While it is true that there was not, and still isn't, any solid data for making any accurate estimate of how many women suffer from post-abortion psychological sequelae, there were three specific findings (readily substantiated by the literature available at that time) upon which to build valid conclusions and specific recommendations. The following is a summary of these points, which I personally communicated to Dr. Koop in a letter dated July 1, 1988.

First, at least some women are psychologically disturbed by abortion. From clinical evidence it is clear that some suffer severe psychological maladjustments, while others have more moderate or mild coping problems. Short term follow up studies, of less than six months, typically report 10 to 20 percent of patients reporting significant psychological problems which they associate with their abortion experience. These findings are confounded by the fact that approximately 50 percent of women who previously agreed to participate in these follow-up studies subsequently refuse to do so. This high refusal rate may itself signify post-abortion avoidance behavior which may be indicative of other psychological sequelae.

Second, by examining those women who do experience psychological sequelae, pro-abortion researchers have identified approximately fourteen clearly defined characteristics (such as feelings of being coerced into the abortion, negative moral beliefs concerning abortion, prior mental health problems, or strong feelings of attachment to the unborn child) which are predictive of poor post-abortion adjustment.

Third, intake information at abortion clinics indicate that 60 to 80 percent of patients seeking abortion have one or more of these predisposing risk factors.

From these three facts we can conclude not only that some unknown number of women experience psychological problems following abortion, but that the majority of women seeking abortion appear to be at risk. How many of these at-risk women actually suffer post-abortion problems is not known. But the evidence is clearly sufficient to raise the concern that abortion may pose a significant public health threat. Therefore, further research should be given a high priority. In the meantime, a national effort should be undertaken to: 1) Help high risk patients avoid abortions; 2) Better inform and counsel patients about risks and alternatives prior to abortion; and 3) Offer better care and understanding to women who are struggling with psychological problems after their abortions.

In response to my suggestion, Dr. Koop sent me a personal letter stating that he understood my line of reasoning and would keep it in mind when preparing his report. He also noted that he had a copy of my book which included results of the first long-term follow-up study of women, an average of ten years post-abortion. Because this study was limited to a sample of 253 WEBA members, Dr. Koop pointed out that "it is impossible to make national generalizations" from such samples.

Dr. Koop's observation is of course true, in the sense of making statistical generalizations, but it does not lessen the value of the WEBA sample in terms of gaining insights into at least the potential importance of the problem. After all, in any public health investigation one must always study the symptoms of the sick population before one can even begin to measure the extent of the illness in the general population. Unless the symptoms are identified first, it is impossible to ask the right questions of the general population. Indeed, the greatest methodological flaw of pro-abortion research is that researchers have concentrated their efforts on proving that psychiatric sequelae are rare without first defining the range of emotional and behavioral problems which women report as being associated with their abortion. In other words, rather than spend any time in actually studying the experience of women who suffer problems after an abortion, they have always been bent on marginalizing the affected women as a dysfunctional minority.

As one final note, it is curious that while Dr. Koop personally reported having seen my study, my research was not included in the extensive bibliography of materials which the Surgeon General's assistant claimed to have studied in preparing the "report." This omission is especially odd since all the studies which were included in the bibliography were also to be dismissed as "methodologically flawed."