Turnaway study shows impact of abortion access on well-being

A study conducted by UC San Francisco reveals the long-term adverse effects of unwanted pregnancy on people’s lives, pointing to widespread challenges that will result from the U.S. Supreme Court ruling to overturn the constitutional right to an abortion.

UCSF’s Turnaway Study found that more than 95% of people who chose to have abortions reported that it was the right decision for them, when interviewed over the next five years. There was also no evidence of mental health problems among study participants following an abortion. However, those who were unable to have abortions because they were past the gestational limit suffered from adverse effects such as serious physical and mental health challenges, economic hardship, lack of support and insecurity.

The study also found that those who sought and received an abortion were more financially stable, set more ambitious life goals, raised children under more stable conditions, and were more likely to have a wanted child later.

“This study has been really important,” said Diana Greene Foster, Ph.D., a professor in the Department of Obstetrics, Gynecology & Reproductive Sciences who led the study. “It provided the evidence that was missing on the consequences of abortion access for people’s health and well-being.”

Foster, a demographer and the director of research at UCSF’s Advancing New Standards in Reproductive Health (ANSIRH) program, added that despite more than 50 scientific papers published because of the study, her own award-winning book on the study, and the study forming the basis of legal briefs at the Supreme Court and elsewhere, the national conversation remains stuck on ideological and political considerations.

“The debate about abortion rarely focuses on what happens to the pregnant person,” she said. “It’s framed as an abstract moral question in which everyone else weighs in without considering why someone would be in the circumstances where they want an abortion—and what happens to them and their lives when they can’t get one.”

Study shows better outcomes with abortion access

In the Turnaway Study, researchers followed 1,000 women from 30 centers around the country for five years—some a few days under a clinic’s gestational limit, and therefore able to receive an abortion, and some who were a few days over the limit and therefore were denied from getting an abortion.

Among those who were denied an abortion, the study found that individuals reported more life-threatening complications from the end of pregnancy, such as eclampsia and infections. Over the longer term, those who were denied an abortion and subsequently gave birth reported worse health and greater chronic pain compared to those who were able to terminate their pregnancy.

The study also found negative effects on the children born from unwanted pregnancies, including poorer maternal bonding and economic insecurity. These parents were also more likely to raise the child alone, without the support of family members or partners, and were more likely to stay in contact with an abusive partner.

In addition, individuals who were not able to access abortion were three times more likely to be unemployed than those who were able to access one. They had four times greater odds of living below the federal poverty line, were more likely to report not being able to afford basic living needs, and were more likely to be enrolled in food assistance or other public safety-net programs such as Temporary Assistance for Needy Families.

Foster said her goal in conducting the Turnaway Study was to provide much-needed data on the consequences of abortion for people’s well-being. She notes that her earlier research on contraception, which led to birth control being more widely adopted, has undoubtedly helped prevent many abortions.

“My agenda going in was to figure out whether abortion causes mental health harm and the ways in which getting it or not getting it would affect people’s well-being,” Foster said.

Yet, she noted, “after the Turnaway Study, it’s hard to be neutral on the topic of a person’s right to choose abortion, because it’s so clearly associated with better outcomes for families and for children.”

UCSF’s Turnaway Study tracked 1,000 people seeking abortions to compare what happened if they were able to receive one versus when they were turned away. These are the findings:

The people denied abortions suffered from more economic hardship: they were 3 times more likely to be unemployed, 4 times more likely to live below the poverty line, and more likely to report being unable to afford basic living expenses.
The people denied abortion were more likely to stay in contact with a violent partner and were more likely to raise the resulting child alone without family or partner support.
The resulting children were more likely to live in poverty.
The people denied an abortion reported more life-threatening complications from the end of pregnancy, including eclampsia and infections.
Those denied abortion who gave birth reported worse health and greater chronic pain than those who were able to terminate their pregnancy.
More than 95% of people who chose to have abortions reported that it was the right decision for them five years later.
95% of people report that having the abortion was the right decision for them over five years after the procedure.
Those who sought and received an abortion were more financially stable, set more ambitious life goals, raised children under more stable conditions, and were more likely to have a wanted child later.
Evaluating impact in post-Roe America

When the Supreme Court’s draft opinion on Roe leaked in May—opening the possibility that abortion could become effectively illegal in 26 states—Foster felt a renewed sense of urgency for her next study, which will document the consequences of the end of Roe for people in states that ban abortion. A team of researchers at ANSIRH are launching that study now.

“We’re going to recruit the people who had appointments that are being canceled and the people who were the last ones served in their state. We’ll follow them through self-guided interviews every two months for two years,” Foster said.

Foster noted that this forthcoming study will ask markedly different questions from the Turnaway Study. “This is about who’s able to get safe abortions, even when it’s illegal. How much help do people need? Despite getting help, who still falls through the cracks? Who does things that are dangerous? Where do people get reliable information? And who are the populations that are most hard-hit?”

As the impact from the reversal of Roe v. Wade plays out across the nation, Foster and her colleagues will be paying particular attention to what happens to the most vulnerable, including minors and people with low incomes, disabilities, and other health conditions—in other words, those least able to circumvent their state’s laws. Whether the end of Roe exacerbates inequalities depends on whether these individuals can access safe abortion medications or travel to the 16 states and Washington, D.C., that have state constitutional or statutory protections for the right to get an abortion.

“We don’t know who’s going to end up carrying a pregnancy to term, because some people in the middle of red states are going to find the means to travel hundreds of miles or to get an abortion by ordering pills online,” Foster said. “And we don’t know who’s going to have access to that information and be able to travel and who won’t.”

Advocating for reproductive health care choice

UCSF has long championed reproductive health care, including a person’s right to choose abortion, even before Roe v. Wade became law in 1973. Leaders continue to present evidence about the need and benefits of access to safe abortion services to those who seek them. UCSF is also preparing to help people get the reproductive health care they need in a post-Roe America.

For his leadership in reproductive health care, Daniel Grossman, M.D., a UCSF professor of Obstetrics, Gynecology, and Reproductive Sciences and director of the Advancing New Standards in Reproductive Health (ANSIRH) program, was named the faculty recipient of the 2022 Chancellor’s Award for Public Service.

“The research that we’re doing will end up changing practice, changing policy and making a difference for people,” Grossman said. “I see the access to safe abortion care is certainly an issue of public health. And this is also an issue of basic human rights.”

In a message to the UCSF community about the Supreme Court decision, Chancellor Sam Hawgood, MBBS, said the ruling “stands in stark contrast to our belief that every person has a fundamental right to make their own informed decisions about their health care.”

“UCSF has a really important role to play,” Grossman said. “And I’m really thrilled to be at an institution that is brave in this area and stands up and will be that loud, evidence-based voice for freedom of choice.”