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Dr Diana Foster and The Turnaway Study: fighting for data science to inform policy

Dr Diana Greene Foster is a Professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco (UCSF). As a researcher and demographer, Dr Foster has dedicated decades to studying the effect of unintended pregnancy on women's lives and is best known for her work as the principal investigator in The Turnaway Study. The topic of abortion can often lead to emotionally charged discussions, but, through a pursuit of scientific truths, Dr Foster strives to bring the scientific evidence concerning abortion to the forefront of public forum.

Published:
Dr Diana Foster and The Turnaway Study Poster - ⦁ The Turnaway Study: Ten Years, a Thousand Women and the Consequences of Having – or Being Denied – an Abortion

The Turnaway Study, launched in 2007, was inspired by a casual question from an abortion provider - 'I wonder what happens to the women we turn away?'. Researchers recruited 30 abortion providers and tracked more than 1,000 women who had either received an abortion or had been turned away after missing a facility's cut-off period. Women were tracked for up to 5 years after, facilitating a cohort study that has now led to the publication of more than 50 peer-reviewed research articles.

A non-exhaustive list of outcomes for women who were denied abortions is highlighted below: 

  • Increased socioeconomic hardship - women who were denied abortions were more likely to live in poverty and three times more likely to be unemployed (1)
  • Greater risk to physical health through a higher probability of experiencing complications related to the birth of the child - carrying an unwanted pregnancy to term shows an increased risk of experiencing potentially life-threatening complications during the birth of the child, such as postpartum haemorrhage, as well as increased chronic pain over the period of five years (2).
  • A negative effect on the whole family - most abortion patients are already parents, and this can lead to a multi-generational burden. Women who received an abortion were able to take better care of older children, whereas children of parents who were denied an abortion showed worse developmental outcomes and were more likely to live in poverty (3).
  • Worse mental health - although both groups showed similar levels of depression, women who were denied an abortion had more anxiety, lower self-esteem and life satisfaction than women who received an abortion (4).

In a recent editorial for Science, Dr Foster summarises her key findings and her hopes for its impact on legislation (5). The overwhelming conclusion of this cohort study is that we should trust that people know what is best for themselves and their families - this is based, not on anecdotal evidence, but on a large and informative dataset. However, in a landmark case (Dobbs v Jackson Women's Health Organization) in 2022, the U.S. Supreme Court overturned the decision of Roe v Wade (1973). Roe v Wade previously protected an individual’s right to abortion until a foetus becomes viable, but Dobbs v Jackson Women's Health Organization now gives individual states the power to regulate abortion. In making this decision, the Court displayed a disregard for the scientific evidence provided by Dr Foster and other researchers in the field, Dr Foster has launched a new study to compare outcomes for people who got an abortion up to two weeks before individual state bans came into effect, with those who planned to get an abortion but couldn't. One can hope that this research will go some way to ensuring access to abortion for women across the U.S. and that the states will instead place data at the forefront of their decisions.

To learn more:

Sources

  1. Foster DG, Biggs MA, Ralph L, Gerdts C, Roberts S, Glymour MM. Socioeconomic outcomes of women who receive and women who are denied wanted abortions in the United States. American Journal of Public Health. 2022;112(9):1290–6
  2. Gerdts C, Dobkin L, Foster DG, Schwarz EB. Side effects, physical health consequences, and mortality associated with abortion and birth after an unwanted pregnancy. Women's Health Issues. 2016;26(1):55–9.  
  3. Foster DG, Raifman SE, Gipson JD, Rocca CH, Biggs MA. Effects of carrying an unwanted pregnancy to term on women's existing children. The Journal of Pediatrics. 2019;205.
  4. Biggs MA, Upadhyay UD, McCulloch CE, Foster DG. Women’s mental health and well-being 5 years after receiving or being denied an abortion. JAMA Psychiatry. 2017;74(2):169.
  5.  Foster DG. The Court is ignoring science. Science. 2022;376(6595):779–.

Image sources
https://www.wamc.org/the-roundtable/2020-06-12/the-turnaway-study-by-dr-diana-greene-foster-explores-access-to-abortion-in-america 

 

Alice L.

 

 

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