Science Vs - Abortion: What You Need To Know

Episode Date: April 27, 2017

Abortion is so taboo. People don’t talk about abortions they’ve had. Doctors don’t talk about abortions they’ve given. But it's happening a lot. Almost a million abortions happened in the US in 2014. So, what actually happens in an abortion, can the fetus feel pain and what are the risks?  To find out we visit an abortion clinic in Texas and talk to Dr. Amita Murthy, Dr. Lisa Harris, Dr. Bhavik Kumar, and Dr. Diana Greene Foster. This episode is not about being pro-choice or pro-life, but pro-facts. Credits:This episode has been produced by Heather Rogers, Wendy Zukerman, Ben Kuebrich, Shruti Ravindran and Rachel Ward. Kaitlyn Sawrey is our senior producer. We’re edited by Annie Rose Strasser.  Fact Checking by Michelle Harris and Ben Kuebrich. Extra help with production and editorial from Alex Blumberg and Jorge Just. Music production and original music written by Bobby Lord. Thanks to Lola Pellegrino, Ronnie Shankar, Dr. Diane Horvath-Cosper, Rachel Jones, Elizabeth Nash, Dr Yoon-Jin Kim, Delma Limones and Gilda Sedgh. Also thanks to Katie Bishop and Reverend David Gushee. Our Sponsors:There is no sponsor! Weirdly we couldn’t find any companies were like ‘hey yeah we want to advertise on an episode about one of the most controversial issues in America’. So… you should be our sponsor! Support quality journalism that isn’t afraid to tackle controversial topics. Become a Gimlet Member for $5 a month to support our shows and receive exclusive perks like early access to new show pilots, an invite to our member Slack, first notice about Gimlet events, and for our annual members, your choice of a newly redesigned Gimlet t-shirt (we recommend the Science VS design). Further Reading:CDC Statistics on AbortionGuttmacher Institute Report on AbortionThe Turnaway Study - Women’s Mental Health and Well-being 5 Years After Receiving or Being Denied an AbortionRoyal College of Obstetricians and Gynaecologists - The Care of Women Requesting Induced AbortionRoyal College of Obstetricians and Gynaecologists - Fetal Awareness Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi, I'm Wendy Zuckerman, and you're listening to Science Versus from Gimlet Media. On today's show, science versus abortion. Abortion is so taboo that many people don't talk about the abortions they've had, many doctors don't talk about the abortions they've given, and when it is talked about, it's politicised and sensationalised. But whether we talk about it or not, it's happening. A lot. A common statistic that floats around

is that one in three women in America will have an abortion in their lifetime. That's from a study which used data that was almost 10 years old. It's currently being updated because the number of women getting abortions is dropping. What we do know is that in 2014, just one year, just under a million abortions happened in America. We're going to talk really openly about abortions. We're going to tell you what exactly happens in an abortion, who's getting them, and what happens to women once they've had them. So we just want to say that this episode is not about being pro-choice or about being pro-life. This is about being pro-facts And if you haven't already guessed

This episode is probably not for little ears Or even for big ears on a little person So if you're a parent or maybe there's kids in the room You might want to switch to headphones So when it comes to abortions There are lots of misconceptions about aborting a conception. But then, there's science. Today on the show, we're pitting facts against fetuses.

Yep, we went there. So we're looking into these three questions around abortion. One, when most women have an abortion, how far along is the fetus and can it feel pain? Two, what exactly happens during an abortion? And three, what are the risks of having one? First up, when most women have an abortion, how developed is the fetus? So from Juno, you know that indie film about a teenager getting pregnant? We learned that by the time a woman gets an abortion... Your baby probably has a beating heart, you know. It can feel pain. And it has fingernails. Fingernails? Really?

Really. So how soon until a fetus really gets fingernails? Well, fingernails is the last. That's like when we think about a baby coming out with fingernails. That's not happening until closer, much closer to the end. That's Dr Amita Murthy. She's an assistant professor in obstetrics and gynecology at New York University, and she teaches med students about fetal development. What's your favourite stage of it? Do you have a favourite?

That's the wrong question to ask me. Why? Because you love them all? I love them all. So let's start at the very beginning. When mummy and daddy love each other very much. Okay, who are we kidding? Let's start here. The sperm is in the vagina and it makes a beeline for the egg. If it breaks through, fertilisation begins. Amita told us that after a woman's egg is fertilised by a sperm,

it divides into two cells and those cells divide into more cells until it creates a ball of cells. And in these early stages, it's called a zygote. What does the zygote look like? The zygote microscopically looks like a wriggling ball. But what's happening inside the zygote is the cells are dividing and separating. The zygote, that wriggling ball, will soon divide into what's called an inner cell mass and an outer cell mass. That outer stuff helps to form the placenta, which supplies oxygen and nutrients to the growing zygote. But let's just focus on that inner cell mass. The inner cell mass is now actually multiple cell layers deep. We're talking about 30, 40, 50 cell layers deep. So it's like, if you can imagine like a sandwich

with lots and lots and lots of lots of meat layers in there and cheese or whatever. So it's like that. And then imagine like you start to roll the sandwich into a burrito kind of thing. Right. Okay. So what Amita is describing here is that this ball of cells, the sandwich, is folding in on itself to create that distinctive shape of the fetus, that kind of curve, or as she describes it, the burrito. So this is all happening in the first few weeks in the womb. And this burrito sandwich whatever thing that Amita is describing is just a tiny tiny ball of cells. The embryo is

actually less than a millimetre at this point. That's half the size of a poppy seed. And by this point many women actually don't know what's cooking inside. They don't know they're pregnant. In fact, it's only once they've missed a period, sometimes weeks after the sperm has met the egg, that a woman might get a pregnancy test. Because it's often not entirely clear when a woman actually got pregnant, there's a couple of ways that researchers and doctors use to estimate how far along a pregnancy is. The most common one is called gestational age. And here, the clock on gestational age starts running

from the first day of the woman's last period, which means before she actually got pregnant. Imprecise, we know. But gestational age, that's what the docs use, that's what we'll use for the rest of the episode. Now, two-thirds of abortions in the US have happened within eight weeks from a woman's last period. By now, the embryo has grown up into a fetus and it's around 15 millimetres, roughly the size of a pumpkin seed.

And this pumpkin seed has some teeny tiny little organs, including a teeny tiny heart. It'll start out as a two-chamber muscle and then starts to become a three and then a four-chamber muscle. And it is moving. And once it starts moving quickly, that's when it starts pushing blood through the fetal body. You have a fully formed tiny little heart, four chambers, at the end of six weeks.

And when you say tiny little, how little are we talking? I mean, we're talking microscopic. And it can do that stuff. Yeah, it can do that stuff. It's kind of amazing. The heart is microscopic. You can't see it with the naked eye. And yet it's still pumping blood around the fetus's body.

It's kind of crazy that you can hear that heartbeat. Your baby probably has a beating heart, you know. Okay, so Juno got that heart thing right. He can feel pain. But can the fetus feel pain? Because this question comes up a lot, and not just in indie films featuring Michael Serra, but also in feisty cable news discussions, and when lawmakers create cut-offs for when a woman is too far along to get an abortion, whether a fetus can feel pain is a big part of the discussion. Bans on abortions at or before 20 weeks

have been enacted in over a dozen states. These bills are based on a theory that a fetus can feel pain at 20 weeks. So whether or not a fetus can feel pain is important, but it's a tricky question to answer because how can we really know? I need to view the fetus, unfortunately. No, you can't interview a fetus,

but there have been studies done in animals, brain scans, brain wave studies done on prematurely delivered babies, observation, dissection in like cadavers, things like that. So using these types of studies, Amita says that as best as science can tell, there are several steps that are needed for a fetus or anyone to feel pain. First, you need to have pain receptors, which are sensors that can detect something painful and then create an electrical pain signal. Second, you need to have nerve fibres that connect that pain signal to the spinal cord and up into the brain. Third, you need to have a brain that is developed enough to process that pain signal. So let's go through these. When do all of these things start happening?

When do the pain receptors start to form? So that's pretty early. Amita tells us that at around six weeks, nerve fibres start to be found in the skin. They can sense touch, vibration and temperature. But these early nerves can't sense pain. That's according to a detailed report on fetal pain and awareness published by the UK Royal College of Obstetricians and Gynaecologists. That report said that immature pain receptors start forming at 10 weeks or so. Until then, quote, pain is clearly not possible, end quote. By this point,

more than 80% of all abortions in the US have already happened. Amita says that all these receptors do is create an electrical signal that says pain. To actually feel pain, we need the wiring that can send those signals to the spinal cord and up into the brain. When do we get that wiring? Well, we know that from about 18 or 20 weeks, a fetus will respond if you accidentally poke it with a needle, which Amita says you might do, say, during a procedure called an amniocentesis. So for example, if you're doing an amniocentesis and you mistakenly hit the hand, the fetus will move the hand away.

Now, the fact that we even have this reflex response tells us that we probably have the circuitry to send those pain signals to the spinal cord and to the base of the brain called the brainstem. But to Amita, that reflex response is something sharp has hit and that it is bad and that that bad sensation is pain is not there. How can we be sure? Because we know that there's no cortex at that time. And we need the cortex to feel that pain. We need the cortex to understand that that is pain. You don't need the cortex for the reflexive action, but to understand that that is a bad thing and then that bad thing is pain,

you need the cortex for. Which brings us to the final stage of development that many researchers think is needed to be able to feel pain, our complex cortex, which is that thick, wrinkly part of the brain that most people think of when they think of a brain. You don't get real cortex until the end of the second trimester. And the completion of connections like through the midbrain, lower brain into the cortex

doesn't happen until 26 to 28 weeks. By now, the fetus is really getting along. Amita says at 24 weeks or around six months, the wiring is getting connected and those wires are fully hooked up by around 26 to 28 weeks. Now, this is why the Royal College of Obstetricians and Gynaecologists report, concluded that this, quote, implies pain is not possible until after 24 weeks, end quote. For context, according to the Centers for Disease Control and Prevention, 99% of abortions in the US have happened before this time. Conclusion, most abortions happen during the first two months and at that time the foetus is the size of a pumpkin seed

but it does have a very, very small heart which beats. When it comes to pain, the best evidence we have tells us that the foetus can't feel pain until at least 24 weeks of development, or six months. Now that we know how a fetus grows, let's find out exactly what an abortion is. For this, we're talking to Lisa Harris, a researcher at the University of Michigan, who's an obstetrician and gynecologist. And she performs abortion, which means she does get a bit of hate

mail. I jokingly call them love letters, but, you know, it's hate mail. There are actually a lot of touching responses that people are genuinely sort of worried about me, worried that, you know, I'll go to hell. And a lot of people pray for me as well. And I actually find that kind of beautiful and touching. So first, Lisa tells us the basics. Pregnancies are divided into trimesters, first, second and third. Each goes for about three months. Now, as we've mentioned, most abortions happen in the first trimester, those first 12 weeks. And Lisa tells us that there are two main ways that women can get an abortion at this early stage.

One is called a medication abortion. Here, a woman takes pills to terminate the pregnancy, and there are two kinds of pills that she'll need. The first is called mifepristone. You might have heard it called RU486. It blocks one of the hormones that is important for sustaining a pregnancy. The hormone that's being blocked is called progesterone. Progesterone tells the body, hey, we're pregnant, baby on board.

And mifepristone, the abortion drug, is kind of like progesterone's evil twin. It's almost identical to the hormone, but here's the critical difference. Mifepristone interferes with how progesterone works. Identical to the hormone, but here's the critical difference. Mifepristone interferes with how progesterone works. So progesterone doesn't tell the body, hey, you're preggers, baby on board. And instead, the body thinks, huh, I guess I must not be pregnant after all.

So that hormone progesterone doesn't work anymore and the pregnancy stops growing. And now you have to help your body get rid of the embryo slash fetus as well as the placenta and all the stuff around it. Or as Lisa calls it, the pregnancy. For this, you need a pill called misoprostol. Women can dissolve it just in their cheek, they can dissolve it in their vagina, they can swallow it. And this pill mimics the process of having a miscarriage. The uterus contracts and the cervix opens and there's a lot of cramping and bleeding and the pregnancy is expelled by the uterus. It's the same process that would happen if a woman was having a miscarriage at home. So that's the medication abortion. Now, these pills often get confused for birth control

and even the morning-after pill, also called Plan B. But they're actually quite different. Unlike a medication abortion, these pills are not shutting down a pregnancy. In fact, they don't even let the sperm get near the egg. Plan B will delay ovulation so the sperm can't reach the egg, while regular old birth control pills prevent ovulation entirely so the egg doesn't get released.

Now let's talk about that second kind of abortion that a woman can get in the first three months. It's when a doctor physically removes a pregnancy, and it's known as a surgical abortion. And let's get one thing straight right up the front. Although this is called a surgical abortion, there's actually no cutting involved. It's not like a C-section. A lot of people don't understand their anatomy, so don't understand that there is actually already a natural opening, that abortion doesn't involve cutting or opening any spaces that aren't already open. And that opening is the vagina. It's like a tunnel straight to the cervix,

which is like a trapdoor to the uterus. And that's where the fetus is coming out of. So when Lisa is doing an abortion, she has to open up the cervix. Some people use a medication to soften and open the cervix beforehand. Some people use these very gently tapered rods that are called dilators to open the cervix. And then once the cervix is open, Lisa can remove the pregnancy, and she can do it in a couple of ways. Many of the devices use suction, which can be just a handheld vacuum device that looks kind of like a big syringe, or instruments that are kind of like tongs or graspers, and a physician can reach in and remove the pregnancy that way. Lisa explained this process of removing the fetus to Science Versus reporter Heather Rogers.

How long does that take? Anywhere from 30 seconds to two minutes. Okay, that's not very long. No, it's really not. People imagine that, you know, it's a whole day of something happening in their body, and it's not. In most cases, it's very quick. If the pregnancy is in its first trimester, you can see the lining of the uterus when you take it out.

And then you would see something that looks like a tiny cotton ball, kind of a whitish, fluffy tissue. Then that's the placenta and the amniotic sac. You can't really see a fetus or fetal parts until about 10 weeks. So that's an abortion up to 12 weeks, and there can be medication or surgical abortions. But what happens for a woman who has a later abortion? Lisa told us that at this point, the fetus is too large to use suction,

so they have to use other instruments, like forceps. This is called dilation and evacuation, or DNA. And heads up, we are going to get detailed here. That involves using the instrument to reach into the uterus and remove the fetus. And generally, it is removed in parts, meaning it's dismembered during the process. And yeah, when it feels or looks like the uterus is empty, you're done. What do the parts look like? I know that's a really graphic question, but they look like very miniature baby parts, a very miniature human form.

And Lisa says that those posters that anti-abortion groups hold around abortion clinics, those photos in them can actually be pretty accurate. I drive by those images every day, and some days my work looks like that, really. I mean, most days it does not, because those images of later second trimester fetuses, those are the tiny minority of abortions. So most days in a typical abortion care center, there wouldn't be later abortions. But sometimes those images actually look kind of like my work today. And while Lisa does this on the reg, there are days that really stick out. She was about four months pregnant with her first child, and she gave an abortion to a woman who was about as pregnant as she was.

And while Lisa was performing the procedure, she felt her baby kick. It was one of the first times it had happened, and she told Heather that it really took her by surprise. It was a feeling that I could feel a fetus kicking, moving inside of me at the same time that I was removing a fetus. And it was something in that juxtaposition that was overwhelming, and I just found myself kind of crying. How did you wipe your tears away? Well, I couldn't because I had sterile gloves on and I was in the middle of a procedure. So they just rolled down my face.

You never had that experience before? I never had that experience before. And part of it, as I think about it now, I think I was so happy to be pregnant and so much wanted to be a mother. And I remember feeling just so privileged that I could be a mother and that I was getting ready with my family to welcome a child. And remember thinking what it meant that not everybody could do that for whatever reason. And remember just feeling fortunate. Now, the one kind of abortion that we haven't talked about yet are those that happen in the third trimester. That's after six months of pregnancy. These are extremely rare. The best statistic that we could find, which is from the CDC, is that 1.3% of abortions in the US happen after around five months. And we couldn't find any reliable studies on why women would get an abortion after that point.

An abortion clinic in Colorado says that these third trimester abortions, quote, are almost always, end quote, because some serious complication developed, mostly because the woman discovered that the fetus had some kind of serious abnormality. That said, the process of getting a third trimester abortion is similar to getting a second trimester one. Except the fetus is further along now. It's usually longer than nine inches by this point, which is around the length of an iPad. Just for context. Anyway, so in these third trimester abortions, you often have to inject the fetus with a drug that will stop its heart and then you often have to induce labour.

Sometimes these steps can happen in a second trimester abortion too. Conclusion. There are two types of abortion. Medication, i.e. taking pills, and surgical, that is, using suction and sometimes forceps. Neither type of abortion involves cutting a woman open. Alright, now we've got the lay of the land in terms of fetal development and what abortions actually are. After the break, we're heading to an abortion clinic in Texas to find out why women are getting abortions. And we'll tell you the risks of having an abortion. Because if you watch

some news, getting an abortion is a very risky business. Hemorrhaging to the point of needing a blood transfusion, perforation of the uterus, heart attack, death. There is a link between abortion and breast cancer. At least 14 women have died and more than 2,000 women have suffered complications. So what do women really risk when they get an abortion? Infertility? Breast cancer? That's coming up after the break.

So Breast cancer? That's coming up after the break. Welcome back. So we've learnt how abortions work. Now let's find out why women are getting them and the risks involved. Heather Rogers, our reporter, headed to an abortion clinic in San Antonio, Texas called Whole Women's Health. Hi, Heather. Hi, Wendy. So before we look into the studies on why women are getting abortions, can you just tell me a little bit about this clinic?

Like, who was in the waiting room? What age group are we talking about? It was surprising because most of the women in the waiting room when I was there definitely didn't look like teenagers. Like there were some teenagers there, but the women were older. I mean, they were in their 20s. Some looked to me definitely in their 30s. And there were even a couple who looked like they were in their 40s. Does that stack up with the data on this? So that does line up with the data that we found. And what that shows

is that most women who have abortions are in their 20s and 30s. And teenagers, they only make up about 12% of all the women who get abortions. How many of these women already had kids? 60%. 60% of women getting abortions in America are already moms. They're already moms. They already have kids. And did you get to speak to some women there? Yeah, I talked to a couple women. And why were they getting abortions? It was interesting. They were getting abortions because one woman told me she just wasn't ready to have a child. And the other woman told me that she already has a daughter and she's about to join the Air Force, and she doesn't have the money for it. It's expensive.

It's so much more expensive than people think, and it's so much more work than people think, and I just, I'm not ready for that right now. Again, I'm not. It's always hard when you go to one clinic, and do we know if this is representative of what's happening across America? Right, right. So like, does the specific represent the general? Exactly.

Right. So this clinic, it does actually in many ways, not in every way. So there's this study from 2013 that looked at almost a thousand women who wanted abortions and it found that 40% of them wanted abortions for financial reasons. So they had financial problems or they couldn't afford to support a child. And that was the biggest reason. That was the most common reason that women gave. Another common reason was that the timing wasn't right and they just weren't ready to care for a child. So there was also another reason. And almost a third of the women who got abortions, they got them for, quote unquote, partner-related reasons. What that means is that they didn't have a good or supportive relationship with the man who got them pregnant.

And in some cases, these men were physically abusive. So some women spoke to me. But then the clinic has these journals. And the women who come through who get abortions can write entries in those journals. And they let us flip through some of these journals. So you're going to hear Rachel Ward. She was with me. She's a producer here at Gimlet, and we went to Texas together.

This is not a baby. It's an embryo slash blood clot slash thick cell that can really alter a person's life. So this woman, she said she's never been faced with such a decision. She's been raised not believing in abortion and always preached to others that unless you were a victim of rape or having this baby would result in death, then it was not right. This is not your decision to make. Only God can take a life. The reason she's here is because she's a single mom of two children. She says that she does it and they live comfortably,

but she doesn't know if she can make it alone with three small kids. I will walk out of here and no longer be pregnant and go home and love my two babies just as much as I did before I walked into this place. I just hope that I'm still allowed to walk into heaven one day. May God see my pain and my struggle and may God be with me and you. And what about this religious aspect? You really don't hear a lot about women who say they are religious getting abortions. Yeah. So there's this data from the Guttmacher Institute, and it says that almost 25%, about a quarter of all women who get abortions. These are 2014 numbers identified as

Catholic. A quarter? Yeah, it's pretty surprising. And then in addition to that, 17 percent of women who got abortions that year identified as what they called mainline Protestant. And then 13 percent more identified as evangelical Protestant. Okay, so just to wrap a bow around this, what the science and the data is telling us is that all kinds of women get abortions, religious, not religious, and women are getting these abortions for a lot of complicated reasons, but one of the most common is that it's about the finances. They don't have enough money or having an unsupportive partner or saying that the timing just isn't right. That's right.

And so the next thing that you looked at in Texas was the risks involved in getting an abortion. So, you know, like any procedure you have, the doctor tells you what your risks are before you have the procedure. In Texas, there's a specific list, the doctor tells you what your risks are before you have the procedure. In Texas, there's a specific list, and this is true in other states as well. There's a specific list of risks that the doctor has to tell you about. And so before we actually get into the science behind those risks and how valid they are, can you kind of walk us through what that actually looks like in real life, like in the room? Yeah, yeah.

So when I was at this clinic in San Antonio, I got to follow around Dr. Bhavik Kumar, who's the abortion provider there. And so I got to see what he does when he's talking to patients. Can you tell me what you're doing today? We're doing procedures and seeing patients for medication abortions. And can you tell me, how do you do your hair? Well, I use a high heat blow dryer and then there's a pomade and then a quick hairspray. That's really nice. Thank you. Thanks. Babic let me follow him around as you met with different patients to talk to them about what was going to happen. And so when a woman comes in for the counseling, he goes in and looks at the sonogram

and he has to read the script that the state mandates. But he does it in this really interesting way. So he looks at the image, talks to the sonographer for a minute. So six weeks and three days is what we measured on the ultrasound size of the patient. And then he goes over to the corner of the room and he doesn't look at the patient, but he greets her. He doesn't look at her. He stands in the corner and he faces this, there's like a counter with a sink and he faces down at the sink and he's got her chart. And Bhavik starts reading the information that the state says he has to read. The state makes me describe the image and then they have a script that I have to read.

So I'm going to start seeing this stuff. And then after that, if you have any questions, we can talk about it. And it includes risks like infertility and breast cancer. It's rare to have problems with your fertility or future pregnancies. And some studies show an increased risk of breast cancer after abortion. Other studies have shown absolutely no increased risk whatsoever. Questions about any of that stuff? It just goes by super fast, like he just says it.

And it's almost like he says it kind of out of the corner of his mouth a little bit. And there's a reason that he isn't slowly and carefully going over this information with them. Just so that they know this is not for me and it's not something that I believe in, but it's something that I have to do. Bavik says that even just mentioning these risks is overstating them. For example, just by saying the word infertility, just that can freak people out. The infertility part is super rare. And just saying that before your procedure makes people scared that they may not be able to have children in the future. And that's usually the number one question that people ask after that is like, how true is that? So that's what we saw and heard in one clinic.

Right. So let's leave Texas and Heather. Bye Heather. Bye Wendy. And dig into the science. Let's start with this question of infertility. Does an abortion increase your risk of becoming infertile? Well, according to the UK's College of Obstetricians and Gynaecologists, if you have an abortion in a safe and legal setting, then there is, quote, no proven association, end quote, with infertility. Interestingly, when it comes to complications with having children in the future, some research has found a link between having an abortion

and an increased risk of having a premature birth. Now, more recent studies have since come along and not found that risk. So perhaps the way that abortions were conducted in the past did slightly increase the risk of having a preemie baby? Maybe they still do. Okay, so that's the risks when it comes to having kids, if you want to later. And then there's that breast cancer line. And some studies show an increased risk of breast cancer after abortion.

Other studies have shown absolutely no increased risk whatsoever. Now, you can find studies that show that women who have an abortion have an increased risk of getting breast cancer. But you can also find studies that don't. So to get the most consistent and accurate findings, you really have to combine studies. One analysis from 10 years ago did just that. They looked at 53 studies, which included 83,000 women with breast cancer, and found that getting an abortion does not increase a woman's risk of developing breast cancer. Another paper published just a couple of years ago looking at 15 studies found the same thing. Now, there's something we haven't mentioned yet, which is that according to Texas law, a woman must be given a booklet that state health officials say outlines the risks of abortion.

The first thing on that booklet's list is death. Now, there is an incredibly small risk of death from an abortion, but according to an analysis of CDC data, a woman is about 14 times more likely to die from childbirth than from an abortion. Researchers have also found that an abortion is safer than many common medical procedures. Like, you're more likely to die from some dental procedures and even plastic surgery than having an abortion. So, away from the very, very, very rare risks, what are some side effects that a woman can expect after an abortion. Cramping, stomach pain and bleeding are common, and very rarely women can actually bleed quite a lot to the point where they could be hospitalised.

Women can also get an infection. In a finished study of more than 42,000 women six weeks after their abortions, 1.7% of them got an infection. Conclusion. There are some short-term common side effects from abortions, but the best evidence we have is that women don't get breast cancer from abortions, abortions are safer than childbirth and even some dental procedures. And studies have not found an association between getting an abortion and becoming infertile.

All right, our final question. What about the effects of having an abortion on a woman's life? Will getting an abortion increase her risk of depression? Will it ruin her life? Because we hear about this story a lot in TV and in politics. In fact, this idea has become so common that it's even got its own name, post-abortion syndrome. And that's why when you think of someone who's had an abortion,

maybe you're thinking of women like this. I went through depression after that. And the grief and the guilt began immediately. I honestly feel like it was the worst mistake I ever made in my life. And I know that I'm going to think about this every day. And I wish more than anything I wouldn't have done it. So that is these women's personal experience. But how common is it?

How likely is it that if you're planning on getting an abortion, you'll be left with some kind of post-abortion syndrome? Well, a really interesting study was started in 2008 where scientists followed several hundred women from 30 clinics around the US and they'd had different experiences with abortion. where scientists followed several hundred women from 30 clinics around the US, and they'd had different experiences with abortion. And they followed these women for five years.

The scientist who started this project is Diana Green Foster, a researcher at the University of California, San Francisco. And her study is called the Turnaway Study. So the Turnaway Study is the first study to look for American women of what the experience of having an abortion is compared to carrying an unwanted pregnancy to term. When you're at a dinner party, what do you tell people you research? Women's health. Because I am so not interested in hearing random people's abortion stories.

So all of the women in Diana's turn-away study wanted an abortion, but one group got them and the other didn't. They were turned away because their pregnancies were too far along so their provider wouldn't do the abortion. Diana and her team studied the two groups, the women who got abortions and those who had the babies. And she followed them up, asking questions about their lives. She asked the women why they wanted the abortion, but also about...

Depression, anxiety, a whole bunch of economic questions, questions about the relationship with the man involved in the pregnancy, including questions about violence from intimate partners. And several years later, Diana tracked how the women's answers had changed over time. And she found... No evidence of mental health harms that might emerge from having had an abortion. So it's just not a mental health story.

That is, over five years, the women who got abortions had similar levels of depression, post-traumatic stress disorder and anxiety compared to those who didn't. And Diana's study isn't the only one to find this. A Finnish paper that was published last year of more than 1,000 women under 18 who got pregnant found no significant psychiatric differences between the women who got abortions and those who didn't seven years later. As for the idea that many women regret their decisions and feel guilty about what they've done, Diana wrote that this was, quote, unfounded, end quote. She found that after three years, the typical woman in her study had more than a 95% chance of reporting that the abortion was

right for her. And two years later, she says, that feeling stuck. Over five years, women who get abortions remain relieved and feel like they made the right decision in having an abortion. So while individuals might have different experiences, the research tells us that a woman's risk of mental health problems is the same, whether she had the initially unwanted baby or not. But differences have been found between women who get abortions and those who don't but wanted one. So, for example, in Diana's study,

while she hasn't published this data yet, preliminary results showed that women who had the baby were... Less likely to be employed full-time, more likely to receive public assistance, but also more likely to be in poverty. And four years down the track, women who didn't get the abortions that they wanted were less able to

make ends meet. Now, when we look back to that Finnish study, we kind of found the same thing, that women who got abortions were more likely to be better off financially and be better educated by the time they were 25 compared to those who gave birth. Now, the research doesn't say that the abortion was the only reason why these women were better off in terms of education, employment and finance, but it does seem to play a role here. Diana also found that for the relatively small group of women who wanted an abortion because they were in an abusive relationship with the father and then they couldn't get one, those women were more likely to still be in that abusive relationship two and a half years later.

And we find that violence from the man involved in the pregnancy declines precipitously for women who have the abortion. And that's because they have broken ties with that person. And to Diana, her study shows that women are realistic about their reasons for getting an abortion. So many of the things that they worry might happen if they're not able to get one, it turns out, actually sometimes happen. And women were right. They knew what to expect. You know, having an abortion is probably not fun at all. And they made the decision to do this stigmatized thing because they looked at their lives and realized they weren't ready for a baby. When you look at pop culture, have you ever watched a movie or a television show about a woman who had an abortion and just thought, my study says the exact opposite thing happens?

I'm so not a pop culture person that I couldn't even tell you when I last saw a movie that had abortion in it. It might have been Dirty Dancing. That's how old and out of touch I am. Conclusion. On average, women who have an abortion

are not at a higher risk for depression or anxiety than women who don't. But when women don't get an abortion that they want, the research shows they have less money, less education and probably less job opportunities. So, when it comes to science versus abortion, do the fears and the outcry stack up? Here's what we know. The majority of women in America have abortions in the first trimester, when the fetus has a heart and is

around the size of a pumpkin seed. In 99% of abortions given in the US, those fetuses probably don't feel pain. As best as science can tell, fetuses can't feel pain until at least 24 weeks or about six months. Abortions don't involve any cutting. It's either pills or suction and potentially forceps. And when it comes to the risks, the best evidence tells us that abortions do not increase a chance of a woman getting breast cancer or being infertile. Most likely, she will get cramps and she will bleed.

And what about guilt or depression? Well, while some women who get an abortion may feel guilty and depressed after, the science tells us the majority do not. And women who get an abortion that they want are not more likely to experience depression than women who have their babies. That's science versus abortion.

This episode has been produced by Heather Rogers, me, Ben Keprick, Rachel Ward and Shruti Ravindran. Caitlin Sawry is our senior producer. We're edited by Annie Rose Strasser, fact-checking by Michelle Harris and Ben Kebrick. Extra help with production and editorial from Rachel Ward, Alex Bloomberg and Jorge Just. Music production and original music by Bobby Lord.

Thanks to Lola Pellegrino, Ronnie Shankar, Dr Diane Horvath-Cosper, Rachel Jones, Elizabeth Nash, Dr Yoonjin Kim, Delma Limones and Gilda Sedge. Also, thanks to Katie Bishop and Reverend David Gushy. Next week, we're diving into coffee, wine and chocolate. One day they're good for you, the next day they're bad for you. What can science tell us about our favourite treats? Wine is good for your health.

Wine and chocolate. I'm Wendy Zuckerman. Back to you next time.