Five years after a decisive moment in their lives—when they had wanted an abortion, but were turned away because their pregnancies were too far along for either their local clinics' ability or legal restrictions—women who were denied an abortion reported worse physical health than similar women who'd been able to obtain abortions, a new study has found.
The differences weren't huge. A little more than one in four women in the study who had given birth after being denied an abortion reported being in "fair" or "poor" health, versus "good" or "very good." That's compared to one in five women who'd received first- or second-trimester abortions at that time. The study followed 1,132 women overall.
The study is the first of its kind and offers some vital new information, the authors say.
"There really hasn't been much research into the long term, so how do women fare beyond those first few weeks or months after giving birth or having an abortion?" asks Lauren Ralph, an epidemiologist at the University of California–San Francisco who worked on the study. "That's where our study really comes in. We found that long-term health of women having an abortion was generally comparable to those giving birth, but when differences did emerge, in physical health status, they were consistently in the direction of worse health among those giving birth."
In addition, two women in the study who had been denied abortions died from complications of their pregnancies. No study participants died as a result of complications from their abortions.
"These maternal deaths could have been avoided had these women had access to the health care that they sought," Ralph says. Although the UCSF study was too small to allow researchers to calculate reliable death rates, nationwide statistics show that, in general, the risk of death is much higher among women who carry pregnancies to term than among women who have abortions.
As states across the country pass new laws restricting (and in certain cases expanding) access to abortion, and advocates prepare for a federal-level fight, Ralph and her team's research is more relevant than ever. Their new paper, published Monday in the Annals of Internal Medicine, is just the latest to come out of a massive effort called the Turnaway Study, which aims to examine how receiving and being denied abortions can affect women's finances, families, and health.
John Horwood, a biostatistician at the University of Otago in New Zealand who has run his own studies tracking people's health over decades, including studies of the mental health of New Zealand women after they got abortions, says that the Turnaway Study is well designed to furnish new insights. It's one of the few to examine the fates of women who give birth after being denied an abortion, Horwood notes, which makes it "one of the better designs" for assessing the abortion's consequences.
Studies about abortions all have certain limitations. A self-selecting group tends to join, perhaps those who feel more at peace with their decision. People often drop off over time—they get busy and don't bother answering scientists' follow-ups. The University of California team did a reasonable job accounting for those problems, Horwood says, and the results were persuasive but unsurprising to him.
"You wouldn't expect, in a Western nation with high standards of medical care like in the U.S., that abortion or childbirth would have common adverse physical health consequences or long-term implications," he says. As for the reasons why women who gave birth ended up faring worse than those who received abortions? "They're stuck in a difficult job. The majority of them appear to be single parents. It's not easy bringing up a child."
Usually, when abortion opponents argue that abortions are bad for women, they say that the procedure can lead to severe consequences for mental, rather than physical, health. And indeed, before analyzing their 1,132 study participants' physical health outcomes, the scientists at UCSF studied the subjects' mental health closely, and published their findings in 2017. The scientists found that, a week after being denied abortions, women experience more anxiety and poorer self-esteem than women who received the abortions they asked for. Five years on, however, everybody's anxiety and self-esteem leveled off, as people seemed to adjust to their circumstances.
Horwood's work, meanwhile, has found that women can experience a spectrum of strong positive and negative emotions after an abortion. By age 30, women who had had an abortion and reacted negatively to it were slightly more likely to have major depression, anxiety, and suicidal thoughts than other women in the study—a group including both those who had an abortion but hadn't reacted negatively, and those who had never had an abortion. Nevertheless, nearly 90 percent of Horwood's study participants who'd had an abortion said they felt they'd made the right decision.
Political pundits can debate the meaning of the Turnaway Study and others, but perhaps this new research is most valuable for those considering an abortion. For them, the bottom line is that abortions are indeed safe, and may even keep a woman healthier than child-rearing that she's unprepared for. As for the mental-health consequences, those who make the decision rarely regret it, or face serious harm. But it all depends, of course, on their feelings and beliefs around abortion in the first place.