the overthrow of Roe v. Wade, which may have been announced this week in the leak of a draft Supreme Court opinion, would be a development with huge political and social implications. Most fundamentally, however, such a statement could almost immediately trigger tectonic changes in the health and well-being of people and children across the country.
We know this thanks to important research published in 2020 that compared the fate of women who had forced pregnancies to term with those who had abortions. The influential Turnaway Study, as it is commonly called, found that, among other things, women who were refused an abortion endured more severe pregnancy complications, more chronic pain and more short-term anxiety.
The Supreme Court’s decision is not final: Opinions go through many concepts, and in theory some judges could still change their mind before making their final decision in Dobbs v. Jackson Women’s Health Organization†
But if the court were to make a ruling along the lines of what Judge Samuel Alito has drafted — as published this week by Politico † more than 20 states abortion is expected to be banned immediately in most cases, with half of those who have “trigger laws” already on their books (meaning abortion bans go into effect almost immediately if: roe were overthrown). In an instant, a community medical service that has been constitutionally protected for nearly half a century would be banned in nearly half the country.
The exact effect of such a drastic loss of access to abortion is impossible to know from our point of view over time. In many of these states, abortion access has already declined over the years as state lawmakers passed heavy restrictions to force clinics to close — half measures they could take until a conservative majority in the nation’s supreme court, such as now, might topple roe downright.
Many pregnant people rely on mail order pills for abortions, and the administration of President Joe Biden has… promised to secure access for them (although anti-abortion states are already trying to limit access to those drugs). Some who want an abortion can also travel to another state where abortion is still legal, although because of the cost it is likely more privileged people who can take advantage of that option. However, both options can help mitigate the consequences of an annulment roe†
Nevertheless, it is inevitable that more unwanted pregnancies would occur if the court denied a federal right to abortion. Diana Greene Foster, a professor at the University of California at San Francisco and the principal investigator of the Turnaway Studywho analyzed how women who had an abortion and women who were refused an abortion were affected by that important moment in their lives, roughly estimates that between a quarter and a third of women with an unwanted pregnancy will complete the pregnancy if roe is tipped over.
Foster and her colleagues have given us a good idea of the health, social and economic consequences of outright abortion bans. The Turnaway Study began in 2007 and followed more than 1,000 women for five years to assess how their lives had changed, if at all, by providing or refusing an abortion. Some women had an abortion shortly before reaching the pregnancy limit set by their state or provider, while others had just passed that limit and were denied an abortion as a result. The differences in the women’s experiences from that critical moment were the subject of the study.
“We find no evidence that abortion hurts women,” Foster writes in the book of 2020 The Turnaway Study that included the findings of the investigation. “For every outcome we analyzed, women who got an abortion were the same or, more often, better off than women who were denied an abortion.”
The mental health of women who had an abortion was better immediately after the procedure than that of women who were refused an abortion. Their physical health improved in the long run. Their next children developed better.
Foster paints a nuanced picture, noting, for example, that after the five-year study period, almost none of the women who ended up carrying an unwanted pregnancy said they still wish they’d had an abortion. But Foster is nonetheless unequivocal in her conclusions about what refusing an abortion meant for the women involved: “We find many ways that women have been injured by carrying an unwanted pregnancy to term.”
The most unexpected and tragic outcome noted in the Turnaway study was that two of the women died due to complications in childbirth. It came as a shock to Foster, who wrote that she “didn’t expect to find even one maternal death in a study of 1,000 women.” The maternal death rate in the US is 1.7 per 10,000, meaning the odds of two women in 1,000 dying were extremely low.
Foster was careful not to be definitive about this finding, writing that a much larger sample size would be needed to draw firm conclusions about the relationship between abortion refusal and maternal death. However, the implications remain grim: “This level of maternal mortality is shocking,” she wrote.
Aside from death, women who are refused an abortion are more likely to have serious complications than women who have had an abortion. The Turnaway study found that 6.3 percent of women who gave birth had life-threatening complications, compared with about 1 percent of women who had an abortion.
Women who were denied an abortion also saw a higher risk of gestational hypertension, which increases their risk of cardiovascular disease later in life. The study found that 9.4 percent of women who gave birth had hypertension during pregnancy versus 4.2 percent of women who had a second-trimester abortion and 1.9 percent of those who had a second-trimester abortion. had undergone the first trimester.
The women who gave birth also had slightly more chronic headaches and joint pain afterwards. As for self-reported health, a measure that has been shown to be a strong indicator of future health and mortality, 27 percent of women who completed their pregnancies after being denied an abortion said they were in fair or poor health, versus 21 percent. of women who had second-trimester abortions and 20 percent of women who had first-trimester abortions.
“To the extent that there were differences in health outcomes,” Foster wrote, “all of them were to the disadvantage of women who had given birth.”
Foster writes with some derision about the patronizing stance of anti-abortion lawmakers who have warned of serious mental health consequences, depression and even suicide, for women undergoing abortions.
Her study discovered a very different reality: “We found no harm to mental health from having an abortion.”
In fact, she explains elsewhere, “The most common emotional response to having an abortion is no.” Two-thirds of the women in the study who had an abortion said they had no or very few emotions after five years; 95 percent of women said the decision was the right one for them, a proportion that gradually increased over the five years. Only 14 percent of women said they still feel sadness after five years, and only 17 percent said they feel guilty.
The women who reported having a hard time deciding on an abortion before actually having one were those who had more negative emotions, as were women living in communities that look down on abortion and women with less social support.
Instead, the main mental health effect measured by the Turnaway Study was that women who were refused an abortion experienced increased anxiety and lower self-esteem in the first weeks and months after being rejected. Based on those statistics, they started catching up with the women who had had an abortion at six months, and by one year the differences between the two groups of women had evaporated.
Like those who had abortions, the women who were denied them became content with their situation, Foster noted. The proportion who said they still wished they had had the abortion dropped from 65 percent a week after being refused an abortion to 7 percent on their child’s first birthday.
Ultimately, the study found no long-term differences between the two groups in levels of depression, PTSD, self-esteem, life satisfaction, substance abuse, or sexual abuse.
The effect of denying access to abortion extended beyond the women involved to their children, both those who already had them and those born from an unwanted pregnancy.
Most of the women who wanted to have abortions in the Turnaway Study were already mothers, as it is often the case national. Because they were rejected for the procedure, the women’s existing children lived in conditions that were more precarious to their financial and physical well-being. They were more likely to live in poverty at some point in the next five years (72 percent versus 55 percent of children born to women who had desired abortions) and more likely to live with adults who struggled to live for food and housing (86 percent versus 70 percent).
The ripple effects were also felt in the relationships between women who were refused an abortion and the children born from that unwanted pregnancy. Those women were much more likely to answer survey questions in a way that indicated they had no emotional connection with their new baby than the women who had an abortion and had another baby later in life.
“Scientific literature on child development shows a link between poor parent-child attachment and children’s long-term psychological and developmental outcomes,” Foster wrote.
The findings of the Turnaway Study add to that body of research. Children whose mothers were refused an abortion were less likely to achieve fine motor skills, gross motor skills, receptive language, expressive language, self-help and socio-emotional developmental milestones in time than the children of women who did have an abortion. It was a small but notable difference: 73 percent versus 77 percent.
Foster finished her book and reflected on the findings of the Turnaway Study and the possibility of a world where: Roe v. Wade was quashed, which seemed plausible in the summer of 2020 after Donald Trump appointed two very conservative Supreme Court justices. During the studies that were part of her and her colleagues’ groundbreaking project, they discovered a profound impact when abortions are denied. Those aftershocks hit every part of a person’s life.
If the Supreme Court makes the ruling signaled in Alito’s draft, many more women in the United States will have to live with those consequences.
“For those women,” Foster wrote in what may be the twilight of… Roe v. Wade“all the burdens outlined in this book—deteriorating physical health, diminished life aspirations, higher exposure to domestic violence, increased poverty, decreased likelihood of a desired pregnancy, worse outcomes for their other children—will result.”