Does Abortion Harm Women? A Review of The Turnaway Study

In 2007, Supreme Court justice Anthony Kennedy, writing the majority opinion upholding a ban on one abortion procedure performed later in pregnancy, seized an opportunity to weigh in on the emotional and mental state of women who have abortions. He wrote, “While we find no reliable data to measure the phenomenon, it seems unexceptionable to conclude some women come to regret their choice to abort the infant life they once created and sustained. Severe depression and loss of esteem can follow.” Clearly, in 2007, there was a serious need for reliable data on the consequences of abortion.

Diana Greene Foster, The Turnaway Study, p. 4

Diana Greene Foster’s groundbreaking 2020 book The Turnaway Study: Ten Years, a Thousand Women, and the Consequences of Having—or Being Denied—an Abortion conclusively negates Kennedy’s assumption. The book shares the findings of the study of the same name. It’s a highly readable and engaging—while data-heavy—book, each chapter of which details a different aspect of women’s lives impacted by abortion or abortion denial, interspersed with in-depth stories from individual participants.

The Turnaway Study

Along with a research team from Advancing New Standards in Reproductive Health (ANSIRH), Foster conducted a study in which researchers recruited participants from abortion clinic waiting rooms across the United States and conducted in-depth interviews with them over the course of five years to see how getting or being denied an abortion would affect their lives. It was the first study to compare two sets of women who all started out wanting abortions for unwanted pregnancies, whose only major initial difference was whether they then got an abortion or were turned away due to being past the facilities’ gestational limits.

The study’s findings have already changed the conversation about abortion rights. It shatters nearly every myth that anti-abortion advocates push regarding women’s well-being.

Social psychologist Dr. Antonia Biggs, my colleague who wrote the paper about why women have abortions, also analyzed most of the mental health data in the Turnaway Study. The paper she led about the five-year trends in women’s depression and anxiety is, deservedly, one of the most heavily cited from Turnaway. . . . This is the paper that Justice Kennedy was looking for when he bemoaned the lack of reliable data a decade before, and the paper that Surgeon General Koop had requested decades earlier.

It thoroughly quashes any idea that abortion causes depression or anxiety.

Diana Greene Foster, The Turnaway Study, p. 108

Even though anti-abortion folks seem so adamant about their claim that abortion is murder, they discount that very claim by trying to bolster their argument with more bogus claims such as that abortion causes depression, anxiety, infertility, physical health problems, or regret. If abortion were the same as murder, they would not need these additional fabricated arguments. But they grasp at straws.

The study’s findings

Here’s a general summary of the study’s findings:

Abortion is associated with better outcomes for women and children compared to carrying an unwanted pregnancy to term. These include lower immediate physical health risks and improved health outcomes for women over the next five years; greater likelihood of having a wanted child at a later date; happier romantic relationships; lower poverty and less need for public assistance; greater ability to take care of existing kids; and a greater likelihood of setting and achieving aspirational life goals in the coming year. A small minority of women regret their decision to have an abortion, just as a similar percentage continue to wish they could have had an abortion after being denied one and having a baby.

Diana Greene Foster, The Turnaway Study, p. 308

With a turnout like this which very clearly shows that wanted abortions improve pregnant people’s lives, you might wonder if Foster and her team had biased methodology. They didn’t. It’s clear that the Turnaway Study was methodologically rigorous, and Foster was the first one to admit anywhere that it fell short.

Addressing pro-abortion bias

My team and I designed this study to be rigorous and objective. I wanted to measure all the effects of having an abortion and of being denied an abortion. When crafting the survey questions, I put myself in the shoes of someone who was concerned about the harms of abortion, because it was important for the study to address those concerns. So I didn’t shy away from asking about the struggles a woman might go through after an abortion—in fact, we asked about more negative emotions than positive ones (so many that one woman said she wouldn’t answer any more questions unless the interviewer assured her we weren’t using this information to prevent women from being able to get abortions). Given how common abortion is, if it hurts women, I wanted to know.

Diana Greene Foster, The Turnaway Study, p. 252

I admire this mindset, and I always strive to do the same in my own studies. In addition to the obvious literary implication, I named my blog She Seeks Nonfiction, because if I am wrong, I want to know. If it was true that abortion was harmful to women, I wouldn’t shy away from that.

At the same time, it’s important to not treat abortion as some saving grace that will guarantee a wonderful life for anyone who has one. For example, the percentage of women who were turned away and forced to give birth who still wished they had been able to get an abortion greatly diminished over time. Obviously, they love their children.

But people don’t usually get abortions because they don’t want kids, but rather because they want any kids they have to have a great life in a healthy and sustainable environment. Many people who got abortions had children later on when they were ready. They loved those children just as much as the turned-away women loved their children, but they were better able to provide for them because they had spent their earlier years becoming financially stable or leaving bad relationships instead of taking care of a baby.

Do people regret abortions?

A paramount finding of the Turnaway Study, which is consistent with other studies, is that 95% percent of people who get abortions do not regret them. This means that, yes, some people do come to regret their abortions, just like anyone can regret anything. Does this mean that abortion should be illegal? Um, no. The fact that some people can regret a choice does not mean that they should not be able to make that choice. Pregnancy and childbirth should not be outlawed even though “a woman in the United States is 14 times more likely to die from carrying a pregnancy to term than from having an abortion.”

Foster shared an amazing quote from bioethicist Katie Watson which explains this concept, the “dignity of risk”:

The dignity of risk is a concept articulated in the 1970s to challenge clinicians’ impulse to withhold options from people with disabilities unless good outcomes were guaranteed, and it’s shorthand for the fact there is no opportunity for success without a right to failure. The dignity of risk reminds us that overprotection is harmful too. American patients’ modern status as autonomous decision makers is grounded in the foundational premise of bioethics: that competent adults must be allowed to take chances and risk pain in pursuit of a better life. The unstated premise of the abortion regret claim is that regret is bad—regret harms patients in some way, and patients should be protected from harm—but we can’t have it both ways. To the degree decisional regret is harmful, the regressive remedy of eliminating or reducing competent adults’ decision-making authority is worse.

Katie Watson, Reframing Regret, The Journal of American Medical Association, quoted in The Turnaway Study pp. 128-129

Misusing the Turnaway Study

The Turnaway Study showed that even when someone’s mental health decreased when initially denied an abortion, their mental health eventually stabilized. In fact, towards the end of the study there was not a huge difference in mental health for women who were or were not able to get abortions. While it is great to know that being denied an abortion does not necessarily destroy your life, Foster shares why this makes her fear for abortion seekers.

Some people will want to use Turnaway Study results to justify abortion restrictions and bans. They will point to the lack of long-term mental health harm of carrying an unwanted pregnancy to term to say that women are resilient. They might characterize the years of financial deprivation associated with raising a child compared to having an abortion as a small price to pay for bringing forth new human life.

This is not an accurate takeaway of the policy implications of the Turnaway Study.

Yes. Women are emotionally resilient. But emotional resilience does not pay rent. Women who are denied abortions continue to report that they do not have enough money to pay for food, housing, and transportation for the full five years of the study. . . .

There is no amount of emotional resilience that could have saved the two women in this study who died as a result of childbirth and who left behind grieving families to cope with the loss of their daughter and mother.

Diana Greene Foster, The Turnaway Study, p. 289-290

The Turnaway Study gives legs to what many of us already knew about abortions: they’re part of life. All kinds of people need them, whether they’re early or later on in pregnancy. Sometimes it is a very easy decision, and sometimes it is hard. Sometimes it’s life or death, but often it’s not. Either way, each individual woman knows what is best for her and her family, and we must never forget that.