THE CRUX OF THE MATTER
Due to the necessary fact checks on each of Joyce Arthur’s allegations, I am nervous that some readers may get bogged down by the required and detailed responses.
Accordingly, I have first provided a preliminary chapter on the most critical complaint. That is, according to Ms. Arthur, many or most CPCs in Canada provide misleading and inaccurate information on the subject of abortion.
This most important preliminary chapter is titled: Abortion Procedures and Risks.
For those of you not faint of heart, you can continue on with my report which more extensively responds to Ms. Arthur’s other false claims.
The most critical false complaint by Arthur is that CPCs in Canada provide misleading and inaccurate information on abortion.
What Arthur knows – and yet conceals – is that the actual CPC abortion-related information is sourced from obstetricians, medical ethicists and the abortion providers themselves.
For example, according to Brian Norton, a board member with the Canadian Association of Pregnancy Support Services (CAPSS) (http://www.capss.com/our-board-of-directors/), the physical risks to abortion outlined in the CAPSS client brochure comes directly from, and is not limited to, abortion providers such as BC Women’s Hospital, Brampton Women’s Clinic, Clinique Médicale Fémina (Montréal), Hamilton Health Sciences, Kensington Clinic, Kootenay Boundary Regional Hospital, Women’s College Hospital (Toronto) and Women’s Health Clinic (Winnipeg).
If Ms. Arthur truly believes the content is not accurate, she should conduct her “misinformation” assault not on CPCs but on the primary sources. Namely, Canadian abortion clinics and hospitals providing abortion services.
Further, Ms. Arthur should run a concurrent “misinformation” campaign against pro-choice affirmed peer-reviewed epidemiological studies.
I conducted a fact check of Arthur’s allegations and what written material is available to clients from most, if not all, CAPSS member CPCs. Arthur’s “homework” is found wanting. She is dishonest. Again.
In case you are thinking I am making this up, let me provide you with the precise word-for-word abortion information from the 2017 CAPSS client brochure (available from all member CPCs), titled: Abortion Adoption Parenting: an informational guide for unplanned pregnancy.
The option of abortion – abortion procedures
There are various abortion procedures available during different stages of pregnancy. In Canada, 90% of abortions are done in the first 12 weeks of pregnancy, avoiding the added risks associated with later term abortions. An ultrasound may be given before an abortion to determine the stage of pregnancy and also afterwards to determine if the abortion is complete. Depending on the type of abortion, the procedure may take between 5–30 minutes, with the entire process being generally less than 2 hours.
Medical abortions (typically up to 7 weeks) – There are 2 methods of medical abortion available in Canada. The first is a combination of methotrexate and misoprostol, and the second is a combination of mifepristone (also called mifegymiso) and misoprostol. Methotrexate is usually given by injection while mifepristone is a pill which is swallowed. Misoprostol is a pill which may be self-administered into the vagina or swallowed. Methotrexate is a chemotherapy drug which stops cell growth. Mifepristone blocks two hormones which are necessary for pregnancy to continue. Misoprostol causes the uterus to contract and expel the embryo. Cramping and bleeding will occur as the uterus contracts and as the embryo is expelled. Medical abortion may take several days to complete and require 1 to 3 visits to the abortion provider. If an incomplete abortion occurs then a surgical procedure may be required.
Surgical abortions – With each of the following surgical procedures, the cervix will be dilated (opened) to allow instruments to enter the uterus. Dilation may be done using misoprostol, laminaria (seaweed sticks), an osmotic dilator (expanding sponge) or metal rods. A local anaesthetic, as well as medication to reduce pain, blood loss and risk of infection, may be given. The tissue removed from the uterus may be examined to identify fragments of the embryo or fetus and the placenta.
vacuum aspiration and dilation & curettage: D&C (1st Trimester) – After dilation, abortion is performed by inserting a long tube (cannula) into the uterus. After the contents are removed by suction, a procedure using a loop-shaped instrument (curette) may also be required to scrape the wall of the uterus.
dilation & evacuation: D&E (2nd Trimester) – This method requires 2 appointments. After 24 hours of dilation, this procedure is performed with the use of both suction and scraping used in 1st trimester abortions (above), and the use of forceps to remove fetal parts. For abortions in the late 2nd trimester, prior to the procedure, a needle may be placed into the fetal heart with ultrasound guidance and potassium chloride injected to ensure the fetus is not alive prior to evacuation.
induction of labour (2nd Trimester) – In the 2nd trimester, as an alternative to D&E, sometimes labour is induced and the fetus delivered. As above, potassium chloride may also be used prior to induction of labour.
No misinformation on the abortion procedures in Canada. Totally accurate. Totally current.
It is Ms. Arthur who misinforms her own readers about CPCs in Canada.
The CAPSS client brochure begins this one-page section with the following introductory statement, in an increased font size and in colour:
Thousands of abortions are performed every year in Canada, and are considered to be a safe medical procedure. However, as with any medical procedure, there are potential risks that you need to consider before making a final decision.
Totally accurate. Unmistakably clear.
The brief CPC information pertaining to emotional risks is attested by abortion providers and pro-choice affirmed epidemiological studies. Though routinely buried by Ms. Arthur and her ARCC political organization, these possible risk factors are in fact acknowledged by other pro-choice organizations in Canada.
Arthur falsely accuses CPCs for frequently using the term “Post Abortion Syndrome”. But more overriding, she has a deep disdain of any term acknowledging abortion-related grief. From her 2016 report:
“many [CPCs] promote misinformation such as the existence of ‘Post-abortion Syndrome,’ which is not a medically recognized condition.”
“48% (79) mentioned negative psychological consequences, primarily in the context of ‘Post-abortion Syndrome’, which is not medically recognized.”
“20% of sites specifically mentioned ‘Post-Abortion Syndrome,’ while 16% did not specifically name ‘Post-Abortion Syndrome’ but listed what many anti-abortion groups believe are its symptoms. 51% of sites offered post-abortion counselling at their centres.”
“Figure 4.1: Group 1: 19.9% (n=33) of websites mention or discuss ‘Post-Abortion Syndrome.’ Group 2: 16.3% (n=27) did not name the fictitious syndrome but instead described symptoms that anti-abortion groups often claim it comprises. Group 3: 50.6% (n=84) offered post-abortion counselling.”
“presenting ‘Post-abortion Syndrome’ as real and common (48% of sites). Neither of these claims are supported by evidence (NARAL 2016).”
“Almost half of centres – 48% (79) – claimed on their websites that abortion results in negative psychological consequences, including depression, suicidal thoughts, or ‘Post-Abortion Syndrome’.”
First, let me first address the fact that Arthur is once again fudging the figures – this time on “Post Abortion Syndrome” being a widespread term on CPC websites. Later, I will speak to the more central issue of abortion and emotional risks.
As we have seen above, Arthur is highly critical of CPCs in Canada for using the designation “post abortion syndrome”. She states in her report that 79 websites use the term “post-abortion syndrome” or use some kind of reference to emotional pain of women after abortion.
Reviewing the 79 websites for myself, this is what I discovered.
When I began my research initially, I discovered that a total of two of these 79 sites had used the word “post-abortion syndrome”:
The Back Porch in Edmonton, Alberta (#9):
“The most common emotional risk is Post-Abortion Syndrome (PAS), which is closely related to Post Traumatic Stress Disorder (PTSD).”
Pregnancy Help Centre Durham also uses the term:
“If you are struggling with guilt, sleep disturbances, depression, intruding thoughts, feelings of despair, and/or thoughts to harm yourself, you may be experiencing symptoms of post-abortion syndrome.”
However recently when I rechecked the two sites I noticed that neither of these sites used the term post-abortion syndrome any longer.
Arthur would have unsuspecting readers believe that 79 CPC sites use the term, when only two in fact did; currently none of the 79 sites use the term.
Deceit? Misinformation? Fabrications? What can we call it?
So I then connected with a CAPSS representative on this subject and I learned that Post Abortion Syndrome (PAS) is not, in fact, a term CAPSS member centres use. For the emotional pain women describe to their centre staff, the common terms used by CPCs are “post abortion stress” or “post abortion grief”.
Further, having reviewed the website used by all Birthright centres, they also do not refer to Post Abortion Syndrome (PAS), as Arthur also dishonestly implies.
Below is the actual “position” of this term for CAPSS member centres, which – wait for it –Arthur knows. She and each of her board members received a written hard copy from CAPSS, years ago.
CAPSS informed Arthur and ARCC that their centres do not use the term PAS, and then gave the following explanation:
Years ago, various prolife professional counsellors and physicians in the USA used the term “post abortion syndrome” when describing the very severe cases of abortion grief. That was, and still is today in medical circles, a labeling misnomer. Post abortion syndrome – i.e. as a “post-traumatic stress disorder” – is not recognized in the Diagnostic and Statistical Manual of Mental Disorders. When describing the emotional pain of abortion, CAPSS centres in Canada use “post abortion stress” or “post abortion grief”. In fact, since the very inception of CAPSS in 1997, “post abortion syndrome” has never been used in any CAPSS publication – whether in membership documents, volunteer training manuals, or brochures.
Having said that, there are excellent US produced publications on abortion grief and recovery which have used (and some still do use) this term. This is regrettable. The misnomer becomes fodder for unhelpful politicization (whether ‘prochoice’ or ‘prolife’), thus hijacking an important conversation on abortion grief and methodologies of care and healing.
Is there any integrity left within the ARCC organization?
Moving on from Arthur’s word games, I now will discuss the matter of emotional risks to abortion.
Here’s the thing. There are all kinds of organizations (including abortion clinics) other than CPCs who also discuss the emotional risks of abortion.
(Also note that Arthur’s percentages and numbers of clinics detailed above who are “guilty” of identifying these emotional consequences of abortion are also wrong since Arthur’s CPC counts in her report are wrong. More on this later.)
Here is the CAPSS client brochure’s content on possible emotional risks along with references of which organizations identify these risks:
After an abortion many women feel some relief, while others have negative emotions. Reactions may be immediate, or feelings may arise years later. Responses vary. They depend on a woman’s age, stage of pregnancy, religious or cultural beliefs, previous mental health, or whether she is being pressured by others into having an abortion.
Women who experience negative emotions after an abortion have reported the following reactions: 4
• Guilt or shame
• Emotional numbing
• Nightmares or flashbacks of the abortion
• Alcohol and drug abuse
• Having thoughts of suicide
As an endnote source, the CAPSS client brochure states (on page 8):
4. Sources: Canadian abortion providers (references available on request). Also see BC Women’s Hospital, “Coping with Ending a Pregnancy,” http://www.bcwomens.ca/health-info/sexual-reproductive-health/abortion-services (accessed March 2017). Also see P.K. Coleman, “Abortion and mental health: quantitative synthesis and analysis of research published 1995-2009,” British Journal of Psychiatry 199, (2011): 180-86; D.M. Fergusson, J.L. Horwood and J.M. Broden, “Abortion and mental health disorders: Evidence from a 30-year longitudinal study,” British Journal of Psychiatry 193 (2008): 444-451; N.P. Mota, M. Burnett and J. Sareen, “Associations between abortion, mental disorders, and suicidal behaviour in a nationally representative sample,” Canadian Journal of Psychiatry 55, no. 4 (2010): 239-247.
Also on this topic of post abortion grief is the fact that there are organizations whose entire reason for existence is to help women heal and recover from their abortion grief. See:
Another source which you may find of interest is the Canadian publication, Complications: Abortion’s Impact on Women (2013), by the deVeber Institute for Bioethics and Social Research. I draw your attention to Section III “The Psychological and Social Impact” and Section IV “Women’s Voices: Narratives of the abortion experience.”
If you doubt that some women experience pain, loss, grief – call it whatever you like – from abortion, I suggest you Google “recovering from abortion grief” and see the resources that come up.
For those women who experience no grief from their abortions, that is wonderful and they are fortunate. But for those who do experience something other than relief, why would Arthur insist that the emotional pain these women experience after abortion isn’t real? And that CPCs, in providing help to these women, are “deceitful and misleading” women, and that CPCs provide “direct misinformation” to these women?
By making these false allegations Arthur belittles and marginalizes women who do experience these very real feelings and emotional suffering after abortion. PostAbortion Community Services (PACS) is one of many abortion recovery outreaches, nationwide, collaborating with CPCs. Program director Doreen Yung informs me that PACS has been helping women seeking healing from abortion grief for 25 years. PACS offers peer counselling, support groups and recovery retreats.
In addition to self-referrals, Yung says clients are referred to them by (pro-choice and pro-life) physicians and agencies. Perhaps to Arthur’s chagrin, PACS has also received referrals from abortion providers.
Regarding informed consent on physical risks to abortion, with only one exception, CPCs note the same risks conveyed by abortion providers and pro-choice medical researchers. In fact, abortion clinics have a much longer and detailed list of the physical risks. Here is the CAPSS client brochure’s entire content on possible physical risks:
• Heavy bleeding
• Increased risk of premature births in subsequent pregnancies1
• Damage to cervix or uterus, including a small risk of infection or scarring2
that can be associated with infertility or miscarriage
that can be associated with infertility or miscarriage
• Possible link to breast cancer *
* controversial; see endnote 3
For endnote #1 (above), the following source is noted on page 8: P. Shah and J. Zao, “Induced termination of pregnancy and low birthweight and preterm birth: a systematic review and meta-analyses,” British Journal of Obstetrics and Gynaecology 116, (2009): 1425-42; H.M. Swingle, T.T. Colaizy, M.B. Zimmerman and F.H. Morriss, Jr., “Abortion and the risk of subsequent preterm birth: a systematic review with meta-analyses,” Journal of Reproductive Medicine 54, no. 2 (2009): 95-108.
For endnote #2, the following detail is noted on page 8: Asherman syndrome, or intrauterine adhesions/scarring or synechiae.
As mentioned, there is only one risk factor that the medical community is in disagreement about. This concerns the worldwide epidemiological research on a possible link to breast cancer. Many studies reveal a link. Many studies do not.
From endnote #3, on page 8 of the brochure: The association between abortion and breast cancer is controversial. “Out of 73 published worldwide studies done to date, 56 show a positive association, of which 35 are statistically significant, while a total of seventeen studies show no link.” From I. Gentles, A. Lanfranchi and E. Ring-Cassidy, Complications: Abortion’s Impact on Women (Toronto: The deVeber Institute for Bioethics and Social Research, 2013), 125. The 3 most recent studies (2014) conclude a link. For example: Y. Huang, X. Zhang, W. Li, F. Song, H. Dai, J. Wang et al., “A meta-analysis of the association between induced abortion and breast cancer risk among Chinese females,” Cancer Causes & Control 25, no. 2 (2014): 227-236. More research is needed.
The two other most recent studies also reveal a possible ABC link (not noted in the above endnote due to space):
U. Takalkar et al, “Hormone Related Risk Factors and Breast Cancer: Hospital Based Case Control Study from India,” Research in Endocrinology 2014, (April 2014) Article ID 872124, DOI: 10.5171/2014.872124; and A. E. Lanfranchi and P. Fagan, “Breast Cancer and Induced Abortion: A Comprehensive Review of Breast Development and Pathophysiology, the Epidemiologic Literature, and Proposal for Creation of Databanks to Elucidate All Breast Cancer Risk Factors,” Issues in Law and Medicine 29, no. 1 (Spring 2014): 3-133.
If of interest, here I lift some commentary on this ABC subject from CAPSS rebuttal publication (pages 17, 21-22):
[Eight] years ago, a committee of the American College of Obstetricians and Gynecologists said: “More rigorous, recent studies demonstrate no causal relationship between induced abortion and a subsequent increase in breast cancer risk.” Committee on Gynecologic Practice, “Induced Abortion and Breast Cancer Risk,” ACOG Committee Opinion No. 434 (Washington: American College of Obstetricians and Gynecologists, 2009).
And from another recent publication is the following (puzzling) observation: “As for the
epidemiological evidence, most scientists worldwide, except in the US, agree that induced
abortion is a known risk for breast cancer” (emphasis added). Gentles, Lanfranchi, and Ring-Cassidy, Complications, 90. This publication cites and discusses the various worldwide studies.
“This discussion must not be ideological nor fall into the trap of epistemic closure,” the CAPSS rebuttal contends. “We must go where the evidence leads.” The author continues, “Debates on this controversial risk most often concern whether methodologies of particular studies are flawed. But politically predetermined editorial biases are far worse and do much more harm. Women deserve better.”
For the sake and safety of women’s health, CPCs recommend more research. I most certainly concur. I trust you, the reader, do as well.
With this preliminary chapter “Abortion Procedures and Risks” concluded, now to the other erroneous allegations by Ms. Arthur.
Tomorrow: Other Erroneous Allegations
Tomorrow: Other Erroneous Allegations