Findings from the Turnaway study, which aims to look at the effects of unwanted pregnancy on women’s lives, were published today in BMC Medicine. In this guest blog, Diana Greene Foster, Principal Investigator of the Turnaway study writes about her experiences in leading it.

When we started the Turnaway study, a main goal was to understand the consequences of abortion for women’s lives. A handful of researchers had posited that many women experience ‘post-abortion trauma syndrome’ – mental health disorders caused by having an abortion. Since nearly one out of three women in the U.S. has an abortion over her lifetime, such a syndrome would potentially affect millions of women.

I’m a demographer, so I naturally think about health conditions in terms of populations and probabilities. Given how many women have had abortions, such an effect, if real, should have been observed long ago. But anecdotally, there are women who speak publicly about regretting their abortion and, at the time we started the Turnaway Study, we knew very little about who regrets their abortions or what those women’s experiences would be if they carried their pregnancies to term.

Lack of data on the consequences of abortion largely stems from methodological challenges. Due to stigma, women don’t regularly disclose their past abortions or divulge that they once considered aborting a pregnancy that they ultimately carried to term.

The Turnaway Study sought to do what hadn’t been done before—use a rigorous study design to examine the effects of abortion on women’s well-being for a large, diverse group of women across the United States, and to look at what happens to women who can’t get the abortions they seek.

Beginnings of the Turnaway Study

In 2008, we began recruiting women who sought abortion care at 30 facilities across the country that had the latest gestational limit within 150 miles. At each facility, we recruited women whose pregnancies were just over that facility’s gestational limit and just under the gestational limit.

So, for example, in the same week, two women presented for abortion care at a facility in the Dakotas. One woman, let’s call her ‘Alicia’, was a 19 year old who was one week over the gestational limit of an abortion facility and was ‘turned away’, not eligible to receive an abortion at that facility. Another woman, ‘Beth’, age 21, presented two weeks under the gestational limit and received her abortion.

We interviewed all women in the study by phone every six months for up to five years, asking them at each interview about their health and well-being and, in the case of women who have children, their children’s health and development.

Our preliminary analyses show no differences in mental health between women, like Beth, who received abortions and women, like Alicia, who were denied abortions. In fact, rates of depression went down over time for women in both groups. We found no evidence of a ‘post-abortion trauma syndrome’. However, we did find large differences between these groups of women in other areas of their lives.

Some of these differences can be traced back to what the women themselves said were their reasons for seeking an abortion in the first place. Among the reasons women gave for wanting to end their pregnancies were that the man involved in the pregnancy was not a man they would want in their lives or to have a baby with, in some cases because he was abusive.

Key findings of the Turnaway study

This month we publish two related articles from the Turnaway Study. The first shows that carrying a pregnancy to term after being denied an abortion slowed dissolution of romantic relationship.

However, two years after seeking an abortion, both groups of women had similar chances of still being in a romantic relationship with the man involved in the pregnancy – about one in three were still romantically involved. We also found that women who had babies rather than abortions were consistently more likely over time to have ongoing contact with the man, likely because she was raising his child.

These findings dovetail with those published today in BMC Medicine. Here, we found that the incidents of domestic violence by the man involved in the pregnancy declined among women who had the abortion but stayed steady when they carried the pregnancy to term. This indicates that being unable to have the abortion tethered women to violent men, while women who have the abortion were more able to escape abusive relationships.

To illustrate these findings, let’s return to the example of Alicia and Beth – both women experienced violence from the man involved in the pregnancy. Alicia, who was denied the abortion and consequently gave birth to a baby, considered the man a boyfriend at the time of conception. Six months later their relationship was no longer romantic.

Still, she had ongoing contact with him and described episodes of violence at both one year and two years after seeking an abortion. At one point, she reported symptoms of post-traumatic stress disorder that she attributed to being attacked by the man and from the stress of having had her child taken temporarily by the police.

Beth gave, as her reason for having the abortion, that she “did not want to have any part in [the man’s] life any more. “I have been mentally abused by [him] daily, and I didn’t want to have a child with him.”  Beth and the man were engaged at the time of conception. She was still in contact with him six months later after the abortion, but they were not romantically involved. She reported no ongoing contact with him at two years.

Implications of the Turnaway Study

One of the most striking lessons from this study is how prescient women’s reasons for wanting an abortion were. It turns out, women who experienced violence before or during their pregnancy and who considered abortion because they feared that having a baby would increase their risk of violence or bind them to an abusive partner, did have reason for concern.

Those fears were unfortunately borne out in the lived experiences of some of the women who were denied abortions who experience continued violence. In other words, these women were right.

These findings serve as a reminder that that any effort to understand the effects of abortion should be viewed in the context of women’s complex lives and should focus not only on the abortion but also its alternative, birth.

A good place to start to understand these effects is by asking women themselves.  Based on Turnaway Study results, women appear to be good judges of whether terminating a pregnancy is the right decision for them.