Here's some abortion science for Maria Miller

Abortion "turnaways" three times more likely to fall below poverty line.

The debate over abortion limits drags on, Maria Miller has enraged Women's Hour listeners by suggesting that the limit should be set by "people's opinions rather than science", according to the Huffington Post.

If I was being nice, I'd say Maria Miller is suggesting that the cold hard anatomical data doesn't cover important social factors that can only be gathered by talking to people. But science also includes social science,  and these controlled studies can give a much better idea of the social factors than mere "opinion". Here's one recent example.

New research from the University of California, the "Turnaway Project", studied women who had turned up at the abortion clinic a few days too late - looking at how they fared compared to their contempories who had got there in time. Here's a summary of what they found, taken from their statement on their Facebook group:

We have found that there are no mental health consequences of abortion compared to carrying an unwanted pregnancy to term. There are other interesting findings: even later abortion is safer than childbirth and women who carried an unwanted pregnancy to term are three times more likely than women who receive an abortion to be below the poverty level two years later.

The study chose two groups with similar demographics - two thirds lived below the poverty line, and 45 per cent was recieving state assistance. A year later, the groups had dramatic differences. 76 per cent of those who were refused abortions were now recieving state help, against 44 per cent from the other group.

The new mothers were also more likely to live below the poverty line, and more likely to be out of work - 48 per cent were working, against 58 per cent of those who got abortions.

Differences also appeared in vulnerability to domestic violence: Turnaways were much more likely to stay with an abusive partner. Reports of incidents of domestic violence for this group in the last 6 months were at 7 per cent, compared to 3 per cent for those who got abortions. The researchers commented that this was completely down to the difficulty of getting out of an abusive relationship when a young child was involved.

The blog io9 spoke to the researchers about the emotional health of the study participants:

As the researchers said at the American Public Health Association Meeting, “One week after seeking abortion, 97% of women who obtained an abortion felt that abortion was the right decision; 65% of turnaways still wished they had been able to obtain an abortion.” Also one week after being denied an abortion, turnaways told the researchers that they had more feelings of anxiety than the women who had abortions.

Women who had abortions overwhelmingly reported feeling relieved (90%), though many also felt sad and guilty afterwards. All of these feelings faded naturally over time in both groups, however. A year later, there were no differences in anxiety or depression between the two groups.

Controlled studies like this one provides meaningful information that mere "public pressure" can't. It's time they were taken seriously by policy makers.

Maria Miller talks to Grant Shapps. Photograph: Getty Images
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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear