It's been quite a week for reproductive-health news—first, the government announced it was backing down on its attempt to impose age limits on access to the over-the-counter emergency contraceptive pill Plan B One-step; then, the Republican-controlled House Judiciary Committee fast-tracked a bill that would outlaw practically all abortions after 22 weeks, even in cases of rape. And in the midst of it all, The New York Times published an in-depth look at new research coming out of the University of California San Francisco that tracks the psychological and economic plight of women who are denied mid-trimester abortions as compared to women who seek and receive abortions mid-second trimester. Called the Turnaway Study, the research unearthed a treasure trove of fascinating data about why women miss the cutoff for abortion services, and how they fare in terms of mental health and economic opportunities after giving birth. In a follow-up, The Daily Beast spoke with the study's mastermind, Diana Greene Foster, about funding for abortion research, how birth control factors into preventing unwanted pregnancy, and taking the Turnaway Study global.
The Daily Beast: When you started the U.S. Turnaway study, was it hard to get funding for the research, considering that abortion is such a hot-button issue?
Diana Greene Foster: It was difficult to get funding, especially before I did a pilot study in the first clinic. Most people assumed that nobody would want to participate in a study or would agree to it right then. Once we demonstrated that women would tell their stories, funding became possible. So it was seed money from the Wallace Alexander Gerbode Foundation that enabled me to even try to do the study. They deserve a lot of credit for taking a risk. I did do this using private foundation money. I wish that the federal government would fund a domestic study like this (they did fund Henry David’s work in then-Czechoslovakia). Almost one in three American women has an abortion. There should be much more research focused on epidemiological and clinical research on abortion. There is an actual law forbidding federal dollars to be spent on research in which an abortion is actually performed. That wouldn’t block my study, but it has set back the science of abortion provision.
One interesting number the Times cites in its story—the percentage of women who were denied an abortion and then later put the child up for adoption was shockingly low (9 percent). Why is this number so minuscule, particularly considering the unmet demand for adopted children in the States?
I am surprised by how low the adoption rate is too. Many more women say they plan to give their child to a relative or place him for adoption, but very few end up doing it—so few that there is too small a sample to say how their outcomes compare to women who raise the child.
Can you talk briefly about the typical profile of a woman seeking a mid-trimester abortion? The Times piece mentions, for example, that most of the women already had one child and had a lower socioeconomic status than women who did not seek a mid-trimester abortion.
The biggest factor in late presentation for abortion is not realizing you are pregnant. Just like all physical conditions, there is a huge range of physiological response. Some women get sick, tired, have food aversions, and some women have no symptoms at all. There are some groups that have a higher risk of not realizing they are pregnant—young women who have never been pregnant before, women with substance-use problems, obese women (this is from a previous study, not Turnaway)—but it can happen to anyone.
One of the factors cited for why women miss the cut-off date for abortions was travel time. How far did your study subjects live from the nearest provider? And is California typical in terms of the number of abortion providers per square mile (for example), when compared to other states?
Unfortunately, I don’t have specific travel time data on hand. I can say that there are huge differentials in the availability of abortion providers by state. California is a state with many providers, although even in rural areas of California, abortion can be hard to access.
The Times piece mentions a study by Henry David in the former Czechoslovakia that found that children “born unwanted” were less popular with their peers, less popular with their parents, and had more negative mental- and physical-health outcomes than their “wanted” counterparts. But it also noted that David lacked a control population. Are you planning to track the development of the children whose mothers were turned away from an abortion—and if so, what kind of data will you look at and what kind of control group are you using?
We are collecting data on the child born after his/her mother was denied an abortion. We are also collecting data for the previous child born to all women in the study (60 percent of whom already had at least one child). And we are collecting data for all children born in the subsequent five years. For each child, we are collecting birth weight and health status at birth, a five-dimension child development scale, information about maternal bonding, breastfeeding, and health. Our aim is to discover if any of these outcomes vary between children who were wanted during pregnancy and those who were not. One thing to note is that many [37 percent, according to a 2012 CDC report] children are not planned. But there is a big range between planned, a happy accident, and, far on the other side, a pregnancy that a woman wants to terminate.
At the very end of the article, it mentions that access to reproductive health care could help prevent some of these cases where women are seeking late-term abortions. Is there any data on how many unwanted pregnancies would be prevented by better access to birth control, whether it’s emergency over-the-counter birth control like Plan B or to the Pill, Depo-Provera, etc.?
My estimate is that about one in five unintended pregnancies is going to be very difficult to prevent. These are the ones that are due to a failure of a contraceptive method or that occur to a woman who does not want to use contraception. But that means that the other four in five could be averted if there was much better information about the risk of pregnancy, the effectiveness of contraceptives, and contraceptive options. In addition to a lack of basic information about sex, contraception, and pregnancy, in the U.S., we make access to contraceptives about as hard as it could be. Oral contraceptives should be made available without a prescription, as they are in other countries ... Women should get a whole year’s supply of methods at a time and not have to waste their time waiting at pharmacies every one or three months for a resupply. Some improvements are imminent with the Affordable Care Act. Theoretically, most women will have insurance coverage and all methods of contraception will be available without a copay and that is a huge improvement over the current system, where even some insured women have to pay out of pocket.
You are also embarking upon a Global Turnaway study. Could you talk briefly about what that is going to entail, where it will be implemented, and how it is similar to, or how it differs from, the U.S. study?
We are collecting data from six countries where abortion is currently legal—Bangladesh, Cambodia, Colombia, Nepal, South Africa, and Tunisia. We want to see how often women are unable to access abortion services, even when it is legal. In South Africa, for example, in the two weeks we were collecting data, half of the women seeking an abortion were turned away. Some were too far along and some did not have enough money to pay. But what I think was the most common reason is that there just weren’t enough trained providers to meet the demand. We are interested in what happens to women who can’t access legal services and we are particularly interested to find out who goes on to seek an illegal abortion. The WHO estimates that one in seven maternal deaths is due to unsafe abortion. And yet little is known about these deaths. This global turnaway study may be the first study to prospectively study women’s experiences seeking illegal abortions. We hope to find out what the physical health consequences of illegal abortion are and who is able to access safe though illegal abortion.