The Turnaway Study Deceives Public About Abortion Risks

Springfield, IL (July 27, 2018) — The claim that 95 percent of women have no regrets or mental illness after their abortions is based on the Turnaway Study’s intentionally inaccurate analysis and an unrepresentative sample of women, according to a new review published in the Linacre Quarterly medical journal.

The review examines a series of studies conducted by a pro-abortion advocacy group, Advancing New Standards in Reproductive Health (ANSIRH). The studies are based on their “Turnaway Study” data set, a series of interviews over a five year period with women who had first-trimester abortions or second trimester abortions, and a sample of women who were turned away by abortion clinics because they sought an abortion after the legal gestational limit.

The New York Times, Washington Post, and many other news outlets have frequently reported on the ANSIRH Turnaway Study. The typical reporter describes the study as proof that abortion isn’t linked to any mental health issues and that 95 percent of women abort have no regrets or problems afterward. But in the new review of the Turnaway Study, Elliot Institute Director David Reardon documents that ANSIRH’s studies are plagued with design problems and overreaching conclusions.

“The authors claim that their sample is representative of the majority of women having abortions, when in fact they used an unrepresentative and highly selective sample and asked misleading questions,” Reardon said. “Both the Turnaway Study and the media reporting hide the truth and mislead the public.”

Problems With the Turnaway Study Sample

Reardon’s review demonstrates that the study’s problems begin with the sample of women studied. Only 27 percent of the more than three thousand women invited to take part in the study participated in the first interview, held six months after their abortions. By the end of the five year study, only 17 percent remained.

Graph of low participation rate in Turnaway Study — Turnwaway Study’s Low Participation Rate

“Seventeen to 27 percent is a very low participation rate and is compounded by the fact that women who anticipate and experience the most negative reactions to abortion are also more likely to refuse to participate or to drop out after the study starts,” Reardon said. “So the women who remained in the study were likely to have the fewest problems, while the ones with more serious issues were steadily dropping out.”

When one reads the fine print in the ANSIRH reports, even the study authors admit that women who reported the highest rates of relief and happiness at the initial interview eight days after their abortions were the most likely to remain in the study, while those who had the most negative initial feelings were more likely to drop out. But this admission was buried in the details of just one of ANSIRH’s reports and was never mentioned in their press releases.

Further, there was an additional bias in which women were invited to participate in the Turnaway Study. According the authors noting that “it is up to the clinic staff at each recruitment site to keep track of when to recruit abortion clients.” This meant that clinic staff could choose not to recruit women who showed signs of distress or staff believed would have problems coping, which would not be reflected in the final study numbers.

The end result is that the sample ANSIRH uses for all of their studies “is clearly biased toward a subset of women who expected the least negative reactions to their abortion, experienced the least stress relative to discussing their abortions, and perhaps may even have experienced therapeutic benefits from talking about their abortions with researchers who affirmed the ‘rightness'” of the abortion, Reardon wrote in the review.

There were other problems with the study design. The Turnaway Study included a sample of women who sought late-term abortions but were “turned away” by the abortion clinic because they were beyond the cut-off time for abortions in their state. ANSIRH claims that this unique aspect of their study allows the authors to compare how women who had abortions fared versus women who were “denied” abortions. But when Reardon studied the details of the ANSIRH documents, he discovered that the authors admitted that one-fourth of the women used in the “turnaway” control group subsequently had abortions elsewhere or reported having a miscarriage.

“As a result, ANSIRH did not even use a true control group,” Reardon said. “The Turnaway Study compares women who were known to have had abortions to a group including both women who had abortions and women who did not.”

Moreover, the study also did not include, or at least report, information on women’s prior or subsequent reproductive history. This further amplifies the absence of any meaningful comparisons, since many women in the “turnaway” group, theoretically treated as not having been exposed to abortion, had in fact likely undergone an abortion at some point in their reproductive lives, either before the study took place or during the five-year-follow up period.

“In the absence of a true control group of women who have never been exposed to abortion, the Turnaway Study cannot tell us anything about the differences between women who have abortions and those who do not,” Reardon wrote in his review.

False Labeling

Reardon’s review also reveals that the ANSIRH authors have misled the public by claiming that the Turnaway Study is a “prospective longitudinal cohort study,” a study that collects data on a group of people for a time prior to the group being exposed to the factor being studied — in this case, induced abortion.

Citing numerous examples, Reardon argues that the Turnaway Study should be properly categorized as a case series study — a study that follows a group of cases (women who sought abortion) to see how they fared (whether they had an abortion or not).

“The Turnaway Study would only be properly classified as a prospective longitudinal study if it followed a large group of women before they became pregnant and then compared the outcomes of those who had abortions, those who carried to term, and those who sought an abortion and were turned away,” Reardon said.

He also believes that the classification of the study as a “prospective longitudinal study” is a deliberate attempt to imply a higher quality study than ANSIRH actually conducted. In his review, he further chastised ANSIRH for ignoring in their reports any mention of the handful of true prospective longitudinal cohort studies on abortion, which contradict ANSIRH’s conclusions. In particular, he cited a series of studies published in Christchurch, New Zealand, which drew on data from a study that followed a group of women from birth to 30 years of age and had a retention rate of 88 percent.

“The Christchurch studies, which have the most extensive pre-abortion history data of any abortion studies ever published, revealed that abortion is significantly associated with increased rates of suicidal tendencies, substance abuse, depression, anxiety, and the total number of mental health problems,” Reardon wrote. “Yet, despite their methodological superiority, the Christchurch studies, like others contradicting the Turnaway Study finding, are consistently overlooked by ANSIRH and the reporters covering their studies. As a result, the major media outlets are giving headlines to fatally flawed studies that promote pro-abortion messages while high-quality studies are routinely ignored.”

Selective and Misleading Results

The problems with the study sample are compounded by the questions the women were asked and the way the results were reported, Reardon said.

For example, a key finding reported in one study is that “compared with having an abortion, being denied an abortion may be associated with greater risk of initially experiencing adverse psychological outcomes.” However, the details in the paper show that this outcome hinges on a single anxiety score from one week after the women were denied an abortion, when presumably they were still dealing with the anxiety of figuring out how to cope with their situation.

“In fact, ANSIRH’s own data actually revealed that beyond this first week, the women denied an abortion who actually did carry to term had significant improvements in anxiety, depression, and self-esteem,” Reardon wrote. “Indeed, the researchers admitted that they could observe no significant differences between the groups. But this is only admitted in the details of the study, not the abstract, conclusions, or news releases.”

Another finding reported by ANSIRH was that the majority of women who aborted believed they had made “the right choice.” The study details reveal that this finding was also based on a single question of whether the abortion was “right” for them and to which they had answer “yes,” “no,” or “uncertain.” The question lacked any nuance or way for women to gauge their thoughts and the level to which they thought the abortion was “right,” nor did it account for the fact that women may be unwilling to voice dissatisfaction over an outcome they could no longer change.

In fact, another, more in-depth study from Sweden found that although 80 percent of the women in that study reported that they were satisfied with the abortion decision, 76 percent also stated that they would never abort again if faced with an unplanned pregnancy — suggesting that the question is more complicated than the Turnaway Study reported.

“Other studies have found that women report both positive and negative feelings after abortion and that positive emotions often exist side by side with deeply negative emotions,” Reardon said. “Yet the ANSIRH authors once again ignored other studies and either did not include questions that would explore this issue more deeply, or failed to report on the answers if they did ask them.”

In fact, he wrote, it’s impossible to know if such questions were included because ANSIRH has refused all requests to make their questionnaire or complete data available on the grounds of privacy, even thought they are required to do so and any identifying data can be redacted. It certainly raises the question of whether they are choosing to selectively publish only the results that fit with their ideology instead of the whole truth.

“In short, the Turnaway study findings are based on a set of low-quality and misleading data, and they are being used by both the authors and the media to push a false and overly reassuring picture of the link between abortion and mental health,” Reardon said. “Women and their loved ones who are facing the possibility of abortion deserve better than to be given false information that may lead them to undergo a procedure that may contribute to harm, trauma and regret.”

Citing: Reardon, D. C. (2018). The Embrace of the Pro-Abortion Turnaway Study. Wishful Thinking? or Willful Deceptions? Linacre Quarterly.