What is the Turnaway Study?

Turnaway Study

Dr. Diana Greene Foster, Principal Investigator on the Turnaway Project, at right. With her are Project Coordinator Michaela Ferrari, Project Director Rana Barar, and Deb Karasek, ANSIRH Research Analyst.

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.

We are currently recruiting women for our study at 26 dedicated clinics across the country from Maine to Washington, Texas to Minnesota. We have enrolled over 400 women and conducted over 600 interviews. The stories that women have shared with us have been fascinating. We have been describing women's experiences at professional meetings and we will continue to do so as we work toward our goal of 2,000 participants.

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 Turnaway Study has three major aims:

To describe the mental health, physical health and socioeconomic outcomes of receiving an abortion compared to carrying an unwanted pregnancy to term,
To understand the effect of access to abortion services on women’s lives, and
To address the recent spate of low-quality research and paucity of high-quality research on the sequelae of abortion.

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

Project Assistant Michaela Ferrari interviews study participants. Participants will be interviewed by phone 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.

We are working collaboratively with selected first- and second-trimester abortion clinics to recruit and enroll 2,000 women into the study. Enrollment at each clinical recruitment site will occur over a period of approximately eighteen months. Eligible individuals include English- and Spanish-speaking abortion patients, 15 years old and older, who have no known fetal anomalies or fetal demise, and who present for care with a pregnancy gestation that is within two weeks above and below the clinic’s upper gestational limit.

We are recruiting two types of participants—women whose gestational age is one day to two weeks over the gestational limit and who are turned away from the clinic without receiving an abortion, and women whose gestational age is one day to two weeks under the clinic’s gestational limit and who receive an abortion. In the clinic, prospective participants speak by phone with UCSF researchers who inform them of the study purpose and risks and benefits, obtain informed consent, and schedule a confidential telephone interview to take place a week later.

Women who choose to participate will be 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 Safeway.

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.

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, 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.