Turnaway Study

What is the Turnaway Study? | Why is the study important? | How is the study being carried out? | Key researchers

What is the Turnaway Study?

Turnaway Study

Dr. Diana Greene Foster, Principal Investigator on the Turnaway Study, at right. With her are (left to right) ANSIRH Research Analyst Deb Karasek, Project Director Rana Barar, and Research Analyst Claire Schreiber.

The Turnaway Study is ANSIRH’s longitudinal prospective study of women who receive an abortion and women who are denied an abortion because they present for care after the clinic’s gestational limit. The study will describe the mental health, physical health and socioeconomic outcomes of receiving an abortion compared to carrying an unwanted pregnancy to term.

From 2008 to 2010, we recruited over 1,000 women for our study at 30 dedicated clinics across the country—from Maine to Washington, Texas to Minnesota. Now in the fourth year of the project, we have conducted over 2,800 interviews. The stories that women are sharing with us are fascinating. Now that recruitment is complete, we will begin to release study results in late 2011.

Although our primary focus in this study is on women’s experiences, we are also gathering information about the health and well-being of children born to women who continued their pregnancies because they were not able obtain an abortion.

Why is the study important?

The major aim of the Turnaway Study is to describe the mental health, physical health, and socioeconomic outcomes of receiving an abortion compared to carrying an unwanted pregnancy to term.

Because of the ideological controversies over abortion, 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. Much of this research has been produced by individuals with an agenda of making abortion illegal and inaccessible to women.

There thus remains considerable controversy in the scientific literature about the findings related to the physical and psychological sequelae of abortion. Much of the existing work compares women who obtain abortions with those who continue their pregnancies to term by choice. Such a comparison is inherently biased and paints 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 do just this.

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 on women and their families. The Turnaway Study is an effort to capture women’s stories, understand the role of abortion in women’s lives, and contribute to the ongoing public policy debate on the mental health and life course consequences of abortion and unwanted childbearing for women.

How is the study being carried out?

Turnaway Study

Research Analyst Claire Schreiber interviews study participants by phone. Participants will be interviewed every six months for a period of five years to track changes in their mental and physical health, education, employment, economic situation, social support, and family relationships.

During recruitment, we worked collaboratively with selected first- and second-trimester abortion clinics to recruit and enroll English- and Spanish-speaking women into the study. Eligible individuals included English- and Spanish-speaking abortion patients, 15 years old and older, who had no known fetal anomalies or fetal demise, and who presented for care with a pregnancy gestation up to three weeks above or two weeks below the clinic’s upper gestational limit.

We recruited three types of participants—women whose gestational age was one day to three weeks over the gestational limit and who were turned away from the clinic without receiving an abortion; women whose gestational age was one day to two weeks under the clinic’s gestational limit and who received an abortion; and women who received a medical or surgical abortion in the first trimester of pregnancy. In the clinic, prospective participants spoke by phone with UCSF researchers who informed them of the study’s purpose and risks and benefits, obtained informed consent, and scheduled a confidential telephone interview to take place a week after recruitment.

Participants are interviewed by phone every six months for a period of five years. Interviews elicit information about changes in the women's mental and physical health, education, employment, economic situation, social support, and family relationships. For women who carry their pregnancies to term, interviews also contain questions about their infant’s health and place of residence and about their own parenting issues and use of social services. After each interview, participants receive a $50 gift card for a large retail store such as Target or Walmart.

Data analysis will be ongoing over the course of the study. Preliminary and final results will be shared with participating clinical sites directly and with the public health community through presentations at conferences and meetings and through articles published in peer-reviewed journals, starting in late 2011.

Next steps: The Global Turnaway Study

According to a study conducted by the World Health Organization in 2009, unsafe abortion accounts for 70,000 maternal deaths and causes the temporary or permanent disability of an additional 5 million women every year. Little is known about the experiences of women who seek legal abortions in countries where abortion is legally restricted but who are denied the procedure because they present for care just after the legal gestational cutoff, or for other reasons. Learning about these women’s experiences (including whether they turn to unsafe abortion) would improve our understanding of the impacts of restrictive abortion laws on the lives of women in diverse legal, cultural and socioeconomic settings.

There have been no prospective studies of women seeking illegal abortion or experiencing an unwanted birth. Very little is known about the consequences of illegal abortion and unwanted birth for women in low-resource settings, beyond its contribution to maternal mortality. This study will allow the global reproductive health community to better understand what motivates women to seek unsafe abortion and how families cope with unwanted births. The research will vastly increase our understanding of the effect of access to safe abortion on women’s overall health and well-being, providing critical evidence for policy and advocacy efforts to ensure access to safe abortion.

The innovative study design employed in our US-based Turnaway Study—interviewing women on either side of a gestational limit—can be adapted to other settings. A global study will benefit from the significant work that has already been done on protocol and tool design to investigate the effects of abortion and unwanted childbearing among women who live in diverse settings where abortion is legally restricted. In 2011, the Turnaway Study team will conduct pilot research in several countries to examine what will be required to adapt the Turnaway Study model for use in other settings around the world. We intend to work closely with in-country partners in countries where abortion is legal to a gestational limit and/or where abortion is accessible up to a gestational limit. Through the pilot project, we aim to forge relationships with medical institutions that provide legal abortion services, as well as potential research collaborators who might partner with us to carry out the larger study if the pilot phase is successful and if funding for a larger study is secured.

Key researchers

Diana Greene Foster, PhD, is the Principal Investigator for the project. Other ANSIRH staff involved in the project include Tracy Weitz, PhD, MPA; Rana Barar, MPH, who is Project Director for the Turnaway Study; and Heather Gould, MPH, who is Research Coordinator.

This study has been approved by the Committee for Human Research at UCSF and is being funded by the David and Lucille Packard Foundation, Wallace Alexander Gerbode Foundation and other private donors.

For more information on this project contact Diana Greene Foster, PhD.

For reproductive health news, see ANSIRH’s blog.