For decades, anti-abortion activists have argued that abortion is harmful to women, claiming that it often leads to regret, mental health issues and dependence on drugs and alcohol. Even former Supreme Court Justice Anthony Kennedy bought into this reasoning, writing in 2007 that those who have abortions may experience “severe depression” and a loss of self-esteem.
That thinking has been used to justify onerous abortion restrictions, such as long waiting periods, that can make it harder to obtain the procedure and even effectively bar it for some.
But does abortion actually harm women? And what of those who are denied a desired abortion? How might their mental health be impacted by a forced pregnancy? These questions are at the heart of research done by Diana Greene Foster, a professor at the University of California, San Francisco in the obstetrics, gynecology and reproductive sciences department.
Foster has spent the past 10 years investigating the outcomes for women who had or were denied abortions, tracking their emotional, physical and economic health. To get the most accurate picture, she compared women who obtained an abortion just before the gestational deadline to women who were too late to the clinic and were turned away. The difference between the two groups was often a matter of days.
The results of Foster’s study, aptly named The Turnaway Study, were recently published in a book with the same title. Among her findings: Abortion did not increase women’s risk of having suicidal thoughts or their chances of developing post-traumatic stress disorder, depression, anxiety, low self-esteem or lower life satisfaction. Nor did it increase women’s use of alcohol, tobacco or drugs. Women who got the abortions they wanted were more likely to have a positive outlook on the future; 95% said abortion was the right decision for them.
The outlook for women who were denied an abortion was less cheery. They were more likely to live below the federal poverty level and to be unemployed. They struggled more than their counterparts to afford basic necessities like food, housing and transportation. They were more likely to stay in contact with violent partners. And they experienced more serious health problems.
Foster’s findings are particularly relevant now, as the coronavirus pandemic, the economic downturn and ongoing efforts to restrict abortion access have made the procedure even more difficult for many to obtain.
HuffPost’s interview with Foster has been edited for clarity and length.
Why did you begin this project?
It really came from wanting to test the idea that abortion hurts women, which is an idea that is circulated widely and promoted by anti-abortion advocates. It is important not just to ask the question of whether abortion hurts women, but also how does restricting access to abortion affect women? There have been hundreds of restrictions in just the past 10 years. So, knowing and understanding the effect of those seems extremely important.
How was the study conducted? It sounds like you relied on clinic staff to connect you to patients.
Exactly. If they were going to turn a woman away, they would give her all the normal counseling and then say, “By the way, there’s a study out of UCSF which will ask you about your health and well-being for the next five years. Might you be interested?” If the woman said yes, they would put them on the phone with us.
Then they would approach the next two women who received an abortion just under the gestational limit to see if they would participate. We followed them over time to ask them about their physical health, mental health, economic well-being and achievement of other life plans.
The leading cause of showing up to a clinic later in pregnancy is not realizing you’re pregnant. That can be a marker of a chaotic life, but it also can happen to lots of people, like women who just had a baby, young women who’ve never had regular periods, women with chronic health conditions that have similar symptoms as for pregnancy.
[Entering the study, the groups of those who received abortions and those who didn’t] were very similar. They don’t have different emotional profiles.
Why did women say they were seeking abortions?
The reasons women sought abortions in this study are very similar to national data on why women have abortions: They didn’t have enough money, had partner-related reasons, needed to focus on other kids, or they believed it would interfere with other future opportunities.
What was surprising was not the reasons they gave, but how prescient they were in predicting the outcome of the people who were denied. So they’re worried about not being financially prepared, and we see that they become poor. They worry that their relationship isn’t strong enough to support a child, and we see that relationships dissolve whether or not they have the baby. They say they need to focus on other kids, and we see that their existing kids do worse when they are denied an abortion than receive it.
One of the main goals of the study was to find out if abortion hurts women. Does it?
No. We don’t find evidence of any systematic pattern of worse mental health for women who receive an abortion compared to those who are denied. We don’t find evidence that abortion hurts women, but there are several ways in which being denied an abortion hurts women.
When the government takes an active role in trying to prevent people from getting abortions, it has serious consequences for their lives ― for their physical health, for their economic well-being and for their life trajectory. This meddling in people’s decision-making is really short-sighted. They’re focused on this one pregnancy and not the woman’s well-being or her existing children.
One of the interesting findings was about domestic violence. Can you elaborate on that?
One in 20 women had reported that they experienced violence from the man involved in the pregnancy in the months prior to becoming pregnant. The difference between women who receive an abortion and those who are denied is that those who receive an abortion see a sharp drop-off in exposure to that guy, whereas the women who don’t receive an abortion have ongoing contact and a higher risk of experiencing violence. Over time, the relationships dissolve and eventually the women extricate themselves, but it is years of continued violence, whereas getting an abortion might have enabled her to get away.
What was the most surprising thing you found?
The most surprising thing was that two women denied abortions died from childbirth and pregnancy, which is a shockingly high rate of maternal mortality, much higher than we would have expected, and a total tragedy.
The other thing that was surprising was just how widespread the effects are. It’s not just the woman’s life, it’s her kids, it’s her future kids, it’s her relationships.
Was there anything that came up in this study that you did not get to research thoroughly or that you think deserves more research?
I wish we’d asked about whether people were trans men. We had the inclusion criteria of just pregnant women so I don’t know if there were trans men who would have participated but didn’t think they were eligible. We also restricted the study to exclude people seeking abortions for fetal anomaly. I should have included them just to understand more about their experience. It’s a separate study, but it really should be done.
How do you hope your research is used?
Our debate about abortion is too abstract. We don’t consider the real people who are involved in it. I would love for people to read the book to have a little glimpse into the lives of people who are in the position of being pregnant when they don’t want to be. There are clear policy implications of putting restrictions in place that slow people down and prevent them from being able to get an abortion if they feel like they need one. I’d like to see a little more compassion.