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The Turnaway Study

Ten Years, a Thousand Women, and the Consequences of Having—or Being Denied—an Abortion

“If you read only one book about democracy, The Turnaway Study should be it. Why? Because without the power to make decisions about our own bodies, there is no democracy.” —Gloria Steinem

The “remarkable” (The New Yorker) landmark study of the consequences on women’s lives—emotional, physical, financial, professional, personal, and psychological—of receiving versus being denied an abortion that “should be required reading for every judge, member of Congress, and candidate for office—as well as anyone who hopes to better understand this complex and important issue” (Cecile Richards).

What happens when a woman seeking an abortion is turned away? To answer this question, Diana Greene Foster assembled a team of scientists—psychologists, epidemiologists, demographers, nurses, physicians, economists, sociologists, and public health researchers—to conduct a ten-year study. They followed a thousand women from across America, some of whom received abortions, some of whom were turned away. Now, for the first time, Dr. Foster presents the results of this landmark study in one extraordinary, groundbreaking book.

Judges, politicians, and pro-life advocates routinely defend their anti-abortion stance by claiming that abortion is physically risky and leads to depression and remorse. Dr. Foster’s data proves the opposite to be true. Foster documents the outcomes for women who received and were denied an abortion, analyzing the impact on their mental and physical health, their careers, their romantic relationships, and their other children, if they have them. Women who received an abortion were better off by almost every measure than women who did not, and five years after they receive an abortion, 99 percent of women do not regret it.

As the national debate around abortion intensifies, The Turnaway Study offers the first thorough, data-driven examination of the negative consequences for women who cannot get abortions and provides incontrovertible evidence to refute the claim that abortion harms women. Interwoven with the study findings are ten “engaging, in-depth” (Ms. Magazine) first-person narratives. Candid, intimate, and deeply revealing, they bring to life the women and the stories behind the science.

Revelatory, essential, and “particularly relevant now” (HuffPost), this is a must-read for anyone who cares about the impact of abortion and abortion restrictions on people’s lives.

This reading group guide for The Turnaway Study includes an introduction, discussion questions, and ideas for enhancing your book club. The suggested questions are intended to help your reading group find new and interesting angles and topics for your discussion. We hope that these ideas will enrich your conversation and increase your enjoyment of the book.

Introduction

What happens when a woman seeking an abortion is turned away? To answer this question, Diana Greene Foster assembled a team of scientists—psychologists, epidemiologists, demographers, nurses, physicians, economists, sociologists, and public health researchers—to conduct a landmark ten-year study. They followed a thousand women from across America, some of whom received abortions, some of whom were turned away. The results were thorough and astonishing.

As the national debate around abortion intensifies, The Turnaway Study offers the first in-depth, data-driven examination of the negative consequences for women who cannot get abortions and provides incontrovertible evidence to refute the claim that abortion harms women. Interwoven with the study findings are ten first-person narratives. Candid, intimate, and deeply revealing, the stories bring to life the women behind the science. The Turnaway Study is a must-read for anyone who cares about the impact of abortion and abortion restriction on people’s lives.

Topics and Questions for Discussion

1. As Dr. Foster writes, the term “turnaway” “resonates with a whole set of issues that surround women’s decision making around pregnancy” (page 5). What are some of the issues she identifies? In your opinion, why might it be important to consider the many ways people and society “turn away” when it comes to abortion?

2. Unlike previous studies that compared women who received abortions to women who carried wanted pregnancies to term, the Turnaway Study studied women with unwanted pregnancies and compared those who received to those who were denied the abortions they sought. Why is this distinction important? How does Dr. Foster describe the advantages of the Turnaway Study’s methodology?

3. According to Dr. Foster, Amy’s in-depth interview (beginning on page 25) shows how “abortion can be a normal part of planning a family and living a meaningful life.” Dr. Foster suggests that stories like Amy’s, which are largely missing from abortion discourse, are essential to consider. Describe how Amy’s circumstances informed her decision to seek an abortion. How does a story like Amy’s contribute to a broader conversation about abortion?

4. Refer to Figure 1 on page 46. For many women who receive later abortions (20 weeks or later), difficulties finding and getting to a clinic are significant factors in delaying their care. Identify challenges and impediments to receiving care that are unique to second- and third-trimester abortions. What effect might these obstacles have on the person seeking care?

5. Dr. Foster discusses the Hyde Amendment, which restricts federal funds from paying for an abortion. What challenges does the Hyde Amendment pose to women seeking an abortion? What do you think of a restriction on abortion that only affects low-income women?

6. In the Turnaway Study, researchers asked women to rate their emotions (regret, anger, sadness, guilt, happiness, relief) with regard to their unwanted pregnancies and separately, their abortions. Women were asked about each emotion individually, allowing, for example, participants to report feeling high levels of both relief and anger. Why is it important that the questions were asked in this way?

7. The Turnaway Study found that women denied abortions had higher anxiety and lower self-esteem in the first six months but did not find differences in mental health between women who received or were denied an abortion in the long run. Were you surprised by any of the findings regarding mental health outcomes? If yes why, and what informed your prior belief?

8. Dr. Foster discusses a person’s “right to make their own personal decisions, even decisions that they might regret,” or what Katie Watson has called the “dignity of risk” (page 128). According to Dr. Foster, how is this an important concept to consider when talking about abortion, especially in light of the Turnaway Study’s findings that mental health is not adversely affected by receiving an abortion?

9. The Turnaway Study found that a woman’s existing and, should she choose to have them, future children benefit across multiple metrics when she is able to receive a wanted abortion. How does this finding add nuance to discussions of children’s well-being, with regard to abortion?

10. In chapter 9, Dr. Foster points out that, even in the wake of the Turnaway Study, “we are still talking about whether abortion harms women and not whether lack of abortion harms women and children.” In your opinion, how could reframing the question in this way affect the discourse around abortion?

11. How does Brenda’s story (beginning on page 265) of being denied an abortion illustrate the Turnaway Study’s finding that women’s concerns about having a child tend to come about, if they are made to carry the pregnancy to term?

12. In chapter 10, Dr. Foster writes, “There are more restrictions on abortion in 2020 than there were in 1973, when the U.S. Supreme Court first affirmed access to abortion as a constitutional right in Roe v. Wade.” What are some reasons she cites for this increase in restrictions?

13. As Dr. Foster points out, “many of us are alive today because our mothers and grandmothers were able to avoid carrying a prior unwanted pregnancy to term” (page 263). How does her own family history illustrate this point?

14. How is the term “reproductive justice” defined on page 280? Why is it important to specifically address the needs of marginalized persons and communities? How do abortion rights fit into a reproductive justice framework?

15. Findings from the Turnaway Study have already made their way into the courtroom, resulting in evidence-based testimony about abortion that would have been impossible before the study was published. In your opinion, and in light of the Turnaway Study’s findings, how might your state’s abortion laws be made to better serve people seeking abortions?

16. Of the ten personal stories shared in the book, which was most impactful, eye-opening, or challenging for you and why?

Enhance Your Book Club

To further enhance your book club, please consider the following materials and resources:

Continued Reading

• Dr. Meera Shah’s You’re the Only One I’ve Told

• Annie Finch’s Choice Words

• Dorothy Roberts’s Killing the Black Body

• Katie Watson’s Scarlet A: The Ethics, Law, and Politics of Ordinary Abortion

• David Cohen and Carole Joffe’s Obstacle Course: The Everyday Struggle to Get an Abortion in America

Screening Suggestions

Dirty Dancing (1987)

The Cider House Rules (1999)

Obvious Child (2014)

Grandma (2015)

Little Woods (2019)

Never Rarely Sometimes Always (2020)

Saint Frances (2020)

Unpregnant (2020)

Documentaries

12th & Delaware (2010)

After Tiller (2013)

Ours to Tell (2020)
Photograph by Christina Samuelson

Diana Greene Foster is a professor at the University of California, San Francisco (UCSF) in the Department of Obstetrics, Gynecology, and Reproductive Sciences and director of research at Advancing New Standards in Reproductive Health (ANSIRH). An internationally recognized expert on women’s experiences with contraception and abortion, she is the principal investigator of the Turnaway Study. She has a bachelor’s of science from the University of California, Berkeley, and a doctorate from Princeton University. She lives with her husband and two children in the San Francisco Bay Area.

"A remarkable piece of research.... The Turnaway Study will be understood, criticized, and used politically, however carefully conceived and painstakingly executed the research was. Given that inevitability, it’s worth underlining the most helpful political work that the study does. In light of its findings, the rationale for so many recent abortion restrictions—namely, that abortion is uniquely harmful to the people who choose it—simply topples."
The New Yorker

"Foster’s findings are particularly relevant now, as the coronavirus pandemic, the economic downturn and ongoing efforts to restrict abortion access have made the procedure even more difficult for many to obtain."
The Huffington Post

“The Turnaway Study provides definitive evidence that abortion access strongly enhances women’s health and well-being, whereas denying abortion results in physical and economic harm. Based on a ten-year investigation, the book combines engaging, in-depth stories of women who received and were denied abortion care along with study data from 50 peer-reviewed papers published in top medical and social science journals.”
—Ms. magazine

“Required reading for anyone concerned with reproductive justice."
Kirkus, starred

"Foster’s clearheaded account cuts through the noise surrounding this contentious issue. Policy makers and abortion rights activists should consider it a must-read."
Publisher's Weekly

"Foster listens to the 'turnaway women,' and lets their stories, even more than her own scholarship, disrupt the accepted moral and political narratives that regulate access to abortion."
Library Journal

“If you read only one book about democracy, The Turnaway Study should be it.  Why? Because without the power to make decisions about our own bodies, there is no democracy.  There is no freedom and justice without reproductive freedom and justice."
—Gloria Steinem

“Dr. Foster brings what is too often missing from the public debate around abortion: science, data, and the real-life experiences of people from diverse backgrounds. Dr. Foster’s book offers the first in-depth look at the impact of being denied abortion on mental and physical health, economic wellbeing, relationships, and families. This should be required reading for every judge, member of Congress, and candidate for office — as well as anyone who hopes to better understand this complex and important issue.”
Cecile Richards, co-founder of Supermajority, former president of Planned Parenthood, and author of Make Trouble

"The Turnaway Study demonstrates the power of narrative in illuminating why women seek abortions. I have always been a feminist, and I believe we have a responsibility to safeguard reproductive rights for women everywhere--and for future generations. In this book, statistics and stories meet to reveal the consequences of denying women this service, as well as what happens when they receive it. The Turnaway Study is an essential read."
—Isabel Allende, author of A Long Petal of the Sea and The House of the Spirits

“Dispelling so many of the prevailing myths about why women seek abortion, this compelling, carefully researched, and unique study makes clear how public policies can so powerfully harm women as they make this deeply personal decision. The moving stories of real women will help illuminate for all of us – both pro-choice and anti-abortion advocates – how restrictive policies can damage the lives of women and their families and why no woman should be turned away when she seeks an abortion.”
—Judy Norsigian and Jane Pincus, authors of Our Bodies, Ourselves

"Discourse and dialogue about abortion are far too often a fact free zone, filled with emotion and ideology and bereft of the wisdom of social science. Foster has been at the forefront of changing this destructive dynamic. She has spent years studying the impact on real people and real lives of being able to access abortion services. Her work challenges how we evaluate morality in public policy--it's a must read."
—Ilyse Hogue, President, NARAL Pro-Choice America

“Our reproductive realities were the victims of fake news before the term existed, which is why Dr. Foster and her team’s work is ever more essential. With rigor and honesty, this book is an important and clarifying contribution to a reality-based conversation about abortion.”
—Irin Carmon, co-author of Notorious RBG: The Life and Times of Ruth Bader Ginsburg

“The stories and findings in The Turnaway Study are captivating and confirm what abortion funds have witnessed from their helplines for decades.  Hundreds of thousands of people calling for help across the country are navigating too many barriers to the care they need. This book illustrates that the process of obtaining an abortion is entirely too complicated and the outcomes of being denied an abortion are unjust.”
—Yamani Hernandez, Executive Director of the National Network of Abortion Funds

“The loud discourse around abortion, framed in the language of politics, religious beliefs, and women’s changing social roles, is so intense that sometimes people don’t take the time to discover the who, what, when and why of actual people making decisions and having real health and social outcomes. Dr. Foster has created an indispensable resource for scientists, policy makers, doctors, and legislators who are seeking facts to inform their opinions.”
—Dr. Stephanie Teal, Professor of Obstetrics and Gynecology, Pediatrics, and Clinical Science at the University of Colorado School of Medicine and past President of the Society of Family Planning

“The Turnaway Study reflects the ultimate in scientific methodology on this contentious subject. The rich, accurate information resonates with the poignant personal accounts. Here is the complete abortion book, both informative for health professionals and accessible to lay readers.”
—Dr. Nada L. Stotland, Professor of Psychiatry at Rush University and past President of the American Psychiatric Association

“Dr. Foster has contextualized the ground-breaking Turnaway Study using the stories of the people who are the most central to the abortion debate but whose experiences are generally overlooked: people who have abortions."
Monica R. McLemore PhD, MPH, RN, FAAN, Associate Professor of Nursing, UCSF and Chair, Sexual and Reproductive Health at the American Public Health Association