Dr. Diana Greene Foster was the lead researcher on the Turnaway Study, a landmark study that followed 1,000 women from 30 abortion clinics for five years.
She found people turned away from abortions were more likely to remain with abusive partners, be less ambitious in what they want to accomplish in life, and have serious health problems.
Foster has written a book about the decade she spent researching these women.
This week, as the Supreme Court mulls a case that could severely restrict abortion nationwide, Foster reflects on the lack of progress despite a boom in research.
During the pandemic, abortions have become even harder to access than usual.
But a Supreme Court case, expected to reach a verdict this week, could make it even less likely that care would return to normal, or even improve, when lockdowns end. The case addresses abortion clinics in Louisiana, but any outcome will, likely, impact other states, too.
Dr. Diana Greene Foster knows better than anyone that being denied an abortion has serious, lingering effects.
She's spent a decade gathering data on the fate of what she refers to as "turnaways." That's her term for the women who tried to get an abortion but couldn't; because they were past the abortion cut-off in their state, didn't know they were pregnant, felt pressured to keep it, or couldn't afford the procedure.
Foster is a researcher at the University of California, San Francisco, in the Department of Obstetrics, Gynecology and Reproductive Sciences, and served as principal investigator of the Turnaway Study. It was a landmark study so influential that it led to 50 different peer-reviewed scientific publications, and inspired similar research in Nepal, Bangladesh, South Africa, Tunisia, and Colombia, all backing up the original finding.
But despite an unprecedented swell of research and awareness, Foster says, she hasn't seen much change in perceptions around abortion, and she wonders what it would take to make a difference. 43 states still ban abortion for women after a certain point in pregnancy. 12 states still prohibit private insurance plans from covering abortion. 34 states don't cover abortion for women on Medicaid except in instances of rape, incest, or situations where carrying the baby could endanger the woman's life.
"I think that the question about whether people decide to carry a pregnancy to term or not is not just an activist question that is still part of a crucial political debate," Foster, who has just published a book reflecting on the last decade, told Insider. "It touches on everything important about how we make our lives and whether we decide to have children, and what other goals we have and how we pursue them."
Being denied an abortion can have negative ramifications that last a lifetime
Foster wants people to know that abortion is incredibly common, to the point where one in four women in the United States will have an abortion over their lifetime. She wants people to know that a large proportion of the women who get abortions do not regret it, while the ripple effect of being denied an abortion lasts a lifetime.
Women denied abortions will likely have health issues that might last for years post-pregnancy, says Foster. They have four times greater odds of living below the poverty level and three times greater odds of being unemployed.
They are likely to stay with abusive partners, have anxiety and eroded self-esteem, and not have aspirational life plans for the coming year. They will likely reduce the scale of what they want to accomplish in life.
Women denied abortions are also more likely to experience serious end-of-pregnancy complications. Two women in the study died from childbirth-related causes.
"Having my son sent my life completely off the rails," a 24-year-old woman named Brenda, told Foster and her researchers. "Pregnancy definitely has a negative impact on people's financial well-being. Because it is very, very difficult to find a job when you're pregnant, to keep a job when you're pregnant, and to find or maintain a job with a baby."
Brenda was denied an abortion when she was 20 weeks pregnant.
Prior to 2006, nobody had thoroughly investigated the negative impact of denying abortions
Foster's research began with a comment from a colleague, during an informal conversation in a hallway.
"I wonder what happens to the women we turn away," Dr. Eleanor Drey, medical director of the Women's Options Center at San Francisco General Hospital, wondered aloud to Foster in 2006. Her comment sparked a decade of research.
Drey was voicing her frustration as a clinician who was unable to help all her patients. But as a researcher, Foster saw an opportunity. "I was thinking about the raging political debate about: 'does abortion hurt women, and why isn't there aren't reliable data to answer those questions?'" Foster told Insider.
But in these women who were turned away from getting abortions, Foster saw a group she could compare against women who did successfully get abortions, and examine the trajectory of both groups' lives.
That inspired the Turnaway Study, which was the first to examine the long-term effects of what happened to the thousands of women who are denied abortions every year, compared to those who got their abortions.
They recruited 1,000 women from 30 abortion clinics across America and interviewed each woman every six months for five years. The study included a mix of white, black, and Latinx women from 30 clinics across the U.S. The average age was 25, and 62% were already raising kids.
Given abortion is a medical procedure "so controversial it decides elections and ruins Thanksgiving dinners," as Foster writes in her book, she expected that the women would be hesitant to participate. But four out of five women agreed to be part of the research, especially when they were told by the researchers that it might help future women.
The study found that much of what we know about abortion is inaccurate
Foster found that almost everything that we consider to be common knowledge about abortions is wrong; women who had abortions were not more likely to have depression, anxiety, or suicidal ideation, and 95% of the women she spoke to reported that having the abortion was the right decision over five years after the procedure.
"We've had this idea that abortion hurts women, and we didn't find that kind of emotional harm that people might have expected," Foster told Insider.
When Foster was conducting the study, she would ask women how often they thought about the pregnancy they'd terminated.
"Only when you call me," one woman told her.
Foster hopes the Supreme Court will take the Turnaway study results into account
The Supreme Court is expected to hand down a verdict on the case of June Medical Services v. Russo, which is about a law requiring Louisiana abortion providers to have admitting privileges at local clinics. Abortion advocates say the law is unnecessary, and just creates more bureaucracy around the already complicated process of getting an abortion. Anti-abortion activists say the law is to protect patients.
If the Supreme Court rules to uphold the law, clinics in Louisiana and across the US could shut down. Pro-choice advocates say such a verdict could open the door to more, slowly eroding abortion rights and access nationwide.
In 2016, a similar case made it to the court, and the judges ruled the restriction unconstitutional. But with two new conservative judges, the verdict may be very different this time.
Foster hopes that when weighing a policy about the benefits or burdens of future restrictions, the court will take evidence based research into consideration.
"We'll see whether this new court with two new conservative judges sticks with the concept that policy should be based on evidence," Foster said. "But the Turnaway Study certainly generated a lot of evidence. It knows there are harms to being denied abortion. In an ideal world, state legislators would take that into consideration."
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