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What Happens to Women Who Are Denied Abortions?

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In Joe Colucci's thoughtful response to my "Nudge and Abortion," he writes:
[D]ata saying that women are generally happy with their children, even after unplanned pregnancies, are unlikely to be representative of the population we're. More relevant evidence comes from the recent study of women who were just barely denied abortions (vs. women who just barely got them) presents a far less rosy picture of life outcomes and mothers' relationships with their children.
On my reading, though, the research Colucci cites strikingly confirms my claim that women who seek abortions are unrealistically negative about the effects of completing their pregnancies.  The study looked at women who were turned away for abortions, largely because their pregnancies were too far along.  Key passage:

When [researcher Diana Greene Foster] looked at more objective measures of mental health over time -- rates of depression and anxiety -- she also found no correlation between having an abortion and increased symptoms. In a working paper based on her study, Foster notes that "women's depression and anxiety symptoms either remained steady or decreased over the two-year period after receiving an abortion," and that in fact, "initial and subsequent levels of depressive symptoms were similar" between those who received an abortion and those who were turned away. Turnaways did, however, suffer from higher levels of anxiety, but six months out, there were no appreciable differences between the two groups.

In other words, even though women who seek an abortion feel like a child will ruin their lives, that's not how they end up feeling if they complete their pregnancies.  At all.  The average woman who says, "A baby would ruin my life!" eventually sings a totally different tune.  A shocking result!

The negative effects of not getting an abortion, in contrast, are obvious: The usual health effects of pregnancy, and the usual financial effects of having a baby outside of a stable family:

Where the turnaways had more significant negative outcomes was in their physical health and economic stability. Because new mothers are eligible for government programs, Foster thought that they might have better health over time. But women in the turnaway group suffered more ill effects, including higher rates of hypertension and chronic pelvic pain (though Foster cannot say whether turnaways face greater risk from pregnancy than an average woman). Even "later abortions are significantly safer than childbirth," she says, "and we see that through lower complications and low incidence of chronic conditions."...

Economically, the results are even more striking. Adjusting for any previous differences between the two groups, women denied abortion were three times as likely to end up below the federal poverty line two years later. Having a child is expensive, and many mothers have trouble holding down a job while caring for an infant. Had the turnaways not had access to public assistance for women with newborns, Foster says, they would have experienced greater hardship.

If the women who gave birth were sicker and poorer, why weren't they more depressed or anxious?  Simple: Either sickness and poverty have little effect on depression and anxiety, or having a child actually reduces depression and anxiety holding sickness and finances constant.  Take your pick.



COMMENTS (7 to date)
John Thacker writes:

A striking stat from that article is that only 9% of the "turnaways" in Foster's study chose to give up their child for adoption. Surely that would have addressed the financial concerns (though not the health ones.) So one could either take that as an argument in favor of nudging in favor of adoption for those mothers, or take the view that since only 9% of them choose adoption, they must end up preferring the kid despite the financial risks.

MingoV writes:

Women who seek abortions after 20-24 weeks of pregnancy are not equivalent to those who seek abortions before the legal cutoff. Pregnant women who wait until after the cutoff are more likely to be ambivalent about their pregnancies. They may want to continue their pregnancies, and they try to get abortions (that they know will be denied) to placate others such as parents or partners. When denied abortions, they may be pleased about having a baby, and this may account for their decreased frequency of depression.

Tim writes:

@MingoV

The comparison is actually between women who were within 2 weeks of the cutoff and those who missed it. So it is about women who were ambivalent.

Steve Z writes:

Pregnancy induces a shift in hormones and neurochemicals that can radically alter the preferences of the person going through it. This makes attempts at 'nudges' difficult. Who is the "true" self whose preferences should be maximized by a beneficient choice-architect: the woman who underwent the full hormone cascade, or the woman for whom the cycle was cut short by an abortion?

MingoV writes:

@Tim:

There's a big difference between procrastination and deliberately missing a cutoff date. The procrastinators' motives may have been fear of the procedure or dislike of abortion (overcome by circumstances). I still believe the procrastinators differ significantly from women who request abortions after the legal cutoffs.

Jacob A. Geller writes:

MingoV has a good point, a point that people often forget when discussing studies that use an arbitrary ("randomizing") cutoff as their instrumental variable.

Remember, we're comparing women who were turned away just after the legal cutoff, with women who got abortions just before the legal cutoff.

That is not at all the same as comparing, say, women who were allowed an abortion at 10 weeks, vs. women who were not allowed an abortion at 10 weeks. Nor is it the same as comparing women who were allowed an abortion at 32 weeks, vs. women who were not allowed an abortion at 32 weeks.

In other words, first-trimester, second-trimester, and third-trimester abortions might have different effects, and this study is only looking at one (piece of) the second trimester. Be careful not to jump from "what happens to women who are denied abortions at 20-24 weeks" to "what happens to women who are denied abortions IN GENERAL." Those are different questions.

Jacob A. Geller writes:

"If the women who gave birth were sicker and poorer, why weren't they more depressed or anxious?"

Might there be a flaw of averages going on here? Maybe the median != the mean.

In words, it might be that the median woman who gives birth is sicker and poorer without being more depressed or anxious, BUT the outlier women who give birth and are both sicker and poorer AND more depressed and anxious, are simply too few in number to outweigh the majority of women who give birth and are sicker and poorer WITHOUT being more depressed or anxious (or who might in fact be slightly less depressed & anxious).

If that is the case, how should one weigh the intense suffering of a small number of women against the indifference or mild pleasure of many women? That's not an easy question, and it's certainly not the kind of question you can answer on the basis of a study like this.

I'd be interested to take a look at the data though and see what the *distributions* look like, not just the averages, so we can see whether the effects of an abortion (again, during the 2nd trimester only) really are fairly consistent...

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