Choice Joyce

Choice Joyce

Essays from a pro-choice feminist liberal skeptic infidel activist (and animal lover)

Tuesday, April 29, 2014

Patriarchal values dominate the sex work debate

Cross-posted from, April 4, 2014

Much has been said and written since the Supreme Court of Canada struck down three prostitution laws in December because they imposed dangerous conditions on sex workers, thereby violating their constitutional right to security of the person. Sex work is legal in Canada, but the criminal laws prohibited various activities around it, including communicating in public, operating or working in a brothel, and living off the income of a sex worker.

The basic question we should be grappling with is: How best can we ensure the safety and rights of sex workers? But that's not really the issue that people seem to be most concerned about, except for sex workers themselves. The battle has become about how best to control sex work under the guise of "protecting" sex workers. Most anti-prostitution activists want to treat sex workers as victims to be rescued and criminalize clients to "end demand," even though that model has failed in Sweden and Norway. On the other hand, many Conservative members of Parliament, some police forces, and right-wing religious groups favour full criminalization of everyone involved.

Sex workers across Canada are virtually unanimous in advocating for full decriminalization as the best protective model, and their position is based on reams of evidence, experience and common sense. So why aren't sex workers being listened to? Why are people so determined to "abolish" sex work? What are they really afraid of?

Prohibitionists (those who want to abolish prostitution through prohibition) can't seem to make up their minds whether sex workers are victims to be rescued or "dirty, evil whores" to be punished and eradicated. This paradox represents a modern version of the old Madonna/Whore complex and the sexual double standard. In Sweden for example, so long as a woman agrees to quit sex work she can be "rehabilitated," but women who don't want to quit are denied legal protection and social services, may suffer eviction and loss of custody of their children, and are deported if they are foreign workers. In other words, if a woman refuses to conform to the stereotype of "victim" or "fallen woman redeemed" she is stigmatized and punished.

The Swedish law is strongly backed by a segment of feminists whom sex workers call "radical feminists" because of their stance against pornography, sex work, transsexuality and anything else that doesn't conform to a vanilla vision of sex. Despite being feminists, their views are closely aligned with those of right-wing conservatives and Christian fundamentalists, which should set off alarm bells in the mind of every thinking person. The right-wing religious contingent longs for a return to tradition and sexually chaste women who save themselves for marriage. They espouse patriarchal ideals where a woman's place is in the home with children, but is that view really much different from the one in which women who choose to do sex work must be punished for it?

I believe that both views are rooted in antipathy to free sexual expression and autonomy, especially for women who dare to have sex in ways that offend moral sensibilities -- sex for pleasure in the case of the Christian Right, and sex for money in the case of prohibitionists. The belief that women need to be protected not only from others but from themselves gives radical feminists the self-appointed right to speak for sex workers and to "rescue" them, in the same way that anti-abortionists have appointed themselves to save women from the "dangers" of abortion by criminalizing it and promoting abstinence until marriage.

I've written previously on the many striking parallels between anti-abortionists and radical feminists. Both cast women as victims and use dehumanizing language to describe sex workers and women who have abortions. Both are paternalistic and don't recognize women's agency. Both demonize third parties as exploiters or profiteers and want to criminalize them -- "pimps" and brothel owners for radical feminists, and abortion providers for anti-abortionists. Both exploit the sad stories of the minority of women who feel damaged by sex work or abortion, and both ignore the majority who choose sex work or have abortions without regret. Both rely on ideology and emotional appeals, as well as their own B.A.D. science (biased, agenda-driven) full of distorted statistics and fabricated "facts." For example, both falsely claim that abortion and sex work are inherently dangerous and bad for women. And both share the delusion that prostitution and abortion can be abolished via criminal laws, despite overwhelming and conclusive evidence that women cannot be stopped from selling sex or having abortions, and that criminalization of either puts women in danger.

The belief that sex work violates human dignity reflects society's moral disapproval of sexual freedom for women, and disbelief that women can actually choose to do sex work. But treating sexuality as if it's some sacred thing to be reserved for love or marriage is narrow-minded. Sex is just sex -- there's all different kinds including casual sex, and people should have complete freedom to do whatever they want sexually as long as they're not hurting others. Retired sex worker Maggie McNeill says: "The decision to sell sex, which seems so extreme and shocking to prudish middle-class women, is for many working-class women not really that big a deal; this is especially true when other members of her peer group are already doing it and she can make 15 times as much in one hour as most of her countrymen make in a day."

In puritanical 19th-century Europe and America, it's estimated that 5.5 per cent of women were working as prostitutes at any given time. Today's estimate is 0.3 per cent of all women. It therefore seems logical to conclude that the best way to "end demand" for paid sex is to continue our path towards more sexual freedom, especially for women. I have argued that the best way to reduce the need for sex work (if that's what we want) is to encourage more women to engage in casual sex more often. After all, modern access to effective contraception and safe, legal abortion means that women need not be held back by fear of pregnancy.

Instead, prohibitionists are determined to repress the "dangerous" male sex drive, a project guaranteed to fail. Some even liken sexual intercourse to violence against women because of the penetration, which is an offensive and total negation of women's sexual agency and desire. Prohibitionists also say that men don't have a "right" to sexual access to women. But sex is a primal human urge that cannot be denied, everyone needs human intimacy and touch, and sex has significant physical and mental health benefits. Since many people have difficulty forming relationships or finding sexual partners (such as the elderly, disabled, obese, socially withdrawn, etc.), sex workers often deliver a necessary health-care service that should be funded by medicare.

Whether money is exchanged for sex or not seems almost irrelevant, since a lot of sex is ultimately transactional in nature, including within marriage. Transactional sex goes back to the very origin of our cultural evolution -- which women engineered and controlled, according to anthropologist Chris Knight in his book Blood Relations. He credits women's granting of sex in exchange for meat as the basis for establishing permanent home bases, a unique innovation that led to agriculture and civilization. By synchronizing menstruation, women were able to stay home (where it's safer and easier) and compel men to go hunting and bring back meat to share before being allowed sexual relations. Knight amasses a wealth of evidence to support this view, and other research corroborates it. Taboos around menstruation originally represented women's power over life, and men's fear of that power. Ironically, the birth of agriculture gave rise to private property, giving men the means to overthrow women's power by treating them as property along with the crops and livestock.

Some feminists may not take kindly to the idea that human culture was founded on a form of prostitution, but that would be a reflection of their own biases against it. If you posit instead that sex (and sex work) is a means of power that women have over men, and a positive expression of their sexuality and autonomy, then the perspective changes dramatically. I've often wondered -- since feminist prohibitionists blame the patriarchy for prostitution, would it end if we managed to achieve an egalitarian world? My answer is no, since there will always be people who cannot obtain sex, and sex workers would likely enjoy influence and prestige in an egalitarian society. Our modern society's negative attitudes towards promiscuous women are a legacy of patriarchy and the male need to guarantee paternity of children by controlling women's sexual behaviour.

Nickie Roberts said in the foreword to her book Whores in History:
"I am wholeheartedly on the side of the unrepentant whore, the most maligned woman in history…in [this book she] speaks up to denounce and challenge her oppressors, and thereby overcome the centuries of lies, denial and stereotyping that have been her lot. Only when she is listened to by the rest of our society will women finally and irrevocably be able to end our division into Good Girls and Bad Girls."

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“Dishonourable disobedience” – Why refusal to treat in reproductive healthcare is not conscientious objection

by Christian Fiala and Joyce Arthur

Published March 29, 2014 in: Woman - Psychosomatic Gynaecology and Obstetrics


In medicine, the vast majority of conscientious objection (CO) is exercised within the reproductive healthcare field – particularly for abortion and contraception. Current laws and practices in various countries around CO in reproductive healthcare show that it is unworkable and frequently abused, with harmful impacts on women's healthcare and rights. CO in medicine is supposedly analogous to CO in the military, but in fact the two have little in common.

This paper argues that CO in reproductive health is not actually Conscientious Objection, but Dishonourable Disobedience (DD) to laws and ethical codes. Healthcare professionals who exercise CO are using their position of trust and authority to impose their personal beliefs on patients, who are completely dependent on them for essential healthcare. Health systems and institutions that prohibit staff from providing abortion or contraception services are being discriminatory by systematically denying healthcare services to a vulnerable population and disregarding conscience rights for abortion providers.

CO in reproductive healthcare should be dealt with like any other failure to perform one's professional duty, through enforcement and disciplinary measures. Counteracting institutional CO may require governmental or even international intervention.

Continue reading full article at Science Direct. (html)

Click here for PDF Version

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Saturday, March 29, 2014

Government Criminalizes Jobs to Protect Workers

Cross-posted from Rabble, March 7, 2014
(Under the title:
When a government protects workers by criminalizing them

Imagine for a moment, if the debate over prostitution laws was aimed at other types of workers...

In a bold move aimed at protecting workers from exploitation while on the job, the government today passed a new law that criminalizes most employers and customers. The law addresses the void left by the Supreme Court of Canada in December 2013, when it struck down laws that it said prevented workers from taking safety measures to protect themselves from abusive customers, but which the government said were designed to prevent people from working, period.

"Our government is concerned about the significant harms that flow from being compelled to work for a living," said Law and Order Minister Punter MacCunny at a press conference to announce the new law, which was passed without any Parliamentary debate. "Working is harmful to vulnerable individuals, particularly women, who should be home having babies."

The most dangerous jobs in Canada are believed to be in the male-dominated industries of logging, fisheries and construction, but reliable data is unavailable due to the government's ongoing "Bonfirefest" program targeting science libraries. "We don't need evidence to know that most jobs pose unacceptable risks to workers," insisted MacCunny. "Every day, workers are compelled to do disgusting or dangerous things for money, like scrubbing toilets or conducting rigorous peer-reviewed studies. This economic exploitation must end."

MacCunny pointed out that 95 per cent of people hate their jobs and want out, according to a new government-commissioned study by the Fundamentalist United Church of Canada (FUCC). Pastor Dan Ho of FUCC said he surveyed about 50 people in Winnipeg, mostly cashiers at Tim Hortons. "Canadians who've been innocently enjoying their coffee and Timbits every morning need to know that all the workers' smiles are forced," warned Pastor Ho, discreetly whisking a crumb from his beard.

Police welcomed the new law, which gives them sweeping new enforcement powers to target the huge increase in organized crime. According to Det. Sgt. Billy Clubber, head of the RCMP's new Slave Save Squad, "We'll be cracking down on slavery rings, basically any place where workers are bribed with wages to provide services for pimps and johns." The law now designates employers and customers as "pimps" and "johns," respectively.

The squad will be recruiting 10,000 new officers to conduct raids of exploitive workplaces across the country. "The price tag is ginormous, but it's worth it to rescue victims," exulted Clubber. "After breaking down doors and waving our guns around, it's gratifying to pacify terrified slaves by tasering them. Then they'll be taken to special rehabilitation centres, where they'll have a chance to learn honest skills such as making licence plates."

However, to reduce program costs, Clubber said that foreign-looking workers will be immediately deported, while a range of pimps and johns will be exempt from the new law, including the Top 1%, elected officials, law enforcement, celebrities, CEOs, devout Christians, and all family and friends of the aforementioned.

To fund the new initiative, the government has diverted $1.2 billion from the Maternal and Child Health program for developing countries. That initiative was abruptly cancelled last year after the government discovered it would have to spend some of the money on birth control pills. Further controversy arose at the time when it was revealed that one of the PMO's top advisers was right-wing talk show host Rash Bimbough, who announced on air that "We're not paying for slutty sluts to have sex!"

Member of Parliament Jilly Schmut has been advocating the criminalization of customers for years, and strongly supports the new law. "I am convinced that the most effective route to tackling wage slavery is to end demand for goods and services by targeting buyers." Schmut also had harsh words for those who traffic hapless workers to different branches or affiliates of the same company, coercing them via promotions and raises, while the traffickers reap huge profits from the slaves' advanced servitude. "These predators are dehumanizing individuals by reducing them to a commodity to be bought and sold," fumed Schmut.

Some wage slaves protested the move to criminalize their customers, claiming it would push them into an underground economy where they would be even more at risk of exploitation and harm. Others insisted that they were not slaves at all, and that they had freely chosen their work and even enjoy it. However, wage slave expert Malicia Fibberly dismissed these anonymous claims, explaining that working 9 to 5 is inherently demeaning and dangerous and must be abolished. "It's annoying to come across people who've been brainwashed into believing they're empowered by their work," complained Fibberly. "That syndrome is called 'false consciousness.'" While Fibberly conceded that some workers probably did enter their profession willingly, she cautioned that "Such people are not representative, and are part of a small, privileged elite. Don't listen to them!"

Law and Order Minister MacCunny agreed, and said the government had to dismiss the voices of workers during the public debate in the lead-up to the new law. "We heard rumours that many workers were inexplicably speaking out against the proposed law during our public consultation process. However, experts advised us that most slavery victims suffer from Stockholm Syndrome, so we plugged our ears."

When questioned further, MacCunny admitted that the government had been "completely overwhelmed" with the over 30,000 online responses it received from the public on possible legal solutions to the wage slavery crisis, only one month before the new law was passed. "Luckily, we had already made up our minds to pass the new law, so we didn't have to bother reading the comments. That also saved a lot of taxpayer money, making it a win-win for everybody!" he declared, pumping his fist in the air.

He also offered assurances that the comment database would never be made available to researchers or the public because "it's now in the same place as the Gun Registry."

MacCunny concluded his comments on a celebratory note. "Let freedom ring! Canadians can now stay home and have babies, and never be exploited by working for a living again."

In other news, the government has promised to explore ways to address the rising incidence of poverty, homelessness, drug abuse, violence, exploitation, and social unrest, and plans to open another public consultation soon.

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Undermining democracy and human rights: A cautionary tale about anti-choice politics

Cross-posted from Rabble, February 7, 2014

Last week, Parliament and the pro-choice movement got a temporary reprieve from the relentless  onslaught of anti-choice motions and bills introduced by Conservative backbenchers who won't take Harper's "No abortion debate allowed" for an answer. Not a single one made the list of pending private members' business for this session.

The news must have come as a huge disappointment to the anti-choice movement, which had been eagerly anticipating the introduction of two explicit anti-choice motions that had already been fully prepared and announced in December by long-time Conservative MP Maurice Vellacott (Saskatoon-Wanuskewin). So what happened?

Vellacott actually had a total of four private member items on the order paper. This forced him to make a "difficult decision," since only one item can proceed to second reading and a vote. On January 31, he chose to go with his Bill C-560, which would require judges to apply the principle of "equal parenting" in custody disputes unless there is proven abuse or neglect.

Vellacott's fourth item was a cloaked anti-choice motion. It would have made it easier to bulldoze just about any private member bill or motion through Parliament, no matter how offensive or illegitimate, by removing committee powers to deem them non-votable. Ironically, Vellacott called this a "democratic reform initiative." All three of his dropped motions can be viewed here.

One might wonder why Vellacott created this surplus of private member business to begin with, knowing he'd have to sideline three out of four items. The main clue is his announcement last July that he's stepping down from politics and will not run again in 2015. The motions therefore represent his last kick at the can, the "pro-life" legacy he wants to leave, and the final kudos he wants to bask in from the anti-choice movement.

Still, why bother with three extra motions that won't go anywhere? Likely because Vellacott is confident that they'll be back soon, even if he won't be: "[B]ased on considerations I have been a part of, I have good reason to believe that the other three items I have on the order paper will be picked up in due course by other good MPs who have spine and foresight." The wording hints that Vellacott himself is a member of this elite club of brave visionaries, and that he's been busy convincing the other members to boldly go forth into the future with his motions.

Vellacott has been an MP since 1997 and has a perfect "pro-life" record according to Campaign Life Coalition. Over the years, he has introduced six anti-choice private member bills, all with the same single-minded goal: to protect healthcare workers from any negative consequences of refusing to do their jobs if they object because of personal or religious beliefs. The last version was the most preposterous.

Returning to the "equal parenting" bill for a moment, it's notable that this bill is at least several degrees less contentious than abortion (although it makes one wonder about Vellacott's possible affinity with "Men's Rights Activists"). One might also wonder whether Vellacott was the object of a talking-to by some higher-up who may have been anxious to avoid yet another iteration of the dreaded "abortion debate."

Since Vellacott's three dropped motions may indeed be coming back, are they worth worrying about? It's almost certain the two explicit anti-choice motions would never go anywhere even if they were introduced, but the cloaked motion to remove the ability of the Committee to veto private members' business, M-490, is perhaps a bit of a wild card. Vellacott claims that:
The motion would fix a current vulnerability in the system that has led to a situation where a small group of MPs are able to control, often from behind closed doors, what issues are and are not allowed to be voted on in the House of Commons. … The motion I am proposing is a bulwark against arbitrary and capricious decision-making when it comes to Private Members Business. Were this motion to pass, decisions on the votability of private members' bills and motions would be made in a fair and objective fashion, free from any sort of political interference or shenanigans.
Really though, the shenanigans are mostly on the side of anti-choice politicians like Vellacott (and Stephen Woodworth, Mark Warara, and others), who continually put forward these hopeless motions and bills against the wishes of Harper, and occasionally throw a hissy fit when they fail to go anywhere. Or, when a bill start to go somewhere like in 2008 with Ken Epp's Bill C-484, it creates division in the caucus, a media circus, and a headachy distraction from the government's agenda. Instead of getting the message though, anti-choice stalwarts in Harper's caucus carry on like they're more determined than ever -- not unlike true fanatics.

With his M-490 motion, Vellacott is complaining about the treatment of Mark Warawa's Motion 408 last March by the Parliamentary Subcommittee on Private Members' Business. That motion, to "condemn discrimination against females occurring through sex-selective pregnancy termination" was deemed non-votable because it failed to meet two of the four votability criteria -- so it wasn't exactly an "arbitrary and capricious" decision.

Bills and motions must not concern questions that are outside federal jurisdiction, or are substantially the same as ones already voted on in the current session of Parliament. The Subcommittee members said that abortion is healthcare and therefore under provincial jurisdiction, and that Stephen Woodworth's Motion 312 was also about abortion and was voted on just six months previously, in September 2012.

The other two criteria are that the bill or motion must not "clearly violate" the Constitution Acts and Charter of Rights and Freedoms, and that it must not be on the same topic as items currently on the Order Paper or Notice Paper as items of Government business.

Vellacott's motion would have dispensed entirely with the constitutional and Charter violation criterion, as well as the one requiring it to be within federal jurisdiction. One can only imagine the kind of odious private member business from backbenchers that would have to be "debated" in Parliament without the Charter criterion in place to deflect them.

Ironically, Warawa's Motion 408 wasn't deemed non-votable based on the Charter criterion, so Vellacott's motion would have made no difference to the result anyway. Vellacott even retained in his motion the criterion that bills or motions could not be "substantially the same" as ones already voted on in the current session, even though that was probably the key criterion that deep-sixed M-408. The Subcommittee's decision was made unanimously by three MPs from three parties (Liberal, NPD, and Conservative), which weakens Vellacott's accusations of political interference. Finally, although the Subcommittee's "expert analyst" had advised the members that Motion 408 was votable under all criteria, the analyst's interpretation was nowhere to be found in the criteria's straightforward language and had no evidence or precedent to support it. Also, his advice was non-binding, so the MPs were free to discount it.

Vellacott's "democratic reform initiative" in M-490 was designed to undermine democracy and remove basic safeguards that protect human rights and other constitutional guarantees, in order to make it easier to smuggle in anti-choice bills and motions.

It's worth remembering that the anti-choice movement has never been a friend of the Charter of Rights and Freedoms. Let's also remember the decidedly undemocratic motivations behind this motion should it arise again in Parliament.

In the meantime, the pro-choice movement will be happy to say goodbye to Maurice Vellacott.

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Thursday, January 09, 2014

How Deeply Flawed Studies on Abortion and Breast Cancer Become Anti-Choice Fodder

The anti-choice movement has been making a lot of noise over a new study out of China, published in the journal Cancer Causes & Control, that purports to show a 44 percent increase in breast cancer risk for women who have had an abortion, with the risk increasing after each subsequent abortion. The study claims this may help explain the “alarming” rise in breast cancer in China over the past 20 years, which parallels the one-child policy introduced in 1979.

But the study’s methodology and data appear seriously flawed, with the results likely reflecting “recall bias.” This would invalidate the study’s findings. Recall bias is a common hazard in case-control studies, which use questionnaires or interviews to gather historical data from participants. Results can be skewed or inaccurate because people have a tendency to forget past events, or neglect to mention them, especially if they are uncomfortable with sharing the information with researchers. For example, underreporting occurs when people are asked about substance use, criminal offenses, family background, or school performance.

Recall bias is even more of a problem when it comes to reporting reproductive history, especially past abortions. In the United States, only 47 percent of abortions were reported in the largest and most recent fertility survey (from 2002). A 1996 analysis cited numerous studies on the topic and found that, as a likely result of abortion stigma, women reported only 20 to 80 percent of their abortions. (The wide range is due to varying interview circumstances, geographic locations, or demographic characteristics of the women.) A significant body of evidence has accumulated on abortion underreporting, going back to the early days of legal abortion in 1960s eastern Europe, as documented by Christopher Tietze and Stanley K. Henshaw:
The classic example is the Fertility and Family Planning Study of 1966, conducted in Hungary a decade after the legalization of abortion. In that survey, the numbers of abortions reported by the respondents for the years 1960-65 corresponded to only 50-60 percent of the number actually performed. A comparable level of underreporting was also noted in 1977.
But how does an apparent association arise between abortion and breast cancer (ABC)? In case-control studies on the topic, researchers select and divide women into two groups: women with breast cancer (the “cases”) and women without the disease (the “controls”). The women in both groups will then be asked whether they’ve had an abortion to see if the disease might be more commonly associated with that. However, cancer patients will be strongly motivated to remember and share their full medical history in the search for answers (this is called “rumination bias”), while women acting as controls in a study have no stake in the outcome and so are less likely to mention past abortions. They would be even less likely to report several past abortions because of the increased stigma. The result is a flawed study, because it will appear that women with breast cancer had more abortions than those in the control group, when they probably didn’t.

This “differential recall” is a known risk in case-control studies in general, although few studies have been done to show the effect in studies on the ABC association. A 1991 analysis in Sweden compared two studies: one that used women’s abortion records from a national registry, and a case-control study that relied on women self-reporting their abortions (that were also recorded in the registry). In the end, 27.1 percent of controls underreported past abortions, compared to 20.8 percent of cases (see Rookus/Leeuwen letter). Another study took place in the Netherlands in 1996 in which case and control groups were interviewed in different regions of the country. The correlation between induced abortion and breast cancer was very strong in regions of the country with a predominantly Roman Catholic population, but much weaker in regions with less abortion stigma. Although the sample size of women who had abortions was small in the Catholic regions, a large number of women in those areas also underreported contraceptive use to a greater extent than in more liberal regions.

Anti-choice activist Dr. Joel Brind has been promoting the ABC association for over two decades. He claims that the Chinese study “neutralized” the recall bias argument. But Brind missed—or chose not to mention—that the journal article contained a confusing error, one that helped to hide the study’s own recall bias shortcomings. Early on, the study authors say:
The lack of a social stigma associated with induced abortion in China may limit the amount of underreporting.
But later in the study, the authors say:
[T]he self-reported number of IA [induced abortions] will probably be underestimated, as the stigma of abortion still exists in China, especially when a woman has more than two IAs. Therefore, this underestimation will inevitably create spurious associations between IA and breast cancer, especially for more IAs.
These two contradictory statements should never have gotten past the peer reviewers.

Regardless of whether abortion is stigmatized in China and to what degree, abortion is still underreported even in countries where abortion is more widely accepted, such as Estonia and Hungary. But the study authors are probably right in their second statement: Abortion stigma does exist in China. An increasing number of young unmarried women are having abortions—often multiple abortions—but there is a stigma in China against premarital sex and an even bigger stigma against out-of-wedlock pregnancies. In these circumstances, it would be very surprising indeed if young Chinese women were not underreporting their abortions. Further, since the study authors admit that abortion stigma in China is more pronounced for subsequent abortions, this would explain the rising association that the authors found between multiple abortions and breast cancer—because women in control groups would be increasingly less likely to report their second or third abortions.

Another type of study, called a “cohort study,” is considered more reliable than case-control studies. In a typical cohort study, researchers spend many years following large numbers of women, some of whom have had abortions, to see which ones develop breast cancer later. Recall bias is not an issue because abortion data is drawn from public records. The result is an accurate percentage of how many women got breast cancer compared to others who didn’t have abortions. Out of at least nine cohort studies done since 1996, not one has found a statistically significant association between abortion and breast cancer, and some found negative associations—meaning abortion might actually protect against breast cancer.

The Chinese study was not a cohort study or even a case-control study. It was a meta-analysis, which combines the results of numerous studies on the same topic to come up with a pooled average. The authors found 36 previous Chinese studies on the ABC association and combined their results to come up with an “odds ratio” of 1.44, which means a 44 percent increased risk of breast cancer for women who had one abortion. However, the authors used 34 case-control studies and only two cohort studies (not included in the nine mentioned above). Neither cohort study showed a statistically significant ABC association. Further, six of the case-control studies that were rated as having the highest quality methodology, according to the authors’ own evaluation, also showed no correlation. In other words, the supposed ABC association arose solely from the weakest 26 studies selected for the meta-analysis, some of which were not even published in peer-reviewed journals.

The major weakness of meta-analyses has a popular acronym—GIGO. It means “garbage in, garbage out.” In other words, if most of the studies you add to the mix are seriously flawed, your pooled result will be worthless as well. To their credit, the study’s authors make clear that induced abortion is not confirmed as a causal risk factor for breast cancer and that their own results should be interpreted with caution. In fact, the scientific community has already dismissed abortion as a risk factor based on the best studies. Given that the correlation only shows up in case-control studies but never cohort studies, it’s highly likely to be an artifact of recall bias.

Although correlation does not equal causation, anti-choice advocates are using the Chinese study to jump to the unwarranted conclusion that abortion causes an increased breast cancer risk. Unfortunately, the study authors never mention other possible risk factors that could help explain the recent rise in breast cancer in China, let alone why they should be rejected in favor of abortion. These include:
  • Fewer full-term pregnancies (one or two) because of the one-child policy;
  • Economic development leading to more affluence and rising body weight (as found in one of the two Chinese cohort studies);
  • Increased industrialization and dramatically increased exposure to environmental toxins in a country with few environmental controls; and
  • Improved protocols for cancer testing, leading to more diagnoses of breast cancer.
Because the study focuses only on China, it also obscures the lack of association between breast cancer and abortion in many other countries. For example, western Europe has low abortion rates and high breast cancer rates, while Russia has high abortion rates and moderate breast cancer rates. It is unreasonable to assume the existence of an ABC association when it’s found inconsistently and depends more on geography or study methodology. Further, if there really were a causal connection, it would show up more robustly across most studies, instead of being all over the map.

The study’s ABC association was quite weak in comparison to major risk factors for breast cancer, such as advanced age, having a family history of breast cancer, or being childless. In a specific population such as women in China, weak associations can turn up by chance, and are therefore random and meaningless. For example, if you compared the population of storks with the rates of childbirth outside hospitals in various countries, a correlation will appear in some of them. It does not mean that storks deliver babies in some countries but not in others. It just means that you can find a correlation between almost anything if you’re determined to find it.

The promotion of flawed studies to try to prove that abortion leads to breast cancer is a political effort spearheaded by anti-choice groups and individuals, who primarily use these studies to reinforce abortion stigma and frighten women. The studies may also be a vehicle to smuggle in dogmatic beliefs under the guise of objectivity and the scientific method. As such, they irresponsibly advance an anti-choice agenda at the expense of science and women’s welfare.

Thanks to Stanley Henshaw and Dr. Christian Fiala for help with previous drafts of this article.

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