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Research project

Turnaway Study

What is the Turnaway Study?

The Turnaway Study is ANSIRH’s prospective longitudinal study examining the effects of unintended pregnancy on women’s lives. The major aim of the study is to describe the mental health, physical health, and socioeconomic consequences of receiving an abortion compared to carrying an unwanted pregnancy to term. From 2008 to 2010, we recruited from 30 abortion facilities around the country—from Maine to Washington, Texas to Minnesota—to recruit about 1,000 women who sought abortions, some who received abortions because they presented for care under the gestational limit of the clinic and some who were “turned away” and carried to term because they were past the gestational limit.

timeline for ANSIRH Turnaway StudyOur skilled research assistants interviewed participants by phone over a period of five years, ending in December 2015. The interviews were wide-ranging, covering topics from physical and mental health to employment and educational attainment to relationship status and contraceptive use to emotions about pregnancy and abortion. We conducted nearly 8,000 interviews over the course of the project, and the stories that women shared with us about their lives are fascinating.

Although the primary focus of the study was on women’s experiences, we also gathered information about the health and development of children born to women who carried unwanted pregnancies to term, as well as the health and development of previous and subsequent children born to all women in the study.

What did the study find?

ANSIRH has published more than three dozen scientific papers in peer-reviewed journals using data from the Turnaway Study. The study finds that many of the common claims about the detrimental effects on women’s health of having an abortion are not supported by evidence. For example, women who have an abortion are not more likely than those denied the procedure to have depression, anxiety, or suicidal ideation. We find that 95% of women report that having the abortion was the right decision for them over five years after the procedure.

The Turnaway Study does find serious consequences of being denied a wanted abortion on women’s health and wellbeing. Women denied a wanted abortion who have to carry an unwanted pregnancy to term have four times greater odds of living below the Federal Poverty Level (FPL). In addition, women denied abortion are:

  • More likely to experience serious complications from the end of pregnancy including eclampsia and death
  • More likely to stay tethered to abusive partners
  • More likely to suffer anxiety and loss of self-esteem in the short term after being denied abortion
  • Less likely to have aspirational life plans for the coming year

The study also finds that being denied abortion has serious implications for the children born of unwanted pregnancy, as well as for the existing children in the family.

Our annotated bibliography provides a complete list of publications. Issue briefs on the mental health and socioeconomic consequences of having an abortion versus carrying an unwanted pregnancy to term are also available in Spanish (salud mental and resultados socioeconómicos). Dr. Diana Foster, the principal investigator for the Turnaway Study, is currently writing a book that presents findings from the Turnaway Study and with stories of women who participated in the study, told in their own words.

The success of the Turnaway Study inspired ANSIRH researchers to collaborate with colleagues around the world to launch the Global Turnaway Studies, designed to adapt the innovative study design for use in different cultural, legal and socioeconomic contexts.

Why is the study ground-breaking?

Because of the ideological controversies over abortion, and the difficulties of study design, before the Turnaway Study, there was little quality research on the physical and social consequences of unintended pregnancy for women. Most of the research that did exist focused on whether abortion causes mental health problems such as depression and post-traumatic stress disorder, or alcohol and drug use.

That body of work often used inappropriate comparisons groups—comparing, for example, women who obtain abortions with those who continue their pregnancies to term by choice—and used retrospective designs that depended on women’s reporting of unintended pregnancies and abortions in hindsight. Such comparisons are inherently biased and paint a distorted picture of life following an elective abortion or pregnancy continuation.

As women’s access to abortion care—whether in the first or second trimester—becomes increasingly restricted, it is extremely important to document the effect of unintended pregnancy, abortion, and unintended childbearing on women and their families. The Turnaway Study was an effort to capture women’s stories, understand the role of abortion and childbearing in their lives, and contribute to the ongoing public policy debate on the mental health and life-course consequences of abortion and unwanted childbearing for women and families.

How was the study carried out?

Participants were interviewed every six months about their mental and physical health, education, employment, economic situation, social support, and family relationships. In order to address the issue of appropriate comparison groups, the women we recruited fell into three categories:

  1. Women who sought an abortion up to three weeks over the gestational limit and were turned away without receiving an abortion (Turnaways);
  2. Women who sought an abortion up to two weeks under the facility’s gestational limit and received an abortion (near-limit abortion comparison group);
  3. Women who received an abortion in the first trimester of pregnancy (first trimester abortion group).

Study groups in ANSIRH's Turnaway Study Study groups in ANSIRH's Turnaway Study We recruited the first trimester group to enable us to compare the outcomes of women who receive later abortions to those of women who obtain abortions early in pregnancy, since the vast majority of abortions in the United States occur in the first trimester.  Women who were seeking abortion care for a fetal abnormality or demise were not eligible for the study.

More information about recruitment for the Turnaway Study can be found here. In addition, the New York Times Magazine published an excellent piece on denial of abortion care in June 2013.

Acknowledgments:

The Turnaway Study would not have been possible without the contributions of past staff members, Interviewers Mattie Boehler-Tatman, Janine Carpenter, Jana Carrey, Undine Darney, Ivette Gomez, Selena Phipps, Claire Schreiber, and Danielle Sinkford; and Project Coordinators Debbie Nguyen, Elisette Weiss and Michaela Ferrari. Sandy Stonesifer also contributed early project management, and John Neuhaus and Jay Fraser provided statistical consulting and data management, respectively.

Research and institutional funding was provided by the David and Lucille Packard Foundation, the William and Flora Hewlett Foundation, the Wallace Alexander Gerbode Foundation, and other private donors. The Turnaway Study started as a small pilot project funded by a seed grant from a private foundation. The success of the pilot project attracted the more substantial funding necessary for the full study.

The study was approved by the Committee for Human Research at UCSF.

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ANSIRH is a program within the UCSF Bixby Center for Global Reproductive Health and is a part of UCSF's Department of Obstetrics, Gynecology & Reproductive Sciences.

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