In the US, there are many laws limiting when and how women can receive abortions. But there is almost no research on what happens to women who seek out abortions and are denied them. Now a team of health researchers at the University of California, San Francisco has completed a longitudinal study of a group they call "Turnaways," women who tried and failed to get abortions due to local laws. The researchers found that women who received abortions were over six times as likely to have and achieve positive life plans than Turnaways.

The Turnaway study

To gather their unusual Turnaway data set, the researchers spent two years interviewing 956 women who sought abortions at 30 different abortion clinics around the US. 182 of them were turned away. All the women were interviewed a week after being turned away or receiving an abortion and then again a year later to assess the longer-term outcomes of their experiences. The team has also just completed interviews with the women that will reveal where they are five years after being turned away or not.

In its first analysis of turnaway data published two years ago, the team found that women seek out abortions for complicated reasons, with the most common being a feeling of financial unpreparedness. This earlier analysis also showed that 86 percent of turnaways chose to keep their children, and 67 percent of them wound up below the poverty line a year later. By comparison, 56 percent of women granted abortions in the study were below the poverty line a year later. This finding lent credibility to many turnaways' concerns that being financially unprepared would cause problems down the line.

It also raised another question. Turnaways often said they wanted abortions because they felt that having a child would "interfere with their future plans." Researcher Ushma Upadhyay wanted to know what this meant and whether it was true, so she led a team in a new analysis of the data. They sought to find out how turnaways planned for the future and whether they carried through on those plans. Upadhyay and her colleagues detailed their findings in a recent paper published in BMC Women's Health.

Loss of hope

One of the most difficult parts of doing this research was sifting through the interviews with turnaways, trying to figure out what their goals were and determining if it would even be possible to measure if they had reached the goals. Women in the study were asked what they thought their life would be like in a year, and Upadhyay told Ars that her team had to disqualify many vague answers like "in a more stable place" or "happier." It's impossible to quantify whether someone has become "more stable," since stability is a very subjective idea.

Ultimately, they were able to quantify 1,304 one-year plans from 757 of the study's participants. These included concrete plans for finances, education, and relationships. Upadhyay and her team classified whether the goals were aspirational, neutral, or negative. An aspirational plan might be a positive statement like "I'm going to have a better job," while a negative plan would be "I expect I'll be much more stressed with another child in the house."

Only 53 percent of the goals were aspirational among turnaways. Women who received abortions had roughly 85 percent aspirational plans. Women who had children but did not parent them had 80 percent aspirational plans. The upshot was that turnaways who kept their children had far fewer positive goals for the future than their counterparts who received abortions.

Of all the goals measured, 47 percent were achieved. There was little difference between turnaways and women who had abortions when it came to achieving their goals. However, as the researchers write in their paper, women who received abortions "were significantly more likely to have both an aspirational plan and to have achieved it" than turnaways who kept their children. Upadhyay was quick to point out that overall, most of the women's goals were aspirational. "They all had high hopes," she said. But Turnaways "were much more likely to have negative goals."

What this latest phase in the Turnaway study reveals is that not having access to abortion can negatively impact women's lives. As Upadhyay and her colleagues put it in their paper, "Whether or not a person has aspirational plans is indicative of her hope for the future. Without such plans or hopes, she misses out on opportunities to achieve milestones in life."

Put bluntly, the Turnaways had fewer hopes, so they had fewer reasons to push themselves toward what they defined as better lives.

Given the current political climate in the US, it's difficult for Turnaways to be heard in debates on this issue. But using the Turnaway studies, policymakers have an opportunity to reframe abortion as a public health issue for women who are suffering in measurable ways when they are not given an opportunity to choose the time when they will raise their children. The researchers believe that their work can help bring much-needed empirical evidence to health policies that govern abortion.

BMC Women's Health, 2015. DOI: 10.1186/s12905-015-0259-1