Best practice for abortion policies: listen to women's stories

Our expert urges policy makers to listen to women and look at the research before making any decisions about de-funding Planned Parenthood.

RANA circleBy Rana E. Barar, MPH, Project Director, Advancing New Standards in Reproductive Health, University of California, San Francisco.


As the debate in Washington, DC rages over the de-funding of Planned Parenthood, researchers at the University of California, San Francisco Department of Obstetrics, Gynecology and Reproductive Sciences are gathering data about the effects on women’s lives of abortion and the consequences of being unable to access that care. The experiences of women who have an unwanted pregnancy and seek an abortion are rarely heard in the conversations happening in the media and in legislative bodies across the country. Researchers at UCSF are conducting a longitudinal study of women about their experiences. In fact, we have conducted almost 8,000 interviews over the past 7 years and these individual stories are helping us paint a richer, more nuanced picture of the landscape of abortion in the United States. What we are finding is that women are prescient in their reasons for seeking to end an unintended pregnancy, and when they have to carry unwanted pregnancies to term, they are resilient, but not unaffected.

For the past eight years, a team at Advancing New Standards in Reproductive Health (ANSIRH), a research group at UCSF, led by demographer and Professor Diana Greene Foster, PhD, has been gathering data as part of the Turnaway Study, a prospective, longitudinal study of almost 1,000 women who sought abortion from 30 sites in 21 US states. The study rose out of a gap in the scientific literature on the effects of abortion and contraception on women’s health and well-being. When the Turnaway Study first launched in 2008, the existing body of literature, particularly on the question of whether there is an association between abortion and mental health problems such as depression, lacked studies that included appropriate comparison groups to women who had abortions. For example, some compared the outcomes of women who had abortions to those who carried chose to carry to term.

The existence of gestational limits that vary from clinic to clinic and state to state gave Dr. Foster the opportunity to examine the outcomes of women who all wanted to obtain an abortion – some of whom were able to receive abortion care while others who presented beyond the gestational limit had to carry their pregnancies to term. As the director of this study, I recruited 30 abortion facilities in 21 states to recruit women into the study at the time they sought to terminate their pregnancies. Women were interviewed on a range of outcomes from physical and mental health to relationships and life plans one week after they received their abortion or were turned away and again every six months for five years.

In one of our earliest publications from the Turnaway Study data, researchers Antonia Biggs, PhD, Heather Gould, MPH, and Dr. Foster examined women’s reasons for seeking abortion care. 40% of women cited financial reasons, 36% said the pregnancy happened at the wrong time, 31% were concerned about their partner and 29% cited the need to focus on their other children. Biggs, Gould and Foster urged policy makers to “consider women’s motivations for choosing abortion, as decisions to support or oppose such legislation could have profound effects on the health, socioeconomic outcomes and life trajectories of women facing unwanted pregnancies.” A clear picture of those profound effects has begun to emerge as we have delved deeper into the data.

Early analyses suggest that women who carry unwanted pregnancies to term are more likely to be in poverty. We also know that women who are unable to obtain an abortion are more likely to stay tethered to abusive partners. There are also early indications that women have reason to worry about the impact of an unintended birth on that child as well as on their existing children. Women do not cite concerns for their own health as frequently in their reasons for wanting to end a pregnancy, but we know that childbirth is much more dangerous for women than having an abortion and we see that in the Turnaway data that shows that women denied abortion have greater short-term morbidity than women who are able to access abortion care.

Recently, researchers Corinne Rocca, PhD, and Dr. Foster have given us strong evidence that women are resilient when it comes to the emotions around ending a pregnancy. Despite the fact that women feel a range of emotions about their abortion experience, predominately relief, although some regret and sadness as well, almost all women, including those who have mostly negative emotions believe that abortion was the right decision for them over the long-term. In addition we see absolutely no link between abortion and adverse mental health outcomes like depression.

The reasons women give for wanting to end an unwanted pregnancy are a good indication of the profound effects we see when they are unable to access abortion care. Policy makers should take the time to listen to women’s stories and trust that women are the experts in the circumstances of their lives. If they did, the resulting policies might actually improve women’s health and well-being.

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