7. What Are the Consequences of Being Denied an Abortion?

Kayla talks about being denied an abortion while incarcerated, and Dr. Diana Greene Foster shares her work on the landmark Turnaway Study.

Guests:

• Kayla Winston, We Testify abortion storyteller (read more about Kayla’s experience here)

• Diana Greene Foster, PhD, professor and demographer at the University of California, San Francisco (Turnaway Study website and book)

Music by Lily Sloane, logo by Kate Ryan. Photos courtesy guests.

Kayla Winston

Diana Greene Foster

Kayla Winston [00:00:01] They probably didn't realize that, like, some of these pregnancy tests could possibly come back positive. They were probably thinking, lik,e this is something we just got to do real quick just because it's the precautions, you know. So the way that it was delivered to me was extremely, like, it was frightening, but it was also embarrassing because it was new news to me. That was just terrible. So how it happened is I, they took me into the restroom. I did a pee test for the pregnancy test. They had me go sit on this bed like this hospital type of bed. And the way that the beds are is is just all public. So it's like one big open space with a bunch of different medical beds, not any doctors office rooms or anything like that. Everybody is seen in public, obviously. So there was a lady in the hallway that shouted to the administrator that was with me and said, hey, it's positive. And in a way that was like, whatever, like it was not a obviously, they had not... They were not feeling the way that I was feeling. They were just thinking, like, just let her know it's a positive type of thing. And it was just very embarrassing because I honestly had no clue that I was pregnant. I had no clue at all. 

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Garnet Henderson [00:01:50] Welcome to ACCESS, a podcast about abortion. I'm your host, Garnet Henderson, and that was Kayla Winston. Kayla lives in Ohio. She's a marketing director, a mom of three, and does a lot of volunteer work in the reproductive justice movement, largely based on her own experiences. 

Kayla [00:02:09] I was in a really tough situation and basically I was with the wrong crowd, with the wrong people at the wrong time. And I got caught up in this scandal that was going on just because I was in camera with the person that was doing the the behaviors. So I got charged with the same crime. It's basically like if someone goes out and robs a bank and if you're with them, whether you ask for the money or you're just the car, you're going to get the same consequence. So it was kind of like a situation like that. And then so, I got sentenced and I, honestly, at the very beginning, was just very distraught and surprised that I even got sentenced to jail. I, I my lawyer, my parents, everyone thought that I was going to... I knew I was going to have to serve a consequence, but we didn't realize that, like the severity of what the judge was thinking. We thought probation, we thought house arrest at the very least. But we never thought that, like, I would have to actually go to jail. So I was already in a very depressed mind state walking in. 

Garnet [00:03:30] Tuberculosis is much more common inside prisons and jails than it is among the general population, mainly due to poor living conditions. So TB screening is part of the intake process. Most people get a vaccine, but Kayla had once had a really bad reaction to the TB shot. So instead, the jail's medical staff was going to do a chest X-ray. Beforehand, they did a routine pregnancy test, and that's how Kayla found out she was pregnant. 

Kayla [00:03:59] They took me to my cell. Obviously, they couldn't do the X-ray and so I couldn't get the TB shot. And you can't be around other inmates if you don't have a TB shot. So they basically just put me in a cell by myself and I just had to stay in there for a long time before we can, they can figure out what, we, both them and myself figure out, like basically what the next move is. So I stayed there for about 24 hours and next thing I know, they were transporting me to the pregnancy pod. I didn't know. I've never been in trouble before this and I never had this experience. I didn't grow up this way, so I just didn't know what to expect. And when I went to the pregnancy pod, it was almost a disbelief because it was like, wow, there's pregnant girls in jail and they have to like designate an area for them. So all of this was new to me. It was a matter of about two to three weeks before I actually saw the doctor. They don't, it's very, just so different, it's a different world when you are incarcerated. They obviously just don't care. And so when I went to see the doctor, I had already knew in my mind when I found out I was pregnant that I can't have this baby. I actually had just had a baby, which is why I was shocked. And so I went to see the doctor about two to three weeks after getting transported to the pregnancy pod. And I immediately told her that, like, I want an abortion. And I asked her, what does the process look like for me to get an abortion? Mind you, I've had abortions. I know exactly what the process looks like. And I at that time, I didn't realize, like, what it's even like for incarcerated inmates to get a regular doctor's appointment or dentist appointment outside of the jail, let alone something of what they consider an extra service or a privilege or whatever they considered it for them to tell me no. So the doctor definitely told me that's not an option for me. I did ask her why. Her exact words were, if that is something that you want to do, then you are only sentenced to 90 days and you can do that when you are released. It just felt belittling to know that, like, I know that I want an abortion right now. I have the support of my fiancee and my parents and I don't have that right in here. And so it really just let me know what the, what the system really is about. 

Garnet [00:06:49] Abortion is a constitutional right in the United States. That right is supposed to extend to incarcerated people, but people in jails and prisons are frequently denied abortions, and all sorts of other medical care, due to the cost and logistics of transporting them to offsite medical facilities. In at least 20 states, incarcerated people have had to fight in court for their right to an abortion. Kayla knows now that she probably could have done this, but the legal battle almost certainly would have lasted longer than her sentence. And at the time, she trusted that a doctor would give her good information. 

Kayla [00:07:28] I actually thought that maybe. You know, when you're incarcerated, you really are in the control of the government and they can make those decisions for you. Because otherwise, why would she tell me no? You know, why would she do the wrong thing, type of thing? And so I had that thought process, like, I guess you can't have abortions when you're in jail. And that is what influenced me to start working in the juvenile system years back, because I just realized that people don't know this. And I know that it's already a stigma around abortion, period. So if people think, especially kids, these are juvenile kids, if girls are thinking that they, there's no option of an abortion then they're not even going to bring it up because it's already a vulnerable topic, it's already, you know, like a stigmatized thing to talk about. So why bring it up if I already know that they're going to say no? So I specifically dealt with the pregnancy pod in the juvenile system because I wanted them to know that, like I understand you may, there are people, obviously, that want to keep their babies. But if you don't, I just want you to know that that is an option. Don't let a physician tell you otherwise or talk you out of it or anything like that. 

Garnet [00:08:55] Kayla spent a lot of her time in jail worrying about what would happen next. 

Kayla [00:09:00] I had just had a baby, so it was a it was just very stressful. That's the best way that I can put it. It was a very stressful situation. I already know what our situation looks like, you know, obviously we weren't in the worst situation, weren't poor, weren't homeless, but we were in a situation where that wasn't what we wanted. And I knew that that was enough. Like, even if we are doing OK, even if I'm not incarcerated and we're fine, we're successful. We're happy. If I don't want to be, we don't have to have a baby. And that was the major thing, is like me knowing what I wanted and wasn't and knowing that that was an option and that option being taken away from me. 

Garnet [00:09:41] Kayla was also disturbed by the conditions that she and the other people in the pregnancy pod were subjected to. 

Kayla [00:09:48] I seen women who were obviously shackled to their beds. Which, mind you, I'm in the pregnancy pod, so I seen a lot. And it touched me so much because, these women are bringing in other human beings into the world. So it's like, you're not really just punishing the parent, quote unquote. What are you really doing to this baby, not allowing her to hold her baby when it first comes out? What are you taking from the child? And shackling her so that it's harder for her to push the baby out? What are you really doing to the health of the mom and the baby? We, our living conditions in there were the worst living conditions that I ever seen. I personally, when I first got there, the pregnancy pod was completely full. There was two people to every cell and everyone was full. So they had people on these little cots in the main area. So I guess what you would call like a lobby or atrium or whatever, and people were sleeping along the wall on these little cots. These cots were like what, like what toddlers sleep on when they take a nap at child care. And these are pregnant women. So there was a lot of time where, like, we didn't have blankets, we never got pillows. So forget that. But there was a lot of times we didn't even have blankets. We didn't have water. The showers were infested with insects. There was, it was very, very cold at night. The food, we were not getting, the proper nutrition. 

Garnet [00:11:28] When Kayla got out, she still could have legally gotten an abortion. But as we learned in episode four, it's much more expensive to have an abortion later in pregnancy. And Kayla says that her feelings about the pregnancy changed once she was able to get back to her normal life. 

Kayla [00:11:45] Honestly, at that point, me and my fiancee basically just felt like we might as well, they forced us to keep the baby. I had, I'm just, I'm I I'm very spiritual and I'm very, I'm big on connections, and I had felt at that point that, like I had a connection with my baby and I just wasn't able to not just put up six hundred dollars to let her go, but also I just felt like they controlled the situation to get the outcome that they wanted. So, yeah, when I got out, it was that it was more so like fuck it. Like we, I'm already this far. I feel like I have a connection with the child. It's six hundred dollars versus three fifty now. And I just feel like maybe this was intended from our higher power. So we just tried to, like, look at things a little differently. Things kind of went back to normal. I had to get a new job, but we had a baby shower. It it was, it was back to normal. Yes. I was happy because now I have this connection with this little person. My fiance is extremely happy. Our other children are happy to have a sibling. So I had a different view on things now, whereas before it was just different. Like I couldn't see myself having a child in the situation that I was in. So as I started getting out, I was back working full time and I was working on my masters and things were going back to normal then, yeah, I got excited, but only because of me. Like, I, I was excited because of my experience. Now, I didn't want a baby because of my experience then, you know, so it wasn't about like I don't ever want any more kids. It was more so like I want to I want to make the decision on when I want to have more kids. And I felt like in that specific situation, I didn't want to have a kid right then. And they made me have a kid right then. 

Garnet [00:14:04] I asked Kayla how she felt about the fact that someone who opposes abortion access might view her story as a success. She was denied an abortion, and went on to have a child who she loves and is able to care for. But she said that if that's what you're getting from her story, you are missing the point completely. 

Kayla [00:14:25] I can have seven children right now and I would be a perfectly fine mother. I don't want seven children right now. And that's the difference. The difference is the choice. The difference is I have the choice to choose when I feel like I'm ready to be a mom, especially someone like me. I was already a mom, so I already know what it takes, and the dedication, and the commitment, and the level of energy and attentiveness that I have to give a child. I already know this, so I definitely feel like I have the right to be like, oh no, not this time. There's all different reasons why people want abortions, but the reason doesn't matter. What matters is the fact that I want to choose when I want to have a baby or not. 

Garnet [00:15:09] It's not just incarcerated people who are being denied abortions in this country. You've heard a lot so far on the show about the many barriers to abortion access. There are laws that make abortion illegal after a certain point in pregnancy, or make it so hard to provide abortions that clinics are forced to shut down. There are protesters who harass and intimidate patients and providers. There's abortion stigma, which creates an environment in which a person who wants to get an abortion might not even know where to start. And now we have a pandemic, which has thrown up all kinds of new barriers. But we rarely hear from those people who wanted an abortion and weren't able to get one. What happens to them? I spoke with the person who literally wrote the book on this. 

Diana Greene Foster [00:16:01] My name is Diana Greene Foster. I'm a demographer at the University of California, San Francisco, and I study women's experiences with pregnancy and the consequences of unwanted pregnancy on people's lives. And I led the Turnaway Study. So the Turnaway Study is a nationwide study of people who were seeking abortion, some of whom got their wanted abortion, and some of them were turned away. And the reason we did this study was to answer the question, does abortion hurt women? Because this is a concept that was widely discussed, used as a political point, even used to suggest, the idea that abortion does hurt women was used as a justification to restrict access. But no, in that conversation, no question about, well, what would the consequences be if women were denied abortion? So the idea that we're going to save women from harmful abortion and then have them carry the pregnancy to term seems rather important to also look at, is there harm to being denied an abortion? So we, I started the study because Dr Eleanor Drey, a physician at the University of California, San Francisco, said to me one day, I wonder what happened to the people we turned away. And it was knowing that there is this group of people who wanted an abortion and couldn't get one is a perfect comparison group for people who received their wanted abortion. They're all in the same situation, being pregnant, not wanting to be pregnant. What happens when they can get an abortion or they can't? And so we started with just that one site. Eventually we went to 30 abortion facilities across the country where if you're too far along in pregnancy for that clinic site, there's no other site within one hundred and fifty miles that will do an abortion later. And really, the idea was to try and find people who would carry the pregnancy to term and be able to compare them to women recruited those same clinics who got their abortion. And because most of these 30 abortion facilities had gestational limits in the second trimester, but 90 percent of women who have abortions in the United States do so in the first trimester, we also recruited a woman from the first trimester for every woman denied. And I'm using the word women throughout, because back in 2007, when we set up this study, I just I have to put it on me. I was not aware that I shouldn't make the eligibility criteria pregnant women. And once I'd done that, then trans men may not have participated. And to our knowledge, we didn't have any trans men. So I'm going to use the word women. But acknowledging that, in fact, in the real world, men do sometimes have abortions, too. So we recruited for over three years, we, about a thousand women and followed them for five years to ask about not just their mental health, but also their emotional well-being, how they felt about their decision and then broader impacts like on their health, on their economic well-being, on the well-being of their children, on their aspirational plans and whether they achieved those aspirational plans. So it was, they were long interviews by phone. A team of heroic interviewers did these interviews over eight years calling people. And we finally, a huge team of scientists at UCSF and some beyond UCSF collaborating with us. And we ended up publishing 50 academic papers. And just in June 2020 a book out by Scribner that I wrote, that summarizes both the you know, why one would do a study on this topic and what the findings are. And then also, because nobody is particularly probably moved by statistics, although the book is light on that from my perspective, also to try and understand, well, what is the lived experience of people who actually have, are pregnant when they don't want to be and they are denied or they receive. And so there are stories of from ten women randomly chosen from the study. 

Garnet [00:20:14] Dr. Foster says that one of the most important takeaways from the Turnaway Study is that people know their own circumstances. 

Diana [00:20:22] Abortion is a political topic. It gets discussed abstractly. And we don't even generally in the broader conversation about abortion in our country, we don't hear from people who are affected at all. So it's not surprising that when people propose abortion restrictions that they don't actually think of the experiences of the people that they're affecting. But the, what is important about the study and about changing the conversation about abortion is to shift to what the people themselves who are affected are actually experiencing and what is their thought process. We've done a lot of work around you know, what are the reasons people give for having an abortion. And our data match exactly the data from Guttmacher nationally on why people say they want to have an abortion. And what's important about the study is when we follow people over time, we see that the things they are concerned about, they're exactly right. They're concerned about financial, their financial well-being. And we find that economically they suffer when they are unable to get an abortion. We find higher poverty, greater evictions, lower credit scores, just this lower employment that lasts for years. So people they say they have economic reasons and they're right. They say, you know, my relationship with my partner is not strong enough to have to support a child. And we find that relationships dissolve regardless of whether people have abortions or give birth. They say they want to focus on their existing children. And we find that whether they receive an abortion or not has measurable impacts on the well-being of their existing children, both in terms of the economic well-being, their ability to support their children and also their child's development, their ability to hit developmental milestones. And then some people talk about their desire to have an abortion in order to pursue future opportunities like finishing school or getting a job or finding their own place. And we find that women are less likely to set aspirational plans for the coming year and less likely to achieve them if they're denied an abortion. 

Garnet [00:22:39] The Turnaway Study lasted long enough that many of the people who received abortions went on to have a child later. 

Diana [00:22:47] There's an assumption that people who have abortions don't want kids, and that is clearly false because 60 percent of them are already parenting. But many of them want to have a pregnancy in the future. They just feel that the circumstances around this pregnancy are not good. So what we did in the study is compare, what are the outcomes for the child born when the woman is denied an abortion compared to women who receive an abortion and are able to have a pregnancy later? How does the well-being of that subsequent pregnancy compare to the one where the woman was denied an abortion? We didn't find differences in birth weight or prematurity or these immediate health outcomes, but we do find differences in two areas. One is the economic well-being of the household where the kid is being raised. So the child is more likely to be raised in a household where there isn't enough money for basic living needs. And these are births that all happened within the five year period of the study. So it isn't that 10 years passed and the woman's economic well-being is improved. It was pretty soon after. But the circumstances are better when she is able to wait. Those pregnancies that happen subsequently are much more likely to be planned pregnancies. And then, when we ask women about their emotional bonding with the child, the the maternal bonding is better for subsequent pregnancies to women who received an abortion than to the women who were denied an abortion and were forced to carry a pregnancy to term. So there's a difference in how the woman feels about the child and their economic differences and their greater chance that the pregnancy was planned. If she has control over the timing of that birth, and it's not the case that all of those subsequent pregnancies were planned, there's still a range. But she, the big difference, not every pregnancy has to be planned. There are happy surprises. But when women feel it is not a happy surprise and that they cannot sustain a pregnancy and they are not ready to have a birth right then, we find that they're right, that there are all sorts of outcomes that we can see that they're worse off when they don't have control over that timing. 

Garnet [00:25:04] Now, you might be thinking, what about adoption? Can't someone who doesn't want to raise a child just put that child up for adoption? But here's the thing, adoption isn't an alternative to pregnancy. It's an alternative to parenting. Not a lot of people who are denied abortions end up choosing adoption. 

Diana [00:25:26] My colleague Gretchen Sisson, who's a sociologist at UCSF, wrote a whole paper about decision making around adoption in the Turnaway Study. So for people who are interested, I recommend that they find that paper. It's available at our website, turnawaystudy.com. But what I would say is two things about adoption. One is that very few people who are denied an abortion actually choose to place the child for adoption. It's about one in 10 actually decide when they're denied an abortion that they're going to place a child rather than parent. And, and I think people give lots of really interesting reasons about not wanting adoption. And we find that people who do place for adoption are more likely to experience regret about not having received an abortion than than women who opt to parent. So just emotionally, it's harder to place for adoption. Now, it may be that people who are in harder emotional situations are the ones who decide to place for adoption to begin with. But it isn't something that everybody chooses. That's one thing. And the other is that any kind of policy decision that says, oh, women should just carry the pregnancy to term and place the child for adoption, is completely callous about the physical risk of pregnancy and childbirth. We see that dramatically in the Turnaway Study. When we ask people about their physical health, it's demonstrably worse if they've given birth than if they'd received an abortion. And it's worse for years. And higher gestational hypertension, higher chronic pain. And then the most tragic finding is that in this not very large study, two women died of childbirth-related causes when they were denied an abortion for that pregnancy. So abortion is still a life and death issue because pregnancy is very high risk. And, yes, pregnancy is natural and pregnancy can be wonderful when you want a baby. But it is such a sacrifice that it seems to me totally callous to suggest that people should undergo that when they aren't actually seeking to have a baby. It needs, given how risky it is, it has to be a choice that people make. 

Garnet [00:27:38] So the Turnaway Study has concluded, but Dr. Foster and her team are already gathering more data. 

Diana [00:27:45] We did this study where we recruited people who show up at abortion clinics and what that, and some people receive their abortion, some people were denied. That doesn't at all capture all the people who wanted an abortion and couldn't get one because many people never make it through the doors of a clinic. They felt like they couldn't raise the money, they couldn't get there. They didn't realize it was legal. They were too far along and were turned away on the phone. So there is, this is like tip of the iceberg of the problem of access to abortion in America. It is not fully captured just by people who are too late. And so with my colleague, epidemiologist Corinne Rocca, we've started a study across the southwestern United States where neighboring states have diametrically opposed approaches to abortion. So New Mexico has more liberal laws, Arizona has very restrictive laws, and Nevada has pretty good laws and West Texas has terrible laws. So we're recruiting people at the point where, we we originally were going to get people at the point where they suspected pregnancy. But it turns out very few people go into a clinic or to get a pregnancy test. So now we're recruiting people from various places and following them to see who becomes pregnant and who, how people make the decision whether to get an abortion and who's able to get one and who's not. So if you only recruit people at an abortion clinic, it's a subset of people who want abortions. And so this is an attempt to actually look at who's able to get an abortion. Do state laws matter? How do people make that decision? So we'll see. We're still collecting data. I have one other study, which is looks at women in Nepal who seek abortions and it's more similar to the US Turnaway Study in that we're recruiting people as they seek abortions. Some of them get it and some of them don't. And what's different about Nepal is that maternal mortality due to childbirth is astronomically higher than it is in the United States. Nutrition levels are lower. And so we're, I'm expecting to see even greater physical health differences between the people who receive and the people who are denied an abortion. And they were already pretty extreme in the United States. 

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Garnet [00:30:42] That's all for today's show Kayla has written about her experience being denied an abortion, and I'm going to link to that in the show notes, as well as to Dr. Foster's book on the Turnaway Study. Many thanks to both of them for joining us today, and special thanks to We Testify. 

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Garnet [00:31:15] Access is produced by me, Garnet Henderson. Our logo is by Kate Ryan and our theme music is by Lily Sloane. If you liked this episode, if you learned something, the very best thing you can do is share the show with a friend. You can donate by visiting glow.fm/apodcastaboutabortion, and that's in the show notes too. You can also help people find us by leaving a rating or review. And don't forget to subscribe to ACCESS wherever you get your podcasts. Follow us on Twitter and Instagram @accesspod. I am always interested in hearing from you if you want to share a story on the show. You can reach me at accesspodcast@protonmail.com, and that's in the show notes as well. A full transcript of this episode is available on our website, apodcastaboutabortion.com. 

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