According to the CDC, in 2009 there were 784,708 abortions performed in the United States. That’s a breathtaking number, no matter which side of the abortion debate you sit on. So many women, faced with pregnancy and a set of given circumstances, made a choice that most of us don’t like to think about or even try to imagine.
What this statistic doesn’t convey is a more mysterious number: how many women wanted an abortion but were unable to get one? And what happens to women and babies when a abortion is denied? That’s the subject of a soon-to-be published study that was profiled in the New York Times Magazine this week. Because of restrictions on abortion by gestational age, women are routinely turned away for being too far along in pregnancy. Diana Greene Foster, a demographer and an associate professor of obstetrics and gynecology at the University of California, San Francisco wanted to see what the results of denial of abortion services mean to women:
Most studies on the effects of abortion compare women who have abortions with those who choose to carry their pregnancies to term. It is like comparing people who are divorced with people who stay married, instead of people who get the divorce they want with the people who don’t. Foster saw this as a fundamental flaw. By choosing the right comparison groups — women who obtain abortions just before the gestational deadline versus women who miss that deadline and are turned away — Foster hoped to paint a more accurate picture. Do the physical, psychological and socioeconomic outcomes for these two groups of women differ? Which is safer for them, abortion or childbirth? Which causes more depression and anxiety? “I tried to measure all the ways in which I thought having a baby might make you worse off,” Foster says, “and the ways in which having a baby might make you better off, and the same with having an abortion.”
The idea of this study is politically heartstopping: I can see advocates from both sides of the debate staring goggle-eyed at this article and wondering if the results will tell them an absolute truth about abortion. Do women who get abortions live to regret them? Do women who cannot get abortions learn to love their children? Will this be the golden ticket toward ending the debate about abortion once and for all?
No. It will not. The results of the study are just as complex as every other previous iteration of the abortion debate.
Foster designed a study that covered a lot of geographic ground and a lot of different cut off points for abortion availability. Some women were turned away at 10 weeks, others were past 20. Others were under the cut-off and received abortions:
Of some 3,000 women who were asked to participate, 956 have completed a baseline interview and agreed to follow-up interviews every six months. Of those women, 452 were within two weeks of their facility’s cutoff and received an abortion, and 231 missed the cutoff by up to three weeks and were turned away. About 20 percent of the turnaways received an abortion elsewhere. Foster compared the remaining women who carried their pregnancies to term with the near-limit abortion patients. (The 273 other women in the study received a first-trimester abortion and acted as a control group. In the United States, 88 percent of abortions occur in the first 12 weeks, and Foster wanted to be sure that the near-limit abortion patients did not differ significantly in their outcomes from first-trimester abortion patients.) Of the turnaways in Foster’s study who gave birth, 9 percent eventually put their children up for adoption.
There are two big questions here. First, why are these women seeking elective abortions? And, what happens to them after they either receive or are denied the abortion that they consciously chose?
While the answer to the first questions varies among individual women, it is safe to say that the data shows that most of the abortion seekers are economically disadvantaged with 10% of them receiving welfare and 80% reporting not having enough income to meet basic expenses. Only about 6% of the women have college degrees, compared to the national average of 18%. A majority of the women in the study already had at least one child.
As to what happens to them afterwards, well, this is the moment where those who discuss the politic of abortion draw a deep breath and hope for justification. And I don’t think that either side will be satisfied with the results. Foster’s study shows that the initial emotion following abortion is relief. Over time, there is no correlation between abortion and an increase in depression and/or anxiety. However, women who were turned away showed increases in anxiety for the immediate 6 months after being denied an abortion. After that there was no appreciable difference between groups. And yes, women who went on to have and raise their children reported loving them and being utterly happy with motherhood.
But while a woman may embrace a child that she didn’t feel ready to carry, all the things that led to her decision to try and abort don’t vanish because she now has a child that she loves. Poverty, lack of familial or partner support, joblessness, housing and food insecurity, lack of access to health care still remain. And in fact, the outcomes for women who are denied abortions in those areas are worse than those who received abortions:
Where the turnaways had more significant negative outcomes was in their physical health and economic stability. Because new mothers are eligible for government programs, Foster thought that they might have better health over time. But women in the turnaway group suffered more ill effects, including higher rates of hypertension and chronic pelvic pain (though Foster cannot say whether turnaways face greater risk from pregnancy than an average woman). Even “later abortions are significantly safer than childbirth,” she says, “and we see that through lower complications and low incidence of chronic conditions.” (In the National Right to Life’s five-part response to preliminary findings of Foster’s study, which were presented at the American Public Health Association conference last year, the group noted that the ill effects of abortion — future miscarriage, breast cancer, infertility — may become apparent only later. Reputable research does not support such claims.)
Economically, the results are even more striking. Adjusting for any previous differences between the two groups, women denied abortion were three times as likely to end up below the federal poverty line two years later. Having a child is expensive, and many mothers have trouble holding down a job while caring for an infant. Had the turnaways not had access to public assistance for women with newborns, Foster says, they would have experienced greater hardship.
So, what are we supposed to take from this study? Is abortion better for women than carrying children to term? Is denying women abortion a route to overcoming misgivings about pregnancy and motherhood? A little of both? Neither? It’s all as clear as mud. We know more today than we did before about the who and why of abortion, and we know more about the aftermath of both abortion and lack thereof. The next step is to decide what we’re going to do about it.
I will conclude by saying two things that I’ve said so often I probably mumble them in my sleep. First, we live in an age where we can significantly reduce the incidence of the kind of crisis pregnancies that the women in this study sought to end. There is no excuse for the lack of access to reproductive health care, sexual health information and contraception that leads to 49% of pregnancies in the US are unplanned. It is well past the time for us to start implementing policies that protect the sexual and reproductive health of our citizens and cut the crisis pregnancy rate dramatically. Reducing crisis pregnancies is the only thing that will reduce the abortion rate.
Second, we need to support families in fact as well as in theory. I’m sickened by the notion that 80% of the women in this study, most of whom already had children, didn’t have enough money for basic needs. Mothers and children should not be living in consistent financial insecurity. The decision to terminate a pregnancy should not be made because a woman lacks the funds to feed the children she already has. The cycle of poverty for these families is crushing and real and it’s time we look at it honestly and figure out how to support mothers and children in meaningful ways.
Photo credit: Joseph Hoban
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