On May 31, LiveAction, an organization dedicated to “ending abortion,” sent out a tweet purported to be based on scientific data: “In 1972, there were 19 deaths from illegal ‘back-alley abortions.’ In 2017, there were 1,001 complications from legal ‘front-alley abortions’ among just 13 states that reported. Abortion is never safe for the mother or child. Abortion is more dangerous now than ever before.”
But as the Washington Post’s Fact Checker column pointed out, the organization’s claims were misleading and based on faulty reasoning. “Comparing deaths to complications,” the Post argued, “is comparing apples to oranges.”
The anti-abortion movement has relied on such misleading statements and cherry-picked research to inform its work for years. Laws targeting abortion clinics with medically unnecessary regulations were often passed under the guise of protecting women's health, and Missouri Governor Mike Parson used the same health argument when he signed an 8-week abortion ban into law. But a new study published in the Annals of Internal Medicine this week offers even more evidence that having an abortion doesn't negatively impact a person’s health—while being denied an abortion does.
According to the study’s findings, there’s actually an increased risk for adverse health outcomes if a woman who wants an abortion is denied one. In fact, two women followed in the study who were turned away by abortion providers died from pregnancy-related complications.
These are the latest findings to come out of the Turnaway Study, a five-year prospective longitudinal study spearheaded by researchers at the University of California, San Francisco's Bixby Center for Global Reproductive Health. The research team followed women who sought—but did not always obtain—abortion care at one of 30 clinics in the US between 2008 and 2010. The researchers' goal was to better understand the long-term mental, physical, and socioecononmic impact of not only receiving an abortion, but also being forced to carry a pregnancy to term.
Participants were divided into three groups: 328 women who had an abortion during their first trimester; 383 women who had an abortion two weeks before the legal gestational limit in their state, and 163 women who were denied abortions because they were past the state's limit and who ultimately gave birth.
Researchers conducted phone interviews every six months for five years, checking in with participants about their health. Ultimately, they found that women who had abortions in either the first or second trimester didn't experience worse long-term physical health compared to those who gave birth after being denied this care.
In short: Contrary to a key message in the anti-abortion movement, abortion does not harm people's health.
In fact, women in the study who were denied abortion care “consistently” faced worse health outcomes than those who weren’t, said Lauren Ralph, the study’s lead author and an epidemiologist at the University of California, San Francisco. “Our findings highlight some of the most serious consequences women face if we continue to restrict women’s access to wanted abortion.”
For example, according to the study, 10 percent of women who gave birth after being denied an abortion said they were diagnosed with gestational high blood pressure; and most (10 of 16) developed the condition during the pregnancy they had wanted to terminate. “These women would have been able to avoid, or at least postpone, this outcome had they been able to obtain desired abortion care,” the study’s authors write.
Women who were forced to carry unwanted pregnancies to term also reported more chronic headaches or migraines and joint pain over time than those who had abortions.
Ralph said it was “sobering” to learn two women in the study had died from pregnancy-related causes. Because maternal deaths are uncommon—approximately 700 American women die each year because of pregnancy or delivery complications—she said they couldn’t assess the significance of these deaths. “But, at the very least,” she added, “we can say that these maternal deaths could have been avoided had these women had access to the healthcare they sought.”
Importantly, this study stands out from previous studies investigating health outcomes following an abortion because of its design: Researchers only looked at people who wanted an abortion.
“Past research has largely looked at health differences between women who chose to give birth and those who chose to have an abortion,” Ralph explained. “But because of something called ‘the healthy mother effect’—that women who are in good health are more likely to continue a pregnancy—this prior research may have actually underestimated or downplayed the relative safety of abortion. This is because you are comparing the health status of two groups over time, but one was less healthy to begin with.”
In other words, past studies have compared apples to oranges.
Since all of the women in the current study sought abortion care, that essentially levels the playing field. “Any differences we observe between groups is more likely due to giving birth or having an abortion, and not other factors that differentiated these groups before they got pregnant,” Ralph said.
Lisa Harris, an associate professor of obstetrics and gynecology at the University of Michigan, said the current research, alongside other papers resulting from the Turnaway Study, is “the best data that we have that abortion does not cause ill health effects—physical or mental.”
The life of a person who chooses to end a pregnancy is probably different in important ways compared to a person who gets pregnant unintentionally and decides to continue the pregnancy, Harris explained. “If we really want to isolate the effect of abortion itself, it’s important the comparison groups are as similar as possible, and that’s what the Turnaway Study did.”
She and Vanessa Dalton, also a professor at the University of Michigan, weren't involved with Ralph's study but co-authored an editorial to accompany it. They argue in the piece that abortion access is an issue that touches all healthcare providers, not just those who offer reproductive care.
For example, they point to exceptions in recent abortion bans—such as those passed in Kentucky, Alabama, Georgia, and Ohio, which would restrict access after six weeks' gestation. If the laws go into effect, the states would allow abortion only in cases where the health of a pregnant person is at risk.
“Data from the current study emphasize that birth always carries more risks for morbidity and mortality than abortion,” Harris and Dalton wrote. “Through the lens of this study, health exceptions to abortion bans would apply…well, always.”
People bring their underlying health to pregnancy, Harris explained, and pregnancy can have serious health consequences, both directly and indirectly.
“A pregnancy ending by abortion is safer than a pregnancy ending in birth,” she added.
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