Latest “Turnaway Study” on Post-Abortion Emotions Badly Flawed: National Right to Life’s In-Depth Analysis

By Randall K. O’Bannon, Ph.D. NRL Director of Education & Research

Editor’s note. This important analysis that appeared a year ago in NRL News Today is as on the mark and significant was it was in 2020.

The fine folk from the University of California -San Francisco (UCSF) – long known as America’s Abortion Training Academy – are out with another installment of their “Turnaway Study,” a five-year-long study that was supposed to be designed to determine the social, psychological, and economic consequences of having an abortion versus being “denied” an abortion in some cases because the pregnancy was so advanced.

As you might expect, given the source, this latest installment assures us that negative psychological reactions to abortion are rare; that whatever feelings there might be dissipate with time; and that women remain firm in their conviction that abortion was the right decision for them. 

Like pretty much everything else put out by the “experts” at UCSF, the media largely accepted the reported results as gospel, rarely asking substantive questions that might have exposed some real deficiencies with the both the individual components or the larger overall study.

We will first examine how the approach taken tilts the results before going in-depth to examine the study’s shortcomings. By way of summary, the results fall short because the researchers interviewed a very unrepresentative sample of women; radically minimized the number of women who are negatively affected by their abortions as demonstrated by other studies (including by self-described “pro-choice” researchers} ; and did not include any women who were actually “turned away” from abortions [denied an abortion].

If, in fact, many women who did not have their abortions were happy with the outcome, it completely undercuts the main thesis of the folks from UCSF. No wonder their voices are missing!

Consider the Source

This most recent study, “Emotions and decision rightness over five years following an abortion: An examination of decision difficulty and abortion stigma,” was published online 1/2/20, ahead of print in journal of Social Science & Medicine. It was the work of Corrine H. Rocca and a team from UCSF’s Bixby Center for Global Reproductive Health, Advancing New Standards in Reproductive Health (ANSIRH).

The study involved 667 women who had abortions between January of 2008 and December of 2010 at thirty different abortion facilities across the U.S. Agreeing to participate at the time of their abortions, they had a baseline interview, another interview about a week after the abortion, and then phone interviews about every six months for five years. Women received a $50 gift certificate each time they completed the survey.

In addition to sociodemographic and basic data on the pregnancy (e.g., gestation, reason for desiring abortion), researchers also asked questions about the woman’s social circumstances (married, working, family, economic support), their views about the abortion, and their emotional states.  Previous “Turnaway” studies involving the same women have examined different outcomes. However this latest survey specifically sought to deal with the difficulty involved in the abortion decision, the trajectory of her emotions over the following five years, and the degree to which abortion’s social stigma impacted her abortion experience.

Not surprisingly, Rocca and her UCSF team concluded that the abortion had minimal emotional impact on the woman, and that whatever initial negative feelings she might have had dissipated over time.  Whatever misgivings or uncertainty that existed about the abortion decision at the beginning were thought to be connected to social stigma towards abortion that a woman internalized from those around her. However, five years out, the authors say, women almost universally agreed that abortion was the right decision for them.

This is all backed by charts and numbers, making it seem very official and scientific. 

The “scientific” spin 

A week after the abortion, 17% of the women reported feeling what the study calls “mostly negative” emotions while 51% reported “mostly positive” emotions. The remaining 32% reported either mixed emotions (12% feeling both negative and positive emotions) or few or no emotions at all (20%).  

Five years later, only 6% still reported negative emotions and just 10% reported mixed emotions. The number reporting positive emotions had shrunk to 19%, but nearly two thirds (65%) were reporting feeling few to no emotions at all in regard to the abortion.

This pattern was largely repeated for every emotion that was studied.  A few women, particularly those who found making the abortion decision difficult, initially experienced some sadness, guilt, or regret after the abortion. Some of those who reported finding the decision “very difficult” reported anger. All groups reported “relief” in their first post-abortion interview, though this was higher for those who did not find it difficult and least so for those that did.  A certain portion, particularly of those who found the abortion decision “not difficult,” reported “happiness” right after the abortion.

No matter what the emotion, all of these were supposed to have dissipated with time for the group as a whole. Thus, we’re told, little or no sadness, guilt, regret, anger (or happiness) was reported at five years.  A few still reported relief, but even that was at a low level.

Altogether, 178, or about 26.7% of the women, reported they found the decision to have an abortion “very difficult.” Another 180 found it “somewhat difficult.”  While the largest individual group, 309, reported that the decision to abortion was “not difficult,” if the other two groups are combined, it means that more than half of the women found that decision difficult to some degree. 

Blaming social “stigma”

The authors of the study assert that both greater difficulty in making the decision and higher negative emotion scores were associated with greater perception of community (or personal) abortion stigma. In other words, a feeling that people in a woman’s community or those close to her would look down upon her if they knew she had sought an abortion. 

At the five-year mark, even for those women reporting the highest level of perceived stigma, 97.7% reported that having the abortion was the right decision. Virtually the same was true for women reporting greater difficulty in making the abortion decision. At five years, 97.9% called having the abortion the right decision.

The bottom line for Rocca and the authors of the study is to assert that they have evidence that, even five years later, women remain overwhelmingly convinced that their decision to abort was the right one and that whatever negative emotions they initially may have had largely vanished with the passage of time.

Aim to change laws

And of course, revealing their aims for the study, Rocca and her team concluded “Our findings challenge the rationale for state-mandated counseling protocols on post-abortion emotions and other policies regulating access to abortion premised on emotional harm claims (e.g., waiting periods).”

In an article in Salon (1/13/20), Rocca admitted that “It is true that some women have complicated feelings about their abortions, and some do wish they had not had one.” However, she argued, “The social, economic, and medical good of abortion access for the hundreds of thousands of women who seek care every year outweighs the small chance that someone will later regret her choice.”

“What this study is showing is that there is a small minority who do regret their abortions,” Rocca said (Wash Post, 1/12/20). “I in no way want to reduce the struggles of those who regret their abortions, but it is misguided to take away the options for everyone based on this minority.”  

Study just plain wrong at so many levels

Many more women affected

Pro-lifers have never said that every woman who aborts automatically regrets her decision or suffers emotionally. But it is clear that many do.  

Anyone who has spent time listening to the stories of post-abortive women knows that many women experience guilt, depression, and/or regret after their abortions –and not simply because of some perceived social “stigma.”

For some, the regret is almost immediate, even as they see or experience the abortion occurring. (The fact that hundreds of women who started chemical abortions, in a matter of hours, have taken progesterone to try to reverse their abortions is itself evidence of serious reservations).

But for other women, the negative reaction does not show up for years, some long after the five-year deadline used by study.  It might be buried until the birth of a grandchild, or when a woman determines her childbearing years have passed.

Rocca and the UCSF team do not deny that such might be the case for some women, but they maintain this is very infrequent. They also dispute the cause.  

Yet in a thirty year longitudinal study involving some 500 women, New Zealand researcher David Fergusson, who described himself as personally “pro-choice,” found that mental disorders might be 30% higher for aborting women (Fergusson, 2008). This raises serious doubts about estimates of only 1-3% having persisting qualms.

A nationally representative survey of 8,005 U.S. women funded by the federal government seems to show that about 6-9% of mental illness, affective disorders, depression may be attributable to abortion, as well as between 7-25% of substance or alcohol abuse (Sullins, 2016).

Apply these percentages to the American women who have endured sixty plus million abortions since 1973 and what does it mean? Millions of women, not handfuls, suffering serious identifiable psychological and social consequences and likely many more struggling at some level after their abortions.

This certainly seems to offer a better explanation of the prevalence of post-abortion stress than do studies which deny or minimize women’s negative emotional reactions.

Haunted by “stigma” or their unborn child?

 “Turnaway” researchers want to consider doubts that a woman has about the rightness of her abortion decision as somehow connected to the social stigma they believe she may internalize or perceive from the community around her. But the UCSF researchers never give any indication they considered that a woman’s doubts or concern or negative reactions may actually be triggered by something real and more basic – awareness of the humanity of the unborn child and her unconscious bond to her own flesh and blood.

It never seems to occur to researchers that the biggest problem that many women have with abortion is that it takes the life of a human being. These hardened abortion advocates are so programmed to disregard the humanity of the unborn child and the moral horror of killing that child that they never really examine what effect the awareness of this reality might have on a woman’s reaction, no matter what those around her say.

An unrepresentative sample

The most fatal flaw of the survey is the clearly skewed sample. If this were a random sample of all women who had abortions who were then regularly polled, in an objective, neutral, well designed survey, over a ten to twenty-year period, it might provide some useful data. But this survey decidedly wasn’t any of that.

Researcher David Reardon wrote this about the Turnaway sample in the Linacre Quarterly in 2018. As the Washington Post (1/12/2020) pointed out in a summary of that article, Reardon noted that “more than two-thirds of the women approached for the study refused to participate. Of those who agreed, half dropped out. Those who reported the highest rates of relief and happiness were the ones most likely to remain…. Those who reported the least relief were most likely to drop out.”

This means a high number of women who were uncomfortable with talking about their abortion experience eliminated themselves from the study even before the survey sample was set.

Pro-life advocates were not the only ones to notice this defect.  Pro-choice commentator Kevin Drum, writing in Mother Jones magazine, said the following:

It’s true that longitudinal studies, by definition, include only people who agree to be part of the study in the first place. If you’re studying some concrete physical phenomenon like lead poisoning or the effect of a new drug, that’s probably OK. 

But this is precisely why longitudinal studies aren’t generally useful for assessing things like emotional states, which can easily affect participation in unexpected ways. 

Rocca says “we have no reason to believe” that happened here, but that’s a pretty lackadaisical approach to legitimate criticism. I can think of half a dozen reasons off the top of my head why emotional states might affect participation. 

Maybe people who feel guilt are less likely to want to be reminded of it periodically for the next five years. Maybe introverts are less likely to participate. Maybe women with traditional upbringings are less likely to participate. Etc. 

This is an endless list, and “no reason to believe” mostly suggests that nobody bothered looking.

If you winnow your sample down to those who are the most committed, those least likely to have doubts, those most likely to defend their choices, then you’re going to get just the sort of results that the “Turnaway” study found.  

But that will tell you nothing about aborting women in general.

No “turnaways” in the latest Turnaway study

Another obvious, but largely overlooked, problem with this latest “Turnaway” study is that this study didn’t include any women who were actually turned away from having an abortion.  

The larger original study sample included some women who planned to have abortions but were unable to get them because they were too far along, because staff were not trained or equipped to do later abortions, or for other reasons. So why were none of them included in this study?  

The authors say “we exclude the Turnaway group because we could not assess emotions about the abortion or whether abortion was the right decision among women who did not have abortion.” 

They do not report the data here, but it is highly significant that elsewhere they admit that they did, in fact, ask these other women about the rightness of their decision after they were “denied” their abortion.

When they did, what did they find? Within a week after their “denial,” even before the baby was actually born, 35% of those women were no longer willing to say that having the abortion would have been the right decision. 

If attitudes could change this quickly and dramatically among women who (one must remember) were previously just as committed to having an abortion as the others in the study who did, it tells us that belief in abortion’s “rightness” is not inherent in the circumstance. It is less a considered, informed, personal moral judgment about or evaluation of the abortion decision and perhaps more about the human tendency to try to accept or adjust to whatever circumstances (or choices) life brings. 

Thus, this study tells us nothing about the objective “rightness” or wrongness of abortion or even the subjective “rightness” or wrongness for a woman’s situation. Women can live with being “denied” an abortion–and so can their children—and be happy about the outcome.

Again, this was just from women’s initial reaction to being told they could not have an abortion before the baby was born. From other “Turnaway” reports, we know that after the birth, 86% of those women “denied” abortions were living with the baby, 59% perceived their relationships as good or very good, and nearly half (48%) had full-time jobs.

These are pretty remarkable outcomes, given what the UCSF researchers tell us about the demographics of this sample. Most of these women were not upper or middle-class women with ideal social or economic prospects, but younger, poorer women likely facing many obstacles. These are considerably more positive consequences than the UCSF team would have led us to believe were likely or even possible for those women “denied” abortions.

Remaining questions

There are other issues about not just the ethics but the potentially biasing effect of paying women (a $50 gift certificate each time they participated in the survey) for their responses. How might this have incentivized women to give the sort of responses they knew interviewers wanted to hear?

One basic problem with many abortion studies is that because patient records are private, abortion clinics and sympathetic abortion researchers have access to clients and data that pro-life researchers and the general public do not.  That means they can control the sample selection, control the interviews, and determine what questions to ask (or to avoid), and then determine what data to release to (or hide from) the public. 

Would an objective team of researchers without UCSF’s heavily pro-abortion agenda have asked the same questions and come up with the same results?

Sponsorship of these studies by wealthy, notorious abortion backers makes one wonder whether studies showing anything else would have ever been funded or published.

Turn Away from the Turnaway Studies

Though they cover it up with loads of impressive looking charts, data, and statistics, the “Turnaway” studies are based on a very selective, non-representative sample of women who were committed to having their abortions and not ashamed to talk about it. Reinforced by researchers and given opportunity to justify themselves, they gave the answers their interviewers wanted to hear.

But if you truly want to know what women’s emotional reactions to abortion are; if you want to know what troubled them about their abortions; if you want to know why millions of women are still in pain about events that happened five, ten, or twenty years ago, ask them. 

Listen to their stories, hear their hearts. Offer comfort and healing.

But whatever you do, don’t tell them the aching hole in their soul isn’t real.