Lecture Vol. 19 # 6A March 16, 1989 cover
Statement of C. Everett Koop MD, ScD
Surgeon General
U.S. Public Health Service
U.S. Department of Health and Human Services
Before the House Committee on Government Operations
The Subcommittee on Human Resources and Intergovernmental Relations
Washington, DC
March 16, 1989
I was in a sense being called to task to explain a letter I had written to President Ronald Reagan in response to a request he had made to me. Let me tell the story as briefly as I can.
January of each year is the month in which pro-life people use the Anniversary of Roe v. Wade, to restate their pro-life position. At the White House on a day, which I think was the 23rd of January of 1987, where Roe v. Wade was being acknowledged by the President, a young political activist of conservative bent, Dinash D'Sousa told the president that if he asked the credible Surgeon General in office - I was that person - to write a report on the health effects of abortion on women, Roe v. Wade could be reversed. That statement was nonsense. The entire pro-life movement was based upon the death of the fetus and to shift to the effects of abortion on women would be to lose their primary stake in the argument.
On July 30, of 1987, President Reagan stated that he thought women were not being informed about the health effects of abortion on women. I think that was a true statement. The President then directed the Surgeon General to assemble a body of information on the health effects of abortion on women. I don't really know if this was a hang-over from the advice he had been given in January, or whether it was something new.
I tried to convince the President that this was the wrong road to take, but was unsuccessful, but it was made very clear to me and I made it very clear to the Chairman of this committee, before which I was appearing that our charge from the President and our deliberations, as well as any conclusions we drew had and have nothing to do with the safety of any abortion procedure for the woman. Rather our focus was on health effects post-abortion, be that weeks, months, or years. I appointed a Commissioned Officer, Commander George Walter, to be my special assistant and serve as a Director of this Abortion Study.
I read 225 articles in the literature on the mental health effects of abortion on women and came to the conclusion that perhaps only one of those articles was a valid scientific presentation. These others all carried the pro-choice or pro-life bias of the authors. If they were pro-choice, there were essentially no health effects on women; if they were pro-life, there were health effects on almost all women.
The next step was to invite six statisticians to review the same literature. I felt they would do this in an unbiased way and that they were more interested in the truth of statistics than they were in ideology. They agreed that my assessment of them was correct and they agreed with my assessment of the 225 articles in the literature.
That brought me to the point where I believed I could not amass any body of literature on this subject as the President had requested, and instead, of giving him a report as he had wanted, I gave him a letter - which I put through 17 drafts - stating that the literature could not be trusted, and that my own experience was such that I knew and had counseled many women who had mental effects after an abortion, but I also had met many women who said that abortion saved their marriage, saved their career, etc. In short, I wrote to the President, that I could not deliver a report because the statistics did not support - either way - the concept that women did have or did not have post-abortion mental affects.
When the letter was ready to go to the President, Otis Bowen, Secretary of Health and Human Services, who had been in on all of my mental gymnastics over this issue, accompanied me to the White House and we presented the letter to the Chair of the Domestic Policy Council and an Administrative Assistant of his. He flatfootedly lied to me when he told me he would hold this letter "close" and present it to the President when he came back from Camp David after the weekend. Contrary to that promise, before Otis Bowen and I had returned in his limo from the White House to the Humphrey Building, a ride that couldn't have taken more than fifteen minutes, this letter was already on the wires.
Unfortunately that day, a new woman was put in charge of the office, occupied by the Associated Press in the building where I had my office - the Hubert Humphrey Building -- on Independence Avenue. She plainly didn't understand the issue, misinterpreted it, misinterpreted my letter, and the message that when out on the AP wires was that Koop finds no evidence of adverse health effects of abortion on women. In my letter, I had told the President that if he wanted the information he had asked me to procure, he could probably get it by quick and dirty research for maybe a million dollars, but to do the study he really wanted would probably cost ten times that prospectively. I did not think it was a study that could have scientific merit done retrospectively. In my own investigations, I felt there were probably more than 30 types of women, who had different backgrounds, religions, family support, church support, community support, etc., who had abortions. Unless each group was studied separately, the conclusions would be invalid.
Many things I said as Surgeon General divided my audience or the nation and on such an explosive subject as abortion, especially when it was improperly reported by the Associated Press, the result was that of a bombshell. This was another occasion when huge shifts in my constituency occurred. To this day, many liberals interpret what they read in the headlines as an indication that I had changed my previously held opposition to abortion, which was totally untrue; I was opposed to abortion before the study, during the study, after the study, and still am. However, unlike many of my critics, I was also honest.
One of the things that ticked me off probably more than anything else was that the American Psychological Association appointed a committee to study the methods I had used to come to my conclusion to see if they were valid. There was a lot of fanfare about the organization of that committee, but when that same committee found that I could have acted in no other way than I did - in other words, they gave my methods their approval - no public  announcement was made.
This statement is a fair assessment of where I stood and why I did what I did. No summary would do it justice.