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Second Critique of a Research Article “Abortion and Mental Health: Evaluating the Evidence” by Major, Appelbaum, Beckman, Dutton, Russo, and West

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The article “Abortion and Mental Health: Evaluating the Evidence” by Major, Appelbaum, Beckman, Dutton, Russo, and West (2009) addresses the relationship between women’s mental health and induced abortion. The authors analyzed the relation between abortion and women’s mental health by reviewing the implications that abortion had on health as documented between 1989 and 2008. Among the reports that were reviewed was the American Psychological Association’s (APA) taskforce on mental health and abortion published in 2008.

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Major et al. (2009) further conducted a longitudinal survey establishing (a) time precedence of the abortion before a mental health variable, (b) conservation of abortion and the mental health outcome variable, and (c) control of the third variables associated with the outcome variable so that plausible alternative explanations can be ruled out. Consequently, they postulate that abortion is a risk factor related to other risk factors of pregnant women. They propose that research designs should include clearly defined and equivalent comparison groups. For instance, it is appropriate to compare only women who have procured abortion with women who have been pregnant. They underscore the problematic nature of relative risk in this assessment since, even within the abortion comparison group, abortion is experienced differently by different women.

The research work had three key objectives. The first objective was to do a review and make an evaluation of empirical research analyzing the connection between mental health and induced abortion. The second objective was to conduct a review of abortion’s mental health risks in comparison to the challenges experienced when one opts for alternatives to abortion. The third objective was to look at the causes of differences in the way women psychologically respond to abortion.

The results could be put into two broad categories. First, most women will experience negative psychological reactions following an abortion as it is a uniquely traumatic experience. Secondly, there are complementary factors that may lead to negative or positive psychological reactions following an abortion. It is because abortion and unwanted pregnancy are potentially stressful life events, and responses depend on the women’s coping strategies and resources (Planned Parenthood Federation of America, 2014). It was reported that the socio-cultural context in which abortion occurs influences psychological reaction to abortion (American Psychological Association, 2008). It was also found out that unwanted pregnancy occur in the context of co-occurring risks, which usually presupposes poor mental health irrespective of pregnancy resolution (Major et al., 2009).

From the study, Major et al. (2009) enumerate their key findings as follows:
a) Risk associated with first abortion for non-therapeutic reasons is equal to the risk women who deliver unwanted pregnancy run;
b) The mental health challenges encountered due to termination of a wanted pregnancy due to abnormalities experienced during pregnancy appears similar to the challenges faced by women who suffer from stillbirth, miscarriage or whose newborns die.
c) Mental health complications suffered by young women seem to be slightly more serious if they disclose that they had an abortion than if they did not do that.
d) There are co-relations between pre-existing and pre-occurring conditions of unwanted pregnancy and abortion. This also relates to conditions that can have long lasting negative implications on mental health no matter how the pregnancy is handled;
e) Adult women who induce an abortion do not have mental health complications;
f) Abortion is undertaken as a result of inconsistency, and it leads to a mix of pleasurable and undesired emotional reactions.

Evaluating Research Methods

The article is based on a solid literature review. The authors focused on critical appraisal, research, and writing (Mertens, 2010). Major et al. (2009) narrowed down their study on mental health implications of women based on how mental health is defined by Word Health Organization. They also analyzed literature on complications related to mental health and associated with induced (not spontaneous) abortion for medical purposes. They narrowed down their review to empirical studies published in English and pre-reviewed journals published between 1989 and 2008. 58 papers based on the US and international samples and the taskforce report, the APA TFMHA 2008, were reviewed. They also surveyed six papers that were published after submission of the TFMA report to APA (Major et al., 2009).

Specifically, the controversy around abortion and whether it should be available for mild to severe fatal abnormality conditions and non-medical reasons is still widely debated. In 1973, the Roe v. Wade US landmark ruled legalized abortion, and more than 35 years on, it continues to elicit political, religious, literary, and legal emotions and controversies (Major et al., 2009). The major debate is ongoing, and, as Beckwith (1995) notes, the major controversy is between pro-life radicals and crusaders of abortion.
The research type employed by the authors closely mirrors non-experimental research. In non-experimental research, variables of interest cannot be manipulated since they are naturally existing attributes. Thus, assignment of a given treatment condition to individuals would be unethical. This deviates from other research types such as experimental research. In the case of the latter, there are random assignments and manipulation of an independent variable while employing strict controls. Even though experimental research provides a better analysis of cause-and-effect relationships, it happens in highly controlled environments. The conditions are quite unethical when applied to women’s mental health and abortion (Sousa, Driessnack, & Mendes, 2007).

In their research, the authors used four sample sets. The first set involved a review of the medical records (where n=31). They made a comparison between women who went through abortion with those who had a different reproductive history by performing follow up analyses of public data sets. The second set involved other data from the survey. 19 of the surveys were done in the United States, 2 were done in Australia, 2 - in New Zealand, 6 - in Finland, and 2 - in Norway. The third set (with n=21) provided a description of the original studies that were mainly done to make a comparison between responses given by women who had a first-trimester abortion with those who had a different reproductive record. The fourth set reviewed the psychological experience of women who had a late-trimester abortion. Finally, 23 papers were reviewed based on the US, meeting all the other inclusion criteria (Major et al., 2009). Therefore, the sampling method used for this survey was very comprehensive and representative of the population around the subject area under discussion, and it was thus very appropriate.

Notably, the authors have documented a very practical work. The practicality of their work is demonstrated by:

1. The sampling method employed. They have reviewed the medical records and other surveys describing the original studies on the first-trimester and late-trimester abortions and their responses. The others have also reviewed the US papers meeting the other inclusion criteria.
2. Non-experimental research. This does not require serious variable controls. It also employs analyses and reviews of the variables in their naturally occurring conditions.
3. Proper literature review. The literature review examines women’s mental health outcomes and implications induced by abortion using clear inclusive criteria. According to the criteria, empirical research, published in English, and pre-reviewed journals, published from 1989 to 2008, must have measured a mental health condition subsequent to abortion as well as analyze comparison groups.
4. The relevance of the study. Abortion and its psychological impacts have been very topic issues for last four decades.

Accordingly, the authors advance the applicability of their research by identifying a number of factors associated with mental health of women who experienced unwanted pregnancy. The study has identified the preexisting as well as co-occurring conditions in a life of a woman, which place her at a greater or lesser risk of poor mental health regardless of the way she resolves her pregnancy. The result could also be applied in conducting appraisals of the meaning of pregnancy and abortion and a woman’s ability to deal with each option. It has also presented various coping strategies a woman may use to accept her decision (Major et al., 2009).

In my opinion, the authors’ findings can be very useful in formulation of public health policy to help tackle the issues related to abortion. It will help institutions to come up with both legal and societal mechanisms of addressing the issues of unwanted pregnancies, abortion, and related mental health challenges. In addition, the knowledge generated from the findings can further elicit public debates to uncover any missing data as to abortion and its relation to mental health challenges. This will help improve the quality of life.

Though the study meets nearly all the scientific requirements, the researchers’ focus on three independent objectives makes the study too broad. The researchers could not have explored all the materials on each subject matter. The researchers could have narrowed the scope of the study to do a review and evaluation of empirical research only related to mental health and induced abortion. It means that there is a need for further research on each of the three objectives independently.

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In conclusion, the authors are clear and straightforward in their writing. They start by giving an abstract overview of the research topic. They also offer in-depth background information on public health debate, abortion, and psychological health challenges associated with unwanted pregnancy. They are equally clear in their framing of the research question about abortion and mental health exploring the variability in abortion experience. Their conceptual framework clearly outlines the assumptions guiding the study. Finally, their literature review and conclusions were equally comprehensive.

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