very strong and dogmatic conclusion that cannot be defended on the basis of evidence since this evidence is lacking by the admission of the report. As I stated to the APA committee in my review [of an earlier draft], the only scientifically defensible position to take is that the evidence in the area is inconsistent and contested. Under these conditions the only scientifically defensible conclusion is to recognise the uncertainty in the evidence and propose better research and greater investments in this area. What the Committee has, in effect, said is that until there is compelling evidence to the contrary, people should act as though abortion has no harmful effects. This is not a defensible position in a situation in which there is evidence pointing in the direction of harmful effects. In this respect, the response of the APA committee to this situation appears to follow the type of logic used by the Tobacco industry to defend cigarettes: since, in our opinion, there is no conclusive evidence of harm then the product may be treated as safe. A better logic is that used by the critics of the industry: since there is suggestive evidence of harmful effects it behooves us to err on the side of caution and commission more and better research before drawing strong conclusions. History showed which side had the better arguments.

What I also think the APA committee has failed to recognise is the size of the research investment needed to pin these issues down thoroughly. The tobacco example is a clear one: there have been literally tens of thousands of studies in this area (I have in fact published over 10 papers on tobacco related topics). This amount of research is needed in an area in which there are strongly divided opinions and deeply rooted agendas. The moral of all of this is very simple: In science drawing strong conclusions on the basis of weak evidence is bad practice. The APA report on abortion and mental health falls into this error.

Furthermore, Professor Priscilla Coleman, another international expert and one of the most published academics on abortion and mental health, has listed six considerable criticisms of the Munk-Olsen study, and points out that data from this study, despite evident problems,

does indicate increased rates of particular diagnoses at specific points in the first year. Relative risk for psychiatric visits involving neurotic, stress-related, or somatoform disorders was 47% and 37% higher post-abortion compared to pre-abortion at 2 and 3 months respectively.  In addition, psychiatric contact for personality or behavioral disorders was 56%, 45%, 31%, and 55% higher at 3, 4-6, 7-9, and 10-12 months respectively.

Having briefly covered the obvious problems with this study, there are also useful points from the perspective of those who carry out public pro-life work outside abortion facilities.

First the Foster et al study cites the Cozzarelli and Major 2000 study which examined the experience of mothers who had interacted with pro-lifers outside of three different abortion facilities in New York. This study has many of the problems mentioned above. However, Foster et al conclude from this study that for some women "negative effects of protester interaction did not extend beyond the short term." In both the Foster, and Cozzarelli and Major studies, it seems the mother's thoughts and feelings about the abortion influence how she perceives pro-lifers outside of an abortion facility.

Second, this study found the following:

"Among women who saw, heard or were stopped by protesters, 48% said that the protesters did not upset them at all, 25% said they were a little bit upset, 12% reported being moderately upset, 9% reported being quite a bit upset, and 7% were extremely upset"

"women who reported more difficulty making the decision to have the abortion reported being more upset than women reporting less difficult"

"Among the 712 women in the study who received an abortion and replied to both the emotions and protester questions, we found no association between emotions about the abortion — regret, relief, guilt, happiness, sadness or anger — and the level of exposure to protesters."

"the presence and intensity of the protester interaction had no effect on women's emotional response to their abortion (relief, regret, anger, happiness, sadness or guilt) 1 week after the abortion"

Third, this study notes that if pro-lifers deterred some mothers from entering an abortion facility they would not appear in this study. Some mothers would have had an interaction with pro-lifers and decided not to have an abortion. These mothers are therefore not recorded. If they were included we'd be looking at mothers who could describe their experience with pro-lifers as good and positive. From pro-lifers they have received moral and emotional support, perhaps a place to stay, financial help, advice and so on. Perhaps a mother going to an abortion facility didn't want to have the abortion in the first place and just needed a word of encouragement, even some sort of sign that would reassure them. It's possible that a pro-life counsellor outside an abortion facility will be the first person not to tell them that they must have an abortion. The researchers could have gone to pro-life pregnancy centres and homes and conducted the same interviews with mothers who had some sort of positive interaction with pro-lifers outside an abortion facility and asked them to answer the questionnaire.

Several pro-life groups provide moral and practical assistance to parents in need. Some make pro-life vigils part of their work, others don't. One pro-life pregnancy centre in the South, Good Counsel Network, does a good job of recording the number of mothers whom they meet on the doorstep of a BPAS or Marie Stopes International abortion facility, but get the help they need and give birth. Last year this pro-life centre recorded 95 such mothers they supported through the rest of their pregnancy. However, there are also many more who prefer not to stay in touch - they had the short term support they needed, sometimes their difficult circumstances change for the better, a boyfriend has a change of heart, and off they go. Sometimes mothers will lose touch and it remains unclear what happens after. The experience of mothers who have a positive experience should be heard and not dismissed by pro-abortion advocates just because these mothers, and the support of pro-lifers, do not fit into the distortions they insist on spreading.