When she heard a woman who ran an abortion clinic wonder what happened to those turned away, researcher Diana Greene Foster embarked on a landmark study comparing the lives of women who got an abortion with those who were “turned away” and forced to carry to term.

The latest findings of Advancing New Standards in Reproductive Health’s (ANSIRH) longitudinal “Turnaway Study,” which recruited participants from 30 abortion facilities across the United States for nearly 8,000 interviews between 2008 and 2015, indicate that limiting women’s access to abortion increases their chances of poverty, unemployment, and dependence on public assistance programs. The research, published last month in the American Journal of Public Health, found that those denied abortion access because they were too far along in a pregnancy were nearly four times as likely to be below the federal poverty level compared to those who received care.

Take the case of one 19-year-old woman with a 9-month-old son who was turned away from a Midwestern clinic. She was working full time as a housekeeper but wanted to go to school to become a registered nurse, according to a case study shared by Foster, professor and director of research at ANSIRH, a collaborative research group at the University of California, San Francisco. 

When she was first interviewed, the woman was receiving public assistance through Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), Women, Infants and Children (WIC), and Medicaid. She had been receiving treatment for depression, obsessive-compulsive disorder, and post-traumatic stress disorder that she said stemmed from being molested and abused in her youth. She said she did not want to continue her pregnancy because she couldn’t afford it. In a year, she expected her life would be harder with a baby as she tried to go to school.

Three weeks after her son was born, she was 20 and living with her boyfriend and two children in a duplex. She had a monthly household income of $900 that she said met her basic living needs “most of the time.” She wasn’t working and was attending technical school full time, but wasn’t sure when she would graduate. She was not being treated for any of her mental health conditions, though she had thoughts of ending her life and said her problems made it “very difficult” for her to live normally. She no longer wished she could have had an abortion but said she felt “disappointed” about both becoming pregnant and being turned away from the clinic.

She was interviewed again a year later. By then, she had begun working full time after finding daycare. But she was homeless with her two children, had zero income the previous month, and had not received the $1,000 in child support for which she was eligible. She did not have health insurance and had been to the doctor just once in the past six months for a birth control shot.

Her story is just one example of how those turned away after seeking abortion care can become further trapped in poverty. Being denied a wanted abortion led some women and their families to become even more financially insecure.

“If you ask women why they want an abortion, the most common reasons have to do with finances. They feel they can’t afford to have a child, and it’s in the economic outcomes that we see the biggest difference between a woman who has received and a woman who was denied an abortion,” Foster told Rewire.

Foster’s report indicates that many women were already struggling financially when they sought abortion care—half had incomes below the federal poverty level and three-quarters reported not having enough money to cover basic living expenses.

Six months after being denied an abortion, women were three times more likely to be unemployed than women who were able to access abortion care. They were also more likely to be enrolled in welfare programs.

The study’s findings match what women seeking abortions say they fear, Foster said—that the denial of abortion care leads to further economic insecurity.

Prior to this study, there was little comparative research on abortion that went beyond looking at women’s mental health or drug and alcohol use. Comparisons of women who had abortions to women who did not seek one and chose to continue a pregnancy were inherently biased, the authors noted.

The study comes as access to abortion care faces increasing hurdles in the United States, Jenny Abrams, a doctor in Seattle and a fellow with Physicians for Reproductive Health, told Rewire.

“This study shows that restrictive legislation really harms women and children’s health, and that the people who should be making those decisions are the patients—the women,” she said. “Restricting someone’s capacity to move up or out of poverty is a huge implication.”

The findings were not surprising to Abrams and mirror what she sees in her own practice as a family medicine doctor and abortion provider. “I often see women who already have large families who feel they just can’t take care of one more kid,” she said. “I also see many low-income families with lots of kids and [I see] the strain it puts on their parents to work multiple jobs and do everything they can to stay afloat.”

Given the false rhetoric around abortion in politics and the bills being pushed denying people abortion access, Foster said it is notable how there is a lot of talk of fetuses but that women are almost absent from the conversation. 

“If you only think of abortion as a political issue then you can forget that there are real women making decisions about their real lives, that they are balancing a lot of lives—the children they already have and the children they want to have.”