In the wake of the U.S. Supreme Court’s 6–3 ruling last month in Dobbs v. Jackson Women’s Health Organization that overturned Roe v. Wade and was condemned by the AMA, nearly half the states are set to dramatically restrict or outright ban the practice of abortion.
As physicians and their patients brace for a new reality that makes it even harder to access abortion care, previous research shows they can expect to see women’s physical and economic health negatively affected if they wish to have an abortion but are unable to access it.
“Women are emotionally resilient, but abortion is associated with improved physical health, financial security, aspirational plans and the ability to take care of existing and future children,” Diana Greene Foster, PhD, MA, said during an AMA Medical Student Section education session recorded for the 2022 AMA Annual Meeting.
Foster is a demographer who directs research at the University of California, San Francisco’s Advancing New Standards in Reproductive Health program, and she wrote the 2020 book, The Turnaway Study: Ten Years, a Thousand Women, and the Consequences of Having—or Being Denied—an Abortion.
Foster and her colleagues followed the nearly 1,000 women for five years and conducted in-depth interviews with 31 of them. The participants included 231 women denied abortions, 452 women who got an abortion just under the limit allowed in the state in which they had the abortion, and 273 women in their first trimester who got an abortion.
Poorer health, more poverty
Researchers found an array of differences in the lives of women who were able to go forward with an abortion when compared with those who were denied abortions because their pregnancies were too far along under the state laws, Foster said in the education session, “Long-Term Implications of Restricting Access to Abortion.”
When compared with women who were able to obtain a wanted abortion, women denied a wanted abortion who went on to give birth were more likely to experience:
- Gestational hypertension.
- Joint pain and headaches or migraines.
- Fair or poor health.
- Death. Two women in the study died of maternal causes.
Women denied abortions also had large and significant differences in their economic trajectories, facing more hardships than women receiving wanted abortions.
The women denied abortions were more likely to:
- Raise children alone, not with family or a male partner.
- Live in households that drop below the poverty level, with 72% of households where a mother was denied an abortion living below the federal poverty level, compared with 55% of those who received the abortion.
- Lack enough money to pay for food, housing and transportation, with 87% of those who were denied abortions reporting that problem, compared with 70% of those who received an abortion.
Researchers also discovered that among women who already had children, the existing children to women denied an abortion had 4% lower scores across all six domains of child development when compared to existing children among the women who were able to have the abortion they sought. This includes the areas of expressive language, fine motor, gross motor, receptive language, self help and social emotional.
“Access to abortion enables women to have children at a time when they have more resources – financial and emotional—to devote to their children,” Foster said.
In a statement reacting to the high court’s ruling overturning Roe v. Wade, AMA President Jack Resneck Jr., MD, said that “access to legal reproductive care will be limited to those with the sufficient resources, circumstances, and financial means to do so—exacerbating health inequities by placing the heaviest burden on patients” from historically marginalized racial and ethnic groups, as well as those from low-income or rural communities “who already face numerous structural and systemic barriers to accessing health care.”
Meanwhile, Dr. Resneck and the AMA welcomed privacy guidance from the Department of Health and Human Services in the wake of the Dobbs decision.
Mental health impact
The Turnaway Study also found that women who were denied abortions had more anxiety and lower self-esteem when the abortion was denied when compared with those who were able to have a wanted abortion, Foster said.
Symptoms and cases of depression, suicidal ideation, post-traumatic stress and life satisfaction didn’t differ between the two groups of women in the study.
“What we have learned from these mental health outcomes is that denying someone an abortion is more harmful than receiving one,” she said. “Many states’ policies mandate people be told about the mental health harm of abortion—these are not based in evidence.”
Read this JAMA Medical News article to learn how abortion bans could affect care for miscarriage and fertility.
Responding to the growing threat of over-policing and surveillance of reproductive health services, the nation’s physicians and medical students at the 2022 AMA Annual Meeting in Chicago adopted policy recognizing that it is a violation of human rights when government intrudes into medicine and impedes access to safe, evidence-based reproductive health services, including abortion and contraception.
Catch up with the other highlights from the 2022 AMA Annual Meeting.