The Human Cost Of Being Denied An Abortion

HuffPost spoke with Dr. Diana Greene Foster about the far-reaching implications of being denied abortion care, ahead of the upcoming Supreme Court case that threatens to overturn Roe v. Wade.

In two weeks, the Supreme Court will hear a case that threatens the constitutional right to access safe and legal abortion. It would be a historic moment with a massive ripple effect if the court decided to turn its back on 50 years of precedent, after Roe v. Wade, the landmark Supreme Court ruling that protects the right to abortion.

The intense political battles over the case, called Dobbs v. Jackson Women’s Health Organization, and abortion writ large often overlook what the fall of Roe would actually mean for women and birthing people in the U.S.

And the impact runs much deeper than most people realize. Dr. Diana Greene Foster, author and head researcher of the Turnaway Study, has devoted her life to the human impact of abortion access. Published last year, the Turnaway Study followed 1,000 women over 10 years and analyzed the long-term impact of being able to access an abortion versus being denied an abortion.

They found that for women who were denied an abortion, there was “an increase in poverty; a decrease in employment that lasts for years; a scaling back of aspirational plans; and years spent trying to raise a child without enough money to pay for food, housing, and transportation instead of pursuing other life goals,” as Foster wrote in the book of the same name. (Foster noted that she “made the mistake” of not including genderqueer or non-binary people in her study when she initially began in 2007.)

The study also found that, contrary to frequent claims from anti-choice advocates, abortion does not harm women’s mental health, and 95% of women who have abortions felt their decision was the right one for them. Women who received an abortion were much more likely (48%) than women who were denied an abortion (30%) to plan and achieve future goals. “It is the women denied an abortion whose life trajectory often took a detour,” writes Foster.

Dobbs v. Jackson Women’s Health Organization is a 2018 Mississippi state law that attempts to ban abortion after 15 weeks of pregnancy. The Mississippi law is in direct violation of Roe, which states that abortion procedures are legal up until viability, which is around 24 weeks.

“If Roe v. Wade is overturned, people need to understand that if you’re already suffering, taking something away does not make the suffering go away. It increases the suffering. And that’s what’s gonna happen here.”

- Shannon Brewer, clinic director at Jackson Women’s Health organization

The Supreme Court could oppose the Mississippi law, which means Roe is still the law of the land; or the court could uphold the state law, whether banning abortion outright or tinkering with the gestational limit, which effectively overturns Roe and reverts abortion laws back to the states. If the latter happens, there are already several states with constitutional amendments or trigger bans which will immediately outlaw abortion in those states.

A post-Roe world will mean a person’s ability to access abortion heavily depends on which state they live in and if they have the economic means to travel to access the procedure.

A world in which Roe is not law of the land will be devastating for women and birthing people in Mississippi: It’s 75 times more deadly to carry a pregnancy to term than to have an abortion in the Southern state. And that’s disproportionately felt by Black women and by poor women in Mississippi.

“If Roe v. Wade is overturned, people need to understand that if you’re already suffering, taking something away does not make the suffering go away. It increases the suffering. And that’s what’s gonna happen here,” Shannon Brewer, the clinic director at Jackson Women’s Health organization, the last abortion clinic in the state, said during a press call earlier this week.

HuffPost spoke with Foster about the cost of being denied an abortion, and the very real consequences for women and birthing people in the U.S. if Roe falls in the wake of the Dobbs v. Jackson Women’s Health organization decision.

As someone who’s studied the impacts of being denied an abortion, how are you feeling ahead of the upcoming Supreme Court case, Dobbs v. Jackson Women’s Health Organization? The fate of Roe is really hanging in the balance here.

I just feel like it’s so political. So many people are viewing it through some kind of ideological lens. They have no idea the magnitude of impact for the people who are actually affected. Even lowering the gestational limit would mean tens of thousands of people would not be able to get abortions ― and that has long-term impact on a lot of people.

If the Supreme Court overturns Roe entirely and every state gets to decide its own legislation around abortion, not everyone will carry the pregnancy to term. Some people will travel and some people will order pills online, but I think what’s overlooked is that many people will be forced to carry pregnancies to term. We need to acknowledge that that comes with substantial harm.

It does feel like such a political conversation. That’s why I was so excited to talk to you because your research really gets at the impacts of abortion access and how it effects every day people’s lives.

It’s covered as a political issue: What is legal precedent? What is one political side per se versus another? How can we, who have ideological conflict, compromise on this issue? As if it’s all so abstract. What we need to be talking about is how it impacts people.

In the case that Roe is effectively overturned and power is reverted back to the states, how do you think that will impact women and birthing people in the country?

It will vastly disproportionately hurt very young women and very poor women. Because if abortion is banned in a state, the people who won’t be able to travel or won’t have the resources or knowledge to order pills online are people who are poor or very young. When I say very young I mean teenagers, who already are at a disadvantage because they’re often later to discover they’re pregnant, and that further narrows their options about where they can go and what they can do.

For very privileged people, it will be an inconvenience, they’ll simply have to travel. Don’t get me wrong, it could be extremely unpleasant to have to travel hundreds of miles and pay a lot of money, but at least they’ll have some say over what happens with their pregnancy and their body, but it won’t be that way for poor people and for young people.

Women rights activists participate in the annual Women's March as they pass by the U.S. Supreme Court Oct. 2, 2021 in Washington, D.C.
Women rights activists participate in the annual Women's March as they pass by the U.S. Supreme Court Oct. 2, 2021 in Washington, D.C.
Anadolu Agency via Getty Images

Talk to me a bit about your research. How did being able to access an abortion or being denied an abortion impact women’s lives?

The beauty of the study design is that the people who received and the people who were denied abortions were the same when we recruited them. All the ways in which their lives diverged are attributable to whether they got that abortion or not, and the impacts are really wide-ranging. From not being able to afford basic living needs like food and housing and transportation, to being more likely to raise your existing children in poverty, to not being able to hold a full-time job.

The health difference is one area in which I think people underestimate the impact on one’s body after continuing an unwanted pregnancy and giving birth. We see not just greater physical health risks in the end of pregnancy, but, over the next five years, a greater likelihood of chronic pain and hypertension for the people who give birth compared to the ones who were able to have an abortion.

Another area is all the life differences. The ways in which people have to scale back their aspirational plans to accommodate a pregnancy that they weren’t ready for, and those people are less likely to set and achieve aspirational plans when they know that they’re not going to be able to get a wanted abortion. And interestingly, that includes wanting to have a child later under better circumstances. Women who are denied abortions are less likely to have an intended pregnancy in the next five years. The circumstances of their lives and raising a child that they weren’t ready for impacts their ability to have a kid later.

What were some of the top reasons that you found women seek out abortions?

In the study, we asked them at their very first interview, “What are some of the reasons that you decided to have an abortion?” And we didn’t give them a list of acceptable reasons to choose from. We just asked it as an open-ended question, and then we went through and categorized all their answers and when we did that, we actually found that their reasons were very close to what the Guttmacher Institute finds when it surveys all people seeking abortion in clinics across the country.

The most common reason is not being financially prepared, so feeling like you don’t have enough money to raise a baby or to raise another baby. The second most common is saying that it’s just not the right time for a baby. Partner-related reasons are third: Almost a third of women in the study gave partner-related reasons. That could be because he’s violent or it could be that he wouldn’t make a good father or isn’t willing. The fourth most common reason we heard was the need to care for their existing children, which accounted for over a quarter of people in the study. Many people don’t realize that the majority of people who have abortions are already mothers and their need to take care of their existing kids is primary.

What’s interesting about all of these reasons is that they’re so closely tied to what the consequences were for the people who were denied. It really is testament that people are making careful decisions, they understand the circumstances of their lives so when they give these reasons, they understand what it would be like to have to carry that pregnancy to term.

I recently wrote an article about how abusive relationships often include some form of reproductive coercion or reproductive control, and how Texas’ recently enacted abortion restriction will only magnify current situations of intimate partner violence. Did you see stories of intimate partner violence come up in your research?

Yeah. One of the papers is by my colleague, Sarah Roberts, who measured exposure to intimate partner violence from the man involved in the pregnancy, and it took an immediate dive for the people who got abortions. People who were able to get abortions stopped being exposed to violence immediately after. For people who carried the pregnancy to term, it was level. They did not experience a decrease, and that’s not because they’re still in a romantic relationship, but because they have continued contact with their abuser because they were about to have a baby with him.

“Whether someone can access abortion directly impacts who they have in their lives and whether they can control their exposure to violence.”

- Dr. Diana Greene Foster

So, accessing an abortion helped people get out of those abusive relationships?

Exactly. This is what’s so underappreciated: Whether someone can access abortion directly impacts who they have in their lives and whether they can control their exposure to violence. In my research, when people responded that their reason for abortion is the man involved in the pregnancy it can just be that it’s a new relationship that isn’t strong enough to raise a child together. But it also can be that he’s violent, and that she’s actually worried for her health and for her child’s safety.

One woman, I remember, said, “Our relationship became violent and I couldn’t see bringing another kid into a life that was going to be surrounded by violence.”

Your research really debunked a lot assumptions people have about women who get abortions. Just the fact that, as you said, a majority of people who get abortions are already parents.

Was there anything from your research that really surprised you?

The rate of maternal death from carrying a pregnancy to term was absolutely shocking. We found a 1% death rate among the people who are denied, whereas maternal mortality is in the low numbers per 10,000, not per 100. It’s an appalling rate of death and it really underscores how dangerous pregnancy is.

It also shows how we, as a culture, take people who are pregnant for granted. I think the reason why we take people for granted and we decide that we don’t trust their decision-making when it comes to getting an abortion is because so many are women. We’re not interested in a woman’s aspirations and her decision-making. Her agency is often completely removed from these conversations.

It feeds off of the stereotype that a woman’s natural role is to be pregnant and give birth, so every and all risk should be taken by women to have a child. But in actuality, the risk of pregnancy is so substantial and it changes your physiology for the rest of your life. It’s one thing to voluntarily choose to take these risks because you want a child, but to do it to somebody against their will is downright callous. It’s unfathomable to think that adoption is a solution when you realize the risks of carrying a pregnancy to term.

Looking ahead to the Mississippi SCOTUS case, what do you wish people knew when discussing abortion rights?

I wish people could have empathy for women and people who are getting abortions. Let them see what decisions this person is making, what are the consequences for their lives and their families. Let’s humanize this so it’s not just about political gain and it’s not just this theoretical conversation of “fetus as a person” versus “the abstract woman as a person.” I wish they could see that there’s, in fact, a lot of people involved and people with real and complicated and important lives.

This interview has been condensed and lightly edited for clarity.

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