August 31, 2015
Amid Abortion Debate, the Pursuit of Science
Posted on Jan 8, 2014
By Nina Martin, ProPublica
TW: First some background. At the Bixby Center and ANSIRH, we are driven by three sets of issues and concerns. One is: How can care be best delivered? That’s the question underlying the non-physician study. We’re very interested in safety in general. Do you need to be in an ambulatory surgery center? Do you need to have a nurse who administers anesthesia? Which kinds of cervical preparations are safe and do the least damage to the cervix?
Two, we care a lot about women’s experiences. We know that 1 in 3 women are going to have an abortion in their lifetime. And choosing to be a parent or not is a big decision. Whatever a woman decides, we want to know what can improve their outcomes. What do they need from their social networks and their friends? What are the long-term effects of silence and secrecy?
The third area of interest is social inequities. Where is there uneven distribution of services, uneven distribution of economic outcomes?
The Turnaway Study arose out of the second and third set of concerns. Abortion opponents have been pushing the idea that abortion hurts women, that they feel regret. With 1.3 million women having an abortion every year, it’s likely that a certain number do feel regret. That’s the natural curve of any kind of big decision. What we want to know is: Who are those women and what do they need?
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But another of our questions was: what happens to women who wanted an abortion but couldn’t get one? What happens to her economically, what happens to her psychologically, what happens to her other kids? That was the underlying question behind the Turnaway Study.
NM: Can you summarize the findings so far?
TW: The take-home from that study is that most women are having an abortion because they say they can’t afford to have a child. And it turns out that they’re right: Two years later, women who had a baby they weren’t expecting to have, compared to the women who had the abortion they wanted, are three times more likely to be living in poverty. They knew they couldn’t afford a kid and it turns out they were correct.
NM: Can you give some specifics about how the study was designed?
TW: The principal investigator is Diana Greene Foster, who was trained as a demographer. It is an eight-year study and includes about 30 abortion facilities in every region of the country. The sole criteria was that the clinic had to be isolated 2014 it had to be the only one within 150 miles that was willing to do abortions up to whatever it set as its gestational limit [the latest point at which it will terminate a pregnancy]. So if a woman was turned away from that facility, she really had no other option. She probably was going to have that baby.
We recruited about 1,000 women 2014 that alone took us three years. About a quarter were women who had been turned away and had a baby they weren’t expecting. Approximately 500 were women who happened to be just under the gestational limit when they arrived at the clinic so were able to get the abortion they wanted. They were the comparison group.
We also wanted to know if women receiving earlier abortions were somehow different. So the remaining participants 2014 about 250 2014 are women who received first-trimester abortions.
We followed the women every six months for five years 2014 a phone interview with a very lengthy survey that includes every question we could think of about their mental health, their economic circumstances, using routine and standardized tools, so we have some basis for comparison. Everyone in the study has finished at least two years, and some women have completed their five years and are rolling off.
NM: What has been your most eye-opening finding?
TW: The study has really exposed how hard it is to be a parent in this country. It is a huge economic investment. And if you don’t have the economic resources to be a parent, there’s nothing to help you.
Data from the study is also helping to answer other questions for which we have no good research until now 2014 for example, how women feel about mandatory ultrasounds before an abortion and what factors contribute to some women feeling regret afterwards.
NM: Finally, I want to talk about some preliminary research you presented at a conference last fall, looking at how state and federal courts view the kind of research you are working on.
TW: ANSIRH was started specifically to ensure that health policy is grounded in evidence. Because many laws aimed at restricting abortion were ending up in the courts, I became interested in how judges were interpreting the science in their legal decisions. We focused on four abortion-related issues where the science is pretty clear 2014 whether women are at risk for suicide after abortion, gestational bans based on the presumption that the fetus feels pain, ultrasound-viewing mandates, and medical abortion regimens.
We looked through over a thousand documents 2014 including lawsuits, briefs, rulings by courts at every level, the scientific studies that are referenced, the CVs of the medical experts whose work was cited. We analyzed not just the court decisions, but their language about the scientific claims, how expert knowledge is referenced, the quality of the research, whether the studies appeared in peer-reviewed journals 2014 that kind of thing. We’ve really just scratched the surface 2014 we had no idea how much there would be out there.
NM: What have you found?
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