In the nearly two years since the U.S. Supreme Court overturned federal abortion rights in the case Dobbs v. Jackson Women’s Health Organization, restrictions on the health care procedure have expanded, particularly across the South.
Currently, 14 states have banned abortion outright, and 11 have restricted it to 22 weeks or less after a person’s last period. Most recently, Florida tightened its restrictions on May 1. Arizona had been expected to ban nearly all abortions in coming weeks, but because the 1864 law that strict ban was based on was repealed this week, the strict ban will apply only temporarily. The state is expected to revert to a previous 15-week ban later this year. As restrictions have spread, the distances that people living in parts of the Midwest and most of the South need to travel to reach an abortion facility are increasing. Simultaneously, reproductive rights opponents are looking to use an 1873 law called the Comstock Act, which outlaws mailing “obscene” material, to further limit abortions—and perhaps to target contraception. This November up to 15 states may vote on abortion rights.
When people want an abortion and can’t get one, the results can harm the physical, emotional and financial health of both parent and child. Some of the strongest evidence comes from a project conducted from 2008 to 2016 that is known as the Turnaway Study. The study followed pregnant people seeking abortion for five years and compared those who got an abortion in their first or second trimester with those who were denied one because they were farther along in their pregnancy than the clinic they visited would allow.
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Diana Greene Foster, a demographer at the University of California, San Francisco, developed the study in the mid-2000s after a Supreme Court case restricted access to abortion because of the then common belief that getting an abortion caused depression—a belief that had no evidence and that her study and others have discredited. “We really needed reliable data,” Foster says. Today’s abortion restrictions ignore both science and public opinion, she says. Scientific American talked with Foster to understand what has happened since Dobbs, how abortion affects people’s health and what’s at stake in the upcoming elections.
[An edited transcript of the interview follows.]
When people decide they want an abortion and are denied care, what happens next? How many people find a different route to get an abortion or opt for adoption?
In the Turnaway Study, about 20 percent of the people who were denied abortions managed to get one somewhere else. Those people were a little earlier in pregnancy, so there was some place they could go that would treat them. But if you’re denied an abortion at the end of the second trimester, there are so few places you can go that most people [in that situation] have carried the pregnancy to term.
When people who were denied an abortion gave birth, we found, just under 10 percent placed that child for adoption. More people considered it, but adoption is not an easy thing. When we talked later to two of the people who made that decision, they both had had unwanted pregnancies again, and neither chose adoption again. And the people who did place the child for adoption are the group that’s most likely to say they still wish they could have had the abortion. Carrying a pregnancy to term and surrendering a child is not at all easy. It’s often taken for granted by people who think that the solution to abortion is adoption; they overlook how difficult that is.
And do you have any sense of whether that breakdown has been changing since Dobbs?
I don’t know—that will be super interesting, and we just don’t have the data yet. Often, I think, people want to say, “Oh, Dobbs happened in June of 2022, so we should see effects in 2022.” But people who are pregnant in 2022 most likely delivered in 2023 if they delivered, and data from 2023 aren’t immediately available in 2024. We don’t have a lot of the vital statistics or adoption data. The data on abortions have been made available—some of them are estimates, but they do seem to show that there’s been an increase in abortion, not a decrease.
Why would that be?
There’s been a huge amount of money and attention put into helping people get their abortions. And I think that was, like, rage donations after Dobbs. I don’t know if that’s sustainable. And then these innovations in getting people access to medication abortion [through the drug mifepristone] almost certainly made a big difference as well.
How do the financial and social consequences of abortion denial ripple down to the children that resulted from such cases over the course of their life?
An American scientist working with Czech scientists followed kids born in what is now the Czech Republic in the 1960s because their mom was denied an abortion by a hospital panel. He showed the kids born of pregnancies where the mom was denied [compared with children whose parent didn’t request an abortion] had worse outcomes for 35 years. But that’s a little dated and a different context.
In the Turnaway Study we followed people for five years. If you ask women why they want an abortion, 60 percent of them are already mothers, and many say that they want an abortion to take care of the kids they already have. And we see worse outcomes for those kids who are born despite these concerns in terms of achievement of developmental milestones and economic security within the family.
And then we looked at kids who were born because the mom was denied an abortion and the next kid born to someone after they had received an abortion—so if someone gets an abortion but then becomes pregnant within the five years of the study and carries that pregnancy to term. You see economic hardship that is concentrated among the kids born because of abortion denial but also worse maternal bonding.
How is the study relevant to the post-Dobbs landscape?
Pregnant people are really determined [to get an abortion] when they’re not ready to have the baby. So we shouldn’t be surprised by the lengths people will go to end that pregnancy.
When Dobbs happened, I really thought a lot of people wouldn’t be able to get their abortions, and I’ve been surprised that there isn’t more evidence that people aren’t getting abortions. I’m also surprised that people aren’t harming themselves to end their pregnancy—maybe the data just haven’t come in yet. I expected that to happen because I knew people would be desperate, and I didn’t appreciate how fast the word would get out about medication abortion access and how much money was put into helping people travel.
There’s been a lot of chatter about enforcing the Comstock Act to target both abortion- and contraception-related materials sent by mail. How could that affect the abortion landscape?
I certainly am not so familiar with this kind of arcane law and why it would still be enforceable. But it would be a big problem if people couldn’t send any medical supplies or pills through the mail. Reducing people’s access to safe care seems like it will further encourage people to do things that are dangerous, and the Turnaway Study is clear about how determined people are to end pregnancies when they don’t want to be pregnant. So we should not make it harder for people to access abortion.
I assume that reducing access to contraception would also increase the number of people who look for abortions.
Yeah, that’s a good assumption. People often rightly think that the risk of pregnancy is low. So lots of people have sex without intending to make a baby. And usually, even if they don’t use a contraceptive method, they usually don’t get pregnant. But there’s a chance of it, and restricting access to contraception makes it more likely people will become pregnant. And I don’t think it makes it very likely they will stop having sex.
How does public opinion see the science on this?
I am kind of surprised, given how much stigma is in our society about abortion, that public opinion is so firmly on the side of trusting people with their decisions. Most people haven’t done the work I’ve done to know that lots of people become pregnant when they aren’t ready and that when they decide to have an abortion, they’re doing it because they feel that it’s best for themselves and their kids and their future kids or their life trajectory. I am amazed that public opinion [in support of abortion] is as strong as it is, given that I don’t know that that message has fully disseminated. I think people see it as a battle between individual decision-making and government decision-making and, on that basis alone, feel that abortion rights are correct. [Editor’s Note: A 2023 Gallup poll found that 85 percent of Americans believe abortion should be legal under either certain or any circumstances.]
What have you been working on since the Turnaway Study wrapped up?
I am leading a study about the end of Roe [the 1973 case that protected abortion rights nationwide], which has been recruiting people as clinics close—the last people who received abortions in their state compared with people who sought abortions after. We’ve also been recruiting through hotlines to get people who are trying to get help to travel for abortions, and we’re continuing the recruitment for that. That work suggests that in states with bans, women are getting their abortions but at a significant delay of about a week.