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Diana Greene Foster is a demographer and professor, and Katie Woodruff is a public health social scientist, both at Advancing New Standards in Reproductive Health in the Department of Obstetrics, Gynecology and Reproductive Sciences at University of California, San Francisco. Foster authored a 2020 book about their work, “ The Turnaway Study: Ten Years, a Thousand Women and the Consequences of Having – or Being Denied – an Abortion.”
Currently, the Maine Legislature is considering LD 1619, which would remove state restrictions on abortion later in pregnancy. Emotions run high on this bill. Yet, gestational restrictions on abortion are politically motivated, not based in evidence.
Rigorous research shows that there is no medical or public health reason to restrict access to abortion later in pregnancy. In fact, doing so has dire consequences for the people denied such care.
In our decade-long scientific study, The Turnaway Study, we tracked almost 1,000 U.S. women — including women from Maine — who sought abortions, many later in their pregnancies. We compared outcomes for two main groups: women just under the gestational limit of the abortion clinic they visited, who received their abortion, and those who were just past that limit, who were therefore turned away and went on to give birth. Because the two groups were virtually identical to start, all the difference in outcomes for the two groups was attributable to whether or not they received the abortion they sought.
Interviewing these women every six months for five years taught us a lot about why people seek abortion later in pregnancy, and what happens when they can’t get that care.
Often people seek abortion care later in pregnancy because they didn’t realize they were pregnant. Later recognition of pregnancy is more common than many realize. Cases include people who use contraception, so they don’t suspect pregnancy; younger people, whose menstrual cycles may be irregular; and those who have other health conditions whose symptoms mimic or mask those of pregnancy.
Other people seek abortion later because they find out new information about their pregnancy. This may be a devastating fetal diagnosis, maternal health condition, or other circumstance that necessitates ending the pregnancy quickly. Pregnant bodies don’t follow a legal timeline, and no one can predict when a healthy pregnancy may suddenly threaten the life of the pregnant person or the fetus.
Some people, particularly those with limited resources and therefore the fewest options, have care delayed because multiple barriers have prevented them from reaching care sooner. Barriers include having to raise funds to pay for the abortion, not being able to get time off work, or having to arrange for travel and childcare. Burdensome and unnecessary regulations have closed many clinics, requiring patients to travel further or wait longer for an appointment.
Post-Dobbs, outright abortion bans in many states are driving up clinic wait times in states where abortion remains legal. All these conditions combine to push people later in pregnancy before they can get abortion care.
Our Turnaway Study showed that gestational limits on abortion care can have devastating consequences for pregnant people and their families. People often underestimate the physical risks of pregnancy, but our study revealed these risks all too clearly. Compared to those who received the abortion they sought, women who were turned away were more likely to have long-term physical health problems from childbirth, including serious conditions like hypertension and chronic pain. Tragically, two women in the study died from childbirth complications.
Being forced to give birth also leads to lasting economic hardship for women and their children. In our study, women denied an abortion struggled to cover basic expenses like food and housing and experienced more evictions and bankruptcies, even years later. They were less likely to achieve aspirational goals such as finding a more secure place to live or establishing healthier relationships. Children whose mothers were denied an abortion were more likely to grow up in poverty and to miss their developmental milestones, compared to the children of women who received the abortion they sought.
The evidence is clear: at any stage of pregnancy, denying abortion care to people who need it is harmful. Pregnant people are the experts in their own lives and circumstances; they deserve respect and compassion from their lawmakers, not unnecessary restrictions on safe, vital healthcare.
