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 recruited from 30 abortion facilities around the country—from Maine to Washington, Texas to Minnesota—to recruit about 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.
Our skilled research assistants interviewed participants by phone over a period of five years, ending in December 2015. The interviews were 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 conducted nearly 8,000 interviews over the course of the project, and the stories that women shared with us about their lives are fascinating.
Although the primary focus of the study was on women’s experiences, we also gathered 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, before the Turnaway Study, there was little quality research on the physical and social consequences of unintended pregnancy for women. Most of the research that did exist focused on whether abortion causes mental health problems such as depression and post-traumatic stress disorder, or alcohol and drug use.
That body of work often used inappropriate comparisons groups—comparing, for example, women who obtain abortions with those who continue their pregnancies to term by choice—and used retrospective designs that depended on women’s reporting of unintended pregnancies and abortions in hindsight. Such comparisons are inherently biased and paint a distorted picture of life following an elective abortion or pregnancy continuation.
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 was 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.
Participants were interviewed every six months about their mental and physical health, education, employment, economic situation, social support, and family relationships. In order to address the issue of appropriate comparison groups, the women we recruited fell into three categories:
- Women who sought an abortion up to three weeks over the gestational limit and were turned away without receiving an abortion (Turnaways);
- Women who sought an abortion up to two weeks under the facility’s gestational limit and received an abortion (abortion comparison group);
- Women who received an 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. Women who were seeking abortion care for a fetal abnormality or demise were not eligible for the study.
ANSIRH has published more than two dozen peer-reviewed publications on data from the Turnaway Study to date. Project Director Rana Barar recently summarized some of the study's main findings for a blog on ResearchGate. In addition, our annotated bibliography provides a complete list of publications. Issue briefs on numerous topics are forthcoming in 2016, and a new interactive website will allow visitors to explore women's stories, as well as the quantitative data, by the end of the year.
The success of the Turnaway Study inspired ANSIRH researchers to collaborate with colleagues around the world to launch the Global Turnaway Studies, designed to adapt the innovative study design for use in different cultural and legal contexts.
The Turnaway Study would not have been possible without the contributions of past staff members, Interviewers Mattie Boehler-Tatman, Janine Carpenter, Jana Carrey, Undine Darney, Ivette Gomez, Emily Hendrick, Selena Phipps, Claire Schreiber, and Danielle Sinkford; and Project Coordinators Debbie Nguyen, Elisette Weiss and Michaela Ferrari. Sandy Stonesifer also contributed early project management, and John Neuhaus and Jay Fraser provided statistical consulting and data management, respectively.
Research and institutional funding was 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.
The study was approved by the Committee for Human Research at UCSF.