Talk:Abortion and mental health/Archive 8

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New study

• What happens to women denied abortions? This is the first scientific study to find out. Posting link here for consideration. KillerChihuahua^?!? 22:49, 13 November 2012 (UTC)

Factual Error found in Regard to the Royal College of Psychiatrists

The paragraph about the UK Royal College of Psychiatrists stated that this organizations review comcluded that there is no link between mental health and abortion. This is a factual error. The truth is that the review concluded that the evidence is inconclusive. Ste11aeres (talk) 20:23, 13 February 2013 (UTC)

No, that's simply not true. The UK RCP report is here. The authors conclude: When a woman has an unwanted pregnancy, rates of mental health problems will be largely unaffected whether she has an abortion or goes on to give birth. (p. 125) In other words, unwanted pregnancies are risk factors for psychological distress, but whether those pregnancies end in abortion or in live birth does not change that risk. Their conclusions were not ambiguous or inconclusive; perhaps you could explain why you view it as such? MastCell ^Talk 04:24, 14 February 2013 (UTC)

Fergusson et al.

PMID 23553240 concluded that "There is no available evidence to suggest that abortion has therapeutic effects in reducing the mental health risks of unwanted or unintended pregnancy. There is suggestive evidence that abortion may be associated with small to moderate increases in risks of some mental health problems." Having looked over this article I find it quite skimpy, as it does not even mention reviews and meta-analyses (with only one exception). I feel that we ought to add mention of this recently published review, which actually looked at the NCCMH data the editors of this page are so in love with, as well as some others, for instance, This one was also by Fergusson et al. Jinkinson (talk) 17:32, 12 July 2013 (UTC)

I'm not quite following... which paper are you suggesting we mention? MastCell ^Talk 17:39, 12 July 2013 (UTC)

(edit conflict) I think Jinkinson means Fergusson 2013 (PMID 23553240).

Fergusson's contributions to this literature has been discussed a number of times on this page (search the archives for his name), so the article ought to be understood in the lens of Fergusson's previous work. I think it might be best to just wait for the response of the broader scientific community before including it. The first response (PMID 23803898) already appears to be quite critical, and I don't think anyone else has addressed it yet. NW (Talk) 17:42, 12 July 2013 (UTC)

Yeah, that is what I meant, NW. It seems David M. Fergusson, who is pro-choice and an atheist, has a long history of publishing research alleging that abortion causes mental health problems. I suppose we could (but don't have to) add mention of some of his studies while pointing out that they have been slammed by the Guttmacher Institute, as well as by the Family Planning division of New South Wales. Jinkinson (talk) 18:20, 13 July 2013 (UTC)

Recent review of scientific studies on the question

The following account of a recent review of research papers has been reverted immediately after it was added:

Of research papers published between 1995 and 2011, thirteen found that abortion constituted a clear risk of mental problems as compared to childbirth, five found no difference, and one found that childbearing had worse results. In the case of unplanned pregnancies, four found abortion involved greater risk than continuing to childbirth, three found no difference. Three studies found that abortion gave rise to a greater risk than a miscarriage, four found no difference, and two found that the miscarriage group showed greater short-term anxiety and depression but that the abortion group had greater long-term anxiety and depression. A review of these papers, which appeared in the July 2013 number of Psychiatry and Clinical Neurosciences, concluded that childbirth brings lesser risk of mental disorders than any form of fetal loss, and that some studies show that abortion brings a higher risk than miscarriage; it also considered that further research is needed (Abstract of the study "Abortion and subsequent mental health: Review of the literature" by Carlo V. Bellieni and Giuseppe Buonocore in Psychiatry and Clinical Neurosciences, Volume 67, Issue 5, pages 301–310 (July 2013) ).</ref>

The revert (on the grounds: "I have read the article (not just the abstract) and see that unlike serious systematic reviews, it does not do any quality analysis of the studies in question") seems to be based on nothing better than the idea that an editor's personal opinion carries more weight than a reliable(?) published source that summarizes in the form of an abstract the content of the study. The deleted account follows closely the published information. Esoglou (talk) 17:11, 27 July 2013 (UTC)

Since neither the reverter nor anyone else has questioned the reliability of the cited source, I have restored the deleted information, making it yet clearer that it is only a report of the conclusions of the review, not a statement of judgement by Wikipedia on the actual facts. Esoglou (talk) 17:54, 28 July 2013 (UTC)

The reliably based information about what the review of evidence says has again been deleted, this time without even a pretence of an explanation. I'll wait until the day after tomorrow before restoring it, in order to give the reverters more time to explain their action. Esoglou (talk) 19:48, 28 July 2013 (UTC)

I agree with those who have reverted your edit. While I can't speak for them, I'll explain my view. A number of major expert bodies have summarized existing evidence on this subject. All of them have reached a similar conclusion: that induced abortion does not cause mental-health problems. You have selected a single review article which reached a different conclusion, and highlighted that article in the lead. On what basis did you choose to highlight this specific review (as opposed to any of the other numerous narrative reviews, systematic reviews, and meta-analyses published on the subject)? We as editors should not be in the business of trying to "debunk" or undermine reputable expert opinion, which in this case is quite clear. I think that your edit violated our policy on undue weight, by citing a single article as equivalent (or superior) to the views of multiple expert medical and scientific bodies.

Finally, while this is a more subjective issue, I agree with NuclearWarfare that the methodology of the article you cited was rather unimpressive, particularly compared to some of the rigorous work that's been done on this subject. In fact, I think it illustrates the finding by Charles et al. that the lower a study's methodologic quality, the more likely it is to report negative consequences of abortion. But that's a separate concern; the main justification in my view for reverting your edit was the violation of WP:WEIGHT. MastCell ^Talk 19:49, 28 July 2013 (UTC)

Hi Esoglou; I missed your talk page post in my watchlist yesterday; in future, perhaps using the new notifications system, could you inform me about the discussion if I appear to not be responding? As for the substance of your comment, I have nothing more to add beyond what MastCell has said. NW (Talk) 20:33, 28 July 2013 (UTC)

As explained by MastCell above, WP:WEIGHT is the primary issue. — ArtifexMayhem (talk) 21:42, 28 July 2013 (UTC)

Thank you all for your comments. I am new here, and will not stay long. But I do think that what the latest issue of a scientific journal that seems to have a certain prestige reports as a review of all the scientific papers published between 1995 and 2011 deserves a mention in the same context as some of those papers. It deals specifically not only with cases of unplanned pregnancy but also with the mental health effects of abortion as compared with miscarriage. So I don't see on what valid grounds it is being excised. However, since three Wikipedia editors want it excluded and nobody (apart from me) defends its mentioning, I will not restore it. Esoglou (talk) 07:58, 29 July 2013 (UTC)

I would like to get your opinion on this review

This review has been brought up before, but after searching the archives I could not find a specific rebuttal to it, so I was hoping if I posted a link here, someone would tell me why it is not even mentioned in the article. I am bringing it up because I want to know what the science says, and this review concluded that "...induced abortion increased the risks for...mood disorders substantial enough to provoke attempts of self-harm." I realize that Johns Hopkins is pretty prestigious, but it isn't gospel. Jinkinson (talk) 18:22, 28 July 2013 (UTC)

Only yesterday did I come to this article. So I don't understand why the 2003 study was not mentioned. There must be some reason other than the difficulty that, unlike the 1990 and the 2008 reports that are mentioned, information about it is not sourced to publications with the names Family Planning Perspectives or Contraception: An International Reproductive Health Journal. Esoglou (talk) 19:50, 28 July 2013 (UTC)

I think the paper isn't cited because it's 10 years old, and a huge amount of evidence has subsequently been published which renders its conclusions outdated (see WP:MEDDATE). The 1990 APA panel is mentioned because it's notable in a historical context. Also, the 1990 APA findings were published in a little journal called Science (as PMID 2181664), not in Family Planning Perspectives or Contraception, so your imputation of motive is not only lazy but also ignorant. The 2008 APA findings are clearly notable, as they express the current position of a major expert body on the subject. MastCell ^Talk 19:57, 28 July 2013 (UTC)

Is it necessary to mention that I set aside ("There must be some reason other than ...") as a reason the choice of citations for the 2008 and 1990 reports (I should indeed have specified which 2008 report) in footnotes 4 and 9? At least you did advance a reason for omitting the 2003 study: it is five years older than the mentioned 2008 papers (which in their turn are five years older than the unmentioned 2013 report). By the way, the article says nothing of the inconclusive judgement of the APA 2008 report on abortions other than a first. Esoglou (talk) 08:01, 29 July 2013 (UTC)

Actually, it does: "The [APA] panel noted a lack of quality data on the effect of multiple abortions. Additionally, the same factors which predispose a woman to multiple unwanted pregnancies may also predipose her to mental health difficulties; therefore, they declined to draw a firm conclusion on multiple abortions." MastCell ^Talk 18:47, 29 July 2013 (UTC)

What I said was intended in reference to the lead. I should not have written "the article". You are right. I apologize. Esoglou (talk) 06:24, 30 July 2013 (UTC)

No worries. MastCell ^Talk 21:21, 30 July 2013 (UTC)

recent edits

I removed the references to Fergusson and Belleini because after rewording them, they seemed a lot more tenuous than the Cochrane and J. Clin Psych references later in the paragraph. There were some WP:PEACOCK words in there too, and I note that the editor who inserted them has also been inserting Belleini et al references into a number of other neonatology (and other) articles. These particular ones did pass MEDRS, but as i noted in my reversion, i think that there is a weight issue here, and the Fergusson and Belleini studies are much less useful; the methodology of the Belleini article actually looked pretty shaky based on the abstract, though i did not read the entire article yet. -- [ UseTheCommandLine ~/talk ]# ▄ 22:24, 30 August 2013 (UTC)

I can agree that there is a weight issue here, but these 2 reviews are independend and their limits are not greater than those of previous reviews. I do not understand why they cannot be quoted here. Principina. 1 September 2013

I notice that quite a number of your edits so far have been the insertion of references to articles by Bellieni, et al, sometimes with no obvious compelling reason. While that could be a coincidence, my experience is that it's usually someone connected with the authors. If that's the case, you may want to review our policies on conflict of interest as well as our policies on citation spam and self-citation (which are sometimes conflated).

As for the Bellieni paper itself, it comes back to undue weight for me. Perhaps it could be acceptable with less effusive language or in an external links section, but I'm still rather skeptical. Since it was just published, and thereby has fewer opportunities to be cited than even the Cochrane paper, I'm inclined to wait a bit anyway, but open to other arguments. -- [ UseTheCommandLine ~/talk ]# ▄ 23:55, 1 September 2013 (UTC)

I have the same concerns about self-citation. More broadly, we've tried to move away from detailed descriptions of individual studies to a broader overview of current medical opinion on the subject. A lot of literature has been published on this subject, of greatly varying quality. We've generally tried to wait until specific studies have been appraised by reputable expert bodies (the APS, the Royal College of Psychiatry, Cochrane, etc) before incorporating them, in order to head off long talk-page debates about study methodology. Thus, I'd favor waiting to incorporate this particular article until it's clear how much weight it will be assigned by the relevant expert community. MastCell ^Talk 23:09, 2 September 2013 (UTC)

NuclearWarfare's revert of my edit

Mere moments ago, NuclearWarfare reverted my edit in which I removed all mentions of Charles et al.'s review, which at the time seemed like the clearly correct thing to do since previous discussions on this talk page have made it clear that major medical bodies' opinions are what count the most. However it seems the cabal insists on including Charles et al., even though it was done by researchers from Johns Hopkins, which is not a major medical body like the APA or NCCMH. NuclearWarfare's pathetic attempt to justify its inclusion by saying that "Just because seven folks on an APA Committee have a report doesn't automatically mean it's superior to a well done systematic analysis from a team out of a single un[iversity]" isn't fooling any of us, since the last time I checked neither he nor MastCell was the final arbiter of whether an analysis is "well done". (I mention MastCell because he has used his own monumental scientific expertise to dismiss another review on this page less than a year ago.) So if someone would care to explain why we include only the non-major medical body reviews that just so happen to say that abortion doesn't cause mental health problems, and provide a logical reason for our doing so, then I think we can consider this issue resolved. Jinkinson talk to me 01:50, 23 April 2014 (UTC)

Have you done a systematic review before? If you haven't, it's a rather interesting methodological exercise, so please give me the opportunity to explain how it usually works: You take your topic at hand and you find literally every source in multiple databases that could possibly be related. You're up to hundreds or even thousands of studies. You then start whittling. You can't just exclude a source because you think the source's conclusions are iffy or not in line with the rest of the evidence, but you need instead to cite a clear reason for exclusion. What you can do is then take your remaining studies and perform a quality assessment of all of them. You're looking for things like sample size (the more the better!) but also research design: randomization, positive and negative controls, blinding, etc. Only then can you go ahead and summarize/interpret the evidence (Khan, K. S.; Kunz, R; Kleijnen, J; Antes, G (2003). "Five steps to conducting a systematic review". Journal of the Royal Society of Medicine. 96 (3): 118–21. PMC 539417. PMID 12612111.).

Statements and position papers by large medical bodies are ideally nothing more than well-done systematic reviews. The medicine-related articles' reliable sources page is unequivocal about this (WP:MEDASSESS): "In general, editors should rely upon high-quality evidence, such as systematic reviews, rather than lower-quality evidence, such as case reports, or non-evidence, such as anecdotes or conventional wisdom. The medical guidelines or position statements produced by nationally or internationally recognised expert bodies often contain an assessment of the evidence as part of the report." (emphasis mine). I'm not dismissing the APA's findings. The people on that committee that wrote that report are all far smarter than I am and have put far more work into summarizing the position of their fellow learned mental health professionals. But the exact same is true for Dr. Blum's work, which seems to be widely-cited and accepted in the broader family planning literature (as per a quick Google Scholar search).

I feel like I have rambled on for a while. I hope this explains my position a bit more. NW (Talk) 02:46, 23 April 2014 (UTC)

Not really--your response above is indeed rambling, but contains very little that pertains to the question I actually wanted answered (see a few sentences down for the actual question). I am tempted to add Bellieni's review myself but I don't want to get topic banned or anything, given that this article is subject to discretionary sanctions. Given the ambiguity of the response I received previously here, I will try to rephrase my question less ambiguously: What makes Charles et al. better than Bellieni et al.? I think we should be consistent as far as including literature reviews is concerned; that is, we should include Charles and Bellieni's reviews, or neither of them, and it seems to me that the only arguments about only including one consist of nothing more than special pleading. However, I'm willing to change my mind if someone can answer this question. I might also note that since apparently being highly cited has something to do with your scientific work being good, perhaps Bellieni's GS cites (h-index 17) will sway your views on this. As it is, I think that by cherry picking the reviews that say abortion doesn't cause mental health problems the article does a huge disservice to our readers by creating an impression that differs significantly from reality. Jinkinson talk to me 22:56, 24 April 2014 (UTC)

I disagree with your addition of the Bellieni review. You ask what makes Charles et al. "better" than Bellieni et al. The answer should be obvious: the Charles paper has been accorded far more weight by experts in the field compared to the Bellieni paper. The Charles paper is cited extensively in the reports from various expert bodies, and informed their conclusions on the subject. In contrast, the Bellieni paper has had no discernible impact on expert opinion in the field. (Granted, it's a more recent paper; if it turns out to impact expert opinion down the line, then we can always revise our article accordingly).

It is our job to clearly convey the state of knowledge and expert opinion in a field. In this case, reputable expert bodies are unanimous in finding that abortion does not cause mental-health problems. It is misleading to present the Bellieni review in a he-said-she-said manner, as a "rebuttal" to the Charles review. Doing so creates false equivalence and a false impression as to the degree of expert support for these viewpoints. It is completely legitimate—and, in fact, required by fundamental site policy—to weight the Charles paper more substantially than the Bellieni paper, because experts in the field have weighted them thusly. It is "cherry-picking" (to use your term) to artificially prop up studies which have failed to gain traction among experts in the field.

Since you raise the question of Bellieni's credentials, it's perhaps notable that he is an anti-abortion advocate and a prominent member of the Pontifical Academy for Life, an anti-abortion lobbying arm of the Catholic Church. These associations do not discredit his published research, but neither are they totally irrelevant. MastCell ^Talk 21:11, 28 April 2014 (UTC)

Agreed

Closing discussion initiated by sockpuppet of blocked user Jzyehoshua. Binksternet (talk) 07:56, 24 January 2015 (UTC)
The following discussion has been closed. Please do not modify it.
I agree that the Abortion Debate category belongs on the page, but due to 24 hour rule I can't revert Binksternet's removal of the Abortion debate category regardless of how clearly wrong that removal is. Thus had to self-revert. --7157.118.25a (talk) 17:56, 19 January 2015 (UTC)

references

references #5 and 6 are dated per Wikipedia:Identifying_reliable_sources_(medicine) ....these newer reviews could replace them [1] and [2] ....IMO--Ozzie10aaaa (talk) 08:37, 22 September 2015 (UTC)

Mental health and abortion law

@SocraticOath: your new addition seems a bit like original research, can you find some secondary sources which talk about the significance of mental health in these laws? –Roscelese (talk ⋅ contribs) 18:45, 1 October 2015 (UTC)

@Roscelese:, please see the refs that I added today to justify this paragraph's inclusion.SocraticOath (talk) 21:21, 2 October 2015 (UTC)

The Guttmacher source seems relevant, but the Newsweek not so much, and neither address the British law. Can you find better sources? –Roscelese (talk ⋅ contribs) 21:58, 2 October 2015 (UTC)

@Roscelese:, I included references to a 2014 book by a reliable-sounding publisher regarding the American portion of this discussion. The British portion has been very easy to demonstrate with sources... please see today's additions.SocraticOath (talk) 13:19, 5 October 2015 (UTC)

What I'm trying to convey isn't that I don't believe that's really in the law, but that the article would benefit from sources commenting on why the inclusion of mental health is significant. –Roscelese (talk ⋅ contribs) 13:31, 5 October 2015 (UTC)

Don't you mean, the article would benefit from sources commenting on why the inclusion of law is significant for this article?--SocraticOath (talk) 15:35, 5 October 2015 (UTC)

I think I figured out what was confusing before... the mental health reason to allow abortions is only really important in the US regarding late terminations of pregnancy; it's not really much of an issue legally surrounding abortions performed before viability. In the UK, I think it's more of an issue because of their stricter rules surrounding abortion. -SocraticOath (talk) 15:55, 5 October 2015 (UTC)

"Don't you mean, the article would benefit from sources commenting on why the inclusion of law is significant for this article?" - Or that, but I meant what I said. Why do law-related sources believe the inclusion of mental health in the law is significant? –Roscelese (talk ⋅ contribs) 17:56, 5 October 2015 (UTC)

I think that one thing people want to know when they read about abortion is, "Where and under what conditions can folks legally get an abortion?" So if this article includes a paragraph related to this question, then so much the better. There is an abortion law article, but it is more written to survey the world's policies than to focus on specific issues.

As for how this is significant in law, seeing as the law is written to protect a woman's health, I suppose it would be common for a person to ask for a clarification: "Is that for physical health only or does that also include mental health?" Now this article provides some insight there too.--SocraticOath (talk) 18:44, 5 October 2015 (UTC)

Why not try to find sources that do this analysis instead of attempting to do it yourself? –Roscelese (talk ⋅ contribs) 19:34, 5 October 2015 (UTC)

@Roscelese:, would you kindly help me to understand your question a little better? Which of the statements of the paragraph on mental health and abortion law seem like original research to you? -SocraticOath (talk) 21:11, 5 October 2015 (UTC)

I modified the wording of the first paragraph to more closely follow what's said in the Guttmacher article in the second paragraph under the heading, "...but not in Abortion Context". -SocraticOath (talk) 22:47, 5 October 2015 (UTC)

SocraticOath's edits appear to be sensible to me, but I also suggest some additional citations, at least for the UK context. This gives some useful background. This research paper on reasons for abortions may also be of some relevance. Bondegezou (talk) 22:52, 5 October 2015 (UTC)

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Missing areas

This page should have more emphasis on mental health as a medical issue and ignore the legal discussions. Particularly it would be good to have sections on: > 2nd & 3rd trimester / late term abortion mental health > Multiple abortion & mental health > Resilence factors. > +Is there anything to be said about men's mental health around/after abortion? I hope the next writer will think - what is useful to caring professionals, including local doctors, counsellors, or even the woman involved? and side-step this 'making a case' frame that seems to be currently presiding. 79.66.52.124 (talk) EJE —Preceding undated comment added 11:02, 24 January 2017 (UTC)

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Major Revision May Be Necessary

This article does not appear to follow the guidelines that apply to Wikipedia medical articles, WP:PSMED. It appears to be as much, or more, about political posturing than about the research. I understand why some editors may like the idea of creating history of the abortion and mental health issue in politics, that is not the topic . . . and indeed would appear to be original research. That is the only explanation I can see for including any mention of the now "ancient" non-report by Surgeon General Koop or the 1990 APA response to Koop's investigation. But these, and many of the sources cited, fall far beyond the pale of WP:PSMED's recommendation to confine sources to peer reviewed literature reviews published within the last five years.

I realize the 5 year threshold is a guideline. It should not preclude referencing the APA 2008 report or the 2011 NCCMH reports, both of which were very comprehensive reviews of the literature. But even these reports are not accurately represented. The current introduction to the article, and even the body of the article, fails to note that the APA task force clearly concluded that abortion does contribute to mental health issues in some women: "Nonetheless, it is clear that some women do experience sadness, grief, and feelings of loss following termination of a pregnancy, and some experience clinically significant disorders, including depression and anxiety." (p 4). See also the abstract of shorter version published in American Psychologist, 2009 which states: "Most adult women who terminate a pregnancy do not experience mental health problems. Some women do, however. It is important that women’s varied experiences of abortion be recognized, validated, and understood," noting that the present Wikipedia article does nothing to "recognize, validate, or understand" the fact that "some women do" experience mental health problems. In both) Both the long and short forms of the APA report goes on to identify groups of women most likely to have negative effects, but this is given little if any space in the present article. Indeed, the question "What factors are associated with poor mental health outcomes following induced abortion" was one of the only three three questions investigated in the NCCMH report, yet the findings of the NCCMH and APA regarding these risk factors has not been given due weight in the present article.

In reviewing the history of this article, I see it has involved considerable contentious editing. Therefore, I've taken the time here to identify key problems that should be addressed for the purpose of discussion and to outline the direction of edits I hope to make over the next few weeks. -- Saranoon (talk) 20:12, 16 August 2017 (UTC)

It's a bit tricky, because this topic is easily summarized from a medical standpoint (there is an expert consensus that abortion does not increase the risk of mental-health issues), but is much more complex as a political issue. In other words, there's very little medical controversy about this topic at present, but quite a bit more political controversy. If we were to strictly cover the medical aspects, then we don't need a standalone article; we could get by with a well-sourced sentence in Abortion#Safety to the effect that induced abortions don't increase the risk of mental-health issues. But there are relevant political aspects, in that the anti-abortion movement has promoted the concept (unsupported by the bulk of the scientific literature) that abortions are "risky" from a mental-health perspective. Koop's report—and the pressure on him to produce ideologically convenient findings, which he resisted—is relevant in that context.

I think the sourcing throughout meets the highest standards set forth by this site's guidelines, although if you have specific sourcing concerns we can address them. More generally, misinformation about abortion is ubiquitous on the Internet, much of it exaggerating or fabricating the risks of abortion as part of a political strategy (see, for example, PMID 21557713). Wikipedia has an ethical responsibility to provide accurate medical information which is all the more acute in settings where misinformation is rife. I think we appropriately convey expert opinion, in accordance with WP:MEDRS and associated site policy. The APA, RCOG, and every other reputable major medical body to examine the issue have reached the same conclusion: that induced abortions don't increase the risk of mental-health issues. I think we convey this accurately at present, and I'm opposed to using cherry-picked language from the sources to weaken or obscure that consensus.

You're correct that the article has been a subject of controversy. For that reason, the existing text represents a consensus version that resulted from lengthy discussion. It can, of course, be improved upon, but most of the issues you identify have already been discussed at length in the talk-page archives, which you may wish to review. Finally, given the contentiousness of the topic area and the existing ArbCom sanctions, it would be helpful if you were to use your main/primary account when editing here. MastCell ^Talk 23:10, 16 August 2017 (UTC)

Intro Summary of APA Task Force Findings

MastCell deleted the two paragraphs I edited in the intro that better clarify the findings and conclusions of the APA Task Force, expressing the view that these clarifications are not necessary. I strongly disagree. But before discussing whether they are necessary, let me ask MastCell, and any others, is there anything in this summary of the Task Force's report that is inaccurate or untrue. For convenience, I replicate the paragraphs below.

The relationship between induced abortion and mental health is an area of political controversy. The American Psychological Association (APA) Task Force on Mental Health and Abortion has concluded that "it is clear that some women do experience sadness, grief, and feelings of loss following termination of a pregnancy, and some experience clinically significant disorders, including depression and anxiety." But giving birth to an unplanned pregnancy may also be stressful. Examining the evidence comparing these two options, the Task Forced concluded that the risk of mental health problems following a single, first-trimester induced abortion of an adult women is no greater than carrying an unwanted pregnancy to term. While observing that abortion may both relieve stress and "engender additional stress," they explicitly rejected the idea that abortion is "inherently traumatic."

Among those women who do experience mental health issues, the Task Force concluded that these issues are most likely related to pre-existing risk factors, including "terminating a pregnancy that is wanted or meaningful, perceived pressure from others to terminate a pregnancy, perceived opposition to the abortion from partners, family, and/or friends, lack of perceived social support from others. . . [and] various personality traits (e.g., low self-esteem, a pessimistic outlook, low-perceived control over life) and a history of mental health problems prior to the pregnancy."(p11) Since these and other risk factors may also predispose some women to more negative reactions following a birth. the Task Force concluded that the higher rates of mental illness observed among women with a prior history of abortion are more likely to be caused by these other factors than by abortion itself. The best predictor of mental health issues following an abortion is a history of mental health issues prior to the pregnancy.''

If we can agree on an accurate statement we can then proceed to a discussion regarding how much of that information should be included in the introduction and where to put the remainder into the body of the article. --Saranoon (talk) 19:10, 21 August 2017 (UTC)

I see MastCell posted a request on my personal talk page asking me to not post any material without first obtaining agreement from other editors. That seems counterproductive. Wikipedia encourages bold edits of well sourced and accurate material. It is clear that what I have posted is well sourced and accurate. If MastCell or others have problems with how it has been placed in the introduction of the article, I encourage them to move the material to a place in the article where they believe it is more appropriate, or to make edits to better clarify the content. But simply deleting my edits, without making a good faith effort to relocate this well sourced and accurate material to another place in the article, impedes rather than contributes the development of a better and more complete article. --Saranoon (talk) 19:20, 21 August 2017 (UTC)

I think you're misunderstanding. You don't need approval from other editors to make changes. But if those changes are disputed, then you need to work with other editors to resolve the dispute rather than just keep re-instating your preferred wording. This process is described here in more detail, and it's all the more vital on a topic such as this one, where the existing language is the result of long, hard consensus-building.

As for the content in question, I think I've already explained my concerns. Your text simply quotes liberally (and somewhat selectively) from the APA report. In the article lead, we need to actually summarize the content of reliable sources (and not just US-based sources, and not just the APA). Those sources are quite clear as to the bottom line: that induced abortion does not increase the risk of mental-health issues (with the caveat that most of the evidence applies to first-trimester abortions, which constitute the vast majority). That needs to be clearly stated, especially since there have been so many efforts (both on Wikipedia and in the larger world) to obscure the facts in service of a political agenda. MastCell ^Talk 23:52, 21 August 2017 (UTC)

Fully agree with MastCell concerning the change. I don't see why APA is so prominent (I would give Charles 2008 and the National Collaborating Centre for Mental Health 2011 at least as much prominence). I also question that quote. Why that rather than "The best scientific evidence published indicates that among adult women who have an unplanned pregnancy the relative risk of mental health problems is no greater if they have a single elective first-trimester abortion than if they deliver that pregnancy"? And the current quote ignores the following "However, the TFMHA reviewed no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors."

So, unless anyone else wants to chip in supporting the current version, I support reverting to the previous version. shellac (talk) 17:56, 24 August 2017 (UTC)

Feel free to work back in anything you think is not fully reflected in the revised introduction. What should not be removed, however, is the fact that the APA report specifically acknowledges that abortion does have mental health impact on some women, especially those who fall within the identified higher risk categories. The NCCMH study is cited in the introduction already. But expand on it if you feel it is helpful. Notably, the NCCMH preface reviewed APA, Charles and Coleman and also summarized the risk factors...and did not dispute these (p18-19) The major limitation of the NCCMH review is that they strictly limited themselves to just three questions (p22). While we should of course report on their findings of these three questions, we should not omit the conclusions of reliable secondary sources (like the APA review, which addressed a broader number of issues) simply because the NCCMH was more restricted in it's approach. Also, Charles is limited to an effort to grade the body of statistical analyzes, it does not attempt to summarize the findings of these studies as the APA report did, but rather to identify which studies the authors believe are most reliable. Bottom line, nothing in NCCMH or Charles contests the findings I summarized from the APA review. Moreover, the findings I report from the APA review are consistent with the findings of other, more recent reviews from Coleman (2011), Bellieni (2013) and Fergusson (2013), showing a consensus of opinion among peer reviewed reviews of the abortion mental health issue to the effect that (a) some women do have negative reactions, (b) those who have problems are most likely to have on or more pre-existing risk factors, (c) the most significant predictor of mental health issues following an abortion is a history of mental health issues prior to abortion, and (d) the by excluding minors, women having multiple abortions or late term abortions, and women with a prior history of mental illness, the best evidence indicates that for an adult woman (without any pre-existing risk factors) a single, first trimester abortion has mental health risks that are similar to those associated with carrying an unplanned pregnancy to term. Notably, if you read the literature carefully, what the last statement means is that the bulk of these studies show both giving birth to an unplanned pregnancy and having an abortion are associated with elevated rates of mental health problems--compared to women who do not have any unplanned pregnancies--but that the risks are similar enough that there is no reason to discourage women from choosing abortion since they face similar mental health risks if they carry to term. The revised intro better reflects these conclusions from reliable secondary sources. The previous version glossed over these important points. ---Saranoon (talk) 19:25, 24 August 2017 (UTC)

In light of Shellac's comments favoring more material form NCCMH and Charles, I have expanded on the NCCMH findings and will attempt to do so with Charles in the near future. I also expanded on the section covering the APA 2008 report, copying the summary from the introduction as a starting point. As we undertake an effort to expand upon and better clarify what these secondary sources are reporting in the body of the paper, it may be easier to revise the introduction to better reflect what these source are actually reporting. ---Saranoon (talk) 20:25, 24 August 2017 (UTC)

Horvath & Schreiber (2017)

I've finally had a chance to obtain and review the Horvath & Schreiber (2017) paper. It is limited to a review of the studies of one research group (Advancing New Standards in Reproductive Health [ANSIRH]) analyzing one data set (The Turnaway Study) (See Table 1). Therefore, the conclusion used in the article text is based on one data set, not a review/synthesis of multiple data sets.

So, my question: Is this source really helpful--and does it really qualify as literature review when it reviews only studies relying on one data set?

Or perhaps more importantly, what are the standards for including summaries of secondary sources under the section "Current and historical reviews." Saranoon (talk) 16:23, 1 August 2018 (UTC)

Coleman (2011) Must be Included as a Reliable Secondary Source

I added a section under "Current and historical reviews" regarding the systematic review by Coleman published in the British Journal of Psychiatry. This is obviously a reputable journal and a reliable secondary source. Moreover, this review was treated as a source by both the NCCMH review and the Fergusson (2013) review, underscoring it's relevance in the literature.

Unfortunately, Coleman's review was summarily deleted by Roscelese who asserted "Rv. Coleman's research, including this "review" specifically, is thoroughly discredited and far too many of the studies in this "review" are her own." Roscelese offers no proof that the study is in fact discredited. In fact, it is very clear that the review has not been discredited given the fact that it is still available from British Journal of Psychiatry and has not been withdrawn, which would be the case for any discredited papers.

Roscelese is apparently confusing "disputed" with "discredited."

Given the contentious area of this research, it is undoubtedly true that Coleman's research has been disputed. Indeed, the section I added included notes from the NCCMH review to the effect that they believed there were methodological problems in regard to Coleman's meta-analysis. That hardly means that everything in her review is "discredited." Their caution is merely that her conclusions may not be as valid and strong as she herself presents them to be. Similar observations are made in CRD review of Coleman's review which states: "The results of the review should be treated with caution due to concerns with the review methodology and reporting, and uncertain appropriateness of the statistical analysis." The CRD review underscores that the main problem is that it is impossible to evaluate the appropriateness of pooling of results from different studies in the meta-analysis given the lack of more complete information about each study included in the pooled analyses: "Without details of the individual studies it was not possible to assess whether or not this was appropriate."

All of this places a question mark over the findings of her meta-analysis, but this is true of every study and review. Koop, the APA, and NCCMH all agree that the data is incomplete and every study has severe limitations. In this case, the last paragraph I put into the Coleman section included notes regarding the NCCMH's skepticism about the reliability of Coleman's meta-analysis. At the same time, it is worth noting that the NCCMH agreed with Coleman regarding the limitations of the APA and Charles reviews. Moreover, no one has argued that Coleman's forest plots (minus the results of her meta-analysis) accurately represent the findings reported in the 22 studies she analyzed, and those forest plots alone demonstrate a consistent trend in the research findings.

Most importantly, Coleman's review was been widely cited in the medical literature, including in subsequent NCCMH and Fergusson reviews. Indeed, Fergusson's review begins with a re-examination of the studies identified by both Coleman & NCCMH. Therefore, the Coleman is clearly one of the major reviews that is a the center of the ongoing discussion of abortion and mental health. At the very least, it is hard to see how it is less important than other reviews included here, such as Steinberg (2011) which is limited to late abortions, Stotland (2011) which is limited to adolescent abortions, and Horvath (2017) which is limited to the Turnaway Study papers.

In short, it is clear that the Coleman review should be included in the article. Toward that end, I invite feedback on how the material I drafted can be better incorporated into the article.Saranoon (talk) 21:39, 1 August 2018 (UTC)

The CRD review of Coleman's paper should be noted. It is not the case that such criticism "is true of every study and review": this is harsher criticism than for your average systematic review. It is understatement to say that, "Their caution is merely that her conclusions may not be as valid and strong as she herself presents them to be." No, the methodological flaws are such that Coleman's review may tell us nothing of value. Being widely cited doesn't matter if the citations are critical: the NCCMH paper is pretty critical of Coleman too, while Ferguson is very critical. Thus, were Coleman's review to be included, I would think it would need clearly-stated caveats around it. WP:MEDRS requires we use the best quality evidence and Coleman is not that, so I would favour maintaining its exclusion. Bondegezou (talk) 10:13, 2 August 2018 (UTC)

The APA task force noted (as have many others), that every study on abortion and mental health problems has numerous limitations, precisely because it is impossible to conduct randomized trials. The number of variables involved and the many pathways to be considered “raises the question of whether empirical science is capable of informing understanding of the mental health implications of and public policy related to abortion.” They further agreed that the key questions needing to be answered "cannot be definitively answered through empirical research." Therefore, since every review is based on studies that have numerous methodological limitations, I stand (with the APA reviewers) by my statement that the CRD's statement that "the results of the review [or any study related to abortion and mental health] should be treated with caution," precisely, as the APA task force noted, nothing has been "definitively answered through empirical research." Therefore, this article, like the reviews, is not able to provide definitive answers. Instead, our goal is to provide a thorough summary of the literature from reliable secondary sources, such as reviews published in the British Journal of Psychiatry.

Please provide the exact quotes from CRD, NCCMH and Fergusson that support your statement that "Colemen's review may tell us nothing of value." CRD does not state that the results of the meta-analysis are meaningless but rather that they cannot be fully corroborated due to lack of sufficient information regarding each of the studies included in the meta-analysis. Also, as I read him, Fergusson is no more critical of Coleman's review than he is of the NCCMH and APA reviews. In fact, in his review he follows Coleman's lead in undertaking a meta-analysis but does so in a way that seeks to address and rectify the limitations in Coleman's meta-analysis. That demonstrates that Fergusson does not think her approach was wrong, but rather that it could be done with more rigor.

Moreover, setting the results of her meta-analysis aside, Coleman's review includes a review of the shortcomings of the APA and Charles' reviews. Neither CRD or NCCMH, or any source I've seen, have disputed her review of those shortcomings. That alone is worth including in the article, as this criticism comes from British Journal of Psychiatry, a reliable secondary source. Just as it is appropriate to cite criticisms of Coleman's review, it is also appropriate to cite her criticisms of the other reviews. That is what balance is all about.Saranoon (talk) 18:04, 3 August 2018 (UTC)

Why would anyone think the basic approach of doing a systematic review and meta-anaysis was wrong? That other people have done systematic reviews and meta-analyses is not some vote in favour of Coleman. We should use the highest-quality evidence and other reviews/meta-analyses have clearly been done better than Coleman's. More later: 'tis the weekend here. Bondegezou (talk) 20:59, 3 August 2018 (UTC)

Only Coleman and Fergusson have done meta-analyses...statistically combining the results of multiple studies. Other reviewers have all done narrative reviews of the literature, not meta-analyses. There is nothing "wrong" with this approach, but it is subjective and absent double blind studies (which are impossible) these narrative reviews are admittedly based on interpreting studies which all have methodological weaknesses so the reviews themselves cannot provide definitive certainty, only educated opinions. -- Saranoon (talk) 23:44, 3 August 2018 (UTC)

The British Journal of Psychiatry review by Coleman clearly qualifies as a reliable medical source under WP:MEDRS, and since this section includes an intent to summarize the history of this field, it is also a critical to the history and development of both the NCCMH and Ferguson reviews and offers valuable criticism of previous reviews, even though there have been questions raised regarding potential problems with drawing reliable conclusions from a meta-analysis of so many studies using so many different methodologies. The latter is a criticism which should be noted, as I have done so, but it is not a reason to delete all mention of this relevant and historically important review. Therefore, I have reinserted the material as I initially drafted it. In my view, other editors are free to refine the presentation and add additional caveats that they may believe are necessary. But it would be inappropriate to simply delete the entire section. Bondegezou has suggested that the CRD review should be cited. I would not object, but it simply elaborates on the same criticism made in the NCCMH, which I already cited, and perhaps more importantly, I am unable to find where CRD has actually published their review in a journal. If another editor wants to solve this problem, or simply cite the PubMed posting, I'm fine with that. Saranoon (talk) 16:41, 6 August 2018 (UTC)

• The article has gotten really bloated and incoherent. In an effort to get back to first principles, I've streamlined it quite a bit. We shouldn't be getting into back-and-forths about this study vs. that study (although, as others have noted, Coleman's work does tend to be viewed skeptically by expert bodies for a variety of reasons). We should be leaving the synthesis of evidence to experts. It's not hard - both the APA and the RCP have produced comprehensive position statements and evidence reviews. We just need to accurately reflect expert opinion on the topic. I've therefore removed all of the subsections dedicated to individual studies, in favor of a top-level review of the current state of knowledge as attested by reputable expert bodies. This seems most consistent with site guidelines and policies, as well as with our overarching mandate to provide the reader with clear, accurate information. It should also be easier to maintain. MastCell ^Talk 22:13, 7 August 2018 (UTC)

Recommendations Regarding Attempt to Streamline Article

MastCell has undertaken an effort to streamline the article. Here are my comment and recommendations.

First, WP:MEDRS reasonably recommends that the most recent reviews should be relied upon, preferably those within the last 5 years, yet Fergusson's 2013 review has been cut. In fact, Fergusson is an objective, pro-choice researcher with a vast list of publications in this area and others. His conclusions have not been challenged, and draws on the NCMMH, Coleman and APA reports , based on his meta-analysis and familiarity with the entire range of research should be highlighted with preference over the older sources.

The overview of the best scientific evidence should reflect what Fergusson review (with metaa-analysis) reports: (1) there is no evidence of mental health benefits from abortion, and (2) that after controlling for pre-existing mental health, compared to women who carry an unplanned or unintended pregnancy to term, women who face a statistically significant increased risk of "[anxiety (AOR 1.28, 95% CI 0.97-1.70; p<0.08), alcohol misuse (AOR 2.34, 95% CI 1.05-5.21; p<0.05), illicit drug use/misuse (AOR 3.91, 95% CI 1.13-13.55; p<0.05), and suicidal behaviour (AOR 1.69, 95% CI 1.12-2.54; p<0.01)." Indeed, by conducting a meta-analysis of 14 studies limited to women with unintended pregnancies, taking into account numerous preexisting factors such as prior mental health, Fergusson et al claim to have demonstrated that the NCCMH's narrative review in which they asserted that “The rates of mental health problems for women with unwanted pregnancy were the same whether they had an abortion or gave birth” (p. 8) (as cited and quoted by Fergusson, as a rationale for his review and meta-analysis) is simply not true once one actually compiles the data from studies of women who faced unwanted pregnancies. The rates of mental illness are different. That is a fact, as Fergusson's meta-analysis shows. What portion of those differences are attributable to abortion, if any, and what portion are attributable to other factors remains a subject of debate. But there is no debate that there is a correlation between abortion and higher rates of mental illness.

Second, speaking of older sources, I disagree with moving the Koop report to the front of the section. It is over thirty years old and simply tells us that Koop did not believe that the quality of studies was sufficient for drawing any definitive conclusions, something the APA Task Force in 2011 reiterated. There are simply no studies that are beyond methodological criticism.

The article should begin with the best information, not the oldest statements regarding how hard it is to be certain of anything. If Koop is included, it should be in a new section at the end titled "History of the Abortion Mental Health Controversy." If we add that section, however, that is (and perhaps should be) an invitation for including a long list of the medical literature, including of course, those with data showing a correlation between abortion and elevated rates of mental illness.Saranoon (talk) 17:48, 8 August 2018 (UTC)

Following MastCell's example of WP:BOLD editing in streamlining the article, I have updated the "Current scientific evidence section in several ways, including the following:

1. In the first two sentences, I have created an opportunity for editors to cite review articles (even older ones) and those articles which are critical of previous reviews. For reasons of space and easier reading, not every article cited should be discussed, but I believe it is important to provide a space to cite every peer reviewed review article that any editor believes relevant in order to provide a more complete bibliography for readers who are seeking sources that they can investigate further. This will also help us avoid battles over deleting content regarding peer reviewed articles, like Coleman's, just because some editors don't like her material.
2. The Fergusson et al review is the most recent and specifically addresses shortcomings of the NCCMH review and conclusions through a meta-analysis of specifically those studies that control for wantedness as well as other pre-existing factors. Fergusson's team is clearly not biased. They advocate for making abortion available without screening for psychosocial indicators. At the same time, this review shows that advances have been made since the NCCMH and APA reviews.
3. I removed discussion of the 1989 APA review. It is so dated it clearly does not belong in the "Current scientific evidence" section. I have no objection to the material being added to the "History of Abortion and Mental Health Issues in the Law and Politics" section. That is a good place for editors to expand the article with material regarding the historical debate over this issue and why it has been seen as important in regard to the legal and political debate.Saranoon (talk) 19:15, 10 August 2018 (UTC)

Roscelese reverted material with only a two word comment "Gain consensus." It is unclear what he/she believes requires consensus. Surely there is consensus in regard to the need to provide accurate, updated material based on reliable medical sources as defined by WP:MEDRS. Also, within the last few weeks, MastCell previously made major edits citing WP:Bold in an effort to provide a more concise summary of the literature. I have done the same. A summary of the most current reviews certainly requires prominent discussion of Fergusson's review, not only because it critiques previous reviews but also because his team provides a meta-analysis restricted to comparisons with women who carried unwanted pregnancies to term. If Roselese or others believe my edits need correction, elaboration, or more balance by inclusion of other materials, I encourage them to make the appropriate edits. That's what collaborative writing is all about. But unless someone can identify specific errors, I believe my edits are accurate summary of the most recent peer reviewed reviews on this subject per WP:MEDRS.Saranoon (talk) 20:39, 15 August 2018 (UTC)

Briefly, the article needs to reflect the actual state of expert knowledge on the subject. Your edits moved it further from this goal. Numerous high-quality reviews as well as position statements by the two major expert bodies in the English-speaking world (APA and RCP) have found that abortion does not cause mental health problems. You are artificially highlighting one paper with alternate findings - giving this paper undue weight and thus violatiour policy on neutrality. It’s fine to be bold, but now that numerous editors have expressed concern about your edits, it’s a good time to stop reinserting them and instead discuss here. I think that’s what Roscelese was getting at. MastCell ^Talk 21:46, 15 August 2018 (UTC)

My edits are clearly intended to "reflect the actual state of expert knowledge on the subject." And clearly Fergusson 2013 is one of the most recent reviews, and one of the only two reviews to include meta-analyses, which "reflects the actual state of expert knowledge on the subject." Since it was written after the APA and NCCMH reviews, it reflects knowledge that was not known or considered in those reviews.

Per WP:MEDRS more recent reviews should have priority, preferably within the last five years. If editors are not willing to follow standard WP:MEDRS guidelines for prioritizing more recent reviews, perhaps we should revert the section back to prior to MastCell's recent edits. Moreover, the position statements of the APA and the NCCMH are just that, position statements based on narrative reviews. Fergusson's meta-analysis based on 8 studies using comparisons restricted to similar women faced with unwanted pregnancies is clearly relevant criticism of the short-comings of those narrative reviews and therefore both weight and NPOV require that the Fergusson review (and Coleman, for that matter) should be covered. In short, it is my understanding that as Wikipedia editors we are to defer to the judgment of the peer reviewers at the medical journals who have determined that Fergusson (and Coleman for that matter) have written reviews that advance the knowledge on the subject. It is their judgement (the peer reviewers) which tells us that this material is relevant and reliable. --Saranoon (talk) 19:12, 16 August 2018 (UTC)

If the APA and RCP change their views on the basis of Fergusson's paper, I'm sure they'll let us know. Until then, you can't artificially inflate the significance of Fergusson's paper to suggest that it outweighs, invalidates, or "rebuts" their conclusions. That's a canonical example of non-neutral editing. You're proposing that we defer totally to a couple of reviewers of Coleman's and Fergusson's paper, while ignoring the substantially larger number of expert reviewers who have reached opposite conclusions. Again, this is a violation of our content policies, and your efforts to push this verge on tendentious editing at this point (leaving aside your apparent use of an alternate account here, which is also inappropriate). On your user talk page, I've notified you formally (for the second time) of the discretionary sanctions active in this topic area. I believe that you are violating them by continuing to push this material in violation of both site content policies and concerns raised here on the talk page. Please self-revert pending further discussion. MastCell ^Talk 21:13, 16 August 2018 (UTC)

It appears you did not actually read my edits, but instead assumed they were the same.

Unless notified otherwise, I'll assume you have no problem with my edits regarding the History section...to which I moved the 1989 APA paragraph and simply added a sentence or two explaining why the previous material regarding abortion for mental health reasons was the basis for the political significance of the Koop letter and the subsequent research and reviews.

Regarding the "Current scientific evidence" section, aside from moving the outdated 1989 paragraph to history, I added just the first paragraph citing the numerous literature reviews, most of which (like Fergusson) were previously cited and discussed until MastCell deleted them a week or two ago.

If you read the entire section, you will see I did not discuss Fergusson, even though, as indicated above, I believe NPOV and proper weight require that this review should be discussed. Your suggestion that we should wait on the APA or NCCMH to respond to Fergusson (and admit they made a mistake in failing to do a meta-analysis as he did of the studies that are limited to unwanted pregnancies) is absurd. The fact that even abortion proponents Fergusson are dissatisfied with the APA and NCCMH reviews, is why NPOV and due weight require expansion of this section.

Research and expert opinions are not static. Fergusson and the other reviews are part of the current expert opinion which is formed by an ongoing dialogue and investigation. Indeed, any fair reading of the APA and NCCMH reports reveals frequent admissions that the difficulty of doing research in this area is so great that there is great uncertainty and all opinions are simply "the best we can do with what we have."

In any event, I did not expand the section and add anything regarding Fergusson's findings, much less "inflate" them. Moreover, I have left your paragraphs regarding the APA and NCCMH reports untouched except for a minor edit in which you made it appear that all peer reviewed systematic reviews had reached the same conclusions, which is clearly not true.

So, what exactly is your complaint? There are five sentences in the first paragraph. They read:

"Numerous systematic reviews on the associations between mental health and abortion have been conducted.[13][4][14][15][16][6][17][18][19] Each has also been the subject of criticism by other reviewers.[14][16][20] While many studies have revealed statistical correlations between abortion and mental health problems, correlation does not prove causation. The best evidence indicates that a disproportionate percentage of women having abortions also had prior mental health problems. This suggests that the higher rates of mental health problems observed after abortion may be wholly, or at least in part, explained by a predisposition toward mental health problems which is more common among the groups of women who are most likely to seek an abortion."

Sentence by sentence: what is untrue or inaccurate or incomplete? Can we work together to fix anything you have problems with rather than simply delete it?

One more minor thing regarding your edits...the NCCMH undertook the systematic review, not the RCP. If you have documentation that the NCCMH was adopted as a position statement by the RCP, that should be cited. Otherwise, while it is my understanding that the RCP recommended that a systematic review was necessary, and it was thereafter funded to be undertaken by the NCCMH, I think we should avoid conflating the two organizations and representing the NCCMH report as a position taken by the RCP. The APA report is a different matter, as it was adopted by the APA leadership.--Saranoon (talk) 22:22, 16 August 2018 (UTC)

The NCCMH is, effectively, part of the Royal College of Psychiatrists, so I don't see a huge distinction there. Beyond that, I think I've explained my concerns repeatedly, and they seem to be shared by other editors. I'm too old (in wiki-years) to respond to this sort of soup-spitting. In my view, you need to be prepared to honestly acknowledge the current state of expert opinion—as documented by unanimous position statements from the major expert groups in the English-speaking world—as a starting point to a serious discussion. MastCell ^Talk 04:54, 21 August 2018 (UTC)

1. I agree that the APA and NCCMH reviews are important and should be covered. None of my edits have involved deletion of their findings. If anything, I have expanded on what they have reported.

2. I disagree that there is any WP policy that gives the final word to the APA or NCCMH or RCP, especially regarding reviews published 10 and 7 years ago, respectively, much less a policy that justifies deleting all references (even by the minimum of a citation) of all subsequent peer reviewed medical reviews by other experts in the field -- especially when these reliable sources, such as Fergusson (2013), examine key conclusions of a previous narrative review in the light of a meta-analysis.

3. You have ignored my request to identify what is wrong or incorrect in the paragraph I added. Doesn't collaborative editing require efforts to incorporate, with corrections when necessary, relevant material? Clearly, many readers beginning a research project on this subject would appreciate having relevant reviews included in the bibliography.

4. Please provide a citation regarding your claim that the NCCMH is "effectively" part of the RCP. And even if it were "part of" that is less than being the same as the RCP. We should be accurate in identifying the NCCMH review as the NCCMH review, not the RCP's. (See following)

5. Your comments about RCP's opinions led me to research that a bit. It turns out that the Times of London reported in 2008 that the "The Royal College of Psychiatrists says women should not be allowed to have an abortion until they are counselled on the possible risk to their mental health." I'll look into it more and add that to the History section. The Times article also states that the reason for the RCP shift in recommendations was "Several studies, including research published in the Journal of Child Psychology and Psychiatry in 2006, concluded that abortion in young women might be associated with risks of mental health problems."

6. Your accusation that I am engaged in "soup spitting" is unfair. It is clear that every edit I have made has cited reliable secondary sources per MEDRS. Following the link you provided to the soup spitting led me to other pages which raise my concerns about how that false characterization and other objections raised about my edits may fall under the categories listed in WP:Bully, most particularly WP:POV_railroad. Let's please work together to continue expanding and improving on this page.

7. According to WP:MASSR: "Do not revert a large edit because much of it is bad and you do not have time to rewrite the whole thing. Instead, find even a little bit of the edit that is not objectionable and undo the rest. (To do this, you can use the "undo" button, then type back in what you want to keep). If a supporter of the reverted edit wants to save more of it, that editor can re-edit in smaller pieces and the article can converge on a consensus version that way." Similar advice is found in WP:PARTR Since you have not articulated any actual inaccuracies in my edits, please help find someway to incorporate them rather than just resort to wholesale reverting of reliably sourced content. -- Saranoon (talk) 15:26, 22 August 2018 (UTC)

The NCCMH is effectively part of the RCP. The NCCMH's web presence is located on the RCP website ([3]), which makes clear that the NCCMH consists of RCP members working with UCL faculty. Reliable sources are likewise clear; see for example, "... a review carried out by the National Collaborating Centre for Mental Health at the Royal College of Psychiatrists...", BMJ 2011;343:d8045. So yes, the NCCMH is, for all intents and purposes, part of the RCP. I don't understand why you've chosen to argue about this, and frankly you could have figured this out for yourself in a fraction of the time it's taken you to revert and stonewall about it.

I have repeatedly identified the problems I see in your proposed additions. You are focusing very reductively and ignoring my concerns, which have to do with undue weight and cherry-picking of sources. It is possible to cherry-pick and arrange reliable sources to create a narrative that is fundamentally misleading, and I think that is what your edits do. I've explained why, repeatedly.

As for the Times article, it appears to refer to a previous iteration of RCP guidance. I'm not able to find any other sources supporting what it says, nor can I find anything directly from the RCP saying that abortion causes mental-health problems (either in 2008 or more recently). Of course, the RCP (along with other expert bodies) has since made a very clear position statement, which innumerable other sources attest to. I'm not clear why you're choosing that particular Times article to highlight, in preference to all of the other available press coverage, both from 2008 and more recently. Can you explain why you feel this particular source is worthy of inclusion, in preference to all of the other mainstream-media coverage before and after 2008? MastCell ^Talk 16:56, 22 August 2018 (UTC)

Also, noting here that Saranoon has opened a thread about this question at the Reliable Sources noticeboard. MastCell ^Talk 22:30, 22 August 2018 (UTC)

Request for Clarification of Objections to moving 1989 APA review to history section

On several occasions my attempts to move the discussion of the 1989 APA review from the "Current scientific evidence" to the "History of Abortion and Mental Health in the Law and Politics" section, under the information about Koop. It seems self evident that the 2008 report by the APA is the more current and that the 1989 report is historical, and was in fact largely driven by the APA's desire to respond to the Koop investigation.

Can those who object to this edit please articulate here the reasons for their reverts of this proposed move of historical content to the history section? -- Saranoon (talk) 15:03, 27 August 2018 (UTC)

I don't think anyone necessarily opposes moving the 1989 APA report to the history section. (I think your edits to that effect were reverted because they were conflated with a variety of other changes which moved the article in a non-neutral direction). I see you went ahead and moved the 1989 APA report to the history section, which looks reasonable to me. MastCell ^Talk 19:26, 29 August 2018 (UTC)

Weight and MEDRS Concerns

Regarding MastCell's revert of my edit regarding the history of the abortion mental health claiming WEIGHT and MEDRS concerns.

1. What is the MEDRS concern? The sources cited are invited commentaries in a peer reviewed medical journal regarding the change in RCP position and an article from the Times of London, a very prominent UK newspaper, that specifically puts the RCP change into historical context (history being the topic of this section). Exactly on what basis are you alleging that these are not reliable sources?

2. Regarding WEIGHT, on exactly what basis are you arguing that the weight that the Times (and other articles) give to this matter should be excluded?

3. Regarding WEIGHT, it is my understanding that even if some editors believe that there is a majority view, at least as expressed by a few medical organizations, that minority views should also be presented in an article. In this case, literally a half dozen literature reviews, including several published following the APA and NCCMH are being banned from the article. I would think that if medical journal editors and peer reviewers are in agreement that these literature reviews add to the literature and should be published, they should be represented in this article...rather than placed on an official censure list.Saranoon (talk) 19:34, 9 October 2018 (UTC)

To quote from policy regarding Due Weight:

Neutrality requires that each article or other page in the mainspace fairly represent all significant viewpoints that have been published by reliable sources, in proportion to the prominence of each viewpoint in the published, reliable sources.[3] Giving due weight and avoiding giving undue weight means that articles should not give minority views or aspects as much of or as detailed a description as more widely held views or widely supported aspects." (emphasis added)

Is anyone really contesting that the peer reviewed reviews by Fergusson and Coleman and Bellini are not "significant viewpoints" or that they have not been published in peer reviewed journals that are normally considered reliable? Moreovere, since even the APA review admits "it is clear that some women do experience sadness, grief, and feelings of loss following termination of a pregnancy, and some experience clinically significant disorders, including depression and anxiety" it is also clear that the "minority" views of Fergusson, Coleman and Bellini are not completely contradicted by the APA but rather contested only in regard to the magnitude of the problem. Per policy, then, due weight requires that these other views and sources should be included "in proportion" to the number of literature reviews on the topic.

I can find nothing in WP Policy that supports the purging of the viewpoints of individual researchers/reviewers that are published in peer reviewed medical journals simply because their conclusions contest the findings of prior literature reviews published by professional organizations. -- Saranoon (talk) 17:35, 10 October 2018 (UTC)

I don't have much to add, because we've been over this before. For one thing, you keep pushing to add a specific news piece by the Times of London. Not only does WP:MEDRS suggest avoiding such pieces, but the source in question is clearly an outlier even among popular-press coverage. Generally, the best way to write these articles is to first identify the best available sources, and then follow where they lead. It's obvious that you haven't taken this approach; if you had, you'd be citing the dozens of other popular-press pieces which more accurately characterized the RCP findings. You seem to be proceeding by identifying a small subset of sources that advance a specific small-minority viewpoint, and then editorially amplifying and privileging those sources. That's the source of my due-weight concern.

More generally, I don't see convincing evidence in the cited sources to support the idea that the RCP recognized "a growing body of literature showing a link between abortion and mental health problems". There is no such body of literature, so the underlying assumption is false; if anything, consensus and the evidence base have moved gradually toward a firmer rejection of a causal link. And so on. MastCell ^Talk 19:22, 10 October 2018 (UTC)

Thanks MastCell, since you offered no arguments or disagreement regarding the fact that the sources I cited are reliable (peer reviewed reviews) and that they represent "significant viewpoints" that should be covered in the current per WP:Due, I'll work them in over the next few weeks.

Regarding the Times, article, it's common for newspapers such as the New York Times (similar in stature to the Times of London), is an ideal source regarding the history of the issues their reporters cover. As you'll see, a number of newspaper articles are already cited in this article, Bazelon for example, and several regarding the history of the issue in regard to Koops letter, which like the RCP position statement, was very short. Furthermore, in citing the Times article, I'm not relying on the reporter to interpret the RCP's guidelines (Fergusson and Casey are better positioned in that regard, since they are experts who were invited to submit their insights in a peer reviewed journal) but rather as a good reliable source putting the RCP modification in historical context, which is the subject of this subsection. Regarding the "growing body of research," that is evident not only in the Fergusson study mentioned in the Times, but in the Casey and Fergusson commentaries, and in the subsequent APA and NCCMH and Coleman reviews which examined scores of studies, which summarized as the "growing body of research," and also by the fact that in 2006, the U.K.'s House of Commons Science and Technology Committee specifically requested the RCP to update its position in light of the research the committee reviewed, including Fergusson's first longitudinal prospective study. Feel free to change the wording if you like.--Saranoon (talk) 20:12, 10 October 2018 (UTC)

---

References

References

Important paper on this topic missing

Recent, important source:

• Horvath, S; Schreiber, CA (14 September 2017). "Unintended Pregnancy, Induced Abortion, and Mental Health". Current psychiatry reports. 19 (11): 77. doi:10.1007/s11920-017-0832-4. PMID 28905259.

This review says, as do other high quality reviews, that studies of the correlation between mental health and abortion have always been observational and therefore confounded (if there is a correlation, which causes which, or are both caused by something else?) (our article already mentions this)

The review describes the Turnaway study, which "prospectively enrolled 956 women seeking abortion in the USA and followed their mental health outcomes for 5 years. The control group was comprised of women denied abortions based on gestational age limits, thereby circumventing the major methodological flaw that had plagued earlier studies on the topic." and puts its results in the context of prior findings. Jytdog (talk) 19:35, 10 October 2018 (UTC)

• • Horvath's paper is not a literature review of the topic, it is only a review of the set of studies based on the single dataset of the Turnaway Study. That data set as been strongly criticized for its super low participation rate, with over 70% of women invited to participate refusing and half of those who did participate dropping out. It is therefore not generalizable to the population of women having abortions. ---Saranoon (talk) 17:11, 26 October 2018 (UTC)
    • User:Saranoon It is a review and is perfectly fine per WP:MEDRS. Yes the paper focuses on turnaway but it also reviews the older literature. Please strike your objection or explain it based on the spirit and letter of MEDRS. I am uninterested in your assertions about criticism; if you have sources for that I would be interested to see them. Thanks. Jytdog (talk) 17:23, 26 October 2018 (UTC)

Horvath's paper devotes only two paragraphs in the section "Early Research," with only a handful of citations. The rest of the paper is entirely devoted to the Turnaway studies. Clearly, it is not a review of the entire subject of abortion and mental health; it is a review of the Turnaway studies alone. It is not even a critical review, as evident by the authors's failure to discuss the high non-participation and dropout rates. Mostly, it is just an argument for ignoring all other research on abortion and mental health in favor of the Turnaway approach--using only women who were turned away from late term abortions as the comparison group.

Regarding criticisms of the Turnaway study, a few minutes of googling lead to this article by Coleman and another by Reardon in a peer reviewed journal and a summary of the latter. There are others, of course, but these are examples FYI.

I do not in principle oppose inclusion of material about the Turnaway studies if and when this article is opened up to a broader overview the published research. But as it stands, major reviews like those of Fergusson, and Coleman and Bellini have been blocked in violation of the principles for due weight and MEDRS, so it is clearly inappropriate to add further imbalance to this article by giving such extensive coverage to a single data set.--Saranoon (talk) 18:49, 26 October 2018 (UTC)

Thanks. yes, reviewing other literature is a small part, but there.

mercatornet is not a MEDRS ref. Its an interesting for Christian/Catholic ethics, but is not relevant here.

The Reardon piece (PMID 30275603) is classified by the Linacre Q as a "research article"; it is not a MEDRS ref.

afterabortion.org is not a MEDRS ref either.

None of these are useful - please read WP:MEDREV and please do not introduce further refs that are not OK to use.

Your objections are not valid under the policies and guidelines. Please self-revert your removal of this content. Please be aware that there are discretionary sanctions on this topic, and policy-violating editing and talk page discussion are likely to result in sanctions being enforced. Thanks. Jytdog (talk) 20:22, 26 October 2018 (UTC)

DSM

@Kailani: "Post-abortion syndrome (PAS) is not included in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR or in the ICD-10 list of psychiatric conditions, nor is the term commonly used outside of the anti-abortion community. " - This statement had four citations. I only have access to two, which don't contain it, but did you check the other two before removing it? –Roscelese (talk ⋅ contribs) 00:18, 25 October 2018 (UTC)

I didn't see any citations on that statement. Kailani (talk)

In that case, I will be restoring it, because there are citations there that you evidently did not check. –Roscelese (talk ⋅ contribs) 16:46, 27 October 2018 (UTC)

@Kailani: The statement has four citations. Are you or are you not saying that you checked the Stotland sources and they do not support the text? –Roscelese (talk ⋅ contribs) 23:26, 27 October 2018 (UTC)

I told you that I didnt see any citations on it. There were zero citations. Look for yourself. [4]. Kailani (talk) 03:16, 31 October 2018 (UTC)

Recent edits

Jytdog recently reverted a large number of edits by Saranoon. I don't propose to discuss those. However, there was one section leftover that appears new compared to a few weeks ago, which reads as follows:

"The idea that abortion was linked to negative psychological effects was widely reflected in the psychiatric literature pre-dating the legalization of abortion in the United Kingdom and the United States."

The Grisez book was by a philosopher and does not, on the face of it, seem like a good source to support the claim being made that the psychiatric literature (so some interpretation of WP:MEDRS may apply) reflected these views. Nor is any mention made of alternate views at the time: e.g. Osofsky & Osofsky (American Journal of Orthopsychiatry. 42(1):48–60, 1972, doi:10.1111/j.1939-0025.1972.tb02470.x) comes to quite a different view.

There is then another section that reads:

"This modified opinion was influenced by a growing body of literature showing a link between abortion and mental health problems, including a 30 year longitudinal study of about 500 women born in Christchurch New Zealand and a Cornwall inquest into the abortion related suicide of a well known British artist, Emma Beck."

Again, is this accurate and does it meet MEDRS?

References

-- Bondegezou (talk) 17:42, 21 November 2018 (UTC)

When looking at previous edits, I saw that another editor had cited the Grisez book previously, though his/her edit was reverted. I thought it was perhaps misplaced but a valid reference and contribution to the article. So, I inserted it in the fashion you described above. I believe it does qualify since it is a true academic review of the literature at that time. (Rather than deleting contributions of editors, I try to look for ways to include them.)

Regarding the second section, as you noted, the statement regarding the impact of the Fergusson study on the request for an update of the RCP statement is accurate and cites two peer reviewed articles and a newspaper article from the UK discussing the change in the context of UK law and politics...and since this section is regarding the history of this issue in law and politics, source policy regarding history and politics is applicable, not MEDRS.

Finally, you reverted the opening sentence in which I cite systematic reviews that meet the MEDRS standard...including several which are more relevant than the APA and NCCMH reviews because they are most recent. As you may know, MEDRS recommends reliance on more recent reviews. While you may feel that this "a list of systematic reviews doesn't add much," I disagree for two reasons. First, the list will help readers find the systematic reviews that are available to advance their own research. This will be helpful for college and high school students, for example. Second, this opening sentence and list is a precursor for further development of this section since these other reviews should be included in the discussion per the requirements of MEDRS to give due weight to the entirety of the literature reviews, not just a selected couple. Fergusson's review, for example, needs to be discussed, and it is in line with other reviews also cited. Since you do not disagree that this list is inaccurate, but simply have the opinion that it not "add much" according to some arbitrary standard of your own, I would ask you to revert your own reversion. As indicated above, I believe it is good policy to look for way to include editors contributions and sources. Move it around, or reword if it you think that will improve i . . . that is what collaborative editing is all about. But simply deleting it because you question how much it "adds" to the article is counterproductive.--Saranoon (talk) 18:25, 21 November 2018 (UTC)

If the Grisez book was previously removed, then I support that past decision and believe we should stick to it. It looked like a polemic to me and not to be a valid review of the psychiatric literature, unlike Osofsky & Osofsky. If we want something more historical, I suggest Osofsky & Osofsky or something similar -- something from the psychiatric literature -- is a better source.

The article should summarise what systematic reviews and guidelines say. Your list of various systematic reviews merely said that they criticised each other, but didn't offer any summary of what they say. That is not a balanced summary of the literature. It gives a false impression that there isn't a broad consensus. Bondegezou (talk) 11:06, 22 November 2018 (UTC)

Necessity for including MEDRS Reviews in order to provide Due Weight

Previously, Bondegezou deleted citations to peer reviewed reviews of the literature alleging that the mere citation of these sources did not substantially contribute to the article. He is correct in noting that these articles should be given greater weight in light of policy regarding due weight and a preference for more recent reviews WP:PSMED: "Look for reviews published in the last five years or so, preferably in the last two or three years. The range of reviews you examine should be wide enough to catch at least one full review cycle, containing newer reviews written and published in the light of older ones and of more-recent primary studies."---Saranoon (talk) 18:04, 26 November 2018 (UTC)

I don't think this comment adequately explains your continued hedging about the fact that the current scientific evidence does not support the claim that abortion causes mental health problems. –Roscelese (talk ⋅ contribs) 18:16, 26 November 2018 (UTC)

Then you aren't reading the content and the reviews carefully enough. The most recent review, by Fergusson, concludes that there actually is a small, measurable effect of abortion on mental health of women who abort compared to women who carry unwanted pregnancies to term based on 14 studies, including a 20+ year longitudinal study. Please read the [Fergusson review] and MEDRS policy. If you would like to help summarize the Fergusson review in a way you feel makes it most accessible to readers, please do.--Saranoon (talk) 18:24, 26 November 2018 (UTC)

I agree with Roscelese. You are cherry-picking the 5-year thing while violating the underlying principles behind WP:MEDRS. (I feel qualified to say that, since I played a major role in writing that guideline). The guideline is designed to ensure we provide readers with clear, accurate, and unbiased medical information. Your activity here—your sole activity on Wikipedia, as far as I can tell—has been to try to obscure a clear statement of scientific consensus on this article by any means necessary. It is disruptive and tendentious, and I am formally asking you to stop. MastCell ^Talk 20:17, 26 November 2018 (UTC)

It appears that you are attacking me rather than discussing the content of the article. No one can dispute that the reviews I have cited are (a) peer reviewed medical journal reviews, (b) meet all the requirements for being considered reliable secondary sources per MEDRS, and (c) that the MEDRS policy requires giving due weight to all such reviews in some reasonable proportion to the number of reviews and recency of the reviews providing a perspective on the topic.

A number of editors of this article appear to argue that Wiki-editors know more than peer reviewers and that "we" have a right to ignore MEDRS and delete content that cites any peer reviewed review articles that criticize or question the conclusions of seven to ten year old review articles that are preferred by the same wiki-editors. That is hardly in keeping with the "spirit of MEDRS" which clearly requires balance of viewpoints from reviews that been accepted for publication in peer reviewed journals. There is no basis in WP:MEDRS for constantly deleting all mention of reviews that post-date, critique, or improve on prior reviews.

It is especially notable that while no one has identified inaccuracies in any of the material I have submitted, nor can dispute that the material is based on reliable secondary reviews published in peer reviewed journals, the response to my edits has been complete reversion rather than seeking ways to include the material in a clearer or more proportionate manner. If, for example, one believe the paragraph I added regarding Fergusson's review of the unwanted deliveries vs abortion in light of the APA, NCCMH and Coleman reviews could be shortened or made more clear or accurate, the proper thing to do is to edit the material . . . not just delete it. Does anyone here understand the idea behind "collaborative editing?" The goal is to find ways to include pertinent material...not to simply make up excuses for deleting it.

Please either (a) clearly describe why the material I contribute it inaccurate so I can edit it to make it more accurate, or (b) edit it to make it more accurate yourself, or (c) restore the material and work in a collaborative fashion to improve this article rather than block improvements of this article.--Saranoon (talk) 22:53, 26 November 2018 (UTC)

One of the reasons that WP:MEDRS exists is to prevent exactly what you're trying to do. As an analogy, it would be possible to create a Wikipedia article, using only peer-reviewed publications, which would make it sound like HIV doesn't exist and is not the cause of AIDS. You're trying to do something similar: you are cherry-picking peer-reviewed papers and arranging them in such a way as to convey an inaccurate and misleading impression of the state of knowledge on this topic. What WP:MEDRS says (among other things) is that it's not enough simply to cite a collection of peer-reviewed papers; the sources must be used in a way that accurately conveys the overall state of knowledge in the field. It absolutely violates WP:MEDRS—and violates our basic responsibility to be honest with the reader—to present a collection of cherry-picked papers in order to rebut or undermine the global scientific consensus on a topic. You are doing exactly that. At this point, the policy issue has been explained to you many times, by several different people. That you persist in adding the same material, along with repetitive walls of text, is a behavioral issue; it falls under tendentious editing, and soup-spitting. MastCell ^Talk 00:44, 27 November 2018 (UTC)

1. That you decline to identify any inaccuracies in my edits must be interpreted as an admission of my accuracy.

2. That you decline my request to edit my changes in a way that, in your opinion, puts the cited material into proper context, must be interpreted as a refusal to engage in collaborative editing.

3. My understanding, which is reflected in many of your own arguments on this page, is that MEDRS objects to use of primary sources, even peer reviewed primary source, and favors instead literature reviews that are published in peer reviewed medical journals. It is exactly such literature reviews that I have cited. That is not cherry picking. That is a sincere effort to include reviews which show the evolving nature of this area of research. In my view, it is clear that editors who insist on citing only a few of the many literature reviews, especially older ones, and object to even a citation to newer reviews which have found fault in prior reviews who are cherry picking...and this is in clear violation of the requirement to give due weight to conflicting reviews.

4. Give me an example of a peer reviewed literature review that has concluded that HIV doesn't exist. Or are you just making things up to justify blocking content that clearly does cite peer reviewed literature reviews?

5. Please give a detailed explanation, preferably from a peer reviewed source, why Fergusson (2013) gives a "misleading impression of the state of knowledge on this topic." If you actually read the paper, it is clear that Fergusson, who is pro-choice, is critical of all prior reviews and is presenting evidence to the effect that the mental health effects of abortion are not as great as abortion critics like to say but as cannot be as easily dismissed as the APA and NCCMH reviews suggested when one really does look at the studies that compare delivering an unwanted pregnancy to abortion. Seriously. Stop ignoring this obligation. Fergusson post-dates these earlier reviews. His review was subject to peer review and published in a highly respected journal and therefore "endorsed" as at least a reasonable interpretation of the literature and as a contribution to the knowledge and debate over this issue. Silencing this source by an asserting, as you appear to be doing, that "the Fergusson team should be ignored in favor of the older reviews by the APA or NCCMH" is simply not reasonable, and is clearly not suggested or supported in letter or spirit by WP:MEDRS. (I realize MastCell is asserting that he is the governing authority on MEDRS given his contributions to that page, but even a governing authority should be able to identify what the problems are with citing Fergusson or other reviews. Moreover, it is my understanding that WP does not actually give such governing authority to individual editors.)

6. You claim that you and others have explained policy to me, but policy is actually explained at WP:MEDRS. The only thing you and others have have explained is that WP:MEDRS is not applied to the abortion and mental health article because a select group of editors policing this article have decided to exclude any reliable, peer reviewed literature reviews, or even citations to these reviews, whenever they conflict with your presentation of the 2008 APA and 2011 NCCMH reviews. It appears that the "consensus" of the policing editors is that the literature must be "frozen" in time, and only those reviews selected, and as interpreted (often incompletely) by your group of policing editors should be allowed despite WP:MEDRS guidelines and preferences for inclusion of alternative views and more recent reviews.

7. I'm a bit confused by your constant accusations of "tendentious editing." Does this mean that editors who actually reading MEDRS and assume that other editors will read and respect those guidelines when introducing reliable secondary sources (medical literature reviews) published in peer reviewed medical journals must be persistent when seeking to overcome the policing of articles by those who seek to promote a POV? If so, yes, I am being persistent precisely because WP:MEDRS makes it clear that the material I am inserting is appropriate, relevant, reliable and should be given due weight.

8. Please read WP:PRESERVE. We could make headway if editors would seek to fix and improve upon my edits rather than simply delete them, wholesale. The content I have provided is accurate and well sourced. If editors believe that other sections should be expanded to give more weight to other views, do that! But deleting well sourced and accurate content simply that is not included anywhere else in the article, is disruptive and anti-collaborative. --Saranoon (talk) 01:20, 27 November 2018 (UTC)

Tendentious editing is a manner of editing which is partisan, biased or skewed taken as a whole. It does not conform to the neutral point of view, and fails to do so at a level more general than an isolated comment that was badly thought out. On Wikipedia, the term also carries the connotation of repetitive attempts to insert or delete content or behavior that tends to frustrate proper editorial processes and discussions.

This is exactly what you are doing. Please try listening to what your fellow editors are trying to tell you. Walls of text with enumerated demands do not inspire collaboration. You are cherry picking policy, and attempting to place wildly unreliable sources (Coleman) into this article. You should not be surprised that such attempts will be resisted. — ArtifexMayhem (talk) 05:16, 27 November 2018 (UTC)

Why do you shift to Coleman rather than Fergusson? If you only object to Coleman, practice WP:PRESERVE to find a place for Fergusson, which clearly belongs here. Indeed Fergusson was prominently included for at least a full year from July 28, 2017 until August of 2018 when it was deleted without discussion or consensus. Regarding [Coleman (2011)], her review was published by the Royal College of Psychiatrists in the British Journal of Psychiatry, the very same group which petitioned for the NCCMH review. When you label sources that you personally object to as "wildly unreliable" and block inclusion of such sources you are substituting your own opinion for that of peer reviewers and editors of medical journals...in complete violation of WP policy. Rather than fighting so hard to exclude material from reliable secondary sources, please be collaborative in helping to find ways to include these additional sources. I understand that there can always be disagreement over how much weight to give to each review, but there is no legitimate excuse for completely censuring literature reviews that have been published in respected peer reviewed medical journals--especially reviews that post-date earlier reviews. --Saranoon (talk) 16:40, 27 November 2018 (UTC)

On health matters we regularly update content as new high quality reviews come out, dropping old ones and content based on them as we go, per the spirt and letter of WP:MEDDATE. Sometimes we keep the old ones to show the history of how the evidence changed with time. In this article the section is "current evidence" and in that context there is little reason to keep older reviews. I just reviewed the sourcing overall and in this section we cite Charles 2008 (PMID 19014789), the 2008 APA review, Horvath 2017 (PMID 28905259), the Cochrane 2013 review (PMID 23450532) and Grigoriadis 2013 (PMID 23656857), the 2011 Royal College review. I reckon we should keep the APA and Royal College reviews as they are major medical bodies but the evidence-based reviews should be updated as we go.

Given that there is no reason for re-instating the 2013 Ferguson review (PMID 23553240). It also asks a strange question - namely whether there is evidence that having an abortion has positive mental health outcomes and frames that in the context of abortion policy (it should have positive mental health benefits, if we are going to do it). This is somewhat odd. In any case one thing that is interesting is that it notes that A better comparison would be between those having abortion and those refused abortion.

That is exactly what the Horvath 2017 review is dealing with - what evidence based on that better comparison shows, and how it differs from the results of worse comparisons. There is reason to keep the Cochrane review as the community considers those to be of especially high quality, but we should ditch Charles 2008 for sure per WP:MEDDATE, along with Grigoriadis 2013 and yes we should keep 2013 Ferguson out as they are all a) at the tail end of the approximate 5-year time frame given in MEDDATE but most importantly per the spirit of MEDDATE, are based on evidence that even Fergusson says is worse than the kind of evidence Horvath is analyzing. We should always be using the best evidence. Jytdog (talk) 17:21, 27 November 2018 (UTC) (strike side comment that is causing distraction Jytdog (talk) 20:22, 27 November 2018 (UTC))

I can support having Horvath in an expanded list of all peer reviewed literature reviews. I can also support giving Horvath a moderate discussion which also reflects the criticisms of the Turnaway Study (previously discussed and cited on this talk page), especially the low participation and high drop out rate. That low participation rate and other problems mean the Turnaway Study results are not generalizable to the whole population. Still, I can agree that it is recent research that deserves attention within the context of questions raised about it. In the same way, the APA and NCCMH reviews deserved attention, but also within the context of questions raised about them. In that regard, Fergusson clearly belongs, not only because of its recency but also because it addresses questions raised and unanswered by the NCCMH and APA review. Both of the latter suggested that the rates of mental illness are likely similar after abortion and after delivery of an unplanned pregnancy, but Fergusson's review of that specific set of the literature showed that their assumptions were not supported by the actual evidence. Instead of parity, there are "small to moderate" greater risk of mental health problems associated with abortion, as demonstrated by eight studies examining 14 outcomes.

The other issue Fergusson addresses, which you call a "strange question" is not strange at all. In fact, the 2008 RCP statement recommended that a new literature review "should consider whether there is evidence for psychiatric indications for abortion" (and elsewhere, should explore "possible risks and benefits to physical and mental health.") The same concern about identifying when abortion is beneficial to mental health was also raised by the Rawlinson Report. It is actually very important both in English law which allows abortion only when the benefits outweigh the risks and in general medical ethics, wherein medical treatments are generally limited to circumstances when the treatment is shown to have positive effects. Therefore, the question of when, how, and for whom abortion improves women's lives is therefore an important one. Indeed, in the 1960's it was hypothesized that easy access to abortion would reduce depression and anxiety rates among women, in general, by reducing exposure to unplanned pregnancies and raising unplanned children. Have you read Fergusson's entire paper, or only the abstract? In any event, as article editors it is our job to reflect what is reported in the reliable secondary sources per MEDRS. We should not be deleting material just because, in one or more editors' personal opinion, the researchers address a "strange question."--Saranoon (talk) 20:11, 27 November 2018 (UTC)

Yes I read Fergusson. You are correct that people's personal views don't matter and I didn't raise that in my actual discussion of using it. To avoid further confusion that you will take it that way, I have struck it. You are not dealing with MEDDATE which is the relevant issue, as I made clear. Jytdog (talk) 20:22, 27 November 2018 (UTC)

(edit conflict) If Fergusson's work is compelling, then expert groups will reassess their conclusions and update them, at which point we will need to update our article. In the meantime, it doesn't make sense to prioritize that one paper in the face of extensive conflicting evidence and expert consensus to the contrary. It smacks of "teaching the controversy" and trying to artificially create more uncertainty in the mind of the reader than actually exists. That's not how we present medical information to our readers. MastCell ^Talk 20:24, 27 November 2018 (UTC)

Where in WP:MEDRS does it say that once a medical organization publishes a review, all subsequent reviews should be excluded from WP until that medical organization updates their review in light of subsequent reviews? Am I just missing that guideline? Or is that just a MastCell personal preference? As I read the guidelines, if a literature review undergoes peer review and is published in a medical journal that is what makes it a reliable secondary source, period.

You also suggest that giving any space to reviews other than those of the APA and NCCMH "artificially create(s) more uncertainty...than actually exists." Have you not read the reviews? Even the APA and NCCMH agree that there is a great deal of uncertainty given the impossibility of doing true double blind studies, volunteer self selection, drop outs, and other methodological studies. As a result, they would agree that their conclusions are based not on solid, irrefutable evidence, but rather on what they consider to be their own best reasonable interpretations of a very mixed bag of evidence. Do you need me to find the page numbers for these admissions of the uncertainties regarding the evidence? Moreover, existing uncertainty is also underscored by several literature reviews following the APA review that express a variety of competing conclusions (Coleman, Fergusson, Bellini, to name a few). To hide those references and the competing viewpoints from readers clearly violates WP:DUEWEIGHT which requires all viewpoints to be covered in appropriate weight.

That multiple critical reviews and competing views have been published in leading journals (including the RCP's own journal in the case of Coleman) demonstrates that these other reviews and opinions are not "fringe" opinions but instead widely accepted as reasonable opinions by peer reviewers and medical journal editors (including the RCP, which you pretend has adopted the NCCMH review as it's final word on this topic). In your opinion, the majority opinion is that of the 2008 APA review and 2011 NCCMH review. I have no problem with these reviews having a prominent role in the article. But they are not the last word, and should not preclude discussion of other reviews until such time as the APA or NCCMH notify us that they have read and analyzed these subsequent reviews. --Saranoon (talk) 20:55, 27 November 2018 (UTC)

MEDRS doesn't say that, nor did I say that. Jytdog (talk) 10:28, 28 November 2018 (UTC)

No, you did not. But it appears that MastCell is saying that any reviews published after the APA and NCCMH reviews should be ignored until these two "expert groups will reassess their conclusions and update them...." That appears to be his personal standard. I see no support for it in MEDRS guidelines.--Saranoon (talk) 20:38, 28 November 2018 (UTC)

• Removed Coleman again since her work is widely understood to be junk. –Roscelese (talk ⋅ contribs) 04:36, 4 December 2018 (UTC)
  • I believe it is up to you to document that claim based on MEDRS sources. Please show me evidence that the Royal College of Psychiatrists has withdrawn her paper on the basis that it is "widely understood to be junk." The opinion of Wikipedia editors regarding a medical review is irrelevant. Only peer reviewed literature reviews published in medical journals qualify for MEDRS. And Cougle clearly qualifies and has been covered in subsequent reviews, including NCCMH and Fergusson, which affirm it's relevance.--Saranoon (talk) 04:56, 4 December 2018 (UTC)
  • Looking through the history of this article, there are clearly a number of editors, such as Trappist_the_monk and Principina and Geremia who have tried to get MEDRS that offer different conclusions included in the article per MEDRS and DUEWEIGHT.--Saranoon (talk) 00:18, 12 December 2018 (UTC)

    I think that you are much mistaken and are putting words into my mouth that I have never spoken. I have edited this article three times: here, here, and here; all of these edits are technical fixes to cs1|2 templates. Please retract your false accusation.—Trappist the monk (talk) 00:39, 12 December 2018 (UTC)

    @Saranoon: You're apparently misrepresenting Trappist. And Geremia may not be the best example to make your case, since he was topic-banned from abortion-related articles for edit-warring in violation of medical article sourcing policies and pushing for sourcing at variance with sourcing guidelines in medical articles (namely pitting primary sources against secondary sources). Perhaps that is useful context for your crusade here, though, which is equally disruptive and at odds with site policy.

    Specifically, I am unclear why you keep adding the Coleman study to the External Links section. That section contains only links to consensus guidelines from expert groups; it does not contain links to individual papers, of which there are many on this topic. If we were to choose a single paper to best represent current scientific thought on the topic, why do you think it should be Coleman's? Her work is held in quite low esteem by expert groups, it would appear, and other researchers have failed to reproduce her findings. I would contend that no serious person, attempting in good faith to honestly convey the current state of knowledge on the topic, would choose that one paper as the sole or best representation to highlight. MastCell ^Talk 00:41, 12 December 2018 (UTC)

I mistakenly interpreted Trappist's here as part of, or in agreement with an edit by IntoThinAir regarding the importance of including coverage of the peer reviewed study by Coleman. There is hardly any "accusation." Regardless of who made what edits, there has clearly been an effort by a number of editors to give WP:DUEWEIGHT to the literature reviews published in peer reviewed journals subsequent to the APA and, in some cases, the NCCMH and RCOG reviews. These include Coleman, Bellini and Fergusson. It appears that there has been a systematic effort to delete all mention of these reviews in complete defiance of WP:MEDRS guidelines. Clearly, Fergusson's 2013 review is the most recent and the most pointed and undisputed effort to examine the evidence that the NCCMH review overlooked, namely a quantative review of studies comparing women who had abortions to those who delivered unwanted pregnancies. That should unquestionably be included in the article. Coleman's review should also be included as it is covered by both the NCCMH and Fergusson and was published by the RCP. MastCell's assertion that the article should only rely on reviews published by the APA and NCCMH is not supported by any policy I can find in WP:MEDRS which appears to treat all literature reviews published by respected peer reviewed medical journals as equal. To assert that Coleman and Fergusson are not experts in the field is ridiculous. Clearly, you can argue about how much weight should be given to each review, but WP:MEDRS supports the necessity to give all reviews at least some weight. As it stands, the article is totally unbalanced and ignores a substantial body of medical literature as interpreted in peer reviewed literature reviews. The only explanation for this is that a number of editors advancing a narrow POV insist that only the APA and NCCMH reviews should be covered. (In regard to the brief abortion and mental health section in the RCOG guidelines," it appears that they did not undertake an independent review but merely restated the conclusions of the NCCMH review. In that sense, while relevant, I don't think it carries as much weight as a "complete review" since it is mostly just a restatement of the prior reviews. I'm not arguing that it should not be cited, but rather that it does not add additional weight against covering the Coleman and Fergusson and Bellini reviews.––Saranoon (talk) 20:02, 12 December 2018 (UTC)

Saranoon, more or less every edit you make has been overturned by a consensus of other editors. I suggest you need to listen to what other editors are saying and perhaps spend some time working on other articles on Wikipedia and taking a break from here. Bondegezou (talk) 22:04, 12 December 2018 (UTC)

Notice that this Article Lacks Balanced POV per reliable peer reviewed literature reviews

WP:Neutral and WP:WEIGHT requires fairly represent all significant viewpoints that have been published by reliable sources. in proportion to the prominence of each viewpoint in the published. In articles related to medical matters, additional guidance is provided in WP:MEDRS which gives preference to more recently published literature reviews published in peer reviewed medical journals, preferably those within the last five years.

As you will see in previous sections of this talk page, and the archives, a number of editors believe that only two reviews, a 2008 review by the APA and a 2011 review by the NCCMH should be discussed or cited in the article. (Reference is also given to the RCOG guidelines which was not a new, independent review but rather a summary of the NCCMH findings)

In fact, numerous other peer reviewed reviews were published in the same time frame and subsequently which offered criticism, clarifications, and new analyses of the literature. These include:

• Coleman PK."Abortion and mental health: quantitative synthesis and analysis of research published 1995–2009." Published by the Royal College of Psychiatry in the British Journal of Psychiatry, Volume 199, Issue 3, Sept 2011.
• Bellieni, Carlo (2013-09-14). "Abortion and subsequent mental health: Review of the literature". Psychiatry and Clinical Neurosciences. 67 (5): 301. doi:10.1111/pcn.12067. PMID 23859662.
• Fergusson, David M; Horwood, L John; Boden, Joseph M (2013-04-03). "Does abortion reduce the mental health risks of unwanted or unintended pregnancy? A re-appraisal of the evidence". Australian & New Zealand Journal of Psychiatry. 47 (9): 819–827. doi:10.1177/0004867413484597. ISSN 0004-8674.

Especially notable is the most recent review, Fergusson (2013), which was specifically designed to test the conclusion offered in the NCCMH review by means of a meta-analysis of only those studies which compared women who had abortions to similar women who carried an unwanted pregnancy to term (i.e. women who had planned pregnancies were excluded from the control group). The following summary of Fergusson's findings were included in the article for over a year, but were subsequently deleted:

A 2013 review by David M. Fergusson and colleagues undertook a re-appraisal of the all the studies (14 in total) examined in previous reviews that compared mental health outcomes between women who had abortions and women who carried an unintended/unwanted pregnancy to term (thereby excluding women who carried a wanted pregnancy to term).[45] Their review revealed that there no evidence that abortion has any therapeutic mental health benefits, i.e.; women who aborted unwanted pregnancies did not fare any better in regard to any mental health outcome examined as compared to women who carried unwanted pregnancies to term. Conversely, there was statistically significant evidence suggesting a small to moderate increased risk of substance use and suicidal behaviors following abortion versus delivery of unwanted pregnancies.[45]

The persistent deletion and exclusion of all peer reviewed medical reviews that have identified an association between abortion and mental health problems is a violation of neutrality. Even if some editors believe that decade old APA and NCCMH reviews still represent the majority view, the review articles published in peer reviewed journals that come to different conclusions are a still relevant minority view that is accepted as reasonable and noteworthy by peer reviewers and medical journal editors.

In fact, none of the editors on this page have disputed that the reviews by Fergusson and Coleman and Bellini are "significant viewpoints" or that they are not reliable secondary sources as defined by WP:MEDRS (namely, literature reviews published in peer reviewed journals. Moreovere, since even the APA review admits "it is clear that some women do experience sadness, grief, and feelings of loss following termination of a pregnancy, and some experience clinically significant disorders, including depression and anxiety" it is also clear that the "minority" views of Fergusson, Coleman and Bellini are not completely contradicted by the APA but are rather contested only in regard to the magnitude of the problem. Per policy, then, due weight requires that these other views and sources should be included "in proportion" to the number of literature reviews on the topic.--Saranoon (talk) 09:40, 18 December 2018 (UTC)

Your position has been rebutted many times before and you continue to ignore consensus.

Fergusson et al. is a re-analysis of studies examined in two other reviews. It is not itself a systematic review and WP:MEDRS prefers systematic reviews where possible. I don't see any reason to give it so much attention.

I also question your summary of the Fergusson paper. Here's how Steinberg et al. (2014a) summarise it: "For instance, in a reanalysis of a sample from New Zealand, Fergusson and colleagues³⁰ found that, compared to women who gave birth to unwanted pregnancies, women who had abortions were not at a significant increased risk of subsequent anxiety disorders, depressive disorders, substance use disorders, and suicidal ideation when mental health at age 15, childhood adversities, and family environment were controlled in analyses." You've put a rather different spin on the results. Likewise, Steinberg et al. (2014b) use the Fergusson paper to support the following statement: "In models that control for confounding factors—such as prior mental health, prior or current adverse experiences, and sociodemographic factors—the association between abortion and subsequent mental health evaporates for mood and anxiety disorders, and suicidal ideation".

I note in passing that Fergusson's work has also been critiqued, e.g. by Leask, 2014. Bondegezou (talk) 14:43, 18 December 2018 (UTC)

By the way, Coleman (2011) was only "Published by the Royal College of Psychiatry" in the sense that they own the British Journal of Psychiatry. It was not commissioned by or endorsed by the RCP. It is not a statement of the RCP's position on anything. Bondegezou (talk) 17:12, 18 December 2018 (UTC)

You do not object to Fergusson being given "too much attention" but rather it being cited and given any attention at all. That is contrary to WP:DUEWEIGHT. You also misrepresent Fergusson as a reanalysis of two studies. In fact, it is a meta-analysis (the most highly valued form of a secondary source literature review) of 14 findings from 8 different studies, the studies being limited to only those identified in the only two other quantitative systematic reviews--Coleman and NCCMH--which compare women who were known to have delivered unwanted pregnancies to women who had abortions. In both cases, limiting the studies examined was in response to criticisms that Coleman's review included comparisons of women who aborted to women who carried to term. NCCMH specifically argued that it was best to only compare to women who had unwanted pregnancies (admitting that mental health rate problems are higher for abortion than for women who carry pregnancies, including wanted pregnancies to term). After excluding comparisons to all women giving birth, the NCCMH (like the APA) then concluded that there was likely no difference when compared to women who delivered unwanted pregnancies...but they offered no quantitative analysis of the eight studies that actually look at this question (just as the APA report ignored this analysis). Fergusson, a pro-choice atheist, by the way, was disappointed in the NCCMH's failure to do a meta-analysis of studies comparing abortion to birth of unwanted pregnancies. His review completes a job that he feels NCCMH left half done. Using the studies identified by NCCHM (and Coleman) he conducted a meta-analysis of just those eight which qualify (with 14 total outcomes measured). In addition, he did a second analysis (Table 2) in which he further narrowed the list of studies to those rated good or very good in the NCCMH review. That analysis showed a 134%, 291% and 69% increased risk, respectively, of alcohol misues, illicit drug misuse, and suicidal behavior in addition to higher rates of anxiety and depression.

As seen in both Fergusson's abstract and the body of the Fergusson review, Steinberg misrepresents the totality of his findings. To quote Fergusson's own summary statement: "There was suggestive but not completely consistent evidence of modestly elevated rates of mental health problems in women having abortion compared with women having unwanted or unintended pregnancy. These findings were particularly evident for alcohol and illicit drug use but were also evident for anxiety disorders and suicidal behaviours for analyses using an unwanted or unintended comparison."

That Fergusson is a reliable source per WP:MEDRS (as are Coleman and Bellini) is not in dispute. I have no objection to citations that may criticize Fergusson. I would note however that the the one you offer, Leask, is from a political perspective in a women's studies (not a psychological review). Even then, it is notable that Leask chief criticism of Fergusson's is that he found that mental health problems were only associated with women who reported "significant distress about the abortion." In other words, she argues, there is no evidence that abortion is "inherently an adverse life event," especially for women who do not report distress over their abortions. In essence, she is arguing that if abortion does not have inherent mental health risks for all women, it cannot be the sole cause of mental health problems. I have no problem with that distinction being covered in the article. But it should be a distinction made in the context of findings, like Fergusson's, which show that abortion may be a contributing cause to a "small to moderate increases in risks of some mental health problems" (from Fergusson's abstract).--Saranoon (talk) 17:20, 18 December 2018 (UTC)

Fergusson et al. is a re-meta-analysis (or perhaps a meta-re-analysis). It is not a full systematic review: it's a halfway thing, they've done a meta-analysis, but they've not done the paper selection. It is, in effect, a critique of those other reviews (as you say, "His review completes a job that he feels NCCMH left half done."). MEDRS prioritises systematic reviews. Fergusson et al. is allowable under MEDRS, but when it comes to DUEWEIGHT, we should clearly prioritise systematic reviews.

Let's look at your suggested summary of Fergusson et al. above: "there was statistically significant evidence suggesting a small to moderate increased risk of substance use and suicidal behaviors following abortion versus delivery of unwanted pregnancies". Let's look at what Fergusson and colleagues say: "There was suggestive but not completely consistent evidence of..." Your phrasing is more conclusive. I see no good argument that we need to include the Fergusson paper. But if we do, we should be clear about what it says.

You want to include a critique of NCCMH, i.e. Fergusson et al. OK, so where do we stop? There are critiques of Fergusson et al. A Wikipedia article is never going to capture all the back and forth of academic debate. Solution: stick with NCCMH. Bondegezou (talk) 17:55, 18 December 2018 (UTC)

That is an absurd argument. The whole point of WP:MEDRS is that articles should be updated in light of newer reviews, like Fergusson's. It is simply crazy to "set the article in stone" based on a single review that is eight years old!––Saranoon (talk) 20:45, 19 December 2018 (UTC)

• Saranoon, the POV tag is not meant to be left indefinitely as a badge of shame. It's meant to indicate a dispute that will at some point conclude. Right now, it looks like people here generally disagree with your proposal. If you do not want the POV dispute to be closed against your opinion, what modifications to your proposal can you make? –Roscelese (talk ⋅ contribs) 21:04, 18 December 2018 (UTC)

The POV tag is meant to call attention to unbalanced articles and to invite editors who have not yet participated to take a look and participate. It should remain for at least weeks, perhaps months, until such time as a substantial number of non-involved editors have had a chance to contribute...or until the tagger, me, agrees that changes have been made to bring it into balance. The effort by Bondegezou to remove it after just two days is an example of how a number of editors feel they WP:OWNBEHAVIOR this article and can delete all relevant and reliable content that does not comport with their POV -- and even hide that fact by removing tags! Incredible! --Saranoon (talk) 20:45, 19 December 2018 (UTC)

I would add that Bondegezou edit summary is misleading and inaccurate: "one editor has disagreed with everyone else's consensus for a while now, but no evidence of any broader dispute." Examining the talk page history, including the archives, demonstrates that numerous editors have tried to correct the imbalance and censorship of reliable WP:MERS reviews but they have been bullied away with reversions and arguments to the effect that this article does not follow WP:MEDRS guidelines for inclusion of reliable sources, instead, a phalanx of editors works together to simply exert their own opinion that any reliable peer reviewed sources that question, challenge, or refine the conclusions of the APA and NCCMH must be excluded. My efforts to cite even a single one of these as a reference, without discussion, have also been reverted!! The censorship of the Fergusson, Coleman, and Bellini reviews is not supportable by any policy based arguments. It is POV pushing, which is exactly why I've put a POV tag on this article.––Saranoon (talk) 20:56, 19 December 2018 (UTC)

You've been pushing Fergusson for nearly a month. There's been an extensive discussion above already. The 7 other editors (including myself) who have participated in the discussion have all disagreed with you. Consensus is clear and it is tendentious of you to use the tag in this manner. Bondegezou (talk) 21:00, 19 December 2018 (UTC)

Pinging other participants in the discussion above: @Roscelese:, @MastCell:, @ArtifexMayhem:, @Trappist the monk:. (Jytdog has left Wikipedia.) Bondegezou (talk) 21:09, 19 December 2018 (UTC)

• Saranoon's proposed changes have been discussed ad nauseum and there is clearly a consensus against them. At this point, I don't really see any new arguments being presented; Saranoon is simply rehashing her previous points in wall-of-text fashion and trying to force the material into the article by edit-warring. There is more than enough evidence of disruptive and tendentious editing here to justify a WP:AE report and a sanction, in my view, and I will eventually get around to filing one as time permits. On another note, I've removed the NPOV tag from the article, as it was being used improperly. The tag is not a consolation prize for editors who fail to gain consensus for their proposed changes. MastCell ^Talk 16:42, 23 December 2018 (UTC)

It is very inappropriate to remove a POV tag in violation of the rules for doing so. The whole point of POV tags is to invite uninvolved editors to participate. For example, it is likely that @Pudeo:, who supported my edit against a previous reversion, found the article through the POV tag noticeboard. Others might also want to become involved. It is notable that the Fergusson material was included for from July 28, 2017 until August of 2018 when it was deleted without discussion or consensus. That is a sign of POV pushing.

It is also notable that several of the editors objecting to giving any weight at all to the reviews by Fergusson, Coleman and Bellini (not even allowing a citation to these sources, much less their conclusions), have actually admitted that these peer reviewed papers are in fact reliable secondary sources per policy and WP:MEDRS at the reliable sources notice board, here. There, for example, MastCell agrees that the sources are reliable sources but defends total exclusion of these sources arguing that they should be given ZERO weight, in preference to his preferred and misrepresented sources (the RCP is not the same as the NCCMH), which is clearly a violation of WP:DUEWEIGHT and WP:MEDRS prioritization of more recent reviews. Even if it were accepted that Fergusson represents a minority opinion (which is not the case, as clearly no one has cited a subsequent literature review that has challenged his clarification of the NCCMH review), WP:DUEWEIGHT requires inclusion of this minority opinion in the article. There are clearly a lot of POV problems with the article, as has been noted in the talk pages by numerous editors over several years. The POV tag is clearly appropriate. Please stop violating policy regarding deletion of reliable sources, giving due weight to reliable sources, and removal of POV tags.––Saranoon (talk) 15:16, 24 December 2018 (UTC)

When to remove #1: "There is consensus on the talkpage or the NPOV Noticeboard that the issue has been resolved." There is consensus on the talk page above that your edits are not appropriate. Bondegezou (talk) 20:04, 24 December 2018 (UTC)

As noted, numerous editors have agreed that the sources I cite are reliable secondary sources per MEDRS[[5]]. The only objection raised is regarding how much weight should be given to what some editors argue is a minority view. (In fact, Fergusson's it is the latest view based on more detailed analyses and it has not been contradicted by any other literature reviews.) In any event, it is clear policy that due weight should be given to all viewpoints published in reliable sources. If you are claiming that there is a "consensus" of editors who agree that policy does not apply to this article, please explain why policy doesn't apply and by what authority a few editors can make that decision. Otherwise, please help to determine how, not if, the reviews by Fergusson, Coleman, and Bellini are to be represented in the article. That is required by both policy and WP:PRESERVE. Any other argument is simply one against WP:NPOV, which is why the POV tag is necessary and appropriate. --Saranoon (talk) 16:27, 27 December 2018 (UTC)

Again, Fergusson et al. is not a full systematic review. They have not done their own finding of studies. It cannot be any more up-to-date than the studies it is piggybacking on.

Due weight should be given. If a viewpoint is only represented in a small minority of less appropriate sources, then due weight can mean not including it.

You have suggested various changes. Every other editor in the Talk discussion above has rejected them. Consensus is clear, ergo the POV tag is inappropriate. You don't have to be happy with that, but you should respect it. Please stop with the accusations of bad faith and the wiki-lawyering. Bondegezou (talk) 17:04, 27 December 2018 (UTC)

First, WP:MEDRS does not limit reliable sources to those that are a "full systematic review." And since reviewers themselves decide on the scope of their reviews (NCCMH limited their review to just three questions), I'm not sure how you are defining a "full" systematic review. Second, Coleman's review is a full systematic review. It is certainly as "full" as the APA review since it includes all the studies the APA reviewed plus additional studies that met her search criteria. So are you saying Coleman should be cited instead of Fergusson? Third, Fergusson's study is a "full systematic review" of ALL the studies cited by the NCCMH and Coleman which use unwanted pregnancies delivered as the control group. Indeed, the introduction of his article makes clear that the purpose of his review was to undertake the meta-analysis to quantitatively test of the NCCMH's narrative conclusion regarding the presumed lack of difference between mental health after abortion to birth of an unwanted pregnancy. NCCMH pointed to this group of studies as a basis for their conclusions, but did not do a meta-analysis of this group of studies. Fergusson did. He provides the missing meta-analyses. Clearly, his review is of the same nature and type as the NCCMH review and meets all WP:MEDRS tests. If the NCCMH review is a reliable secondary source (which also includes a meta-analysis of different issues), so is Fergusson's review. Can't get much more relevant to the article than that.––Saranoon (talk) 20:04, 27 December 2018 (UTC)

My comments above were focused on the Fergusson et al. review, as that was the one you were focused on. MEDRS prioritises systematic reviews. You do not appear to understand what a systematic review is: I recommend the online learning at Cochrane. Bondegezou (talk) 16:08, 28 December 2018 (UTC)

Globalization

For an article on such a global subject, it seems focused too much on American politics, and the statements of American organizations. The United Kingdom gets a passing mention and the rest of the world is ignored. Rather problematic for an article that should not cover only one country. Dimadick (talk) 17:00, 27 December 2018 (UTC)

The reason why this is nearly all about American politics is probably because in much of the rest of the world (or at least the Western world with which I am most familiar) issues surrounding abortion are not a matter for political controversy in the same way as they are in the US. Most of the rest of us, even if we would not wish to see foetuses that we have had a part in producing aborted, accept that abortion is a basic freedom that pregnant women should have (and I find it rather strange that the self-proclaimed "land of the free" should be the outlier here). This situation leads to there being many political sources produced in the US rather than just the medical sources that are produced elsewhere, so most of the readily available sources about such topics are American. Phil Bridger (talk) 22:26, 21 January 2019 (UTC)

That's not true, Ireland was pro-life less than a year ago and I know about a lot of latin-american countries that are still pro-life. I agree that this article is too focused on US politics, also many of the sources doesn't look neutral (the ones that are from organizations specially dedicated to advocate for abortion). --2603:3024:18F0:B800:4894:3FB6:E5C7:2CE9 (talk) 08:16, 24 May 2019 (UTC)