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“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.