Abortion is a hotly debated and poorly studied medical procedure. There are a few studies of dubious validity that connect abortion to mental illness and drug use. Politicians have used these studies to justify greater limitations on women seeking abortion in the United States.


There has been no sustained effort to study what happens to women who want abortions but can't get them due to restrictive rules. Until now. These women are called turnaways. A new longitudinal study reveals what happens to their economic position, health, and relationship status after seeking an abortion and being denied it.


AP Photo by Peter Morrison

Public health researchers with the UC San Francisco group Advancing New Standards in Reproductive Health (ANSIRH) used data from 956 women who sought abortions at 30 different abortion clinics around the U.S. 182 of them were turned away. The researchers, led by Diana Greene Foster, followed and did intensive interviews with these women, who ran the gamut of abortion experiences. Some obtained abortions easily, for some it was a struggle to get them, and some were denied abortions because their pregnancies had lasted a few days beyond the gestational limits of their local clinics. Two weeks ago, the research group presented what they'd learned after two years of the planned five-year, longitudinal "Turnaway Study" at the recent American Public Health Association conference in San Francisco.

Here's the short version of what they discovered, from a post they made on the Global Turnaway Study Facebook page:

We have found that there are no mental health consequences of abortion compared to carrying an unwanted pregnancy to term. There are other interesting findings: even later abortion is safer than childbirth and women who carried an unwanted pregnancy to term are three times more likely than women who receive an abortion to be below the poverty level two years later.


Below, you can find the longer, more complex version of the story. I spoke with Foster about the groups' preliminary findings.

Poverty

The women in the Turnaway Study were in comparable economic positions at the time they sought abortions. 45% were on public assistance and two-thirds had household incomes below the federal poverty level. One of the main reasons women cite for wanting to abort is money, and based on the outcomes for the turnaways, it seems they are right.


Most of the women who were denied an abortion, 86%, were living with their babies a year later. Only 11% had put them up for adoption. Also a year later, they were far more likely to be on public assistance — 76% of the turnaways were on the dole, as opposed to 44% of those who got abortions. 67% percent of the turnaways were below the poverty line (vs. 56% of the women who got abortions), and only 48% had a full time job (vs. 58% of the women who got abortions).

When a woman is denied the abortion she wants, she is statistically more likely to wind up unemployed, on public assistance, and below the poverty line. Another conclusion we could draw is that denying women abortions places more burden on the state because of these new mothers' increased reliance on public assistance programs.


Violence and Drug Use

In the Turnaway Study, the researchers could find no statistically significant differences in drug use between women who get abortions and women who don't. There appears to be no correlation between abortion and increased drug use. One interesting bit of data they did find was that drug users who couldn't get abortions were more likely to give their babies up for adoption.


Unfortunately, when it comes to domestic violence, being denied an abortion makes a really big difference. Turnaways were more likely to stay in a relationship with an abusive partner than women who got abortions. A year after being denied an abortion, 7% reported an incident of domestic violence in the last six months. 3% of women who received abortions reported domestic violence in the same time period. Foster emphasized that this wasn't because the turnaways were more likely to get into abusive relationships. It was simply that getting abortions allowed women to get out of such relationships more easily. So it's likely that these numbers actually reflect a dropoff in domestic violence for women who get abortions, rather than a rise among turnaways.

This pattern of violence is also part of a larger pattern that shows turnaways are more likely to remain connected to the fathers of their children. Obviously, this isn't always a good thing, as the violence statistics reveal. But even in the vast majority of cases where violence isn't involved, Foster noted that these men aren't living with the turnaways. The researchers asked women about cohabiting with partners, and found that men were no more likely to live with a turnaway who'd borne their children than they were to live with a woman who had an abortion. "The man doesn't stick around just because you have the baby — that's the crude way of putting it," Foster said.


Emotions

One of the biggest concerns about abortion is that it causes emotional problems that lead to clinical depression. The Turnaway Study looked at that question from two angles: how did turnaways and women who got abortions feel; and did they become clinically depressed. "It's important to remember that how you feel is a separate question from whether you have a mental health problem," Foster said. We'll look at women's emotions here, and discuss mental health in the next section.


As the researchers said at the American Public Health Association Meeting, "One week after seeking abortion, 97% of women who obtained an abortion felt that abortion was the right decision; 65% of turnaways still wished they had been able to obtain an abortion." Also one week after being denied an abortion, turnaways told the researchers that they had more feelings of anxiety than the women who had abortions. Women who had abortions overwhelming reported feeling relieved (90%), though many also felt sad and guilty afterwards. All of these feelings faded naturally over time in both groups, however. A year later, there were no differences in anxiety or depression between the two groups.

In other words, the Turnaway Study found no indication that there were lasting, harmful negative emotions associated with getting an abortion. The only emotional difference between the two groups at one year was that the turnaways were more stressed. They were more likely to say that they felt like they had more to do than they could get done.


None of this translated into clinical depression. "Abortion and depression don't seem directly linked," Foster said. "We'll continue to follow these women for five years, though. So we might find something else down the line."

Physical and Mental Health

The Turnaway Study found no indication that abortion could be linked with increased mental health disorders. There were no statistical differences between turnaways and women who had abortions when it came to developing clinical depression.


But turnaways did face a greater health risk from giving birth. Even late stage abortions are safer than giving birth. The researchers said at the APHA meeting:

We find physical health complications are more common and severe following birth (38% experience limited activity, average 10 days) compared to abortion (24% limited activity, average 2.7 days). There were no severe complications after abortion; after birth complications included seizure, fractured pelvis, infection and hemorrhage. We find no differences in chronic health conditions at 1 week or one year after seeking abortion.


If you look at all this data together, a new picture emerges of abortion and how the state might want to handle it. To prevent women from having to rely on public assistance, abortions should be made more widely available. In addition, there is strong evidence that making abortions available will allow women to be healthier, with brighter economic outlooks. By turning women away when they seek abortions, we risk keeping both women and their children in poverty — and, possibly, in harm's way from domestic violence.

Learn more about these studies from the abstracts of the American Public Health Association panels here and here.


The Turnaway Study was funded entirely through donations. If you would like to support more research into the lives of turnaways around the world, please consider donating to the Global Turnaway Study on Indie GoGo.