A landmark study tracks the lasting effect of having an abortion — or being denied one

People seeking abortions could face new barriers in many states if the Supreme Court overturns Wade. In The Turnaway Study, Diana Foster documented what happens when someone is denied an abortion.

Malte Mueller/Getty Images

Diana Foster knows what will happen when someone is denied an abortion. She documented it in her yearslong research project, The Turnaway Study, and her findings show how getting an abortion or being denied one affects a person's mental health and economic wellbeing.

For over 10 years, Dr. Foster and her team of researchers tracked the experiences of women who had received abortions or who had been denied them because of clinic policies on gestational age limits.

The research team interviewed each of the study participants for five years and found that those who were denied abortion had worse economic and mental health outcomes than those who received care. The study participants who received an abortion said they made the right decision.

The Turnaway Study was inspired by a Supreme Court abortion case. Justice Anthony Kennedy speculated in the majority opinion that abortions lead to poor mental health, and that there was no reliable data to measure the phenomenon.

Kennedy's speculation and admitted lack of evidence captured Foster's attention, because you can't make policy based on assumptions of what seems reasonable without talking to a representative sample of people who actually wanted. The justice thought that having an abortion was more likely to lead to mental health outcomes than having one.

The study did not assess the effects of existing abortion restrictions on patients or anticipate a future in which Wade is overturned. It didn't address the experiences of trans people seeking abortion care, who may face more access barriers than the women who were turned away.

Foster spoke with NPR about the study and how relevant it is today.

The interview has been edited to make it clearer.

Who participated in the study? They were compared to people who seek abortions.

The sample looked very similar to the population of people who seek abortions nationally. The majority of the women were mothers. Most of them were in their 20s. At the time they were seeking an abortion, about three-quarters were already below the federal poverty level.

They were recruited right up near the limit, so they tended to be later in pregnancy. I had an idea before I started this study that people seeking abortion later in pregnancy would be different. That turned out to be false. The people who seek abortions later in pregnancy were not different from the people who seek abortion earlier, with the exception that they tended to have been a lot later in realizing they were pregnant.

What did you learn about the lives of women denied abortions after five years?

Some areas of their lives are vastly different from those of women who got abortions. The first thing is health. Carrying a pregnant woman to term and delivering a child is riskier than having an abortion. Two women who died after delivery were the most tragic, one died of an infection and the other of a very common pregnancy complication.

Socioeconomic well-being is one of the areas that we see differences in. People who are denied abortions are more likely to live in households where there isn't enough money for basic living needs. They are more likely to raise children alone if they are denied an abortion. They are equally likely to be in a relationship if they received or were denied an abortion.

Those who receive the abortion report their relationship is better. It is changing fundamental aspects of people's lives, including their chance at having children later under better circumstances.

What did you find for the women who were able to get an abortion?

The people who receive an abortion have better mental health than the people who are denied it. I believe that the experience of having an unwanted pregnancy is associated with serious anxiety and distress. People improve over time.

People can have an emotional reaction to having had an abortion. People were asked about six emotions. Positive emotions outweigh negative emotions, but a lot of people have negative emotions about it.

People can feel regret about having an abortion, but they still feel like they made the right decision. I regret that I had to have an abortion. They can feel sad, and sad is different than depressed. People tell us that they stop thinking about abortion if they have strong positive emotions and strong negative emotions. One woman told us that she only thinks about it when she's called for an interview.

The idea that this event is disrupting peoples lives forever is not accurate for most people. This is something that people say they need to do, and they did it, and moved on with their lives.

Did you see any differences among women who had the support of their family, friends or community?

To narrow in on who is experiencing mental health distress over time, my colleague analyzed the mental health data and found that those who experience a lot of stigma around abortion are more likely to experience mental health distress. It is rare, and a history of childhood abuse and neglect is the bigger predictor of poor mental health.

What impact did being denied an abortion have on families who already had children?

People who seek abortions are often already parents, so it is often surprising to people who don't think about abortion. Sixty percent of people who have abortions are already mothers, and they give as reason for wanting to have an abortion that they need to take care of the kids they already have. When we look at the well-being of those existing children, we see differences based on whether or not their mom received an abortion. The children of mothers who were denied abortions are less likely to achieve certain development milestones.

What do you think this research will do to the discussion of Wade?

The Turnaway Study was not designed with this moment in mind because I did not think that we would see an end to Roe so quickly. The Turnaway Study shows that people who become pregnant and are unable to get a safe, legal abortion in their state will experience long-term physical health and economic harm. We have not become a more generous country that supports low-income mothers. When people are denied an abortion, those outcomes are still going to happen.

The Turnaway Study doesn't address the fact that many people will circumvent their state laws and travel to other states to get an abortion, or that they will order medication abortion. Some people will try dangerous things. We do not know the full effect of this decision.

Rebecca Ramirez produced the audio version of the interview.