“If the government restricts people’s ability to make decisions for themselves, it will make their lives harder,” said Diana Greene Foster, lead researcher of the Turnaway Study.
Demographer Dr. Diana Greene Foster saw a need for authoritative, rigorously researched data on abortion. It could reveal the effects of unwanted pregnancy on women’s lives, she realized, and help inform the policy debate. With a team of more than 40 women scientists, psychologists, economists, public health researchers and epidemiologists, she met the challenge with the groundbreaking Turnaway Study.
Among its revelations:
- Abortion does not harm women’s mental health: Ninety-five percent of women who had an abortion say it was the right decision for them five years later.
- Those who were denied a wanted abortion were more likely in later years to have insufficient money to pay for housing, food, transportation and other essentials.
Insights from the study have been released in more than 50 peer-reviewed journals and Foster’s 2020 book, The Turnaway Study: Ten Years, a Thousand Women and the Consequences of Having—or Being Denied—an Abortion.
For her body of work as a reproductive health researcher and educator, Foster has recently been named a MacArthur fellow—popularly known as the MacArthur Foundation “genius grant.”
Ms. talked with Foster about the Turnaway Study, her current research and how part of the $800,000 grant will support a play that could be the next Vagina Monologues.
This interview has been edited for length and clarity.
Andrea Cooper: Congratulations on the MacArthur grant. How did you react to the news? What work will the grant support?
Dr. Diana Greene Foster: I was shocked. It’s hard to be held up (for this honor), especially because this research is not a one-woman show. It was a huge collaborative effort. But I’m thrilled to get attention to the Turnaway Study at a time when the study is super relevant.
Right now I have a study in Nepal, one of the few about abortion funded by the National Institute of Health. I’m hoping to get a renewal but there’ll be a gap (in funding). Now I can keep 14 interviewers in Nepal employed until I can get the next round of funding, hopefully.
Also, my sister has written a play about the Turnaway Study. It’s a story of the science and the p0eople in the study, but it’s also fictionalized. The Dr. Foster character is more fun than me. It’s being performed at the Kitchen Theatre Company in Ithaca, New York, next May. There’s a lot of interest. My sister is going to make it freely available so any theater that wants to put it on as a benefit for abortion rights or clinics could do that. It’s funny and smart.
This question of ‘Does abortion hurt women?’ desperately needed to be addressed scientifically.Diana Greene Foster
Cooper: Nobody grows up thinking, “I want to be a demographer and reproductive health researcher.” How did you choose this work?
Foster: I was in a meeting recently that had an icebreaker, asking what we wanted to be when we grew up. I remember taking a [career] test in middle school. It definitely didn’t come up with abortion researcher.
I am super quantitative and I am interested in feminism. This question of “Does abortion hurt women?” desperately needed to be addressed scientifically. Justice Anthony Kennedy had allowed abortion restrictions to stand on the basis that he thought it was reasonable to conclude people would be depressed if they got abortions. There was no reliable data, he admitted, and we just needed reliable data. So it was a perfect question for me.
In a chance conversation with Dr. Eleanor Drey, (medical director of the Women’s Options Center at San Francisco General Hospital), she mentioned they’re turning people away. For me, it was the study population we’d all been waiting for. We can follow people who have abortions, but who do we compare them to? It needs to be the people who want abortions and can’t get them. It really sparked the study.
Cooper: What are the most important conclusions of the study, especially since Roe was overturned?
Foster: That’s easy. When we ask people why they were having an abortion they gave us a whole lot of reasons. The things they were concerned about–finances, relationships, their kids–all of those are exactly what was experienced by the people who were denied.
People who are making this decision understand their circumstances. They understand the consequences of carrying a pregnancy to term. When they’re not able to make this decision for themselves, their lives and their kids’ lives will be measurably worse off.
We can trust people’s decision making. We should know that if the government restricts people’s ability to make decisions for themselves, it will make their lives harder.
Cooper: Fifty-percent of U.S. abortions are obtained by mothers who already have children. What did the study reveal about them?
Foster: People don’t understand how much this decision about whether to end a pregnancy has to do with desires to be a good mother to the kids they already have and to have children later under better circumstances. Many people who get abortions still want to have kids later, but they want to have them with the right partner, with the right financial situation, with stable housing or a stable job. They’re wanting to be good parents to the kids they already have or to the chance of future children. That is not a narrative that is out there very much.
Cooper: What was most surprising about the study results?
Foster: The most shocking thing is that we had two maternal deaths. Two women in the study died right after childbirth of common reasons that people die after childbirth—one of infection and one of eclampsia.
It goes to show something that is not appreciated, which is how dangerous pregnancy is. Any cavalier comments that ‘women will just drop babies off at fire stations’ and that this is no big deal are really callous about the true risks of continuing pregnancy and childbirth.
Our failure as a society to acknowledge the sacrifice that pregnant people make when they have a baby is misogyny, ignorance and misogyny.
Cooper: How has your research been used in the public policy debate on abortion?
Foster: I testified in 2016 in front of the Senate Judiciary Committee, which was discussing a national 20-week ban. My colleague Antonia Biggs has testified internationally and domestically in cases where the claim is that abortion causes mental health harm. She has shown that it doesn’t.
My bigger hope is not just to convince judges but to broaden the conversation about abortion. It isn’t just that abortion is a political topic or an ideological or religious topic—abortion is an issue that affects people who have responsibilities to themselves and their kids, and whether they’re able to access abortion has effects on everybody’s well-being.
People don’t understand how much this decision about whether to end a pregnancy has to do with desires to be a good mother to the kids they already have.
Cooper: Since Roe was overturned, many states have enacted bans of various kinds. Are policymakers aware of the Turnaway Study findings and choosing to ignore them?
Foster: It’s not my area of expertise to get in the mind of Republican lawmakers, but my sense is that they are voting on ideology and on the basis of a desire to be reelected. They know that in their primaries the most anti-abortion candidate wins—in the primary and not in the general.
The Republican Party has been picking people who are particularly anti-abortion. That isn’t where the general public is, but I think that is often where primary voters are, so they’re doing it for political reasons and not considering the ramifications.
Cooper: Tell us about your current research on the consequences of the end of Roe. You’ve got participants in 17 states that ban or heavily restrict abortions, who you’ll follow for two years.
Foster: I’m leading the study with colleague Nancy Berglas. We started in June 2022, recruiting the last people who were served in their state before a ban took effect, and then people who sought abortions in those states after.
What we’re finding is somewhat consistent with what we’ve seen from #WeCount, the Society of Family Planning effort to count abortions in clinics, which is that there has been a lot of travel.
Before the Dobbs decision took effect, I estimated based on the scientific literature that maybe a quarter of people who live in banned states wouldn’t be able to access abortion. Now from my study and #WeCount data, I think the true estimate is much lower, that many more people are traveling than I would have thought possible.
That’s due to a massive influx of funds and growth of clinics in states without bans. Also there’s been expansion of virtual telemedicine clinics and pills sent directly from websites and organizations like Aid Access. There’s been a humongous transformation in abortion in the United States in the last few years.
In fact, the numbers of abortions are going up. That doesn’t mean that there aren’t people who are not being served. I’m sure that every 15-year-old in Alabama and Mississippi has not gotten the word about medication abortion pills or the possibility of traveling.
There are people who are undocumented, incarcerated or hospitalized and those people are probably not able to access care. The most disadvantaged are probably the most likely to carry those pregnancies to term.
Cooper: So the goal of the study is to understand the experience of trying to get an abortion in the states with bans.
Foster: Yes, compared to those who were able to get an abortion when it was legal.
How have these bans delayed abortion even for people who were able to get them eventually, or raised the cost, or made people disclose their pregnancy to people they preferred not to disclose it to? There are all sorts of costs associated with these bans, even if the people end up getting an abortion. Who gets their abortion at what cost?
Cooper: In Nepal, you’re looking at abortion in a more global context. Why Nepal?
Foster: In many places, the law can be good and still people are not able to access care. One of the places with the most progressive abortion laws is Nepal. Except for reasons of sex selection, it’s legal to 12 weeks on demand and beyond that for people with specific health or socioeconomic conditions. It’s free in public hospitals.
Despite this very good law, it’s just not fully implemented. That’s because it’s the poorest country in Asia and one of the poorest in the world.
One of the best groups of scientists is there, capable of doing a longitudinal study. So there was a strong team of scientists, one of the world’s best abortion laws and the consequences of being denied an abortion and trying to raise a child in a country where there are already very high levels of child malnutrition. The stakes are extremely high.
We have 1,800 women in the study and have followed them for nearly three years. What turns out to be super interesting is measures of child well-being—comparing a child born when the mom preferred to have an abortion, to the next child born to someone who got their abortion. What are the consequences for children based on the circumstances of their births?
Cooper: Do you imagine the findings in Nepal will apply to other countries?
Foster: Yes. The experiences of women in this country also are likely universal. We may have a higher level of resources, but the fundamental importance of trying to be in control over when and whether to have kids, that’s a universal struggle.
Cooper: It’s been a volatile couple of years for abortion rights supporters. What would you say to them?
Foster: The amount of effort that pro-choice people have made has been humongous. It has been so successful in enabling people to get care. People have created really creative websites to help disseminate information. All the work has had a beneficial effect for people who are seeking abortions. The only question is if (supporters) can keep up the energy so the success continues.
Cooper: Why do you enjoy this work?
Foster: I enjoy collaborating with the smartest, kindest, most empathetic and engaged scientists. I appreciate the willingness to apply science to such a human topic and to have empathy with people who are disproportionately the folks in our society who have the least.
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