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November 18, 2012 12:28 PM Groundbreaking new study: what happens to women who can’t get abortions

By Kathleen Geier

Abortion is one of the most common surgical procedures in the United States, and one of the central political issues of our time. Yet in spite of this, there is surprisingly little solid social science research on many of the important social, psychological, and economic consequences of abortion outcomes. Having good research on abortion is important, because research findings are often used to justify abortion policy and law.

For example, in the Supreme Court’s 2007 Carhart case, which upheld a ban on so-called “partial birth abortion,” Justice Anthony Kennedy’s decision infamously invoked the paternalistic notion that protecting women from possible negative consequences of their own decision to abort justified abortion restrictions. In the Carhart opinion, Kennedy was influenced by junk social science studies by anti-abortion advocates claiming that women who have abortions suffer from a “post-abortion syndrome” characterized by regret and severe mental health issues. There is no scientific evidence that post-abortion syndrome exists, but that didn’t stop Kennedy from basing his decision on its alleged effects anyway.

One extremely important question Kennedy didn’t give much thought to is the other side of the question: that is, what happens to women who seek abortions but are denied them. For reasons of both ideology and feasibility, this issue had not been studied much — until now, that is. Researchers at the University of California in San Francisco are currently conducting a major longitudinal study of just this question. Known as the Turnaway Study, this project is examining “the mental health, physical health and socioeconomic outcomes of receiving an abortion compared to carrying an unwanted pregnancy to term.” The findings thus far suggest that women who are denied abortions fare significantly less well than those who are able to obtain them.

I’ll discuss those findings later, but first I wanted to describe the study’s methodology. Working with first and second trimester abortion clinics, researchers recruited about 1,000 participants who fell into these three groups:

women whose gestational age was one day to three weeks over the gestational limit and who were turned away from the clinic without receiving an abortion; women whose gestational age was one day to two weeks under the clinic’s gestational limit and who received an abortion; and women who received a medical or surgical abortion in the first trimester of pregnancy.

The women were interviewed by phone every six months, for a period of five years. They were questioned about subjects including their physical and mental health, educational attainment, financial and employment status, family life, and, for women who carried their pregnancies to term, their parenting issues and children’s well-being. The researchers have recently begun to release the preliminary findings, which have not yet been published. They presented them at a recent meeting of the American Public Health Association. Here are some of the highlights:

— Most women (86%) who carried their pregnancy to term kept their baby; 11% gave the baby up for adoption.

— Being denied an abortion appears to have impoverished women and had a negative effect on their employment status. Researchers say that at the beginning of the study, there weren’t any economic differences between those who got an abortion and those who were denied one.

However, after a year, “[W]omen denied abortion were more likely to be receiving public assistance (76% vs. 44%) and have household income below the FPL [Federal Poverty Level] (67% vs. 56%) than women who received an abortion. The proportion of women denied an abortion who were working full time was lower than among women who received an abortion (48% vs. 58%).”

— Anti-abortion advocates often claim that women who abort are more likely to develop drug problems. However, the study suggests that that is not the case; abortion did not increase the risk of drug use.

— One year later, those denied an abortion were significantly more likely to have experienced domestic violence in the past six months and significantly less likely to rate their relationship with their child’s father as good or very good. At the study’s baseline, there were no differences in these areas between the two groups.

Some cautionary notes about these findings: first, they are not the final results. Second, they have not yet been published in a peer-reviewed journal, so it’s possible they may not past muster scientifically.

Third, as is the case with every social science study, it is not necessarily clear whether the outcomes are the result of causation or correlation. The study’s methodology appears to be sound; the sample size is large, and according to researchers, there were no notable observed differences between the control group (those who got an abortion) vs. the experimental group (those who didn’t). Nevertheless, there is reason to wonder whether there were in fact significant unobserved differences between the two groups. Women who are unable to organize themselves to get an abortion before it’s too late may be suffering from more financial or emotional problems than those who get one in time.

It’s also possible that they may feel more ambivalent about their decision to abort in the first place. If any of these differences exist at the outset, then the worse outcomes for the women who were denied abortion could be due to those pre-existing factors, and not the denial of abortion in and of itself. There are statistical techniques that researchers can use to control for observed and unobserved differences, but in the end separating correlation from causation is always a thorny issue. You can never know what would have happened to the turned away women in a counterfactual universe where they were able to get the abortions they needed.

Those caveats aside, the study may well prove to be the largest and best study of its kind we get, and its findings appear to be valid and reliable. In that light, the results are illuminating, and alarming. The women who were denied abortions fared significantly less well on virtually all fronts. One of the most basic and most powerful tenets of feminism is that, contra Justice Kennedy’s insulting paternalism, women themselves are the best judge of what is good for them. These study findings strongly support that conclusion; women who received abortions did much better than those who were denied abortions against their will. This suggests that if the women had received the abortions they sought, they would have fared better as well. Trusting women is not only common sense, it makes excellent public policy sense as well.

Kathleen Geier is a writer and public policy researcher who lives in Chicago. She blogs at Inequality Matters. Find her on Twitter: @Kathy_Gee

Comments

  • golack on November 18, 2012 3:55 PM:

    It also highlights the lack of a safety net. I presume the study mainly dealt with women at or near the poverty level. The lack of health care, the lack of paid time off, the lack of ability to return to a job after taking time off for a child, the lack of outreach to make sure the get all the benefits that are available, the lack of affordable child care if they have and keep their child, etc....

  • golack on November 18, 2012 4:09 PM:

    It also highlights the lack of a safety net. I presume the study mainly dealt with women at or near the poverty level. The lack of health care, the lack of paid time off, the lack of ability to return to a job after taking time off for a child, the lack of outreach to make sure the get all the benefits that are available, the lack of affordable child care if they have and keep their child, etc....

  • c u n d gulag on November 18, 2012 4:16 PM:

    Jayzoos H. Keerist, having an, "I could have had a V-8!" moment!

    Whocouldathunkit?

    That if you have a woman, who, due to whatever circumstances, actively sought out an abortion, was denied one, and was made to go through what I call "Forced Labor" for months, and then had to either give the child up for adoption, or support and raise it for at least the next 18-21+ years (or, for life), or longer, didn't do as well financially, mentally, or physically, as a woman who wanted one, and was able to receive one?

    What some of these anti-choice people seem to think, is that women wake up in the morning and say, "Jeez, you know what I haven't had done in awhile? I haven't had a abortion. Let me have some wanton, unprotected sex, get knocked up, and have that fetus cut out of me. Yeah, THAT'S what I've been missing. THAT'S the ticket."

    The choice is NOT, 'Hmm... Miller, or Miller Lite?" If a woman feels like this is not the right time, or circumstances, to have a child, that should be HER CHOICE!

    I've said this any times before, if men got pregnant, abortions would be fast and free, and the places to get them, would outnumber fast-food restaurants.

    This whole anti-choice movement, consists of people who have been on the wrong side of every singe civil and human rights issue of the last 100+ years. Blacks, women, gays, etc.
    So, because they look like @$$holes, they decide to rail against women, and protect the "rights" of zygotes, like they're all Martin Luther King Jr's.

    If these @$$holes adopted the children that they force women to birth, I might at least have some grudging respect for them.
    BUT NOOOOOOOOOOOOOOO!!!!!
    Too many of the babies are black or brown.
    They'd rather travel to Russia or Ukraine or Poland, or wherever, and get themselves a shiny new white model.


  • Barbara on November 18, 2012 4:39 PM:

    Women are the best judges of what is good for them. Indeed. We absolutely need to move the discussion forward beyond all of the paternalistic BS that surrounds the reality of abortion in women's lives.

  • Rich on November 18, 2012 6:15 PM:

    I'm a social scientists who has worked with medical researchers for a couple decades, there's nothing second rate about a "social science study". There are limitations to most kinds of research. Biologics get hampered by half-lifes, unstable assays, etc.

    As for the results of this study will anyone do anything with them? Will NARAL put them in a fundraising letter or see them as a basis for action? The advocates for choice has mostly sent out fundraising letters and kept their comfortable office space and aslaries for the last several decades. We can complain all we want about anti-choice advocates but they have an agenda and grassroots. Nothing will happen until advocates for choice are organized and have competent leadership. I'd like to see Kathleen and others call for that and call out the lazy leadership of the movement which until recently had been allowed to hang onto their positions for several decades.

  • joanneinDenver on November 18, 2012 8:14 PM:

    Let’s us review the law and the funding to see if what context these decisions were made.

    First of all, Roe v. Wade specifics different rights for the woman depending on the
    age of her pregnancy. A pregnancy is generally thought to be 280 days divided into three trimesters. The first is from date of the day of the last period to about 13 1/3 weeks; the second trimester is the next 13 1/3 weeks; and the third, starts around 27 weeks and ends with birth.

    There is an absolute right to an abortion during the first trimester. In the second trimester, the individual state may regulate abortion, as long as there is not an “undue burden on the mother” and provision for the life and health of the woman. In the third trimester, the state may prohibit abortion, again, as long as there is provision to protect for life and health of the woman.

    Funding for abortion is a second factor. The Hyde Amendment prohibits federal funding for abortion except in cases of rape, life of the woman and there may be other exceptions of which I am not sure.

    However, states may use their own funds to pay for abortion, including Medicaid abortion. So do, some don’t.

    So, the very first question is: Who denied the women, in question, an abortion?
    I presume that it would have to have been a doctor following the laws of his or her state; or his or her decision on what abortions he or she was willing to perform; or, denial because the woman did not have the money to pay for the abortion.

    The next question is: Was the relevant law broken? Did someone try to prevent the
    Women from securing an abortion until it was “too late” in a particular state? Was the woman given wrong information from medical personnel? Was the women intimated or
    Physically prevented from accessing an abortion facility.

    I will look forward to reading the entire report to see the answer to these questions.

    I am presuming that no woman died because she was denied access to abortion.


  • VaLiberal on November 18, 2012 8:46 PM:

    I see it as a civil rights issue. Regardless of which position one takes, the biggest impact of these TRAP laws is on women of little means. And the fact that a woman of one socioeconomic level can flout state or federal laws simply because she can afford a plane ticket and/or a private doctor while another woman is stuck with no options except a forced pregnancy (or worse) because she doesn't have the money makes it COMPLETELY discriminatory. I don't care if Suzy Richbitch has 9 homes while Jane Doe only has a Sec 8 apartment, but I get damned mad when the law imposes a 2-tier justice system that guarantees Jane doesn't have a hope in hell of doing better because she's saddled with a child she can't support.

  • Anonymous on November 19, 2012 9:14 AM:

    Val.iberal

    But the study states:

    "Researchers say that at the beginning of the study, there weren’t any economic differences between those who got an abortion and those who were denied one."

  • Barbara on November 19, 2012 9:41 AM:

    This statement is so emblematic about everything that is wrong with the anti-abortion movement:

    "I am presuming that no woman died because she was denied access to abortion."

    Savita Halappanar died because she was denied access to an abortion. (http://www.guardian.co.uk/world/2012/nov/17/ireland-abortion-case-father)

    Please don't chortle about the rarity of such events; you don't have that right, claiming as you do that you inhabit a moral universe in which even losing ONE FETUS IS TOO MANY.

    In any event, the real point is this: you are willing to put up with the most degraded kind of world -- one in which women are propelled into poverty with children who are barely cared for by parents who are unready, poor and struggling because "at least they didn't have an abortion."

    Your moral reasoning comes down to "well, at least they're not dead." So much for valuing personal autonomy and freedom.

    And by the way, the answer to your question is that these are women who were turned away because they were beyond the deadlines that the clinics could medically or legally address.

  • joanneinDenver on November 19, 2012 6:26 PM:

    Barbara,

    You just launched a personal attack on me based on sentiments I never expressed and do not hold. You know nothing about me. There is nothing about what I posted that spoke to my "moral reasonings." Do not EVER suggest that I condone women dying in childbirth or from a dangerous pregnancy. I spend years doing what I could to help women who desperately needed and wanted to control their fertility...but who did not want an abortion, once inadequate birth control or the lack of any left them pregnant.

    My comment about "no women dying" was restricted to the outcomes described in this particular study. My own grandmother died in childbirth. I believe that the medical problems that threaten women's health and life occur more frequently towards the end of the pregnancy. So, it would be important to know if that were the outcome for any of these women. I was glad to note that there were none reported.

    "these are women who were turned away because they were beyond the deadlines that the clinics could medically or legally address."

    You are absolutely right this is why the women could not get an abortion. The term "denied" suggests that they needed permission to get an abortion and were somehow denied it. No woman needs "permission" to get an abortion. She does need to seek it in accordance with the rules of her state and the facility she choose. The question is really what happened after the women were unable to get an abortion at the specific clinic. Did they change their minds? Or, were they unable to afford to go to a facility, either in their own state or another more liberal state, and seek a late-term abortion?

    It is also important to note that the study has not yet been published or peer-reviewed.
    So its findings are preliminary at best. I do think the use of the word “denied” is biased, for the reasons I cited above. I can’t tell if that term is used at all in the report or is just a headline.

    There are two other aspects of this study that I hope the researchers explore. One is that there is little time difference between the women who successfully sought an abortion close to the “deadline” and those who were unable to obtain an abortion because there were just over the “deadline.” What are the differences in outcomes for just these two groups? What were the reasons for waiting so long for each group. Were they the same?


    There is another group that could well be a control group: that of women who wanted their babies and carried them to term. What were the economic and other outcomes for them? Did it differ from the women who had babies because they could not obtain an
    Abortion? This would be important because it might help understand the economic
    impact (disadvantage?) of being a mother.


    I think this research is too important to be tossed into the political hopper. And, Barbara, I don't know why you are so angry that you find it necessary to project opinions on people that you don't even know. I think it unfortunate.