The Toll of the Unwanted Pregnancy

Eliza Partika

July 05, 2022

In the wake of the Supreme Court's decision last month to repeal a federal right to abortion, many women will now be faced with the prospect of carrying an unwanted pregnancy to term.

One group of researchers has studied the fate of these women and their families for the last decade. Their findings show that women who were denied an abortion are worse off physically, mentally, and economically than those who underwent the procedure.

Dr Diana Greene Foster

"There has been much hypothesizing about harms from abortion without considering what the consequences are when someone wants an abortion and can't get one," said Diana Greene Foster, PhD, professor of obstetrics and gynecology at University of California San Francisco (UCSF).

Greene Foster leads the Turnaway Study, one of the first efforts to examine the physical and mental health effects of receiving or being denied abortions. The ongoing research also charts the economic and social outcomes of women and their families in either circumstance.

Greene Foster and her colleagues have followed women through childbirth, examining their well-being through phone interviews months to years after the initial interviews.

The economic consequences of carrying an unwanted pregnancy are clear. Women who did not receive a wanted abortion were more likely to live under the poverty line and struggle to cover basic living expenses like food, housing, and transportation

The physical toll also is significant.

A 2019 analysis from the Turnaway Study found that two out of the 1132 participants died as a result of maternal, or pregnancy-related, causes. Both of these deaths occurred among people denied a wanted abortion. This amount of maternal mortality translates into 1 death out of every 100 women giving birth in the study, a rate that is substantially higher than national maternal mortality rates. The researchers also found that women who carry unwanted pregnancies have more comorbid conditions before and after delivery than other women.

Lauren J. Ralph, PhD, MPH, an epidemiologist and member of the Turnaway Study team, examined the physical well-being of women after delivering their unwanted pregnancies.

Dr Lauren Ralph

"They reported more chronic pain, more gestational hypertension, and were more likely to rate their health as fair or poor," Ralph said. "Somewhat to our surprise, we also found that two women denied abortions died due to pregnancy-related causes. This is my biggest concern with the loss of abortion access, as all scientific evidence indicates we will see a rise in maternal deaths as a result."

At least one preliminary study, released as a preprint and not yet peer reviewed, estimates that the number of women who will die each year from pregnancy complications will rise by 24%. For Black women, mortality could jump from 18% to 39% in every state, according to the researchers, from the University of Colorado Boulder.

State of Denial

Regulations set in place at abortion clinics in each state individually determine who is able to obtain an abortion, dictated by a "gestational age limit" — how far along a woman is in her pregnancy from the end of her menstrual cycle. Some of the women from the Turnaway Study were unable to receive an abortion because of how far along they were. Others were granted the abortion because they were just under their state's limit.

Before the latest Supreme Court ruling, this limit was 20 weeks in most states. Now, the cutoff can be as little as 6 weeks — before many women know they are pregnant — or zero weeks, under the most restrictive laws

Over 70% of women who are denied an abortion carry the pregnancy to term, according to Greene Foster's analysis. 

Interviews with nearly 1000 women — in both the first and second trimester of pregnancy — in the Turnaway Study who sought abortions at 30 abortion clinics around the country revealed the main reasons for seeking the procedure were (a) not being able to afford a child; (b) the pregnancy coming at the wrong time in life; or (c) the partner involved not being suitable.

According to the US Centers for Disease Control and Prevention, 59.7% of women seeking an abortion in the United States are already mothers. Having an unplanned child results in dramatically worse economic circumstances for their other children, who become nearly four times more likely to live below the poverty line than their peers. They also experience slower physical and me ntal development as a result of the arrival of the new sibling.

Dr Liza Fuentes

The latest efforts by states to ban abortion could make the situation much worse, said Liza Fuentes, DrPh, senior research scientist at the Guttmacher Institute. "We will need further research on what it means for women to be denied care in the context of the new restrictions," Fuentes told Medscape Medical News

Researchers cannot yet predict how many women will be unable to obtain an abortion in the coming months. But John Donahue, PhD, JD, an economist and professor of law at Stanford University in California, estimated that state laws would prevent roughly one third of the 1 million abortions per year based on 2021 figures.

Ralph and her colleagues with the Turnaway Study know that restricting access to abortions will not make the need for abortions disappear. Rather, women will be forced to travel, potentially long distances at significant cost, for the procedure or will seek medication abortion by mail through virtual clinics.

But Ralph said she's concerned about women who live in areas where telehealth abortions are banned, or who discover their pregnancies late, as medical abortions are only recommended for women who are 10 weeks pregnant or less.

"They may look to self-source the medications online or elsewhere, potentially putting themself at legal risk," she said. "And, as my research has shown, others may turn to self-managing an abortion with herbs, other drugs or medications, or physical methods like hitting themselves in the abdomen; with this they put themselves at both legal and potentially medical risk."

Constance Bohon, MD, an ob/gyn in Washington, DC, said further research should track what happens to women if they're forced to leave a job to care for another child.

Dr Constance Bohon

"Many of these women live paycheck to paycheck and cannot afford the cost of an additional child," Bohon said. "They may also need to rely on social service agencies to help them find food and housing."

Fuentes said she hopes the Turnaway Study will inspire other researchers to examine laws that outlaw abortion and the corresponding long-term effects on women.

"From a medical and a public health standpoint, these laws are unjust," Fuentes told Medscape. "They're not grounded in evidence and they incur great costs not just to pregnant people, but their families and their communities as well."