The Turnaway Study: Ten years, a Thousand Women and the Consequences of Having- or Being Denied – an Abortion by Diana Greene Foster, PhD

Introduction

There is a constant fear in women seeking abortion, “will they recieve an abortion and what they hope to be a second chance? Or will they be turned away” (Foster 1). 

Jan 22, 1973 Roe v. Wade: 

Supreme Court has permitted states to impose a huge number of restrictions on abortion

There is a constant fear in women seeking abortion, “will they receive an abortion and what they hope to be a second chance? Or will they be turned away” (Foster 1). 

Supreme Court has permitted states to impose a huge number of restrictions on abortion

Gestational limit: when baby can no longer be terminated 

2016: Trump and Pence pledge to reverse Roe, this is a real possibility with the Supreme Court almost having enough conservative votes ( additions of Neil Gorsuch and Brett Kavanaugh) to give states full discretion to ban abortion outright. ( Foster 3). 

Political debate has shifted in the last few decades- “instead of focusing on the rights of fetuses versus the rights of women, Anti-abortion advocates have tried to reframe abortion debate as a women’s health issue, suggesting that abortion hurts women…Where evidence is lacking, policy makers have routinely invented it. In 2007 SC Justice Anthony Kennedy… He wrote ‘While we find no reliable data to measure the phenomenon, it seems unexceptional to conclude some women come to regret their choice to abort the infant life they once created and sustain. Severe depression and loss of esteem can follow” ( Foster 4). 

According to the data from the Centers of Disease Control and Prevention:  

  • Over 90% women having abortions in USA are in 1st Trimester, withen 13 weeks after their last period
  • 8% have abortions between 14 -20 weeks
  • Just over 1% have abortions when they are more than 20 weeks pregnant

Point of book: answer question does abortion hurt women?  What are the harms from being turned away? > Compares outcomes physical, psychological, financial, romantic familial 

“In these pages, I document the emotional, health, and socioeconomic outcomes for women who receive wanted abortions and those who were denied one. Before our judges and policymakers consider eroding abortion rights or criminalizing abortion, I want them- and the voters- to understand what banning abortion would mean for women and children” (Foster 7).

“As a scientist, I realize that science will never solve the moral question of when a fetus becomes a person, nor will it answer the legal question of when if ever; the rights of a fetus should outweigh those of the person whose body carries it. But our oral and legal opinions should be based on an accurate understanding of our world” (Foster 8).

Chapter 1: The Turnaway Study

Human life amendment: Name given to various proposed constitutional amendments since 1973 that would grant legal personhood to embryos and fetuses – would criminalize all abortion, sometimes without exceptions

1987 President Reagan: promised to fight to overturn Roe. Hired Surgeon General C. Everett Koop (he publicly opposed abortion) to find evidence that abortion hurt women.

Found nothing! Koop: “I regret, Mr. President, that in spite of a diligent review on the part of many in the Public Health Service and in the private sector, the scientific studies do not provide conclusive data about the health effects of abortion on women” ( Foster 14). 

“Between 1 in 4 and 1 in 3 women in the US will have an abortion during their lifetime” (Foster 15).

“just a few days determines whether a woman can access abortion- facilities set their gestational limits to reflect their doctors’ level of comfort and ability, as well as to comply with state law” (Foster 16). 

“Some abortion doctors wear bulletproof vests to work”

⇨Violence of anti-abortionists has increased substantially> “ but the fact that the national media most often pays attention to abortion clinics when there’s a mass shooting or bombing creates a misperception that abortion facilities are constantly under violent attack. The media focus on protesters contributes to the misperception that abortion is a political act rather than the provision of routine health care” (Foster 18). 

Findings: no evidence that abortion hurts women

“For every outcome we analyzed, women who received an abortion were either the same or, more frequently, better off than women who were denied an abortion. Their Physical health was better. Their employment and financial situations were better. Their mental health was initially better and eventually the same. They had more aspirational plans for the coming year. They had a greater  chance of having a wanted pregnancy and being in a good romantic relationships… And the children they already had were better off, too” (Foster 21).

Ways women were hurt by carrying unwanted pregnancy to term: 

  • Long run: increased chronic head and joint pain, hypertension, poorer self- rated health overall. 
  • 2 deaths of women in study
  • Short term: increased anxiety, loss of life satisfaction, those with violent partners find it more difficult to extricate themselves after the birth (Foster 22). 

Misconception that women are misled/misinformed. Turnaway study > EVIDENCE that Women are able to foresee consequences and make decisions that are best for their lives and families (Foster 23) 

Abortion is often under ordinary circumstances not extreme (Foster 24). 

Chapter 2: Why do people have abortions? 

⇨An Interview w/ Jim Buchy OhioState Rep:

“What do you think makes a women want an abortion?”

“Well,…there’s probably a lot of reas- I’m not a woman… I don’t know. I’ve never- It’s A question i’ve never thought about before”

“This one moment completely captures the disconnect between the politics of restricting abortion and the lived experience of women who want one”( Foster 32).

There is very little press on the actual women’s experience> “the idea of women as decision-makers is often excluded from the conversation entirely” (Foster 33).

People who don’t support abortion rarely hear about it ( Foster 33). 

Table of Reasons Women Seek Abortions in the US: https://bmcwomenshealth.biomedcentral.com/articles/10.1186/1472-6874-13-29/tables/2

Later abortions? Thought of as morally more wrong. A huge factor is the amount of time it took for a woman to figure out if she was pregnant (Foster 45).

COVID is leading hospitals to deem abortions as a “nonessential procedure” : https://www.ansirh.org/news/ob-gyn-teaching-hospitals-often-restrict-abortion-beyond-state-law

Gabrielle Blair: “unwanted pregnancies can only happen when men orgasm irresponsibly. I’m not saying that the solution is to share blame equally. Instead. We need less blame all around, MORE SEX EDUCATION, and much better CONTRACEPTION OPTIONS” (Foster 49). 

“Two in five women seeking abortion report some problem in accessing contraceptives, including 1 in 5 who reported that they ran out of contraceptive supplies before becoming pregnant.”  >make contraceptive methods as easy to procure and use as possible, for everyone (Foster 53). 

Chapter 3- access

“Restrictions on abortion, supposedly intended to make abortion safer or reduce chance of abortion regret, instead put abortion out of reach for osme and vastly dispropotionately affect the already disadvantaged- low-income women, women of color, women with chronic health conditions, women with very young children, and teenagers” (Foster 65). 

Average Costs in US:

  • 1st Tri: $500
  • 14-20 wks: $750
  • After 20 wks: $1,750  (Foster 65).

“Half of the women seeking abortion in the US live below the federal poverty level” (Foster 66)

“A dozen states have banned private insurance companies from funding abortion. IN states without such laws, many insurance companies do cover abortion, That said ¾ of the women in our study who had insurance did not recieve any assistance in paying for the abortion from their insurance company” ( Foster 67)

⇨1976 Henry Hyde introduced an amendment to federal annual health spending bill restricting any federal funds from paying for abortion, including Medicaid. “Hyde amendment”  

1990s Exceptions added for cases of rape, incest, severe maternal issues (Foster 68)

This effects 7.5 mil US women (3.5 of which are low income) 

“Refusing to cover abortion may result in as many as a ¼ of women who wanted an abortion carrying an unwanted pregnancy to term… for ¾ who do get an abortion anyway … abortion is delayed to a point where the fetus is more developed and the procedure more difficult” 

(Foster 69) 

How can we make private abortion funds better? Possible interviewee idea ? or OG research?

  • Nonprofits 
  • Help 1/7 abortions in the US
  • Extremely underfunded &understaffed (Foster 70).

⇨Restrictions: ridiculous and lied about > no evidence of making abort safer> few clinics can afford (Foster 71). 

State counseling: “ increase cost and travel burden by requiting women visit twice and wait for a specified period of time between receiving counseling and having abortion procedure” (76) 

How have other countries solved this problem? Big difference US politics are extremely influenced by religion ( Foster 81). 

BODILY AUTONOMY 

“Making abortions more difficult to access does not mean that only the morally deserving get their abortions It means that only adult women who don’t have physical or mental health issues and who have money and social support get their abortion” (Foster 88). 

Chapter 6: Women’s lives

1992 supreme court decision Planned Parenthood v. Casey: “The ability of the women to participate equally in the economic and social life of the nation has been facilitated by their ability to control their reproductive lives” ( Foster 163). 

RBG ( joined the supreme court in 1993) criticizes Roe v Wade: does not oppose the legality of abotrion> she says the court had “incomplete justification” of the decision:  “The conflict, however, is not simply one between a fetus’ interests and womans interests, narrowly conceived, nor is the overriding issue state v private control of a womans body for a span of 9 months. Also in the balance is a woman’s autonomous charge of her full life’s course” from: https://scholarship.law.unc.edu/cgi/viewcontent.cgi?article=2961&context=nclr

70% seeking abortion = age 15-30 the years we decide where who we are! 

“ there’s good reason to think having a baby when one is not ready- in a abusive relationship is already struggling to provide for existing kids, say- might make a big difference in one’s life trajectory” (Foster 164). 

Who had aspiration plans for the coming year:

denied abortions 56%: 30% likely to set and achieve

Received abortions 86%: 48%   (Foster 168). 

15-20% of general public think abortion should be banned in any situation including rape and incest (Foster 171).

Vicious cycle: not enough $ for abortion leads to procedure that costs more, then one needs more $, eventually, one may be turned away for exceeding the gestational limit (Foster 173).

Leading cause for abortion = not enough money > 3/4 reported not enough $ for basic living expenses (Foster 173).

Socioeconomic outcomes of women who received or women who were denied an abortion

Credit scores: “They found that being denied an abortion increased past- due bills by $1,750 on average, a 78% increase relative to the amount that was past due on their credit reports prior to the pregnancy” (after 5 years  bad financial events increased by 81%)  (Foster 179)

THE ECONOMIC CONSEQUENCES OF BEING DENIED AN ABORTION

https://www.nber.org/papers/w26662.pdf (Foster 180).

“It is important to understand the complicated lives women lead, the competing demands on their time, resources, and affections” ( Foster 186). 

Chapter 7: Children

“More than half of the women having abortions are mothers, and their desire to ccare for the children they already have is a leading reason for abortion” (Foster 199) 

96% denied > lacked money to pay for basic living

83% received> “

Live in poverty (D72% vs R55%)

Household that receives public assistance ( 19% vs 10%)

Live w adults who dont have enough money  for basic living ( 87% vs 70%)  (Foster 202). 

“Adoption is clearly not an easy solution to hte problem of an unwanted pregnancy for women who preferred to have an abortion. Few women choose it and those who do place a child fo adoption hae the highest incidence of regret and negative emotions after the pregnacny” (Foster 210). 

Contraceptive Use

“Women with public health insurance living in one of the 33 states where public health insurance is not allowed to cover abortion, even getting contraception covered at the time of an abortion is extremely difficult. Covering contraceptive services through public and priv insurance… would be an effective way to help women prevent any future unintended pregnancies” 

Difficult to pay for contraception- most abortion clinics don’t offer a wide range of methods (Foster 213). 

“Abortion is not just about a woman’s rights v an embryo’s/ fetus’ rights; it’s also about whether women get to have children when they are ready to care for them”  (Foster 214). 

Chapter 8- Men

  • ¼ men desire women to continue pregnancy
  • Men are often the reason women choose abortion 
  • Being denied abortion reduces the chance that women are in a very good relationship years later, further evidence of the role abortion in enable women to set their own life course (Foster 238-39)

Chapter 9: Reactions to and Reflections on the Study

95% of women who have abortions feel it was right decision (Foster 247) 

“ We are still talking about whether abortion harms women and not whether the lack of abortion harms women and children” (Foster 248) 

A different perspective on the  argument that we were all a fetus once (Foster 263) 

Chapter 10- Turnaway Study and Abortion Policy

“The number of facilities that provide abortion has decline dramaticly.”

  •  Peak in early 1980s @ 2,700
  • Currently @ about 800

Foster worries her study results may be used to help poor women access abortions only  for economic reasons (Foster 278).  

⇨Reproductive Justice

“Abortion rights are clearly central to equal participation in society. But women and people who are trans and nonbinary with less privilege and less opportunity are rightly concerned wit ha larger set of issues”  ( Foster 279). 

“…The important emphasis is that real reproductive rights stem from people being able to pursue their own personal desires and goals… Alternate justifications still predominate” ( Foster 280).

  • Bc women will die of illegal abortions ( Public health) 
  • Fund contraception and abortion to lower population growth (demographic)
  • $ spent on family planning reduces public expenditures on med care for unwanted pregnancies (fiscal – relating to gov $/ taxes)
  • Reduce carbon emissions (environmental) 
  • ^not good motivations for providing clinical care for women. 

“Note that none of these were mentioned as reasons for wanting an abortion by women in our study”  

“ Studies have shown that people want more control over contraceptive decision-making compared to other types of od medical care… the amount of mistrust that already exists is serious. The only way to inspire trust is to have the goal of the clinician be to serve the interests of the patient rather than the interests of the taxpayer, the environment, or the church” (Foster 81). 

Cases to look at: Whole Woman’s Health v. Hellerstedt 2016

Two restrictions: abortion facilities must be “mini-hospitals” (didn’t take effect)  have admitting privileges to a hospital w/in 30 miles 

About half abortion clinics closed in Texas (40) if mini hospitals were required > (10)

Struck down the laws as unconstitutional> must have data that supports that the new law would actually improve women’s health

Then Trump became president…. Anti- abortion legistrators passed new laws w/o regard > “it was clear they wanted these new laws to be challenged all the way to the supreme court, at which point trumps new appointees might abandon WWH v Hellerstedt”  (Foster 283-83). 

Planned Parenthood v. Casey 1992

Retained prohibition on banning before viability but discarded trimester framework, allowing restrictions on abortion throughout preg so long as they don’t put “ undue burden” on women

Turnaway study proved “Denying women access to abortion services results in worse physical health, poorer economic outcomes, and reduced life aspirations, including the chance to have quality relationships and wanted pregnancies later” ( Foster 284) 

What would happen if Roe v Wade 1973 were overturned? 

Constitution protects right to abortion, set up trimester system 

  • 1st no restrictions imposed
  • 2nd some restrictions
  • Around 3rd (after viability) can be banned

Opposing argument on pg 289 

Chapter 11: Next Steps for Science

This chapter SUPER HELPFUL: proposes a common myth and busts it with data from the study 

“Women are making thoughtful decisions. Mandated delays by the gov are unnecessary. Frankly patronizing, and cause abortions to occur later in pregnancy. Gestational limits run the risk of making women rush their decision in trying to make a deadline… The largest cause of delay is not knowing one is pregnant, 2nd most common is raising funds for operation travel to ge tto one of a diminishing number of abortion facilities” (Foster 307).

Story of Dr. George Tiller: provided 3rd trimester abortions, continues despite bombings and threats and being shot and wounded in 90s, assassinated at 67 in his church by anti- abortion extremist, motto = “Trust Women” (Foster 312). 

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