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 collaborated with 30 abortion facilities around the country—from Maine to Washington, Texas to Minnesota—to recruit over 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.
Data collection for the study is ongoing. Our skilled research assistants interview participants by phone every six months over a period of five years. The interviews are 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 have conducted thousands of interviews thus far, and the stories that women have shared with us about their lives have been fascinating. We will continue to document their experiences until the study ends in December 2015.
Although the primary focus of the study is on women’s experiences, we are also gathering 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.
Because of the ideological controversies over abortion, and the difficulties of study design, there is little quality research on the physical and social consequences of unintended pregnancy for women. To date, most of the research has focused on whether elective abortion causes mental health problems such as depression and post-traumatic stress disorder. Even objective researchers who used rigorous scientific methods to examine the effect of unintended pregnancy on women’s lives have been limited in their ability to come to strong, far-reaching conclusions due to challenges in carrying out research in this area and a lack of studies designed to answer the question.
Much of the existing work uses inappropriate comparisons groups—comparing, for example, women who obtain abortions with those who continue their pregnancies to term by choice. Such comparisons are inherently biased and paint a distorted picture of life following an elective abortion or pregnancy continuation.
In addition, the retrospective design of many of these studies depends on women’s reporting of unintended pregnancies and abortions in hindsight. Abortions are notoriously underreported, and the level of underreporting varies by characteristics associated with health and well-being. To understand the impact of abortion and unintended childbearing on women’s lives, well-designed prospective research that uses appropriate comparison groups is needed. The Turnaway Study is designed to address this need.
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 is 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.
Between January 2008 and December 2010, we recruited women who sought abortions at 30 abortion facilities around the United States. In order to address the issue of appropriate comparison groups, the women we recruited fell into three categories:
- women who sought an abortion at a gestational age one day to three weeks over the gestational limit and who were turned away from the facility without receiving an abortion (Turnaways);
- women who sought an abortion at a gestational age one day to two weeks under the facility’s gestational limit and who received an abortion (abortion comparison group);
- women who received a medical or surgical abortion in the first trimester of pregnancy (first trimester abortion group).
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, but most of the women in the abortion comparison group were in the second trimester. Other eligibility criteria included being English- or Spanish-speaking and 15 years old or older. We obtained parental consent for minor women to participate in the study in states where parental involvement was required for the abortion procedure. Women who were seeking abortion care for a fetal abnormality or demise were not eligible for the study.
In the facility, prospective participants spoke by phone with UCSF researchers who informed them of the study’s purpose, risks and benefits; obtained informed consent; and scheduled a confidential telephone interview to take place a week after recruitment.
Participants agreed to be interviewed by phone every six months for a period of five years. These confidential interviews elicit information about changes in the women’s mental and physical health, education, employment, economic situation, use of social services, social support, family relationships, and much more. For women who carry their pregnancies to term or who had previous or subsequent children, interviews also contain questions about their children’s health, care and development. After each interview, participants are compensated for their time with a gift card from a major retailer.
The study has been approved by the Committee for Human Research at UCSF. Research and institutional funding is 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. Donations, large and small, help ANSIRH launch innovative research projects examining some of the most controversial, and therefore underfunded, reproductive health issues of our time. Please consider contributing to our work.
- Diana Greene Foster, PhD, is a Demographer and the Principal Investigator of the study. She is evaluating the physical health, mental health and socioeconomic outcomes for women. She will begin to analyze the data on child well-being and development in 2013.
- Antonia Biggs, PhD, is a social psychologist. She is analyzing the reasons women have an abortion, the factors associated with delayed discovery of pregnancy, and the mental health consequences of having an abortion compared to being turned away.
- Karuna Chibber, DrPH, MHS, is a public health social scientist. She has examined women’s reasons for seeking abortion, focusing specifically on how women articulate their partner’s role in their decision to seek abortion. She is also examining how women’s experiences of intimate partner violence over time are associated with receiving versus being denied an abortion.
- Caitlin Gerdts, PhD, MHS, is an epidemiologist. She is contributing to analyses of the socioeconomic and physical health effects of receiving vs. being denied an abortion. She is also contributing to analyses of the effect of receiving vs. being denied an abortion on women’s attitudes towards abortion.
- Sarah Roberts, DrPH, is a public health social scientist. She is investigating women’s experiences with tobacco and drugs. In addition, Dr. Roberts is contributing to analysis and writing on several other topics.
- Corinne Rocca, PhD, MPH, is an epidemiologist. She is investigating women’s emotional responses to pregnancy, abortion, and unwanted childbearing. She will also analyze data on the measurement and stability of pregnancy intentions in the cohort over time.
- Ushma D. Upadhyay, PhD, MPH, is a public health social scientist. Her research is on the prevalence of the “Turnaway problem” in the United States. She is also examining the likelihood of achieving one-year goals among women who received and women who were denied a wanted abortion. Dr. Upadhyay also plans to analyze contraceptive use and risk of subsequent unintended pregnancy among the Turnaway study groups.
- Heather Gould, MPH, is the research coordinator for the study. She has examined the counseling practices at the facilities that recruited for the Turnaway Study. She is also collaborating on several of the data projects described above.
The Turnaway Study would not be possible without the contributions of past and present staff members, including Project Director Rana Barar, MPH; Research Assistants/Interviewers Janine Carpenter, Undine Darney, Ivette Gomez, Selena Phipps, and Danielle Sinkford; and Project Coordinators Elisette Weiss and Michaela Ferrari. Sandy Stonesifer also contributed early project management, and John Neuhaus and Jay Fraser have provided statistical consulting and data management, respectively.