What Happens to Those Who are Turned Away From Accessing Abortion?

Note: This episode and the episode’s shownotes utilize the term “women,” when talking about the Turnaway study results, because women made up all of the participants. Many people, including trans men and non-binary individuals, still require access to safe and timely abortion care.

 On December 1st, 2021, the Supreme Court will be hearing oral arguments to Dobbs v. Jackson Women’s Health Organization—a 15-week abortion ban out of Mississippi, which will put the ability to access abortion care out of reach for so many. Dr. Diana Greene Foster, researcher at the University of California, San Francisco and author of the Turnaway Study: Ten Years, A Thousand Women, and the Consequences of Having- or Being Denied- an Abortion, talks to us about her book on the study, the science and stories behind it, and why the upcoming Supreme Court case is a direct affront to reproductive health.

 The Turnaway Study began in 2007 as a way to answer whether or not abortion hurts women—an idea that has impacted policy for decades and has even underlined the Supreme Court’s decision to ban one type of abortion. The study followed a diverse set of participants from 30 U.S. facilities, comparing the outcomes of those who received abortions as compared to those who wanted them but couldn’t get them. For five years, participants were interviewed on their physical health, mental health, socioeconomic wellbeing, and life outcomes.

The study quickly found the opposite to be true; limiting access to abortion led to women experiencing significant risks to their physical health, financial health, and life outcomes. Medical literature has made clear that carrying a pregnancy to term is associated with much greater health risk than having an abortion, which was confirmed by the study. Tragically, two study participants died as a result of not being able to access an abortion, while many reported higher rates of chronic pain, hypertension, and short-term mental health concerns. Additionally, women denied abortion care were much more likely to end up living below the federal poverty level, more likely to receive public assistance, more likely to be in situations of domestic violence, and less likely to set and achieve aspirational plans. People who received their wanted abortion had a higher rate of later intended pregnancies—increasing the likelihood that, down the line, participants had wanted and healthier pregnancies with better partners, more support, and when they were ready. Finally, the children of mothers who received an abortion experienced better outcomes as well, with less likelihood of living in poverty, and increased likelihood of achieving developmental milestones.

The Turnaway study was also instrumental in busting multiple myths including:

 ·Only poor, childless, teenage, irresponsible, nonreligious, [fill in your stereotype] women have abortions.

·Abortion is always a difficult decision. Women need more time.

·Adoption is the solution.

·Making abortion illegal doesn’t stop it from happening. It only makes it unsafe.

· Abortion is physically risky.

·Later abortions are always for fetal anomaly or maternal health.

·Women who have abortions regret their decisions, experience post-traumatic stress symptoms, use illicit substances to cope, and are depressed. Or the opposite myth: If you think having an abortion makes you dressed, having an unwanted baby is much worse.

·Having a baby (from an unwanted pregnancy) brings a couple together.

·Women are selfish when they choose to have an abortion. Women who have abortions don’t want to be mothers.

·Women’s lives are harmed by abortion.

Links from this episode

The Turnaway Study: Ten Years, A Thousand Women, and the Consequences of Having- or Being Denied- and Abortion
Dr. Diana Greene Foster on Twitter
Dr. Diana Greene Foster’s New York Times piece, What Happens When It’s Too Late of Get an Abortion

Transcript

Jennie: Welcome to rePROs Fight Back, a podcast where we explore all things reproductive health, rights and justice. I'm your host, Jennie Wetter, and I'll be helping you stay informed around issues like birth control, abortion, sex education and LGBTQ issues and much, much more-- giving you the tools you need to take action and fight back. Okay, let's dive in.

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Jennie: Welcome to this week's episode of rePROs Fight Back. I'm your host, Jennie Wetter, and my pronouns are she/her. So I hope everybody had a wonderful Thanksgiving. I am actually recording this before Thanksgiving because we have a four-day weekend and I need to get this to my editor. So I I'm looking forward to having a nice chill Thanksgiving weekend. I don't have anything major plans. I am really looking forward to just having a relaxing weekend. It's about my favorite time of year. I think I've mentioned this before, but I'm a bit of a book nerd. So this is when you start seeing all of those like best books of the year lists come out. So I just saw this really wonderful one from NPR come out and you can go back and see, I think all the way back to 2013, like whole huge variety of book recommendations from them. So I am going to definitely take some time to dig into that list, to see books that I maybe haven't heard about yet, or haven't, um, added to my, to-read list that I need to think about reading. So I'm super excited and I'm sure I will be buying some books over the weekend and adding a bunch of books to my to-read list. Otherwise, I don't really have a ton planned. I need to start thinking about what I am going to bake for over the holidays. I'm already having people ask, like, what are my baking plans and what am I going to bring to things? So I need to start sitting down and thinking about all the things I want to make. So I have a game plan in place, cause I do not have one right now and I need to start thinking about it. So that's what I'm going to do. I hope all of you had a wonderful Thanksgiving. I am very much looking forward to having a four-day weekend. So that's super exciting. And when this comes out, tomorrow is going to be the really important Supreme Court case Jackson Women's Health Organization v. Dobbs, where they are challenging the Mississippi 15-week abortion ban. This is really important because right now under Roe v. Wade and Planned Parenthood v. Casey, it says that pre-viability abortion bans are unconstitutional. So 15 weeks is definitely before viability. So this really strikes at the heart of the holdings at Roe v. Wade and Planned Parenthood v. Casey. So this is really, really big case. Like it is hard to understate what a big deal this case is. It really has the ability to effectively overturn Roe v. Wade, even if they don't issue a ruling saying Roe v. Wade has gone, right? If they say a 15-week abortion ban is okay, that just completely guts the protections that are enshrined at the heart of Roe v. Wade. So this is a really important case. And so we're going to talk about, what I think is really important about this case, is what happens to all of those people who are turned away from accessing the abortion care they want. And I thought that was a really important thing to talk about today, to have that in mind, as we're hearing about the arguments and how the arguments went and how the justices are likely to rule and what that means politically, I just wanted to make sure our attention is focused solely on the people and all of the people that could be turned away if this 15-week abortion ban is allowed to go into place. And this goes for Texas too, right? What does this mean for all of the people who are being turned away from those clinics? What does this mean for their lives?

Jennie: So I could not think of a better person to talk to you for this then Dr. Diana Greene Foster, who wrote the Turnaway study. I am so excited to have her here to talk about it. You all should definitely check out the book that is written about the study called the The Turnaway Study: Ten Years, a Thousand Women, and the Consequences of Having—or Being Denied—an Abortion. Y'all, it is a really important read and it's even more important with the very, very strong possibility that the Supreme Court could go Roe v. Wade, um, this year. So we really need to be thinking about what is happening to those people who are turned away. And so I am super excited for y'all to hear this interview. So with that, uh, let's go to my interview with Dr. Foster.

Jennie: Hi, Dr. Foster, thank you so much for being here today.

Dr. Foster: Thanks for having me, what a pleasure to be on your podcast.

Jennie: Um, before we get started, do you maybe want to take a second and do a quick introduction and include your pronouns?

Dr. Foster: Sure. My name is Diana Greene Foster and my pronouns are she, her, hers, and I am a researcher at the University of California, San Francisco, trained as a demographer, which is like a statistician for statistics that have to do with people. And I started the Turnaway study when a physician said to me, “I wonder what happened to the people we turned away.” And I realized that that was the perfect population to study to understand what the consequences are of receiving a quantitative abortion compared to the only option available to people who are pregnant and don't want to be, which is to carry the pregnancy to term. So that's where the study started-- back in like 2007. And, um, just in 2020, we, I published a book summarizing both the reason for the science, how we did the study and then some stories about the women who were in this study.

Jennie: Perfect. And I cannot recommend the book enough. It is a very good read. The stories are amazing. The data is great and there's just so much information in it. So while we're going to talk about it today, I definitely still recommend people check it out and a hard copy. Okay. So I guess before we get to the results, maybe let's just talk a little bit about the study itself. So what were you looking at?

Dr. Foster: So our goal was to really answer the question: does abortion hurt women? This is an idea that has affected policy and even motivated the Supreme Court to ban one type of abortion. So if you're going to use the idea that abortion hurts women to ban abortion, well, then you really need to know, does not getting an abortion hurt women? And so that's what this study was able to do. Look at, uh, the experience of people who've received abortions compared to those who wanted them and couldn't get them. And we followed them. We've recruited them from 30 facilities across the country where if you were too far along for that facility, there was no one nearby who could do an abortion later. And we recruited people who were just over the limit, just under the limit and then a set of people who were in the first trimester and followed them all for five years, interviewing them about their physical health, their mental health, their socioeconomic wellbeing. And then some really open-ended things like what are your life plans? How are your kids, you know, what's your living situation to try and get a bigger, broader picture of people's lives.

Jennie: This feels so particularly timely right now with all of the legal challenges to abortion, which I know we'll get to later, but just, it really seems particularly important in this moment to understand what happens to those people who aren't able to get an abortion.

Dr. Foster: Yeah. It is not something that when we're talking about the Supreme Court or when you see abortion covered in the papers, it's just… I have not broken through to change the conversation, to try and raise awareness of the really broad consequences. It's not just an ideological battle between people with sets of rights. It's their real life, with broad long-term consequences.

Jennie: Okay. So let's turn to the results and we'll break it into buckets like you did in the book. So maybe we'll start first with what were some of the health results you saw?

Dr. Foster: So most people don't know, but the medical literature is completely clear that carrying a pregnancy to term is associated with much greater risk than having an abortion, even an abortion later in pregnancy. And our study results completely confirmed that people who, just looking at the end of pregnancy, people who give birth had more serious complications, and not to get to the very worst first, but the most tragic finding of the entire study is that two women died from pregnancy and childbirth related causes because they were denied an abortion. So it is astronomical, the death rate is much higher than we would have expected. And what it tells you is it's just the sharpest view of how risky birth can be. And that we take it for granted because women do it. And often people do it even when they, you know, because they want a child, and not necessarily understand all the risks, but the risks are serious. And not only just the end of the pregnancy, do we see a difference, but for five years later, there's a difference in the incidents of chronic pain and hypertension where those who were denied an abortion fare worse than those who receive it.

Jennie: Yeah. I think that is something that cannot be understated, right? Like the maternal health risk in the U.S. is high. It is the highest, I think, the highest in the developed world. And so there are real risks to carrying a pregnancy to term that, you know, you often hear conversations around the anti-abortion side of like making sure it's safe because you know, “we have to protect women because abortion is unsafe,” which is not true, but there's no equal conversation then of the risks of carrying that pregnancy.

Dr. Foster: Yeah. It's shocking to me, how little we acknowledge the risks of pregnancy. My 80 year old mother-in-law has a chronic cough. She gave birth to four kids and we've just learned it's because she gave birth, you know, 50 years ago to kids, it changed her internal anatomy to push up against her esophagus. Like when you decided to become pregnant with someone we don’t say, “but you might have a chronic cough later.” No, you know, we have no idea. And that's just like one tiny thing. But in fact, it's a physiological change, both through pregnancy and pretty much forever after that—it changes your body. And we should like…Mother’s Day should be this incredible…we shouldn't just get chocolate and flowers. I don't know what would do us justice, but it is so substantial. And so underappreciated, just the birthing part of being a mother, nevermind all the rest of it.

Jennie: And I know physical health, wasn't the only area you saw results into. You saw results related to mental health?

Dr. Foster: Yeah. So I was really interested in measuring the ways in which it was thought abortion might hurt people and the way it might help people or that being a parent might hurt people or help people. So we measured the standard kind of psychological diagnoses, like anxiety, depression, post-traumatic stress, but also things like life satisfaction and self-esteem and suicidality were among the things that we measured. And my colleague, Antonia Biggs, who's a social psychologist, led most of these analyses. And what she found is that there is short-term harm from being denied an abortion. So there's higher anxiety, lower self-esteem, lower life satisfaction among the people who were denied in abortion. But by one year they look similar to the people who received an abortion, and they look similar for the next five years. So they're really, to the extent that there are differences in mental health, it's that women who are denied abortions actually fare worse, but in the long run, people are resilient. It isn't a big mental health story and that's consistent with when you ask people why they want an abortion, it's… they don't usually give mental health reasons. They give socioeconomic reasons and relationship reasons and other responsibilities like their children. So I guess in retrospect, we shouldn't be surprised that there aren't mental health differences. And I think it's really important to look to what women in this case… I'm sorry, I'm using the word “women” because they were in this study, they were all women. But look to what women said were their reasons for abortion. Cause it's very telling of what the consequences are when they're not able to get one.

Jennie: Yeah. I also found that really interesting, right? Just the resilience of the women in this study, because it would seem like being denied access to an abortion, it has a huge life impact on you. And so it was really fascinating to me to see like a year later, like everybody had pretty much bounced back and like there weren't longer mental health [implications].

Dr. Foster: I am surprised by it because there is such thing as postpartum depression. And we didn't see it in this study. And I think it's possible that if we did a study entirely of people who said that their reason for abortion was mental health, that we would see much bigger effects, but that just isn't super common in this population, in the United States. It's not super common. So I'm not saying there couldn't be an effect, but among people for whom that isn't their main reason, we don't see an effect.

Jennie: Great. I think the next bucket of results you had were women's lives, which you definitely saw some big effects.

Dr. Foster: Yeah. So some of the areas where we found biggest differences is in economic wellbeing. So when a woman is denied an abortion, she's much more likely to end up living below the federal poverty level. She's more likely to live in a household where there just isn't enough money to pay for basic living needs like food, housing, and transportation. She's more likely to receive public assistance, but it's just not enough to mitigate the loss of employment because raising a kid sometimes precludes having a full-time job. My favorite quote from the study is a woman who was denied the abortion. And she tried to raise the child, but it was, her life was very difficult. There was domestic violence involved and she was saying how hard it is to work, [how you can] become financially dependent on somebody else when you are pregnant. So she said, I'm going to edit her a little to take curse words out just because it's not me, so this is slightly edited… “It is very, very difficult to find a job when you're pregnant, to keep a job when you're pregnant, or maintain a job with a baby, especially if your partner doesn't want to help.” So domestic violence skyrockets, because you're financially dependent on your partner because you have to be home with the kid. Pregnancy is an incredibly scary thing. If you cannot trust the person you're with, that's just devastating.

Jennie: Yeah.

Dr. Foster: And we did see among life outcomes, my colleague, Sarah Roberts, found that when women receive their wanted abortions, the incidents of domestic violence from the man involved in the pregnancy goes down sharply because she stops being in touch with him. And when she carries the pregnancy to term, there is no decrease. There's not an increase in violence, but there's no decrease. And that's not because she continues to be romantically involved with him. It's because she continues to have contact with him because they've just had a child together. So yeah, among the life differences, incidents of intimate partner violence is another. And then a third is that two colleagues at the University of California, San Francisco and at the University of Nebraska looked at women's aspirations. So at the end of each survey, we asked them, the people in the study, what do you, how do you see your life in one year? And how do you see your life in five years? Because previous studies have like looked at people who chose abortion and people who chose to give birth as teenagers and found that people who chose abortion were more likely to graduate from high school, but not everyone wants to graduate from high school. So I didn't want to hold everyone to the same standard. I wanted to let people set their own goals and see if they achieve it. So in asking these open-ended questions, where do you see your life in a year and in five years we're able to tell, to give people a chance to-- do they see their life improving? And then the things that they want to accomplish-- are they accomplishing them? And so it was found that people are more likely to set and achieve aspirational plans if they receive an abortion than if they are denied an abortion. And it was also found that someone is more likely to set aspirational plans in five years, if you received the abortion.

Jennie: Yeah. It, um, I know the economic one was definitely the one that I think I have seen cited the most as like one of the big things out of the study, but I also find this very interesting as well. Right? Like having an abortion, like it allowed people to set bigger goals for their future, that they were then able to like move forward too. And that's big.

Dr. Foster: Yeah. Yeah. It is big it's, you know, I think it's why this, that's why a lot of people are motivated to be politically active on this topic is there's a gut feeling that this is bigger than just one medical procedure. This is about women's… primarily women's participation in society.

Jennie: And I think we saw a funny example of that recently, like the week we're recording this, we just had this past weekend on SNL, Cecily Strong doing the Goober the Clown sketch and talking about how she wouldn't be there if she hadn't had an abortion just before her 23rd birthday. And like, those are stories that you hear of like how, how it impacts your life going forward and being able to chase more of those dreams.

Dr. Foster: Yeah. One thing that moved me was the upcoming Supreme Court case that I know we'll hit on later is Dobbs V Jackson…And the process of doing a Supreme Court case is that people who have evidence that they want to be considered submit them as a friends of the court brief-- so amicus briefs-- and one of them was by professional female athletes. And just, you know, I just think it so brave to come out with their own stories. And it's one type of aspiration, not one that I had an ever any hope of achieving, uh, to be a professional athlete, but that, you know, that people have their own life aspirations. And this is core to people achieving their goals. And I'm sorry. I know you're about to ask me about kids, but sometimes people's goals are to have kids and to have better circumstances. And people sometimes do mention those as their aspirations. We actually looked at the wellbeing of kids and most relevant to this is that, you know, people, many people having abortions want to have kids later under better circumstances. And that's what the study finds is that people who received their wanted abortion had a higher rate of intended pregnancies later. So they were more likely to have a child under better circumstances with a better partner when they were ready, if they received an abortion than if they were denied an abortion and had a child before they were ready. So it's not like this child's just an extra child that you weren't ready for. It actually impacts your chance of having a wanted child later.

Jennie: Yeah. I think that's also really important. Cause I think, you know, in the like, caricatures that get painted of people who have abortions it's often, you know, don't like kids or I don't know some other, like, not understanding of often people who have abortions are already parents or that they've then go on to have kids later that are wanted kids.

Dr. Foster: Yeah. And so we actually looked wanting to take care of the kids you already have is one of the most common reasons people give for wanting an abortion. So about a third of people nationally who are seeking abortion, say their reason is that they need to take care of kids they already have. And what we, we asked about the wellbeing of people's existing kids through a whole bunch of different questions-- their health, their economic wellbeing, their achievement of developmental milestones. So this is, you know, does the kid achieve, you know, gross motor receptive language? There's different kinds of ways in which a child is developing. And what we find is that existing children whose moms, so these are children that existed at the time the woman became pregnant and didn't want to be pregnant, if their mom received the abortion, they're less likely to live in poverty, less likely to live in a house where there isn't enough money for basic living expenses. And they're more likely to achieve developmental milestones than the kids whose mom also became pregnant but was denied the abortion and carried the pregnancy to term. So it's when people say, “I need to have this abortion because I want to take care of the children that I already have” they’re right in thinking that their ability to take care of their existing kids is going to change if they have a child before they're ready.

Jennie: Yeah. I mean, I think this underscores what I think we already know, like women know what they want and what is best for them and their families and should be the ones making the decisions.

Dr. Foster: Yeah.

Jennie: And then I know this last kind of bucket, you already touched on a little bit, but it's men, men in the women's lives. How were they impacted?

Dr. Foster: So there have been, um, not very many studies I know of about men's involvement in abortion. So just a little bit of this background info, which is that the vast majority of men involved in the pregnancy are also involved in the decision-making about the abortion. And three quarters of the men either wanted the woman to get the abortion or wanted to let her be the one to decide. And when we look at why women want the abortion in a third of cases, 30%, the woman says that her reason for the abortion is that her relationship with that man is not good enough to support a child or something else about the relationship, sometimes because he's abusive. And in about 1 in 20 cases, the woman was experiencing abuse prior to the pregnancy. But sometimes it's that the relationship isn't good enough. He doesn't want to have a baby. And we find that regardless of whether the woman received an abortion or was denied an abortion, the relationship with the man and the often with the pregnancy slowly dissolves, and there is no difference, by like three years, there's no difference in the chance that the couple is still together. So it's not that having a baby is going to make this poor relationship actually work-- it's these relationships are dissolving and there's potentially a slight period of slowdown in the dissolution of the relationship. But by three or so years, there's no difference in the chance that they're still together.

Jennie: So I think one of my favorite things about the book, other than the stories, cause I think it was so powerful to hear the women's stories in their own voices, was the section you did talking about the myths that the data disproved, I really loved seeing those myths being taken on, um, head on. And I know we don't probably have time to go through all of them, but are there a couple that are like your favorites? Or go through all of them.

Dr. Foster: I have a feeling your listeners are already the first myth was that only poor childless, teenage irresponsible non-religious whatever stereotype women have abortions. And I think your audience already completely knows that that's not true. That there, that it's something that is experienced by all sorts of people. A good one to address is the second one, which is that abortion is always a difficult decision and that women need more time to decide. And the Turnaway study, actually, we asked people how hard was it to make up your mind about this abortion? And about half people say it's difficult and half say it's not difficult and that it's easy. Doesn't mean that people are, are taking it lightly. It just means they've considered it. And the answer is obvious about what they should do. And this idea that people need to have more time to decide is, uh, is just mandating delay in access and making it more difficult to, to get. The third one that I listed was that adoption is the solution. And I think it is a surprising result from the study is that when people are denied abortions, they don't automatically choose to place the child for adoption. In fact, very few do; fewer than one in 10. So it's just not an easy solution to the problem of unplanned, unwanted pregnancy. It is rarely chosen because it's associated with all sorts of difficulties. That is not an easy route. Childbirth is not easy and placing a child for adoption is not easy. And note that there are people who got pregnant and knew first off that their choice was adoption. And they're not in this study, but I'm saying that if people's first choice was abortion, adoption is not a substitute

Jennie: And mental health differences for that group, or was it mental health? There was some different…

Dr. Foster: Yes. The difference is that they wished they still could have had the abortion. So the people who kept the child…most of them don't continue to say that they still wish they could've had the abortion, but if they place the child for adoption, then they're more likely to say they, they wish they could've had the abortion. The next one was that making abortion illegal doesn't stop it from happening, only makes it unsafe. This one is a pro-choice message. And it's, it's wrong on lots of fronts. One is that when abortion is hard to get, it doesn't even have to be illegal. It's just hard to get; people won't get it. You know, the Hyde amendment, which prevents funding for poor people to have their abortions covered, that prevents people from getting abortions. It's not like there's some like miracle solution and that people automatically just get their abortions when they, if they want them badly enough, that is not the case. So that's one problem with that sentence is it does stop it from happening for some people. And it only makes it unsafe is also a problem because now there are very safe ways of having abortions that may or may not be legal depending on your context, but people who order medication abortion pills, that can be a perfectly safe abortion. It's the same pills that you get in a clinic. So that whole sentence and that whole framing needs to go in my opinion. Ready for the next one?

Jennie: Yes.

Dr. Foster: Abortion is physically risky. This is usually an anti-talking point. And the complication from abortion is very low. It's lower than wisdom tooth extraction. It's lower than tonsillectomy. And more important is that if you're pregnant, you're, you're not choosing between a tonsillectomy and an abortion. You're choosing between birth and an abortion and birth is much more physically dangerous than abortion. The next one is having a baby from an unwanted pregnancy brings a couple together. That one we just discussed and it's not true. So the relationships dissolve whether the woman gets abortion or not. And then here's one, women are selfish when they choose to have an abortion. Women who have abortions don't want to be mothers. And we talked about this a little bit, but most people having abortions are already mothers. It's about 60% nationally. And when they decide to end an unwanted pregnancy, they’re sometimes considering the needs of their existing children. And sometimes they're just wanting a better life for a child they could have later.

Jennie: And also is selfish bad? Like I want it… I have things I want to accomplish in my life. And right now is not the time to have a child. Like doesn't feel particularly selfish or if it is, it's not a bad thing.

Dr. Foster: Yeah. One could embrace it. In fact, I don't see the evidence that people are selfish when they're choosing it. Yeah. I wouldn't call wanting to achieve life aspirations selfish, but often people are giving reasons that have to do with other people… they’re responsible for other people and they're trying to take care of them. So it's not, although caring about yourself is legitimate they're also trying to care for other people. And then my last one is that women's lives are harmed by abortion. And that is definitely not found by this study. Uh, abortions are associated with better outcomes for women and children compared to carrying a pregnancy to term.

Jennie: Okay. So that brings us to the big thing, which is abortion is at the Supreme Court right now, and it's for gestational bans, which is the focus of this book. So one, there's the Texas case, which maybe by now we'll know, but by the time this airs what the Supreme Court decided in that case. But for sure, no matter what they have this next case, which is Dobbs v. The Jackson Women's Health Organization, which is about a 15-week ban, like what are the implications for a 15-week ban and related to the Turnaway study?

Dr. Foster: Yeah. That it is so relevant to the study. This, the idea is that Mississippi passed a ban at 15 weeks. Before that, since 1992, the Planned Parenthood v. Casey, the Supreme Court hasn't allowed bans prior to well, supposedly the viability is a standard. In fact, many states have 20-week bans that haven't been brought to the Supreme Court, but they're trying to lower it to 15 weeks. And the Turnaway study has a lot to say about it. One is that there's an idea that 15 weeks is enough time for people to get their abortions. And that is not true. In this study, we excluded people who were seeking abortion for fetal anomaly or maternal health. So these are the people who often were late in discovering they were pregnant and then followed by a huge slew of logistical barriers to getting an abortion earlier. So there are lots of things that slow people down and lots of them are imposed by our government. For example, there are bans on insurance coverage, public and private insurance coverage, which means that you have to come up with the cash to pay for a medical procedure. And that slows people down. That's a common thing that slows people down. There are other restrictions that close clinics on the basis that somehow their hallways aren't wide enough or their air conditioning system isn't something enough. But when a clinic shuts down, then people have to travel farther. So they have to raise more money. They have to find the logistics of childcare and travel in order to get to someplace that's even farther away. And then those that are farther away are serving more people. There are wait times. It's, you know, we make it as hard as possible to get an abortion. Then we're shocked when people don't do it quickly. Um, so that's one thing. And the other is just the lack of understanding about late discovery of pregnancy. And you know, some people, the minute they conceive, they start to feel nauseated. And some people are supposedly lucky cause they never felt nausea. And that can be great if you have a wanted pregnancy, but if you didn't think you were at risk of pregnancy because you are using contraception, then that absolutely will slow you down from not realizing you're pregnant [like] people who've never been pregnant before, people who have other chronic conditions, people who've just given birth. And so their whole system is a little out of whack, people who have irregular periods, people who are using contraception, all of these are reasons people gave us for not recognizing that they were pregnant. And yet I bled through both of my pregnancies early on. And so if I had not been trying to be pregnant, I absolutely could have thought those were periods.

Jennie: Yeah.

Dr. Foster: I think there's very little sympathy for people who are making this choice. It's partly because we as a society, not you and I, you know, doubt people's decision-making. Um, and then, you know, because we're so worried that they might be taking this decision lightly, we're happy to make it as difficult as possible. And that approach is wrong. We need a little bit more understanding of why people make this decision, the circumstances of their lives, their responsibilities, and then actually try and make it easier, not harder. And that will make abortions happen earlier, which most people prefer. So whether you're anti-or pro-abortion rights, you probably want them to happen earlier if they're going to happen. So it's the right thing to do. And that's not the direction that the Supreme Court seems to be.

Jennie: Yeah. That's what I'm worried. I'm worried.

Dr. Foster: Yeah, me too.

Jennie: So we always like to end with what can the audience do, and I know this one is a little different because we're not talking about a specific law or anything. One, I would recommend reading Dr. Foster's book, but Dr. Foster, do you have any recommendations of things people can do?

Dr. Foster: It's so hard. I'm not an activist. I'm totally a nerdy scientist. And, and if I could just like stare at my statistics all day, I, that would make me most comfortable. And so I really don't have advice for how to make change. I, I want to say that telling the truth and speaking your values about why this is an important issue should make a difference. I'm not confident that it does, but it's what I know to do. Why this is an important issue has to do with caring about quality of people's lives and caring about their autonomy in tracking out their lives. And if we can stick to those values, explain those values, maybe not view this as quite such a political fight, but more a desire to make people's lives better. Maybe that will help a little.

Jennie: I think that sounds great. Dr. Foster, thank you so much for being here. I really appreciated talking to you.

Dr. Foster: Thank you so much for having me; thanks for hosting this podcast.

Jennie: Okay. Y'all I hope you enjoyed my interview with Dr. Foster. I had a great time talking to her. I hope y'all really do get a chance to check out her book on the Turnaway study. It's really important. And you know, she does a really great job talking about what happens to all of the people who are turned away and why this is so important. So please have that in mind tomorrow, as you're hearing all of these discussions about the Supreme Court case and what it means politically and, and such and such, just to remember, we need to think about the people and what this means to their lives, to the people who are not able to access the abortion care that you need. Yeah. So with that, I think we're going to go ahead and wrap it up.

Jennie: Thanks for listening everyone. And we'll see you on our next episode of RePROS Fight Back. For more information, including show notes from this episode and previous episodes, please visit our website at reprosfightback.com. You can also find us on Facebook and Twitter at RePROS Fight Back, or on Instagram at reprosfb. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.

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