Harms of abortion denial

Just a couple weeks ago, a judge struck down a Tennessee law that forced women to wait 48 hours before receiving an abortion, calling the mandatory waiting period “gratuitously demeaning to women.” That victory relied heavily on data from the landmark Turnaway Study.

“I can’t overstate how critical the Turnaway data has been on litigation,” said Amy Myrick, a senior staff attorney at the Center for Reproductive Rights, during a Tuesday Annual Meeting Session on “Consequences of Abortion Received and Denied: The Turnaway Study.”

The largest study to examine women’s experiences with abortion and unwanted pregnancy in the U.S., the Turnaway Study began in 2008, recruiting participants from 30 abortion facilities around the nation. The study sample included both women who received abortions because they sought care while still under the gestational limit and women who were turned away and carried to term because they were beyond the gestational limit to receive an abortion. Researchers with the study — an effort of the Advancing New Standards in Reproductive Health program at the University of California-San Francisco — then followed participants over five years.

A major finding? The overwhelming majority of women said abortion was the right decision for them even five years later. Also, receiving an abortion was not associated with mental health harms — a common claim by those who oppose and restrict reproductive rights — and, in fact, it’s the denial of abortion services that actually harms women.

The study found that one week after having an abortion, the chances that a woman felt like it was the right decision was higher than 97%. Five years later, that likelihood went up to 99%.

“Women can make these decisions for themselves,” said session presenter Diana Foster, the study’s principal investigator.

During the session, Foster offered a recent update on the Turnaway Study, findings from which were first unveiled in 2012 at the APHA Annual Meeting. Since then, the study has resulted in 50 published papers in 21 peer-reviewed journals as well as a recently published book, “The Turnaway Study: Ten Years, A Thousand Women, and the Consequences of Having or Being Denied an Abortion,” which Foster said she wrote to raise awareness among the general public.

The Turnaway Study found no evidence that having an abortion hurts women, especially when it comes to mental health, Foster reported. However, women denied an abortion did report worse initial mental health outcomes, such as higher anxiety and lower self-esteem. Over time, both groups of women showed improvements in mental health and eventually stopped thinking about the abortion at all.

Regarding physical health, women denied an abortion experienced more life-threatening complications than women who received an abortion and were more likely to report being in fair or poor health. Two women denied abortion during the study died due to complications of pregnancy and childbirth, Foster reported.

Women denied an abortion who carried an unwanted pregnancy to full term also had greater odds of living in poverty and faced greater hardships trying to provide for their children, compared to women who did receive an abortion. Women denied abortion for an unwanted pregnancy were also more likely to stay in contact with violent partners, putting themselves and their children at greater risk.

Over time, abortion doesn’t help or harm women’s mental well-being, Foster told session attendees, but the procedure is associated with improved financial circumstances, aspirational goals, physical health, and the ability to care for existing and future children.

Myrick, at the Center for Reproductive Rights, told attendees that the landmark study has been essential in the courts, where advocates face a never-ending litany of attempts to eliminate and restrict abortion rights. (And advocates are readying for a seismic shift in abortion access after this week’s new confirmation to the Supreme Court.) In particular, she said Turnaway provides lawyers like herself real data to counter the cherry-picked anecdotes often used to justify abortion restrictions as somehow beneficial to women’s health.

For example, prior to Turnaway, it was more difficult to show that mandatory waiting periods for abortion provided no benefits to women and posed an unnecessary burden to accessing abortion services. However, Turnaway — which was specifically designed to compare women who seek and receive abortion to those who seek and are denied one — found waiting periods offered no benefit to women’s well-being at all.

Looking forward, Myrick said evidence on the burdens and harms of abortion denial will be more critical than ever.

“We’re at a challenging moment,” she said. “And this data is so critical.”

Visit the Turnaway Study to learn more.