The Wyoming Supreme Court is currently considering the legality of banning most abortions in the state.
This issue has been debated by the courts nationally for decades. At one point in 2007, former U.S. Supreme Court Justice Anthony Kennedy speculated that women can be depressed after getting an abortion and regret their decision, but said there was no reliable data to prove this.
That perked Diana Greene Foster’s ears.
“It really was time to not just assume and to actually collect rigorous data,” the University of California San Francisco professor said.
Foster decided to find out: How do women’s mental, physical, and financial health fare if they get an abortion versus getting turned away? The result is her 10-year-long Turnaway Study, following over a thousand women.
She shared her findings with Wyoming Public Radio on a recent trip in the Equality State.
Editor’s Note: This interview has been edited for clarity and brevity.
Hanna Merzbach: How did you actually go about this study?
Diana Greene Foster: This idea for the study was sparked when an abortion doctor said to me, she wonders what happens to the people they turn away. And I hadn't realized that clinics regularly turned people away. Clinics turn people away for a lot of reasons: health conditions, maybe not being able to pay for the abortion. They also sometimes turn people away because they're a little bit too far along in pregnancy.
We had two groups of people that were very similar at the beginning, but one group got that abortion and one group didn't. Because we recruited at so many sites across America, we ended up recruiting some people who got an abortion at the same exact point in pregnancy where someone else would've been denied an abortion in a different state.
HM: Tell me about what you found.
DGF: On the main question of whether abortion hurts people's mental health, we don't find evidence of that. In fact, we found worse mental health among people who are denied abortions, and that means a short period of anxiety, lower self-esteem. Over time, the two groups look the same in terms of mental health, not because both groups are doing badly. In fact, both groups improve over time. It's not really a mental health story, and that's consistent with when you ask people why they want an abortion.
Usually it's money, ability to take care of their existing kids, the quality of the relationship with the person they became pregnant with, their other life goals and responsibilities. It's in all those other areas that we see the big differences.
On many indicators, the two groups look the same, but if they vary, it's always to the detriment of people who are denied. Your physical health is worse because of complications from the delivery, but also for years later. Your economic stability and wellbeing is worse, and not only do they suffer, but their kids suffer.
More than half of people who get abortions are already parenting, and it's not uncommon for someone who's parenting, who wants an abortion, to say their reason is to take care of the kids they already have. And sure enough, we see that existing kids are more likely to live in poverty and less likely to hit developmental milestones if their mom couldn't get that abortion.
HM: I'm curious how you've seen your research be used. I imagine it's being referenced in a lot of these court hearings and different cases making their way around the United States, and I've heard that it's being used by both sides.
DGF: The most famous statistic from the study is that more than 95% of people who get their abortions say they made the right decision. What the people who are opposed to abortion like from the study is that it's also true that the people who were turned away, most of them eventually say they were glad they were turned away. So, what's surprising about that is that the people who are denied abortions seem like they're faring worse. They have worse physical health, worse financial wellbeing. Their kids are doing worse. Their relationships are not as good. But you never know the path you didn't take is one thing. It's also hard to tell anyone that you wish you hadn't had your child.
HM: How has the research impacted your own stance on abortion rights?
DGF: I think my stance is very evidence-based. I thought that people who were denied abortions would be depressed, and that's not what the data show, and I'm very happy to report exactly what the data show. I didn't have a huge agenda. I was more interested in providing some data, so we don't always make these decisions knee jerk or based on ideology, that we can actually listen to the people who are affected, see what their outcomes are and make decisions that hopefully improve everybody's wellbeing.
HM: I want to switch gears a little bit. I was at the recent Wyoming Supreme Court hearing. It was the first time justices considered Wyoming's abortion case. They're trying to determine the constitutionality of two near total abortion bans, which a district court judge struck down last year. I was talking to a couple attendees there. Some people who were on the more anti-abortion side were saying, ‘If you don't want a baby, it's your responsibility to prevent that from happening.’ What do you say to those kinds of arguments?
DGF: Two-thirds of the people in my study became pregnant when they were using contraception. The other third of people weren't using a contraceptive method. I think that it’s actually not that easy to consistently use a method. I have sympathy for people who couldn't access contraception or didn't think they were at risk. They weren't planning on having sex. Some people are raped.
Pregnancy isn’t something that we need to blame people for. It happens despite folks' intentions, and it also sometimes happens that people want abortions when they intend to become pregnant because their circumstances change, because they get some new information, like a diagnosis. So this is not just so simple like, ‘Oh. People should prevent pregnancy.’
HM: Some of the justices were also very focused on this discussion of when life begins. The state holds that life begins at conception. The plaintiffs who are suing the state are saying that is a religious viewpoint. Some of the justices were saying, ‘I don't know if that's religious. Isn't this rooted in some kind of secular ideology? Is there science that backs that up?’
DGF: I don't know that this is a question science can answer. I certainly don't have anything beyond my own personal viewpoint on this, and everyone's viewpoint seems to be a product of how they were raised and their religion and their circumstances. It’s maybe not something that is easy for the government to decide for everybody.
HM: What should listeners, especially in a rural state like Wyoming, be thinking about?
DGF: The crisis of maternity care in this state is huge, where there's just an insufficient number of doctors. This is not a good context for people to carry pregnancies to term if they don't have good access to healthcare. People vastly underestimate the risks of pregnancy. We had two women from the study die within days of childbirth, both from common causes of maternal death. We had no deaths among the people who had abortions. We actually saw worse health for years later among the people who'd given birth.
HM: You finished conducting the Turnaway Study a couple years ago. What are you researching now?
DGF: I have a study of the consequences of the end of Roe, a federal guarantee of abortion rights. That study has 1,800 people in it. They're all from states with bans. I thought it was going to be another Turnaway Study, but in fact, the vast majority of people get their abortions anyway. They just do it with great delay and great expense. The fraction of people who needed second trimester abortions went from 8% to 17% because they had to travel hundreds of miles, take time to raise money or gather resources. So they may be getting their abortions, but they're getting them later.
I'm sure that wasn't the intended effect of banning abortion. It's why we do actually need to study these things, because you can't assume that passing a ban means no one ever gets an abortion again. Instead, it changes how they get them and the experience, and we need to know, what is that effect?
