DIGEST July 2022

When women are turned away

What happens when a pregnant person wants an abortion, but cannot get one? How does their life change? How is their health or economic situation affected? These are the questions that a multidisciplinary group of researchers led by Professor Diana Greene Foster of the University of California, San Francisco, decided to answer more than a decade ago. At that time, there had never been a comprehensive, long-term study in the United States of the impact of being denied an abortion.

Greene Foster and her colleagues felt this was a pressing need, given the many anti-abortion restrictions coming up across the US at the state level. Perhaps, if clear evidence of the life consequences of being “turned away” was presented to legislatures and courts, these measures could be stopped or reversed?

The Turnaway Study enrolled over 1,000 women from 40 states in 30 abortion facilities across the country; a painstaking process that took three years. The participants were a representative group of the women who seek abortions in the United States: most of them were in their twenties (60%), while 18% were teenagers; 37% were white, 29% Black, 21% Latina, 4% Native American, and 3% Asian. Half of them were living in poverty, with those seeking abortion later in pregnancy even more likely to be poor (57%), while 25% of the participants were middle-class or wealthier. Sixty percent already had children, and 61% were in a relationship with the man with whom they became pregnant.

Of the more than 1000 women enrolled, 25% were refused an abortion, usually because they were past the gestational age at which the clinic would perform one (sometimes, but not always, the legal limit in that state), while 50% had a later abortion (just under the gestational limit) and 25% had one in the first trimester. In the US, 90% of women obtain an abortion in the first trimester, but the researchers chose to oversample those obtaining abortions later in pregnancy, because statistically, there would be almost nothing distinguishing them from those being refused one—only a matter of a few days on either side of the gestational limit.

The research team carried out phone interviews with all these women, twice a year, over a period of five years—a massive endeavor! They asked them questions about their physical and mental health, financial situation, life goals and the well-being of their children. They asked them why they had sought an abortion, and the obstacles they had encountered. They asked about the role of the men in their lives in making the decision, and how their relationships were affected. They explored as many dimensions of these women’s lives as they could, often using creative ways of analyzing the data. In one study, economists matched the 1,000 women with their Experian credit score: the women on either side of the gestational limit initially had a similar financial profile, allowing for a valid comparison. But those who were denied an abortion had worse credit scores for years afterwards.

The study generated a trove of information, resulting in over 50 scholarly articles, many of which can be found at http://www.turnawaystudy.com . The material has been organized in a highly readable book entitled The Turnaway Study, which was published in 2020.

The book combines summaries of the data with interviews of ten of the women who were part of a group that had agreed to do additional longer-form interviews. It’s fascinating, complex, uplifting and heartbreaking reading at the same time. Very real. What struck me the most in the interviews was how many of the women experienced stigma and shame about their situation, whether they had an abortion or were denied one:

“I don’t regret the abortion at all. I’m where I’m supposed to be in my life. So, I know I made the right decision for myself. But I definitely feel like I should have been more open and honest with my friends and family at the time. It would have helped me process it a lot quicker. Instead, it has taken me, like, five or six years to really feel confident about my decision.” (Martina, who had an abortion)

“This time around I had my mother there for me. So, it was much easier, even if I didn’t have support from my boyfriend, I had the support from my family to back me up. It was still really rough because I had preeclampsia [life-threatening high blood pressure during pregnancy]. It was a really, really tough pregnancy. My mother attended every doctor’s appointment with me. And that made it so much easier. At times I wanted to tell her about my first pregnancy, but I just couldn’t open my mouth and just tell her. I just didn’t want to feel rejected from her. I’ve always kept that a secret from her.” (Sofia, who was denied an abortion and placed the child for adoption.)

The most reported Turnaway finding debunked a common right-wing talking point about abortion: that abortion causes women to feel regret or develop mental health problems. No, it does not. Maybe you’ve read somewhere that 95% of women who have abortions feel their decision was right for them: this is a key finding of the Turnaway Study. In fact, the study found that women who receive an abortion fare better than those denied one on any number of measures: health, employment, financial situation, intimate relationships, and well-being of their children.

But other important findings abound. For example, why do some women have an abortion in the second trimester? While rare, these abortions are highly stigmatized. The main reason may surprise you: the women did not realize they were pregnant until they were far along. (I’ll always remember a physician and well-known abortion provider telling me that while she was a medical student at Harvard, she only realized she was pregnant at 22 weeks. She had no nausea and had her period throughout: she just thought she was gaining weight because of the horrible hours she was putting in. So, if she didn’t realize…).

Overall, why do women seek abortions? The right-wing loves to portray women as frivolous, irresponsible or immoral. But in fact, the Turnaway Study finds that women are generally thoughtful and realistic about why they shouldn’t have a child: “…the reasons women give for wanting an abortion strongly predict the consequences they experience when they are denied that abortion,” writes Greene Foster.

And the study’s findings on the harms of denying someone an abortion are stark:

Women denied an abortion experienced sustained economic hardship and insecurity, which was not experienced by those who had received one.

Women denied an abortion are more likely to stay in contact with a violent partner. Yet, they are also more likely to raise the resulting child alone.

The development and financial well-being of existing children suffer when their mothers are denied an abortion.

Giving birth can cause serious health problems, while having an abortion does not.

Adoption is not an easy alternative to abortion.

Last year, the evidence from the Turnaway Study was cited in numerous amicus curiae (“friend of the Court”) briefs to the Supreme Court of the United States in the case of Dobbs v. Jackson Women’s Health Organization: briefs by economists, public health experts, physicians. The ultra-conservative majority of the Court blithely disregarded this evidence, and overturned the federal, constitutional right to abortion in the United States, unleashing hardship and misery on thousands of people. This will hit harder those who are already in precarious situations. Remember: half of those who seek an abortion every year are already living in poverty. Young, Black people will be especially affected.

As the damage unfolds and the harm grows, judges, legislators and other leaders cannot say that they didn’t know. Oh, they knew. They simply didn’t care.

In loving solidarity to all those who support abortion access,