A quick note before we start: This episode includes a mention of rape.

Dan Gorenstein: The Supreme Court’s decision to overturn Roe v. Wade is a tidal wave.

News clip: Abortions will not be available in many conservative states.
News clip: Utah is one of 13 states that recently passed a so-called “trigger law.”
News clip: Tennessee has trigger laws already on the books that will ban abortion within 30 days.

DG: Within a matter of weeks, abortion could be banned or severely restricted in about half of the country.

That means more people will now be denied abortions.

What will happen to them?

Today, in this precarious moment when so many of us are trying to glimpse the future, we talk with the leader of a landmark study who helps us think about what will happen to them.

She shares her research and what she’s seen in her own family.

From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein, this is Tradeoffs.

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DG: Like a lot of people, Diana Greene Foster was sitting in front of her computer last Friday morning. 

Diana Greene Foster: As I had been every other morning in June, which is at 7 a.m. my time, wake up, check the computer and see if the Supreme Court has made women’s lives more difficult that day.

DG: Diana is a professor and the director of research at Advancing New Standards in Reproductive Health, a research group at the University of California San Francisco.

Diana knew the Court was likely to overturn Roe v. Wade.

But seeing it in black and white on her computer still filled her with dread. 

DGF: People are so ready to look at other aspects of it, like the political aspect. What’s it going to do to the midterms? And really not thinking about what it would be like to be pregnant in the middle of a red state and not wanting to be pregnant, like how desperate that must feel. And now there’s no legal clinic in the state.

DG: Diana has studied contraception and abortion for more than 20 years.

She’s always been interested in what happens to women if they can’t get abortions.

Since 2008, she’s led a first-of-its-kind research project called the Turnaway Study.

Diana and her team recruited nearly a thousand women who were seeking abortions at 30 clinics across the country, a representative sample of women who get the procedure nationwide. 

DGF: About half were under the federal poverty level. Sixty percent were already mothers. Fifty percent were in their 20s. They were from all racial ethnic groups.

DG: Women were just under — or just over — what states’ deemed the legal limit for getting an abortion based on how far along they were.

So some of the participants got their abortion and others were “turned away.”

Diana’s group checked in with the women every 6 months for 5 years — nearly 8,000 interviews to chart the impact of having or not having the procedure.

DGF: When we started the study, the common dialogue around abortion in the United States was that abortion hurts women. And this was an idea that had been put forth by people opposed to abortion without a lot of data to support it. And if you restrict access to abortion on the basis that abortion hurts women, well, then you really need to ask, what is the harm of not getting an abortion if you felt like you needed one? So the Turnaway Study was poised to do both.

DG: So, Diana, you and your colleagues have published 50 peer reviewed papers and a book.

You’ve written that based on all of those findings, you do not expect the end of Roe to lead to a big spike in the number of children being born. Why is that?

DGF: Most people who are denied abortions will be denied abortions early in the first trimester, and they will have time to travel and time to find other options. The most disadvantaged people will be least likely to be able to travel, least likely to be able to get pills online. But those same people who have babies now from a pregnancy they didn’t want are actually less likely to have babies later because A) they’ve just had a kid and they’re struggling to support that child and B) because they’re going to be poorer, because their relationships are going to be worse, they’re just less likely to be in the circumstances later where they’re ready for another child.

DG: You estimate that about a quarter of people who previously would have been able to get an abortion will now give birth in a post-Roe world. I want to focus on them and what your research suggests is going to happen to them. 

You’ve chronicled this impact in three ways: medically, economically and socially.

Let’s start with medically. What did your research say about the physical and mental health impacts of being denied an abortion?

DGF: What we see is that there’s an immediate worsening of mental health. They’re more likely to have high anxiety in the short run upon being denied an abortion. Over the long term, this isn’t primarily a mental health story. There is a very large difference in physical health. We see that people are more likely to report chronic pain, more likely to report hypertension if they’re denied that abortion than if they receive it.

DG: Let’s turn to the economic impacts, Diana, which are admittedly pretty staggering.

Your research found people who were denied abortions were more likely to live in poverty, they had more debt and they were less likely to be able to work full time. 

What stands out to you about the economic consequences people denied an abortion could face in a post-Roe world?

DGF: This is not in some ways a surprise. When we ask people, why do you want an abortion, their number one reason is they feel like they can’t afford to have a child. This end of Roe will make things worse because there will be more people forced to have babies before they’re ready. And one interesting thing, if you have in your mind, this is a teenager forced to have a kid at 17, yes, that happens. But the more common is someone in their 20s who’s already struggling to raise the kids she already has. And so the idea is that she’s now going to be caring for more kids. And so it’s not just her life that’s affected. It’s her existing children, and it’s the well being of that of future children that she’d like to have.

DG: And is there any particular interview or story that jumps out to you that illustrates the economic squeeze women face when they don’t get an abortion? Is there someone you think of?

DGF: Yes. So glad you asked that. A woman who was in California. She’s 18. She said, “I wish I’d had her when I was older, more stable, more financially set, just pretty much to where I knew who I was, because it was like raising her and trying to figure me out. But I was raising both of us, myself and her.” 

DG: Finally, let’s talk about the social consequences.

Like with mental health, you found that being denied an abortion had a short-term impact on self-esteem and life satisfaction, but that evened out after a few years.

Over the long-term, how did the social lives of women in your study, Diana, who were denied abortions differ from those who got the procedure?

DGF: There are very large differences in what people accomplish with their lives. So, for example, they’re less likely to be in high quality relationships. They’re less likely to have achieved other aspirational plans.

DG: Aspirational plans like what?

DFG: So at the end of every survey, we asked them how do they see their life being different one year and five years later? Some people say I want to finish my community college degree. I want to have a more stable home. I want to take good care of this baby. But even including child related aspirational plans, people who are denied abortions are less likely to set and achieve aspirational plans.

DG: Like all studies, there are some limitations to the Turnaway Study. Critics point to the sample size, saying it’s small and that people who felt worse about their abortions may have been less inclined to answer questions about it. What do you say to those critiques of the work?

DGF: So those are really important questions. The idea of the study was not to be as big as possible, but to be careful in who we recruited so that we got women who were similar at baseline and that the ways in which their outcomes diverged could be attributable to whether they got their abortion or not. So, in fact, the study didn’t have to be big to draw important conclusions about the consequences of abortion for people’s lives. And then you could think, oh, the study is biased because something about people’s attitude about abortion is affecting their willingness to participate. OK, people could have selected based on attitudes towards abortion. But I cannot see how they could have opted in to participating in the study based on their future economic or physical health trajectories.

DG: So to sum up, Diana, based on your research, women who were denied abortions were more likely to suffer from long-term health effects, struggle financially and in their relationships. If people take one thing away from your research, Diana, about what life in America will be like now that millions of people can no longer get abortions, are going to be denied these abortions, what should it be?

DGF: It’ll be the people who already have the least resources who are going to be forced to experience the greatest hardship. So this is going to deepen inequality and this is going to make people whose lives are hard even harder.

DG: When we come back, Diana talks about how an unwanted pregnancy played out in her grandmother’s life, and how her grandmother’s experience echoes what a post-Roe future may look like.

MIDROLL

DG: Welcome back.

The fall of Roe v. Wade has people looking ahead to a future where more people are denied abortions and forced to give birth when they’re not ready.

Diana Greene Foster’s Turnaway Study offers one of the best academic crystal balls we have.

But long before Diana started studying abortion, she saw firsthand the impact that banning abortion can have through her grandmother Dorothy.

Diana’s mom was adopted, so Diana was 12 the first time she heard her grandmother’s voice.

She was huddled around the family phone with her mom, dad and older sister.

DGF: So my mom called and she said, “Hi, is this Dorothy?” And she gave all of Dorothy’s maiden names. And my mom didn’t know exactly what to say, she was kind of waiting to hear what was going to happen on the other end of the line. But there was silence. Dorothy was not helping her. So she’s going on like, “I knew you a long time ago in San Diego. I was young.” Finally this very little voice comes and she says, “What was your birthday?” And my mom told her birthday. And Dorothy said, “Are you my daughter?” And my mom said, “I think so.”

DG: And like that, Diana had another grandmother.

When she moved to California for college, she and Dorothy grew close. The two spent weekends together at Dorothy’s remote hunting cabin in the Santa Cruz hills.

One visit, Dorothy told Diana about her mother’s birth.

DGF: She got pregnant when she was 19. The father said if she told anyone it was his, he’d get all his friends and say it could be theirs.

DG: Dorothy was overwhelmed. 

Her parents wanted her to get an abortion. 

Diana thinks if the procedure had been safe and legal, Dorothy would’ve gotten one.

But in California in 1940 that wasn’t a legal option.

So her parents shipped her from their home in Los Angeles to the Salvation Army Home for Unwed Mothers in San Diego.

And Dorothy gave birth to Diana’s mom.

DGF: She named my mom Joy. She was hoping that that would give her a life of joy.

DG: Dorothy’s life was hard right after the baby was born. 

Childbirth left her unable to walk for weeks.

Rebuffed by her parents, Dorothy bunked up with one of the girls she met at the home.

DGF: The brother of that girl raped Dorothy because he said she was already no good. And Dorothy has told me that that’s what hurt the most of the whole experience. This feeling that she was now worthless because of what had happened to her.

DG: Diana says Dorothy — who passed away in 2012 — did a lot: She owned an insurance company, she owned a hair salon, she traveled.

But it was not the life Dorothy had mapped out for herself.

Diana believes having a child before she wanted one and all the trauma that followed knocked Dorothy off course.

DGF: I think something was stolen from her in that moment: status and health and a sense of well-being and a sense of being protected. And that loss affected the rest of her life.

DG: Despite her business ventures, Dorothy struggled with money and with relationships. She never had any more kids.

It’s impossible for Diana to know how much Dorothy’s unwanted pregnancy altered her grandmother’s life or what role it played in the specific challenges the woman faced.

But Diana says Dorothy’s life — and the lives of the women in the Turnaway Study — are a reminder of the price people pay when abortion is illegal.

DGF: Having an unwanted pregnancy and having the experience of having to carry it to term affects all of the rest of your reproductive and social and economic decisions after that. And although people are resilient and they come to terms with pregnancies that they didn’t intend, life is harder.

DG: Diana has spent much of the past week talking about the Turnaway Study, about what we should expect in a world where more people are denied abortions.

But she’s also been working on her next research project. 

DGF: We’re poised to recruit from 17 abortion facilities in states where it’s now illegal and follow people who had appointments on the books that are canceled, as well as people who were served just before the decision, so that we can see, well, how does the experience change of trying to get an abortion when it’s legal in your state and it’s not legal in your state?

DG: Diana is hoping to get up to 2,000 participants.

Diana says this study will look at whether people are able to get abortions after they’re banned, and if so, how they get them. 

DFG: Do you decide to travel out of state? If so, who is it who gets to travel? And who tries to do dangerous things and where do they get the idea to do that? I think it’s completely clear that denying people access to abortion results in worse consequences for their health and their families’ well-being. So that doesn’t need to be demonstrated again. What needs to be shown is how do people acclimate to something that has been a right for 50 years and is suddenly not a right and in fact is illegal?

DG: Diana hopes hard data on the impact of abortion bans will inform state lawmakers who now control this decision.

She expects to start getting responses this week.

I’m Dan Gorenstein, this is Tradeoffs.