What’s the lasting effect of having an abortion, or being turned away? Here's what research tells us.
In 2007, Diana Greene Foster, a demographer at the University of California, San Francisco, set out to answer a pivotal question: Does abortion hurt women?
Inspiration came to the professor of obstetrics, gynecology and reproductive sciences in the wake of the U.S. Supreme Court decision in the Gonzales v. Carhart case that year.
Justice Anthony Kennedy, who authored the opinion to uphold a federal partial-birth abortion ban, speculated on how having an abortion can impact women's mental health.
The court found "no reliable data to measure the phenomenon," Kennedy said. But it seemed impossible to not reach the conclusion that "some women come to regret their choice to abort the infant life they once created and sustained."
"Severe depression and loss of esteem can follow," he said.
Indeed, there was no reliable data — so Foster set out to find some.
She reached out to abortion clinics across the country, talking to women who were able to get an abortion and those who were turned away because they were past their state's legal limit to receive one.
The study is held up by experts today as a first-of-its-kind effort to understand the lasting effects of ending an unwanted pregnancy versus carrying it out to term. And, as the Supreme Court seems poised to overturn its landmark Roe v. Wade, the study gives a valuable measure of how curtailed access to abortion procedures could impact millions of women in Wisconsin and beyond.
More: Almost all abortions would be illegal in Wisconsin if leaked Supreme Court opinion overturning Roe stands
Over five years, Foster and her research team conducted 8,000 interviews with nearly 1,000 women. They followed the women over the years, measuring the impact having or not having an abortion had on their mental, physical, financial and familial well-being.
In the years since, they have used the data to dive deeper into those issues and more, authoring more than 50 scientific articles in peer-reviewed research journals.
The work has shed light on a subject long mired in stigma and lacking representation in the scientific literature, moving beyond political and religious arguments to measure the various factors that influence a woman's choice to have a child.
How did being denied a wanted abortion change women's ability to care for all of their children? How did it influence their quality of life and mental health? Whether or not they stayed with an abusive partner? Their family's socioeconomic status?
The research remains highly regarded by reproductive health experts.
"The Turnaway Study is brilliant," said Jenny Higgins, a professor of obstetrics and gynecology at the University of Wisconsin-Madison. "It's an incredibly strong source of evidence and the study design is so fantastic."
Here's what to know about the study and what researchers found.
Who was part of the Turnaway Study?
By 2016, when the study concluded, the team of 11 researchers had conducted 8,000 interviews on a group of nearly 1,000 women over a span of five years. They recruited from 30 clinics across the country, in addition to having a comparison group of women who sought an abortion in the first trimester of their pregnancy.
Most people — 92.7% — seek abortions in the first 13 weeks of pregnancy, according to 2019 data from the US. Centers for Disease Control and Prevention.
But there are women who seek them later for various reasons, and Roe v. Wade states that while women can legally seek an abortion in their second trimester, states can impose limitations that are reasonably related to maternal health. After the point of "fetal viability," which is generally around 23 or 24 weeks, a state can regulate abortions or prohibit them entirely, so long as the laws contain exceptions for cases when abortion is necessary to save the life or health of the mother.
Why do women seek abortions?
In the interviews, women listed many reasons for seeking an abortion. The most common were: not being able to afford a child, the pregnancy coming at the wrong time in their lives, and/or the man involved not being a suitable parent.
Most women who seek abortions have already had one or more children.
What delays the timing of requests?
The women in the study had been turned away due to legal limitations. Study participants said they were seeking an abortion past their state's limit because they didn't realize they were pregnant and/or because of logistical issues that slowed down their ability to access one.
The researchers found young women and women who have never had a child before were at a higher risk of not recognizing pregnancy in the first trimester.
More: More than 1 in 5 women have irregular menstrual cycles. What does that mean for abortion access?
Women in their 20s made up the majority of those who got abortions in 2019, at 56.9% according to CDC data.
Do abortions hurt mental health?
The Turnaway Study looked at how getting or being denied an abortion impacted women's mental health and well-being over the years.
Researchers looked at rates of anxiety, depression, post-traumatic stress and suicidal thoughts and also surveyed participants on their self-esteem, life satisfaction, stress and social support.
They found the women who had an abortion had no evidence of negative impact on their mental health or well-being, despite anti-abortion claims that this could be the case.
Those who were denied an abortion had elevated levels of anxiety and stress and lower levels of self-esteem soon after they were denied an abortion. Over time, though, their outcomes improved.
By six months to one year after seeking the abortion, those who got the abortion and those who were turned away had similar levels of mental health and well-being.
The researchers also found that while women felt a mix of positive and negative emotions after getting an abortion, the most common emotion reported was relief. Nearly all participants — 95% — said that the abortion was the right decision for them five years after receiving it.
Can denials threaten financial stability?
The women in the study who were turned away and went on to give birth were more likely to experience an increase in household poverty lasting at least four years after being denied.
The researchers looked at the participants' credit scores, levels of debt and public records on the number of bankruptcies and evictions they had. All were negatively impacted.
Those who were turned away also were more likely to report not having enough money for basic living expenses such as food, housing and transportation. They were three times more likely to be underemployed.
Children born to the women who were turned away were more likely to live below the federal poverty line than the children of those participants who got the abortion they were seeking and subsequently had a child.
What can denials mean for women?
The researchers found instances of physical violence from the man involved in the pregnancy decreased for women who were able to obtain an abortion, but not for those who were unable to obtain one.
Five years out, women who were denied an abortion were more likely to be raising their children alone, without the support of family members or male partners.
What is the impact on children?
The researchers looked at the development of each of the women's children. The older children of those who were turned away — those born before the unwanted pregnancy — showed worse development than those of mothers who could get an abortion.
This shows the multigenerational impact of a woman being forced to carry an unwanted pregnancy to term, Foster noted in an editorial published this month in the prestigious journal Science.
They also found that carrying an unwanted pregnancy to term was associated with poorer bonding between the mother and newborn compared with the bond between those mothers who had a baby after getting the abortion they were seeking.
What are the comparative health risks?
Major complications from abortion requiring hospitalization are rare, according to the American College of Obstetricians and Gynecologists, which also maintains abortions are "an essential component of women's health care."
On the other hand, pregnancy complications can pose major risks to women's health.
More: If Roe is overturned, Wisconsin law would allow abortion only 'to save the life of the mother.' Doctors say it's not always so clear-cut.
These risks bore out in the Turnaway Study as well.
Women who were turned away reported more life-threatening complications like eclampsia and postpartum hemorrhage. They also reported more chronic headaches or migraines, joint pain and gestational hypertension. Two of the study's participants died after delivery due to pregnancy-related causes.
Women are 14 times more likely to die from giving birth than they are from an abortion, Foster noted.
Are there criticisms about this study?
Critics have argued the findings are overblown because of what they see as a low participation rate among those who were asked to join it and also because of potential selection bias — the idea that women who chose to participate in the study represent a particular type of perspective.
These are challenges that most studies of this type face, said Kate Dielentheis, a Froedtert Hospital obstetrician and gynecologist who is also associate program director for the OB/GYN residency at the Medical College of Wisconsin.
Abortion is a sensitive topic, making interviewing people about it a particularly tough task. Considering that, she said, the participation rate of 30% is not absurdly low.
Unlike other types of medical studies, where researchers can, for example, randomly select who gets a new medication and who gets a placebo pill, researchers cannot randomly select who does or does not get an abortion.
Overall, Dielentheis said the number of studies the team has since published in reputable research journals is one indication of the study's reliability. So are the academic pedigrees of the researchers who made up the team and the overall prestige of UC-San Francisco's OB/GYN training program, she said.
Contact Devi Shastri at 414-224-2193 or DAShastri@jrn.com. Follow her on Twitter at @DeviShastri.
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This article originally appeared on Milwaukee Journal Sentinel: What to know about the landmark Turnaway Study on abortion access