Short Wave - The Turnaway Study: What The Research Says About Abortion

Episode Date: May 9, 2022

A leaked draft opinion in the Supreme Court case Dobbs v. Jackson Women's Health Organization has placed uncertainty on the future of abortion rights in the United States. As written, the opinion would overturn Roe v. Wade protections. We at Short Wave were immediately curious about the data behind abortions: What happens when pregnant people are denied abortions? For answers, we turned to Dr. Diana Greene Foster, the lead researcher on the interdisciplinary team behind The Turnaway Study. For over a decade, she and her fellow researchers followed just under a thousand women who sought an abortion across 21 states. These data may give us insight into pregnant people's lives in a post Roe v. Wade United States. - Read more about The Turnaway Study on UCSF's website: https://bit.ly/3P1tV8B- Read the research resulting from The Turnaway Study: https://bit.ly/3KNAit8- Read Dr. Foster's book, The Turnaway Study: Ten Years, a Thousand Women, and the Consequences of Having — or Being Denied — an Abortion: https://bit.ly/3si0i9zSee pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. A draft Supreme Court opinion that would overturn Roe v. Wade, the case that protects the right to an abortion, leaked last week. And as news spread, a crowd formed outside of the Supreme Court building here in D.C. Our colleagues at all things considered went to the steps. The emotions surrounding abortion were and are high. We at Shortwave, well, we'd, turned immediately to the research. Specifically, the turnaway study, led by Dr. Diana Green Foster.

It's the first U.S. study to, quote, rigorously examine the effects of getting versus being denied, a wanted abortion, on women and their children. We talk to people to hear about how they're doing. To actually know how people are feeling, you need to talk to them. And unlike previous studies, this focused on women's well-being, not on the children's well-being, although we did collect data. on those outcomes too. And this study happened while abortion access was being actively debated in the courts. Back in 2007, Supreme Court Justice Anthony Kennedy wrote the majority opinion for Gonzalez v. Carhart. In the majority decision, which said, no, you can't do that procedure anymore, Justice Anthony Kennedy said, quote,

While we find no reliable data to measure the phenomenon, it seems unexceptionable to conclude 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, end quote. And Dr. Foster's reaction to that? You can't make policy based on assumptions of what seems reasonable without talking to a representative sample of people who actually wanted an abortion. And if you think people might be depressed if they get an abortion, well, then you really need to know what happens if they wanted an abortion and couldn't get one. So that's exactly what Dr. Foster and her interdisciplinary team of researchers set out to do to ask women these questions. Today, we take an up-close look at the turnaway study, how it was done, what it found, and what it means for today's conversation about abortion. I'm Emily Kwong, and you're listening to Shortwave, the Daily Science podcast from NPR.

Dr. Diana Greenfoster is a demographer by training. That's someone who, as she puts it, quote, is good at statistics and cares about people's outcomes. Demographers, studied birth, death, migration. And in looking at abortion, the turnaway study was the first of its kind in the U.S. For over a decade, it tracked the lives of just under 1,000 women who all saw abortion care. Dr. Foster and her team recruited participants from 30 facilities in 21 states across the U.S. In 2007, when I started this study, I specified that the eligibility criteria pregnant women. And so when I talk about the study, I use the word women. But I think the experiences

of trans men and non-binary people might show even greater hardships in accessing care. The women who participated in the study fell into a few groups. Broadly, they got the abortion they sought because they were under the cutoff window for their state, or they were turned away and were denied an abortion. They closely resembled the population of people seeking abortions. They closely resembled the population of people seeking abortions nationally. So 60% of the women were already mothers. About half were in their 20s, which is typical. About three quarters were already below the federal poverty level. At the time they were seeking an abortion. So to summarize, the typical study participant was just like the typical abortion seeker, already a mom in her

20s and living below the federal poverty line. And the only real difference is that they tended to be later in pregnancy because we recruited them right up near the gestational limit. And for the next five years, Diana and her team called up these study participants every six months. In those phone calls, they checked in on a range of outcomes, like their health, their economic well-being, and how they felt about their decision. And I think I had an idea before I started this study that people seeking abortion later in pregnancy would somehow be, different, and that turned out to be completely false, with the exception that they tended to have been a lot later in realizing they were pregnant. And that can happen to people when they don't have pregnancy symptoms, when they have a chronic health condition with symptoms that are in common

with pregnancy, when they were using contraception in the month they conceived, and so they thought they were protected, and so they didn't realize they were pregnant. And let's just state, around 90% of women who seek an abortion do so in their first trimester. Your study found that those who seek an abortion in their second trimester did so for a few reasons. It was because they found out about their pregnancy late, like you just said, or because they experienced real obstacles to getting an abortion earlier. What were some of those obstacles? When we ask people what slowed them down, the leading reason is that they needed to take time to raise the money to either pay for the procedure or pay for travel.

Laws around abortion seem designed to slow people down. For example, we have laws that say that private insurance and public insurance can't cover an abortion procedure. So then there's this medical expenditure that people have to pay out of pocket and they take time to raise that money pushing the abortion later. We even have mandatory waiting periods. So those, like, by definition, slow people down. So we do not have a streamlined legal approach to having people get their abortions. And there are huge areas of the United States without abortion providers. So the study, part of what makes it unique is that it looks at women who were denied, who were turned away. What did you learn about their lives after five years of follow-up conversations?

We see a couple areas where their lives dramatically diverge. in outcomes. The first is health. So consistent with the medical literature, carrying a pregnancy to term and delivering a child is much more physically risky than having an abortion, even a later abortion. We see much more severe physical health complications from birth, including, most tragically, two women who died after delivery. One died of an infection and one died of a very common pregnancy complication. The other area that we see big differences is in socioeconomic well-being. This is not just about poverty, although we see that people who are denied abortions are more likely to live in households where there just isn't enough money for basic living needs.

And they're more likely to be raising children alone if they are denied the abortion than if they receive one. They're equally likely to be in a relationship. whether they received or were denied an abortion. But those who receive the abortion report that their relationship is higher quality. So it's changing the fundamental aspects of people's lives. When somebody receives an abortion, they're more likely to be able to have a subsequent pregnancy under better circumstances. Do we see better maternal bonding with that child and better economic circumstances? So more likely to live above the, the poverty level and with enough money for basic living needs.

For those women who were able to get an abortion, who you followed in the turnaway study, what did you and your fellow researchers find about them? We see better mental health initially for the people who receive an abortion compared to those who are denied it. And for both groups, improving mental health over time. We asked people about six emotions, happiness, sadness, regret, relief, anger, and guilt. And we asked how often they were feeling these emotions over time. And then also how often they were thinking about the abortion over time.

And what we learned is that positive emotions outweigh negative emotions, but a substantial number of people do have negative emotions about it. People can experience the emotion regret and still feel. like they made the right decision about having an abortion. So I regret that I was in the position where I needed an abortion, but given that I was, I'm glad I had it. And they can feel sad, and sad is different than depressed. So people have a range of emotional responses. And over time, people say that having strong positive emotions and strong negative emotions, both of those reduce over time. And people tell us that they stop thinking about abortion. One woman told us, Only think about it when you call me for these interviews.

Wow. So this idea that somehow this event is somehow disrupting people's lives forever, that is not accurate for the vast majority of people. This is something that people say they needed to do and they did it and moved on with their lives. Your group found that over 95% of the women who received an abortion and did an interview five years out said, it had been the right choice for them. That's right. How do you react to that? It's reassuring that people can make decisions for themselves.

And I'm glad that people don't experience widespread regret about this because it's clearly something you can't undo. But the other thing that gives me hope, besides from people feeling that they made the right decision, is that when we ask people, there are reasons for abortion. those concerns are exactly the outcomes that people experience when they're denied in abortion. So when we ask them, why did you want an abortion? They say, I can't afford to have a child right now. And we see that their economic outcomes are much more tenuous if they're denied an abortion.

They say, I want to take care of the child I already have. And we see the outcomes for that child are worse if they're denied an abortion. They say that the relationship isn't good enough with the management. involved in the pregnancy, and we see those relationships dissolve regardless of whether the woman received the abortion or not. So people are making careful decisions because they understand the circumstances of their lives. This research, it doesn't happen in a vacuum at all. The Supreme Court cases like Roe v. Wade, they are centering on questions about bodily autonomy, women's reproductive health.

what does this body of research add to this discussion right now? What the turnaway study shows is that people who become pregnant and are unable to get a safe legal abortion in their state will experience long-term physical health and economic harm. You know, we haven't become a more generous country that supports low-income mothers. And I think what the turnaway study doesn't answer about the current time, is that many people will manage to circumvent their state laws, and they won't carry that pregnancy to term. And they'll travel or they'll order medication abortion pills online,

and they'll manage to get an abortion. And some people will try dangerous things and potentially harm themselves. So we really don't know the full effect of this decision. It's very likely to further existing inequities. So very young women won't be able to travel out of state. People without computers won't order pills online. Poor people won't be able to afford all of that. And so this decision will disproportionately hurt people who are already disadvantaged.

I have one last question, which is more just personal. Just wanted to know how this week has been for you. I've never been so popular with the media. But it's not something I cherish. I wish that this study wasn't relevant anymore. And I also wish that when we talked about abortion, it wasn't abstract and ideological and what is this going to do, the midterm elections.

I wish that when we talked about it, that we thought about the people that were going to be affected and viewed them as human beings, who are trying to take care of their families and trying to take care of themselves and are trying to make good decisions and that when we circumvent their decisions, their outcomes are worse so that there are people whose life course is at stake here. Dr. Foster, thank you so much for coming on Shortwave and for talking about this research you led with us.

Thank you so much. We're going to leave links in our episode notes to a few things, to the studies that resulted from this work, as well as Dr. Foster, 's book, The Turnaway Study. Ten years, a thousand women, and the consequences of having or being denied in abortion. Today's episode was produced by Rebecca Ramirez. It was edited by Giselle Grayson, who is our senior supervising editor. Rebecca Ramirez also checked the facts.

Gilly Moon was the audio engineer. Special thanks to our colleagues, Lauren Hodges, Adrian Florido, and Sammy Yannigan at all things considered. I'm Emily Kwong. Thank you for listening to Shortwave, the Daily Science Podcast from NPR.