Forty years ago, the US Supreme Court decided in Roe v. Wade that states could not ban first-trimester abortions. Wonkblog’s Sarah Kliff takes a look at what’s been happening since; her charts document the decline in the number of US abortion providers from the mid-1970s to early 2000s (holding steady since then); an increase in state abortion restrictions, with 92 enacted in 2011 alone; and an increase in the proportion of abortion patients who are low-income and minority. Perhaps most surprising to those of us already aware of these trends is the result of a recent survey: only 44% of Americans under 30 knew the Roe decision was about abortion.
How does the legality — and equally importantly, the accessibility — of abortion affect women’s health? Two recent studies are worth highlighting. In her post today, Kliff summarizes findings from a Guttmacher Institute study published in The Lancet last year. The authors looked at abortions worldwide, and concluded:
We found that abortions continue to occur in measurable numbers in all regions of the world, regardless of the status of abortion laws. Unintended pregnancies occur in all societies, and some women who are determined to avoid an unplanned birth will resort to unsafe abortions if safe abortion is not readily available, some will suffer complications as a result, and some will die. Measures to reduce the incidence of unintended pregnancy and unsafe abortion—including improving access to family planning services and the effectiveness of contraceptive use, and ensuring access to safe abortion services and post-abortion care—are crucial steps toward achieving the MDGs [Millennium Development Goals].
In other words, tighter abortion laws don’t necessarily mean fewer abortions – just fewer safe abortions. But not every woman who’s denied an abortion by a provider will end up getting one elsewhere. The Advancing New Standards in Reproductive Health research group at University of California San Francisco is conducting a prospective longitudinal study to describe “the mental health, physical health, and socioeconomic consequences of receiving an abortion compared to carrying an unwanted pregnancy to term.” From 2008 to 2010, they recruited over 1,000 women who sought abortions at 30 abortion facilities around the US. Some of those women were under the clinics’ gestational limits and received abortions, while others were past the gestational limits and, having been denied abortions on that basis (i.e., turned away), carried their pregnancies to term. The Turnaway Study is still conducting participant interviews, which occur every six months for five years.
It’s important to note that this study is still ongoing, and results have not yet been published in peer-reviewed publications. But Turnaway Study researchers did present at the 2012 American Public Health Association annual meeting (abstracts here and here), and i09′s Annalee Newitz wrote about their findings so far, including the following:
Unfortunately, when it comes to domestic violence, being denied an abortion makes a really big difference. Turnaways were more likely to stay in a relationship with an abusive partner than women who got abortions. A year after being denied an abortion, 7% reported an incident of domestic violence in the last six months. 3% of women who received abortions reported domestic violence in the same time period. [Study leader Diana Greene] Foster emphasized that this wasn’t because the turnaways were more likely to get into abusive relationships. It was simply that getting abortions allowed women to get out of such relationships more easily. So it’s likely that these numbers actually reflect a dropoff in domestic violence for women who get abortions, rather than a rise among turnaways.
This pattern of violence is also part of a larger pattern that shows turnaways are more likely to remain connected to the fathers of their children. Obviously, this isn’t always a good thing, as the violence statistics reveal. But even in the vast majority of cases where violence isn’t involved, Foster noted that these men aren’t living with the turnaways. The researchers asked women about cohabiting with partners, and found that men were no more likely to live with a turnaway who’d borne their children than they were to live with a woman who had an abortion. “The man doesn’t stick around just because you have the baby — that’s the crude way of putting it,” Foster said.
…The Turnaway Study found no indication that abortion could be linked with increased mental health disorders. There were no statistical differences between turnaways and women who had abortions when it came to developing clinical depression.
But turnaways did face a greater health risk from giving birth. Even late stage abortions are safer than giving birth.
The Supreme Court has the final word on whether laws are constitutional; researchers have the ongoing task of documenting how laws affect public health. These and many other studies give strong evidence that when women have more control over whether and when to have children, women enjoy better health.