Researchers call for more abortion studies to be retracted

Health and science experts published a commentary in the British Medical Journal on Tuesday calling for the retraction of four older abortion-related studies that, despite documented flaws, have influenced major anti-abortion decisions over the past 20 years, including the 2022 U.S. Supreme Court decision that overturned federal abortion rights.

The commentary comes the same month academic publisher Sage Journals retracted studies calling into question the long-established safety record of the abortion drug mifepristone, which were produced by anti-abortion activists shortly before they sued the U.S. Food and Drug Administration over the same drug. 

The timing of these two events is coincidental, lead author Julia H. Littell told States Newsroom (she said the authors submitted their article last year, and it only recently completed the peer review and editorial process). But she said that in this post-Roe era, as abortion restrictions increase, pressure has mounted to correct the record on abortion safety. 

“There’s a lot of damage that has been done, and probably will continue to be done, but it’s really important that scientific and medical journals correct these kinds of mistakes so that people don’t lose faith in science,” said Littell, a professor at the Graduate School of Social Work and Social Research at Bryn Mawr College. “How that’s going to play out in courts is a whole different story. It’s quite possible that some expert witnesses, and maybe even judges, will continue to cite these papers, even if they are retracted. But we think it’s really important to get this corrected, so that the downstream effects on medicine and public policy aren’t dire.”

The authors, 17 experts on reproductive and mental health and scientific methods from around the world, are calling for the correction or retraction of four studies published between 2002 and 2011, which they say erroneously attributed women’s mental health issues to abortions they had, in some cases by confusing correlation with causation and failing to correct for factors that explained the relationship.

“It turns out that women who have abortions may be more likely to have mental health problems to begin with,” Littell said. “They tend to be living in greater situations of adversity; they tend to be more exposed to domestic violence and other forms of interpersonal violence. … And when you don’t control for that, which is absolutely a predictor of abortion, then yes, later on, it looks like they have more serious mental health problems. But the problem was there all along. Abortion isn’t really predicting that. Abortion is co-occurring with that.”

The studies were authored by a handful of longtime anti-abortion activists and have received intense scrutiny and criticism over the years, but continue to be cited by lawmakers and judges to defend anti-abortion policies, including the FDA case the U.S. Supreme Court will hear next month. 

The studies are: 

• “Depression and unintended pregnancy in the National Longitudinal Survey of Youth: a cohort study,” published in 2002 in the British Medical Journal (which also published  Tuesday’s commentary). The authors of this study are longtime abortion opponent David C. Reardon, who also co-authored two of the recently retracted Sage articles, and Jesse R. Cougle. The cohort study concluded that the risk of depression was higher in women who had an abortion compared with those who continued an unwanted first pregnancy. But the commentary writers say an independent re-analysis of the same data found that the study incorrectly identified unwanted first pregnancies and did not control for pre-pregnancy levels of depression. The journal made partial corrections, but the commentary authors say “serious methodological problems remain uncorrected.”

• “Generalized anxiety following unintended pregnancies resolved through childbirth and abortion: a cohort study of the 1995 National Survey of Family Growth,” published in 2005 in the Journal of Anxiety Disorders, and written by Cougle, Reardon, and Priscilla K. Coleman, a retired Bowling Green State University professor of human development and family studies, and a longtime anti-abortion activist. The study concluded that abortion was associated with higher rates of anxiety than giving birth, but, according to the commentary authors, an independent re-analysis showed that pre-existing levels of anxiety and exposure to domestic violence accounted for this association.

• “Induced abortion and anxiety, mood, and substance abuse disorders: isolating the effects of abortion in the national comorbidity survey,” published in 2009 in the Journal of Psychiatric Research and authored by Coleman, Catherine T. Coyle, Martha Shuping, and frequent anti-abortion expert witness Vincent M. Rue. This analysis concluded that abortion increased the likelihood of various mental health problems and substance use disorders, but the commentary authors say the results could not be replicated because of incorrect statements about the methodology.

• “Abortion and mental health: quantitative synthesis and analysis of research published 1995-2009,” published in 2011 in the British Journal of Psychiatry, authored by Coleman. This was a meta-analysis that ultimately concluded that abortion accounts for a substantial increase in the risk of adverse mental health outcomes. The commentary authors say the study failed to meet methodological criteria for systematic reviews, noting that 11 of the 22 included studies were authored or co-authored by the sole author of the meta-analysis.

“We believe that journal editors and their publishers have an ethical obligation to correct the scientific record in these cases,” the commentary writers said, several of whom have been studying the health impacts of abortion for years. They are calling for the 2002 and 2005 articles at minimum to be accompanied by expressions of concern and the 2009 and 2011 articles to be retracted “because of the overwhelming and incontrovertible evidence of their methodological flaws, inaccurate results, and invalid conclusions.”  

Littell, an expert on meta-analyses, said the 2011 study is the most egregious, in part because there was only one author, which is not the recommended standard for this type of tedious and difficult analysis. She said she was among several researchers who wrote letters to the editor of the British Journal of Psychiatry more than a decade ago calling for its retraction. The commentary writers estimate it has been cited in at least 25 court cases and 14 parliamentary hearings across six countries.

Neither Coleman, Cougle, or Reardon responded to requests for comment by the time of publication. 

These researchers have long stood by their work and some continue to testify as expert witnesses in abortion-related lawsuits. Coleman in a rebuttal submitted to the British Journal of Psychiatry in 2022 blamed renewed calls to retract her research on pro-abortion bias. “I have not been the only recipient of this form of bullying due to publishing research results that run counter to a political agenda,” Coleman wrote.

The British Medical Journal told States Newsroom in a written statement: “We are grateful for the concerns raised in the analysis article that we have published today. The issue remains under consideration by our research integrity team. We will make our final decision public once we have completed our internal process”

The remaining three journals did not respond to a request for comment by the time of publication.

Correcting the scientific record: ‘If we don’t, who will?’

The commentary writers also say they are trying to restore public confidence in science.

“It is a concern to me that people will begin to, if they haven’t already, lose trust in science if they can’t rely on the publications out there to be valid,” said Antonia Biggs, associate professor and social psychologist at the University of California San Francisco’s Advancing New Standards in Reproductive Health, which produced the Turnaway Study. That research found that women who have abortions do not suffer worse mental health outcomes than those denied abortions. “It is the responsibility of us as researchers or publishers to adhere to science and to make sure that the scientific record is accurate. If we don’t, who will?” 

UCSF professor Diana Greene Foster, who led the longitudinal Turnaway Study, also co-authored the commentary. (Editor’s note: Reporter Sofia Resnick contributed proofreading and editing to Foster’s 2020 book about the study.) UCSF professor Ushma Upadhyay, another commentary co-author and Turnaway Study researcher, is also pursuing a paper re-examining the retracted Sage research.  

Chelsea Polis is another commentary co-author who has been involved in efforts to retract flawed reproductive-health-related research. She is a senior scientist of epidemiology at the Center for Biomedical Research at the Population Council, which developed the abortion pill at the center of the FDA lawsuit, along with contraceptives and other reproductive health products. 

In 2022, the journal Frontiers in Psychology published Coleman’s critique of the Turnaway Study but, according to Inside Higher Ed, re-examined the article post-publication after critics, including Biggs and Polis, pointed out that Coleman’s article had been edited and peer reviewed primarily by scientists from the anti-abortion think tank the Charlotte Lozier Institute.

Also in 2022, Polis led a group of 16 scholars who submitted their concerns to the British Journal of Psychiatry about Coleman’s 2011 meta-analysis. An investigative article published by the British Medical Journal reported that an independent panel had determined that the 2011 study should be retracted. But according to the BMJ, the Royal College of Psychiatrists, which owns the British Journal of Psychiatry, overruled the panel after Coleman threatened to sue. Panelists and editorial board members resigned in protest over concerns the journal lacked editorial independence. The Royal College defended its decision not to retract in a 2023 statement, citing the “distance in time since the original article was published” and “the widely available public debate on the paper.”

Polis told States Newsroom the fear of lawsuits can deter retractions, a fear she understands firsthand. In 2020, the medical device company Valley Electronics of Zurich, Switzerland, sued Polis for defamation after she raised concerns about how their Daysy fertility tracker was being marketed as a contraceptive based on a paper that was ultimately retracted. The company lost the lawsuit.

“Editors, journals, and publishers have very little incentive to retract papers (and sometimes avoid retracting even when it really should be done),” Polis said in an email. Polis is an advocate for abortion access, but she said her research critiques have been based on concerns over methodology and not policy positions. She said this work analyzing and calling out flawed science has brought her into a community of scientists dealing with similar legal battles. 

 “In so many ways, people willing to do this kind of unappreciated, generally unrewarding, sometimes dangerous, and yet extremely critical scientific integrity work need more help and meaningful support,” Polis said. 

Biggs told States Newsroom she doesn’t know where these new calls for retraction will lead. But she said she plans to continue pointing out the flaws in these studies, because their influence has had real-world impact. 

“When we’re talking about these policies, they have real effects and can have the effects of denying someone a wanted abortion,” said Biggs, referencing the Turnaway Study she worked on, which found more negative short-term mental health outcomes for patients denied abortions, as well as more long-term health and socioeconomic outcomes. “It’s going to impact them. It’s going to impact their children and their families.”