Hi, I’m Wendy Zukerman and you’re listening to Science Vs from Gimlet Media... this is the second part of our election primer, a series of politically charged episodes that we’re updating and re-releasing ahead of the US midterm elections. On today’s show: Abortion.

President Donald Trump has appointed two conservative justices to the Supreme Court and many feel it’s only a matter of time before Roe v Wade, the court decision giving many women right to an abortion, will be overturned. 

<<Now for the first time since Roe v Wade America has a pro life president, a pro life vice president, a pro life house of representatives>>

As we come up to the midterms… the battle over abortion is fast becoming one of the key issues of the election

<<Donald Trump’s disrespect of women is unacceptable, but congressman Steve Knight’s position on abortion is even more troubling.>>

<< In West Virginia, we believe in sanctity of life. But senator Joe Manchin voted to provide funding for planned parenthood the largest abortion business in the country>>

And in these debates you’ll hear many things about abortion: that it’s painful for the fetus, and that late term abortions are a huge issue. But what does the science say about all this? We dug into these question and more in an episode we published last year. We made sure the research is up to date And it is. So here’s our episode .. Science Vs Abortion…  

BEAT 1: INTRO

Abortion is so taboo... People don’t talk about abortions they’ve had. Doctors don’t talk about abortions they’ve given. And when it is talked about, it’s politicized and sensationalized.

But whether we talk about it or not, it's happening ... A LOT.

A common statistic that floats around is that one in three women in America will have an abortion in their lifetime^[1]. That’s from a study which used data that was almost 10 years old. ^[2]It’s currently being updated, because the number of women getting abortions is dropping.^[3][4]

What we do know is that in 2014, almost a million abortions happened in America.^[5].

We’re going to talk really openly about what exactly is an abortion, who’s getting them -- and what happens to women after they’ve them? So we just want to say that this episode is not about being pro choice or about  being pro life. This is about being pro-facts. [ding] 

And if you haven’t already guessed, this episode is probably not for little ears, or even for big ears on a little person. So if you’re a parent or maybe there’s a kid in the room, you might want to switch to headphones.

So, when it comes to abortion ... there are a lot of misconceptions… about aborting a conception… But then... there’s Science

AHHHHHH

Today on the show...we’re pitting facts against fetuses… yep… we went there. So we’re looking into these three questions around abortion.

1. When most women have an abortion, how far along is the fetus? And can it feel pain?
2. What exactly happens during an abortion?
3. And, three what are the risks of having one?  

BEAT 2: DEVELOPMENT

First up, when most women have an abortion, how developed is the fetus?

So from Juno... you know, the indie film about a teenager getting pregnant... we learned that by the time a women gets an abortion..^[6]…

<<Tape from Juno - your baby probably has a beating heart you know! It can feel pain. And it has fingernails.

Juno: Fingernails, really?>>

Really? So, how soon until a fetus really gets fingernails?

AM Well, fingernails is the last... Like when we think about a baby coming out with fingernails… .that’s not happening until closer, much closer to the end.

That’s Dr. Amita Murthy   - she’s an assistant professor in obstetrics and gynecology at New York University^[7]. She teaches med students about fetal development.

WZ What’s your favorite stage of it. Do you have a favorite?

AM That’s the wrong question to ask me.

WZ because you love them all?

AM because i love them all.

So, let’s… start at the very beginning… when Mummy and Daddy love each other very much…

<<Music cuts short>>

Ok. Who are we kidding?

Let’s start here. The sperm is in the vagina and it makes a beeline for the egg. If it breaks through... Fertilization begins. Amita told us that after a woman’s egg is fertilized by a sperm… it then divides into two cells… and those cells divide into more cells… and it creates a ball of cells. And in these early stages it’s called a zygote^[8]. 

WZ what does the zygote look like?

AM the zygote, microscopically, looks like a wriggling ball. But what’s happening inside the zygote is the cells are dividing and separating.

The zygote, that wriggling ball, will soon divide into what’s called an inner cell mass and an outer cell mass. The outer stuff helps to form the placenta -- which supplies oxygen and nutrients to the growing zygote^[9]. But today let’s just focus on that inner cell mass.

AM The inner cell mass is now multiple cell layers deep like 30, 40, 50 cell layers deep^[10] so it’s like, if you can imagine a sandwich with lots of meat layers in there and cheese or whatever.  So it’s like that and then imagine you start to roll the sandwich into a burrito kind of thing.

Right, okay, so what Amita is describing here… is that this ball of cells, the sandwich, is folding in on itself to create that distinctive shape of the fetus -- the kind of curve -- or as she describes it, the burrito.^[11]

So this all happening in the first few weeks in the womb. And this burrito... sandwich... whatever... thing… that Amita is describing is just a tiny tiny ball of cells…  the embryo is less than a millimeter at this point^[12]… that’s half the size of a poppy seed. And by this point, many women actually don’t know what’s cooking inside. They don’t know they’re pregnant…  

In fact it’s only once they’ve missed a period… sometimes weeks after the sperm has met the egg...^[13] That a woman might get a pregnancy test…

Because it’s often not entirely clear when a woman actually got pregnant…  there's a couple ways that researchers and doctors use to estimate how far along a pregnancy is. The most common one is called gestational age. And here the clock on gestational age starts running from the first day of the woman's last period. Which means before she actually got pregnant. Imprecise, we know. But gestational age, that's what the docs use, that’s what we'll use for the rest of this episode^[14]. 

Two thirds  of abortion in the US^[15] have happened within 8 weeks from a woman’s last period. By now, the embryo has grown up into a fetus^[16], and it’s 15 mm^[17] [18]-- roughly the size of a pumpkin seed^[19].  And, this pumpkin seed, it has some teeny tiny little organs, including a teeny tiny heart.    

AM it'll start out as a two-chamber muscle and then starts to become a 3 and then a 4 chamber muscle. It is moving. and once it starts moving quickly that’s when it starts pushing blood through the fetal body. You have a fully formed tiny little heart, four chambers at the end of 6 weeks.^[20]  

WZ when you say tiny, how little are we talking?

AM microscopic.

WZ it can do that stuff.

AM it can do that stuff. it's kind of amazing

The heart is microscopic… you can’t see it with the naked eye, yeah…  and yet it is pumping blood around the fetus’ body!

<<Tape from Juno - your baby probably has a beating heart you know!

Ok, so Juno got that heart thing right....

<< It can feel pain. >>

But, can the fetus feel pain? because this question comes up a lot -- and not just in Indie films featuring Michael Cera… but in feisty cable news discussions, and when lawmakers create cut offs for when a woman is too far along to get an abortion -- whether a fetus can feel pain is a big part of the discussion.^[21] 

Bans on abortions at or before 20 weeks have been enacted in over a dozen states^[22]. These bills are based on a theory that a fetus can feel pain at 20 weeks"

So whether or not a fetus can feel pain is important. But a tricky question to answer. Because how can we really know?

WZ  You can't interview a fetus, unfortunately.

AM No you can't interview a fetus. But There have been studies done in animals. This is brain scans brain waves studies done on prematurely developed prematurely delivered babies observation dissection and cadavers. Things like that.

So, using these types of studies Amita says that as best as science^[23] can tell there are several steps that are needed for a fetus or anyone to feel pain.

First, you need to have pain receptors -- which are sensors that can detect something painful… and then create an electrical “pain!” signal. Second you need to have nerve fibres that connect that “pain!” signal to the spinal cord and up into the brain. Third you need to have a brain that is developed enough to process that pain signal.

So let’s go through it, when do all of these things start happening?

[00:20:20] WZ when do the pain receptors start to form? [2.7]

[00:20:23] AM So that's pretty early.

Amita tell us that, at around 6 weeks, nerve fibers start to be found in the skin -- they can sense touch, vibration and temperature -- but these early nerves can’t sense pain.^[24]. That’s, according to a detailed report on fetal pain and awareness published by the UK Royal College of Obstetricians and Gynaecologists. That report said that “immature pain receptors” start forming at 10 weeks or so... until then “pain is clearly not possible”^[25]. By this point, more than 80 percent of all abortions, in the US, have already happened"^[26].

Amita says all these receptors do is create an electrical signal that says “pain!”. To actually feel pain we need the wiring that can send those signals to the spinal cord and up into the brain… When do we get that wiring? Well, we know that from about 18 or 20 weeks^[27] a fetus will respond if you accidentally poke it with a needle. Which Amita says, you might do, say, during a procedure called an amniocentesis.

AM So for example if you mistakenly look if you're doing an amniocentesis and you mistakenly hit the hand the the fetus will move the hand away. [00:41:03]

Now the fact that we even have this reflex response... tells us that we probably have circuitry to send those pain signals to the spinal cord… and the base of the brain -- called the brain stem^[28]… But  to Amita that reflex response is something very very different to pain….

AM: That is reflex but the understanding that something sharp has hit and that it is bad and that that bad sensation is pain is not there.

WZ how can we be sure.

AM because we know there’s no cortex at that time.

WZ And we need that cortex to feel that pain.

AM we need the cortex to understand that pain, you don’t need to cortex for reflexive action^[29]. But to understand that is a bad thing and that bad thing is pain, you need the cortex for.

Which brings us to the final stage of development that many researchers think is needed to be able to feel pain… our complex cortex -- which is that thick wrinkly part of the brain that most people think of when they think of a brain.

AM You don't get real cortex until the end of the second trimester and the completion of connections like through the midbrain, lower brain into the cortex doesn't happen until 26-28 weeks

By now, the fetus is really getting along.... Amita says at 24^[30]weeks, or around 6 months…  the wiring is getting connected… and those wires are fully hooked up by 26 to 28 weeks^[31], ^[32]. ^[33] [34]Now, this is why the Royal College of Obstetricians and Gynaecologists report concluded that this “implies pain is not possible until after 24 weeks”.  For context, according to the Centres for Disease Control and Prevention, 99 percent of abortions in the US have happened before this time^[35].

Conclusion: Most abortions happen during the first two months^[36]. And at that time the fetus is the size of pumpkin seed. But, it does have a very very small heart, which beats. When it comes to pain -- the best evidence we have tells us that the fetus can’t feel pain until at least 24 weeks of development, or 6 months. 

BEAT 3: WHAT IS AN ABORTION?

Now that we know how a fetus grows…  let’s find out exactly what an abortion is. For this we’re talking to Lisa Harris, a researcher at the University of Michigan who’s an obstetrician and gynecologist^[37]. And she performs abortion, which means she gets a bit of hate mail.

LH I jokingly call them love letters, but, you know, it’s hate mail. But there are actually a lot of touching responses that people are worried about me, worried that I’ll go to hell, and a lot of people pray for me as well, and I actually find that kind of beautiful and touching.

So, first Lisa tells us the basics… pregnancies are divided into trimesters… First, second and third. Each goes for three months. As we’ve mentioned, most abortions happen in the first trimester…those first 12 weeks..  and Lisa tells us that there are two main ways women can get an abortion at this early stage.

One is called a medication abortion… Here a woman takes pills to terminate the pregnancy… and there are two kinds of pills she’ll need.... the first is called mifepristone, you might have heard this called RU-486.^[38] … 

<<It blocks one of the hormones that is important for sustaining a pregnancy. >>

That hormone being blocked is called progesterone. Progesterone tells the body: ‘Hey, we’re pregnant! Baby on Board!’ And.. Mifepristone, the abortion drug, is kind of like progesterone’s evil twin. It’s almost identical to the hormone. BUT. Here’s the critical difference…. mifepristone interferes with how progesterone works… so progesterone DOESN’T tell the body, “Hey you’re preggers, baby on board.” And instead, the body thinks-- huh, I guess I must not be pregnant after all.

So that hormone, progesterone, doesn't work any more, and the pregnancy stops growing.

And now, you have to help your body get rid of the embryo/fetus, as well as the placenta and all the stuff around it, or as Lisa calls it the pregnancy. For this, you need a pill called misoprostol [my-so-prostill],

LH Women can dissolve just in their cheek, they can dissolve it in their vagina, they can swallow it…

And this pill mimics the process of having a miscarriage…^[39].

LH The uterus contracts and the cervix opens and there's a lot of cramping and bleeding and the pregnancy is expelled by the uterus. it's the same process that would happen if a woman was having a miscarriage at home.

So that’s the medication abortion. Now these pills often get confused^[40] for birth control and the morning after pill, or Plan B.  But they’re actually quite different. Unlike a medication abortion these pills are not shutting down a pregnancy…. In fact they don’t even let the sperm get near the egg. Plan B delays ovulation, so the sperm just can’t reach the egg… While regular old birth control pills prevent ovulation entirely, so the egg doesn’t get released.

Now, let’s talk about that second kind of abortion that a woman can get in the first three months^[41]… it’s when a doctor removes the pregnancy… and that’s known as the surgical abortion. And let’s get one thing straight right up the front… Although it’s called a surgical abortion, It’s not like a C-section.

LH A lot of people don’t understand their anatomy. So don’t understand there is already a natural opening, that abortion doesn’t involve cutting or opening any spaces that aren’t already open.

And that opening is the vagina… it’s is a tunnel straight to the cervix which is like the trapdoor to the uterus… and that’s where the fetus is coming out of…. So, when Lisa is doing an abortion, she has to open up the cervix.

LH: Some people use a medication to soften and open the cervix. Some people use these very gently tapered rods that are called dilators to open the cervix…

And then, once the cervix is open…Lisa can remove the pregnancy, and she can do it in a couple of ways. Many of the devices use suction …which can be 

just a handheld vacuum device that looks kind of link a big syringe. Or instruments that are kind of like tongs or graspers. And the physician can reach in and remove the pregnancy that way.

Lisa explained the process of removing the fetus to Science Vs reporter Heather Rogers

HR How long does it take.

LH Anywhere from 30 seconds to two minutes.

HR Okay, that’s not very long

LH No it’s not and I think that people imagine that, you know, it’s a whole day of something happening in their body and it’s not. In most cases it’s very quick. 

If the pregnancy is in its first trimester, you can see the lining of the uterus when you take it out…

And then you would see something that looks like a tiny cotton ball. kind of a whitish fluffy tissue and that's the placenta and then the amniotic sac.  You can't really see a fetus or fetal parts until about 10 weeks.

So that’s an abortion in up to twelve weeks…. And there can be medication or surgical abortions.

But what happens for a woman who has a later abortion? Lisa told us that at this point the fetus is too large to use suction, so they have use other instruments like forceps. This is called a dilation and evacuation, or D and E. And heads up -- we are going to get detailed here.

LH  that involves using the instrument to reach into the uterus and remove the fetus. and generally it is removed in parts, meaning it is dismembered during the process.
And, umm, yeah, when it feels or looks like the uterus is empty, um, you're done.

HR what do the parts like. i know that's a really graphic question but

LH they look like very miniature baby parts.  A very miniature human form.

And Lisa says that those posters that anti abortion groups hold around abortion clinics-- those photos in them-- can actually be pretty accurate.

LH I drive by those images every day and some days my work looks like that, really. most days it does not because those images of later second trimester fetuses those are the tiny minority of abortions.^[42] So most days in a typical abortion care center there wouldn't be later abortions. But sometimes those images actually look kinda like my work today.

<<MUSIC POST>> 

And while Lisa does this on the reg -- there are days that stick out. She was about four months pregnant^[43] with her first child, she gave an abortion to a woman who about as pregnant as she was. And while Lisa was performing the procedure, she….felt her baby kick. It was one of the first times it had happened...  and she told Heather it really took her by surprise.

LH: It was the feeling that i could feel a fetus kicking, moving inside of me at the same time that I was removing a fetus. There was something in that juxtaposition that was overwhelming. And I found myself kind of crying.

HR: How did you wipe your tears? Like --

LH: Well I couldn’t because I had sterile gloves on so they just rolled down my face. 

HR You'd never had that experience before

LH I never had that experience before. And part of it as i think about it now, I think, I was so happy to be pregnant and so much wanted to be a mother. and i remember feeling so privileged that i could be a mother and that I was getting ready with my family to welcome a child. and I remember thinking how -- what it meant that not everybody could do that for whatever reason and remember just feeling fortunate.

<<Music post - or just some silence> >

Now the one kind of abortion we haven’t talked about yet… are those that happen in the third trimester… after 6 months of pregnancy…These are extremely rare. The best statistic we could find, from the CDC, is that 1.3 percent of abortions in the US happen after around 5 months ^[44]. And we couldn’t find any reliable studies on why women would get an abortion after that point. An abortion clinic in Colorado says these late abortions “are almost always” because serious complication developed, mostly because the woman discovered the fetus had some kind of serious abnormality.^[45]

That said…the process of getting a third trimester abortion is similar to getting a second trimester one. Except the fetus is further along now, it’s now usually longer than 9 inches^[46]  - around the length of an iPad - just for context... anyway, so, in these third trimester abortions you often have to inject the fetus with a drug that will stop its heart^[47], and then you often have to induce labour ^[48] Sometimes these steps can happen in a second trimester abortion too.. 

Conclusion: there are two types of abortions - medication, i.e. taking pills... and surgical, that is, using suction and sometimes forceps. Neither type of abortion involves cutting a woman open. 

Alright, now that we’ve got the lay of the land in terms of fetal development and what abortions actually are… after the break we’re heading to an abortion clinic in Texas to find out why women are getting abortions. And we’ll tell you the risks of having an abortion. Because if you watch some news… getting an abortion is a very risky business.

<<everything from lacerations of the cervix or uterus to infections to death^[49].>>

<<montage from cable news/youtube clips saying abortions are risky for women.>> 

So, what do women really risk when they get an abortion?  Infertility? Breast cancer? That’s coming up after the break.

<<SFX>>

<<BREAK>>>

BEAT 4: THE REASON WOMEN GET ABORTIONS

Welcome back.

So… we’ve learnt how abortions work. Now let’s quickly find out why women are getting them... and the risks involved.

Heather Rogers, our reporter, headed to an abortion clinic in San Antonio, Texas called Whole Woman's Health.

Whole women’s health how can i help you?

Hi Heather

HR: Hi Wendy

WZ: So before we look into the studies on why women get abortions… can you tell me a bit about this clinic…like who was in the waiting room, what age are we talking about here?

HR: It was surprising because most of the women in the waiting room when I was there, definitely didn’t look like teenagers, they were older, 20s and 30s and 40s.

WZ: Does that stack up with the data on this?

HR: So that does line up with the data that we found, what that shows is most women who have them are in their 20s and 30s. Teenagers, they only make up 12 percent of all abortions^[50],^[51].

WZ: And how many had kids?

HR: 60 percent.

WZ: 60 percent of women in America who get abortions are already mums?

HR: Yeah, they’re already mums, they already have kids.

WZ: Did you get to speak to women?

HR: Yeah.

WZ: And why were they getting women in this clinic getting abortions?

HR: It was interesting, they were getting abortions because, one woman told me she wasn’t ready to have a child and the other woman told me that she already has a daughter and she’s about to join the Air Force and she doesn’t have the money for it.

It’s expensive. It’s so much more expensive than people think, and it’s so much more work, and I’m just not ready for that right now, again. I’m not.

WZ: It’s always hard when you go to one clinic…. Do we know if this is representative of what’s happening across America?

HR: Does the specific represent the general? The broader picture

WZ: Exactly!

HR: Well it does, not in every way but in many ways…there’s a study from 2013 study of almost 1000 women^[52] who wanted an abortions found  40 percent of the women got abortions for financial reasons^[53]. That is, they had “financial problems” and “can’t afford to support a child.^[54] That was the biggest reason, that was the most common reason. Another common reason was that the timing wasn’t right, and they just weren’t ready to care for a child^[55]. ^[56] So there was also another reason that this study showed was almost a third of the women got abortions for quote “partner related reasons.”^[57] what that means is that they didn’t have a “good” or supportive relationship with the man who got them pregnant, and in some cases the men were physically abusive.

HR: So some women spoke to me but the clinic has these journals, and women who come through can write entries into the journals. And they let us flip through some of these journals. So you're going to hear Rachel Ward, she was with me, she’s a producer here at Gimlet, and we went to Texas together.

RW This woman says that this is not a baby. it's an embryo, slash blood clot, slash thick cell that can really alter a person’s life.

So this woman, she said she's never been faced with such a decision..she’s been raised not to get an abortion… and she preached to others..this is not your decision to make, only god can take a life. the reason she's here is because she's a single mom of two children. And she says she does it and they live comfortably but she doesn't know if she can make it alone with three small kids. i will walk out of here and no longer be pregnant and go home and love my two babies just as much as I did before I walked into this place ..i just hope that i am still allowed to walk into heaven one day. may god see my pain and my struggle and may god be with me and you.

RW Wow.

HR Yeah.

WZ: What about this religious aspect, you really don’t hear a lot about women who say they are religious getting abortions.

HR: Yeah. So there’s this data from the Guttmacher Institute and it says that almost 25 percent, almost a quarter of women who get abortions, and these are 2014 numbers, identified as Catholic.^[58] 

WZ: A quarter?

HR: Yeah, it’s pretty surprising. In addition to that, 17 percent of women who got abortions that year were “mainline Protestant” and then 13 percent more identified as Evangelical protestant^[59].

WZ: Ok, so to wrap a bow around this… what the science and data is telling us is all kind of women get abortions… religious not religious… and women are getting abortions for a lot of complicated reasons… but the most common is that it’s about the finances, they don’t have enough money, or having an unsupportive partner or saying that the timing just isn’t right

HR: That’s right.

BEAT 5: RISKS

WZ And so, so the next thing you looked at in texas was the risks involved in getting an abortion.

HR so, you know like any procedure you have the doctor tells you what your risks are before you have the procedure. in Texas there’s a specific list, and this is true in other states^[60] as well, there’s a specific list of risks that the doctor has to tell you about.

WZ and so before we actually get into the science behind those risks and how valid they are, can you kind of walk us through what that actually looks like in real life like in the room.

HR Yeah, while i was in this clinic i got to follow around Dr. Bhavik Kumar who’s the abortion provider there. So i got to see what he does when he’s talking to patients.

HR Can you tell me what you’re doing today?

BK We’re doing procedures and seeing patients for medication abortions.

HR Ok. And can you tell me how do you do your hair.

BK I use a high heat blower dryer and there’s some pomade and then a hair quick hair spray.

HR: It’s really nice.

BK: Thanks.

HR: Bhavik let me follow him around as he met patients to talk to them about what was going to happen.

<<Hello i'm Dr Kumar>>

HR And so when a woman comes in for the counseling, he goes in and he looks at the sonogram. And he has to read the script that the state mandates. But he does it in this really interesting way. So he looks at the image, talks to the sonographer for a minute.

BK six weeks and three days is what we measured on the ultrasound. Size of the pregnancy tissue.

HR And then he goes over to the corner of the room.  And he doesn’t look at the patient, but he greets her. He stands in the corner faces there’s like a counter with a sink. And he faces down at the sink, and he’s got her chart, and Bhavik starts reading the information the state says he has to read.

<<ambi - the state makes me describe the image and then they have a script that i have to read. So i’m going to start saying the stuff and then after that if you have any questions we can talk about it.>>

HR And it includes risks like infertility and breast cancer.^[61] [62]

BK [fading up] It’s rare to have problems with your fertility or future pregnancies and some studies show an increased risk of breast cancer after abortion. Other studies have shown absolutely no increased risk whatsoever. Any questions about that stuff?^[63].

HR It just goes by super fast, he just says it. and it’s almost like it he says it, it comes out of the corner of his mouth a little bit. And there’s a reason that he isn’t slowly and carefully going over this information with them.

BK just so that they know this is not from me and it is not something that I believe in but something i have to do.

HR: Bhavik says that even just mentioning these risks, is overstating them. For example, by just saying the word infertility, just that can freak people out.

BK The infertility part is super rare and just saying that before a procedure makes people scared that they may not be able to have children in the future. And that’s usually the number one thing they ask is ‘How true is that?’

HR So that's what we saw and heard in one clinic….

WZ: Right. So let's leave Texas... and Heather... bye...

HR: Bye Wendy

WZ: and dig into the science… And let’s start with this question of infertility. Does an abortion increase your risk of becoming infertile? Well, according to the UK’s Royal College of Obstetricians and Gynecologists, if you have an abortion in a safe and legal setting, then there is "no proven association" with infertility.^[64] [65]

Interestingly when it comes to complications with having children in the future …  some research has found a link between having had an abortion and an increased risk of having a premature birth… ^[66]

Now, more recent studies^[67] have since come along^[68]… and not found that risk^[69]. So, perhaps the way that abortions were conducted in the past did slightly increase the risk of having a premie baby, maybe they still do.^[70] Ok. So that’s the risks when it comes to having kids if you want to later.

And then there’s that breast cancer line.  

BK: Some studies show an increased risk of breast cancer after an abortion, other studies have shown absolutely no increased risk whatsoever

Now, you can find studies^[71] [72] that show that women who have an abortion have an increased risk of getting breast cancer. But. You can also find studies that don’t. So to get the most consistent and accurate findings you really have to combine studies. One analysis looked at 53 studies, which included 83 000 women^[73] with breast cancer and found that getting an abortion does not increase a woman’s risk of developing breast cancer^[74]. Another paper^[75], looking at 15 studies... found the same thing.

Now there is something we haven’t mentioned yet, which is that is that according to Texas Law women must be given a booklet that, state health officials say, outlines the risks of abortion^[76]. The first thing on that booklet’s list is death^[77]. Now, there is an incredibly small risk of death from an abortion -- but according to an analysis of CDC data, a woman is about 14 times more likely to die from childbirth than from an abortion^[78]. Researchers have also found that an abortion is safer than many common medical procedures^[79]. Like, you’re more likely to die from some dental procedures and even plastic surgery than having an abortion.^[80]

So away from the very, very, very rare risks^[81]. What are some side effects^[82] that a woman can expect after an abortion? Cramping, stomach pain and bleeding are common.^[83] [84]And, very rarely, women can actually bleed quite a lot, to the point where they could be hospitalised^[85].  Women can also get an infection…. ^[86] [87]In a Finnish study of more than 42,000 women, 6 weeks after their abortions, 1.7% of them, got an infection.

Conclusion:  There are some short-term, common side effects from abortions. But the best evidence we have is that women don’t get breast cancer from abortions. Abortions are safer than childbirth and even some dental procedures. And studies have not found an association between getting abortion and becoming infertile.

Alright...our final question…  what about the effects of having an abortion on a woman’s life?  Will getting an abortion increase her risk of depression? Will it ruin her life… because we hear about this story a lot in TV and in politics. In fact, this idea has become so common that it’s got its own name: post-abortion syndrome^[88].^[89] Which is why when you think of someone who’s had an abortion. You might think of women like this.

<<Montage: I went through a depression after that. And the grief and the guilt began immediately. I honestly feel that it’s the worst mistake i ever made in my life. And i know i’m going to think about this every day and i wish more than anything i wouldn’t have done it.>>

So that’s these women’s personal experience, but how common is that?  How likely is it that if you, if you're planning to get an abortion, will be left with some kind of post abortion syndrome?

Well a really interesting study was started in 2008^[90], where scientists followed several hundred women from 30 clinics around the US… and they’d had different experiences with abortion.

And they followed these women for five years... the scientist who started this project is Diana Greene Foster, a researcher at the University of California, San Francisco... And her study is called The Turnaway study.

DGF so the turnaway study is the first study to look for american women of what the experience of having an abortion is compared to carrying an unwanted pregnancy to term

WZ when you're at a dinner party, what do you tell people you research?

DGF women's health. because i am so not interested in hearing random people's abortion stories.

So… All of the women in Diana’s turnaway study wanted an abortion… but one group got them... and the other didn’t. They were turned away because their pregnancies were too far along so their provider wouldn’t do the abortion.... Diana and her team studied the two groups: the women who got abortions and those who had the babies. And she followed them up  asking questions about their lives… She asked women why they wanted the abortion… but also about

DGF depression, anxiety. whole bunch of economic questions. questions about the relationship with the man involved in the pregnancy including questions about violence from intimate partners.

And several years later, Diana tracked how the women's answers changed over time. And she found

DGF no evidence of mental health harms that might emerge from having had an abortion.

it's just not a mental health story.

That is… Over five years^[91], the women who got abortions had similar levels of depression , post-traumatic stress disorder^[92] and anxiety compared to those who didn’t^[93][94]. And Diana’s study isn’t the only one to find this^[95][96][97]. A Finnish paper of more than^[98] a thousand women under 18 who go pregnant… found no significant psychiatric differences between the women who got abortions and those who didn’t seven years later…

As for the idea that many women regret their decisions? And feel guilty about what they’ve done? Diana wrote this was “unfounded”^[99] She found that after three years the typical woman in her study had more than a 95 percent chance of reporting that the abortion was right for her^[100]. And two years later, she says that feeling stuck.

DGF over 5 years women who get abortions remain relieved and feel like they made the right decision in having an abortion

So while individuals might have a different experiences... the research tells us that women’s risk of mental health problems is the same whether she had the initially unwanted baby or not.

But, differences have been found between women who get abortions and those who don’t, but wanted one. So for example, in Diana’s study, while she hasn’t published this data yet, preliminary results showed that women who had the baby were...

DGF: Less likely to be employed full time, more likely to receive public assistance, but also more likely to be in poverty.

Now, when we look back to that Finnish study  we kind of found the same thing, women who got abortions were more likely to be better off financially and be better educated by the time they were 25 compared with those who gave birth..

Now, the research doesn’t say that the abortion was the only reason these women were better off in terms of education, employment and finance … but it does seem to play a role here. 

Diana also found that for the relatively small group of women who wanted an abortion because they were in an abusive relationship with the father… and then couldn’t get one, those women were more likely to still be in that abusive relationship 2 and a half years later^[101].

DGF We find that violence from the man involved in the pregnancy declines precipitously for women who have the abortion and that’s because they have broken ties with that person.

And to Diana, her study shows that women are realistic about their reasons for getting an abortion. So many of the things women worry might happen... if they’re not able to get one... It turns out actually sometimes happen.

DGF <<And the women were right they knew what to expect> Having an abortion is probably not fun at all. And they made the decision to do this stigmatized thing because they looked at their lives and realized they weren’t ready for a baby

WZ when you look pop culture, when you see a movie or tv show and think they’ve got it wrong, my study says the exact opposite thing?

DGF I’m so not a pop culture person, I couldn’t even tell you the last time I saw a movie with an abortion in it, it might have been Dirty Dancing that’s how old and out of touch I am.

<<Dirty Dancing music>>

Conclusion: On average, women who have an abortion are not at a higher risk for depression or anxiety. But… when women who don’t get abortions they want, the research shows they have less money, less education… and probably less job opportunities.

So when it comes to Science Vs Abortion do the fears, and the outcry stack up?

Here’s what we know. The majority of women in America have abortions -- in the first trimester -- when the fetus has a heart. And is around the size of a pumpkin seed.

In 99 percent of abortions given in the US, those fetuses probably don't feel pain.  As best as science can tell, fetuses can’t feel pain until at least 24 weeks, or about 6 months.

Abortions don’t involve cutting a woman open.… it’s either pills… or suction and potentially forceps.

When it comes to the risks. The best evidence tells us that abortions do not increase a chance of a woman’s getting breast cancer or being infertile. Most likely she will get cramps, and she will bleed.

And, what about guilt? Or depression? While some women who get an abortion may feel guilty… and get depressed after. The science tells us, the majority do not. And women who get abortions that they want are not more likely to experience depression than the women who have their babies.

That’s Science Vs Abortion.

CREDITS

Tomorrow we’re continuing our look at the science behind election issues with our episode on Climate Change.

This episode was originally produced by Heather Rogers, me, Wendy Zukerman, Ben Kuebrich and Shruti Ravindran. And updated by Meryl Horn. Kaitlyn Sawrey is our senior producer. We’re edited by Annie Rose Strasser and Blythe Terrell.  Fact Checking by Michelle Harris, Meryl Horn and Ben Kuebrich. Extra help with production and editorial from Rachel Ward, Alex Blumberg and Jorge Just. Music production and original music written by Bobby Lord. Mix and sound design by Bobby Lord and Emma Munger. Thanks to Lola Pellegrino, Ronnie Shankar, Dr. Diane Horvath-Cosper, Rachel Jones, Elizabeth Nash, Dr Yoon-Jin Kim, Delma Limones. and Gilda Sedgh. Also thanks to Katie Bishop and Reverend David Gushee.

I’m Wendy Zukerman fact you tomorrow.