Turnaway Study offers insights on the impact of losing access to abortion : Shots

With Roe v. Wade primed to be overruled, people seeking abortions could soon face new barriers in many states. Researcher Diana Greene Foster documented what happens when someone is denied an abortion in The Turnaway Study.

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With Roe v. Wade primed to be overruled, people seeking abortions could soon face new barriers in many states. Researcher Diana Greene Foster documented what happens when someone is denied an abortion in The Turnaway Study.

Malte Mueller/Getty Images

Though it’s impossible to know exactly what will happen to abortion access if Roe v. Wade is overturned, demographer Diana Greene Foster does know what happens when someone is denied an abortion. She documented it in her groundbreaking yearslong research project, The Turnaway Study and her findings provide insight into the ways getting an abortion – or being denied one – affects a person’s mental health and economic wellbeing.

For over 10 years, Dr. Foster and her team of researchers tracked the experiences of women who’d received abortions or who had been denied them because of clinic policies on gestational age limits.

The research team regularly interviewed each of nearly 1,000 women for five years and found those who’d been denied abortion experienced worse economic and mental health outcomes than the cohort that received care. And 95% of study participants who received an abortion said they made the right decision.

The idea for the Turnaway Study emerged from a 2007 Supreme Court abortion case, Gonzales v. Carhart. In the majority opinion upholding a ban on a specific procedure used rarely in later abortions, Justice Anthony Kennedy speculated that abortions led to poor mental health. “While we find no reliable data to measure the phenomenon, it seems unexceptionable to conclude some women come to regret their choice to abort the infant life they once created and sustained,” he wrote. “Severe depression and loss of esteem can follow.”

Dr. Diana Greene Foster is the lead researcher on the interdisciplinary team behind The Turnaway Study.

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Simon & Schuster

Kennedy’s speculation — and admitted lack of evidence — captured Foster’s attention, “because you can’t make policy based on assumptions of what seems reasonable without talking to a representative sample of people who actually wanted an abortion,” she said. The Turnaway Study fact-checked the justice’s guess, finding that not having a wanted

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Hit with $7,146 for two hospital bills, a family sought health care in Mexico : Shots

Claudia and Jesús Fierro of Yuma, Ariz., review their medical bills. They pay $1,000 a month for health insurance yet still owed more than $7,000 after two episodes of care at the local hospital.

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Claudia and Jesús Fierro of Yuma, Ariz., review their medical bills. They pay $1,000 a month for health insurance yet still owed more than $7,000 after two episodes of care at the local hospital.

Lisa Hornak for Kaiser Health News

The Fierro family of Yuma, Ariz., had a string of bad medical luck that started in December 2020.

That’s when Jesús Fierro Sr. was admitted to the hospital with a serious case of COVID-19. He spent 18 days at Yuma Regional Medical Center, where he lost 60 pounds. He came home weak and dependent on an oxygen tank.

Then, in June 2021, his wife, Claudia Fierro, fainted while waiting for a table at the local Olive Garden restaurant. She felt dizzy one minute and was in an ambulance on her way to the same medical center the next. She was told her magnesium levels were low and was sent home within 24 hours.

The family has health insurance through Jesús Sr.’s job, but it didn’t protect the Fierros from owing thousands of dollars. So when their son Jesús Fierro Jr. dislocated his shoulder, the Fierros — who hadn’t yet paid the bills for their own care — opted out of U.S. health care and headed south to the U.S.-Mexico border.

And no other bills came for at least one member of the family.

The patients: Jesús Fierro Sr., 48; Claudia Fierro, 51; and Jesús Fierro Jr., 17. The family has Blue Cross and Blue Shield of Texas health insurance through Jesús Sr.’s employment with NOV, formerly National Oilwell Varco, an American multinational oil company based in Houston.

Medical services: For Jesús Sr., 18 days of inpatient care for a severe case of COVID-19. For Claudia, fewer than 24 hours of emergency care after fainting. For Jesús Jr., a walk-in appointment for a dislocated shoulder.

Total bills: Jesús Sr. was charged $3,894.86. The total bill was $107,905.80 for COVID-19 treatment. Claudia was charged $3,252.74, including $202.36 for treatment from an out-of-network physician. The total bill was $13,429.50 for less than one day of treatment. Jesús Jr. was charged $5 (70 pesos)

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Never-ending costs: When resolved medical bills keep popping up : Shots

Suzanne and Jim Rybak, inside the craft room where their son, Jameson, would encourage Suzanne to make colorful beach bags, received a $4,928 medical bill months after it was supposedly resolved.

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Suzanne and Jim Rybak, inside the craft room where their son, Jameson, would encourage Suzanne to make colorful beach bags, received a $4,928 medical bill months after it was supposedly resolved.

By Gavin McIntyre/Kaiser Health News

Every now and then, Suzanne Rybak and her husband, Jim, receive pieces of mail addressed to their deceased son, Jameson. Typically, it’s junk mail that requires little thought, Suzanne said.

But on March 5, an envelope for Jameson came from McLeod Health.

Jim saw it first. He turned to his wife and asked, “Have you taken your blood pressure medication today?”

He knew showing her the envelope would resurface the pain and anger their family had experienced since taking Jameson to McLeod Regional Medical Center in Florence, S.C., two years ago.

As KHN previously reported, Jameson was experiencing withdrawal symptoms from quitting opioids. Suzanne feared for her son’s life and took him to McLeod’s emergency room on March 11, 2020.

There, they encountered a paucity of addiction treatment and the potential for high medical costs — two problems that plague many families affected by the opioid crisis and often lead to missed opportunities to save lives.

Jameson was not offered medications to treat opioid use disorder in the ER, nor was he given referrals to other treatment facilities, Suzanne said. The hospital wanted to admit him, but, being uninsured, Jameson feared a high bill. The hospital didn’t inform him of its financial assistance policy, Suzanne said. And he decided to leave.

Three months later, Jameson, 30, died of an overdose in his childhood bedroom.

Months of red tape

In the following months, the Rybaks received bills from McLeod Health addressed to Jameson. He owed $4,928, the bills said. Suzanne called and wrote to hospital administrators until September 2020, when the bill was resolved under the health system’s financial assistance program.

That was the last they had heard from McLeod Health until the new envelope arrived March 5 — one week before the two-year anniversary of Jameson’s ER visit. That visit was what Suzanne calls “the beginning of the end for my son.”

When the Rybaks opened the envelope,

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Nurses are raging and quitting after RaDonda Vaught verdict : Shots

The conviction of RaDonda Vaught in an accidental injection death has sparked fear and outrage among many nurses, who have been faced with long hours, mounting responsibilites and staffing shortages.

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The conviction of RaDonda Vaught in an accidental injection death has sparked fear and outrage among many nurses, who have been faced with long hours, mounting responsibilites and staffing shortages.

Nicole Hester/AP

Emma Moore felt cornered. At a community health clinic in Portland, Ore., the 29-year-old nurse practitioner said she felt overwhelmed and undertrained. Coronavirus patients flooded the clinic for two years, and Moore struggled to keep up.

Then the stakes became clear. On March 25, about 2,400 miles away in a Tennessee courtroom, former nurse RaDonda Vaught was convicted of two felonies and now faces eight years in prison for a fatal medication mistake.

Like many nurses, Moore wondered if that could be her. She’d made medication errors before, although none so grievous. But what about the next one? In the pressure cooker of pandemic-era health care, another mistake felt inevitable.

Four days after Vaught’s verdict, Moore quit. She said the verdict contributed to her decision.

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“It’s not worth the possibility or the likelihood that this will happen,” Moore said, “if I’m in a situation where I’m set up to fail.” In the wake of Vaught’s trial ― an extremely rare case of a health care worker being criminally prosecuted for a medical error ― nurses and nursing organizations have condemned the verdict through tens of thousands of social media posts, shares, comments and videos. They warn that the fallout will ripple through their profession, demoralizing and depleting the ranks of nurses already stretched thin by the pandemic. Ultimately, they say, it will worsen health care for all.

Statements from the American Nurses Association, the American Association of Critical-Care Nurses, and the National Medical Association each said Vaught’s conviction set a “dangerous precedent.” Linda Aiken, a nursing and sociology professor at the University of Pennsylvania, said that although Vaught’s case is an “outlier,” it will make nurses less forthcoming about mistakes.

“One thing that everybody agrees on is it’s going to have a dampening effect on the reporting of errors or near misses, which then has a detrimental effect on safety,” Aiken said. “The only way you can really learn about errors in these complicated systems is to have

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How to reboot from unhealthy pandemic habits : Shots

Scheduling time on the calendar for a workout and setting small, achievable goals are just a couple of ways we can focus on rebuilding healthy habits.

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Michael Driver for NPR

The early days of lockdown restrictions had a profound effect on people’s daily lives. Alcohol sales skyrocketed, physical activity dropped off sharply, and “comfort eating” led to weight gain, too.

So, what’s happened since March of 2020? After two years of pandemic life, many of these effects persist. The strategies we used to adapt and cope have cemented into habits for many of us. And this is not a surprise to scientists who study behavior change.

“We know when a shock arises and forces a change in our behavior for an extended period of time, there tend to be carryover effects because we’re sticky in our behaviors,” says Katy Milkman of the University of Pennsylvania, and author of the book How To Change. In other words, our pandemic habits may be hard to break.

Take, for example, alcohol consumption. During the first week of stay-at-home restrictions in March 2020, Nielsen tracked a 54% increase in national sales of alcohol. This came as bars and restaurants closed. A study from Rand documented a 41% increase in heavy drinking among women in the months that followed. (Heavy drinking was defined as four or more drinks for women within a few hours.)

“Of concern is the fact that increases in drinking are linked to stress and coping,” says Dr. Aaron White of the National Institute on Alcohol Abuse and Alcoholism. He points to a study that found a 50% increase in the number of people who said they drank to cope in the months right after COVID began compared to before the pandemic.

After a spike in sales in the spring of 2020, alcohol sales dipped.

But the most recent data from Nielsen show sales of beer, wine and spirits at the start of 2022 remain higher than they were in 2019. That trend is also reflected yearly: In 2019, spirit sales totaled about $16.3 billion, compared with $21 billion in 2021. Bottom line: Alcohol sales have remained higher than they were before the pandemic, even after adjusted for inflation.

Changes in physical activity have followed a similar pattern. Scientists at UC San Francisco analyzed data from a wellness smartphone app,

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U.S. mental health care needs an overhaul, argues former NIMH director Tom Insel : Shots

For over a decade, psychiatrist and neuroscientist Dr. Thomas Insel headed the National Institute of Mental Health and directed billions of dollars into research on neuroscience and the genetic underpinnings of mental illnesses.

“Our efforts were largely to say, ‘How can we understand mental disorders as brain disorders, and how can we develop better tools for diagnosis and treatment?'” Insel said in an interview with NPR.

But in the very first pages of his new book, Healing: Our Path from Mental Illness to Mental Health, he admits that the results of that research have largely failed to help Americans struggling with mental illnesses.

“Our science was looking for causes, while the effects of these disorders were playing out with more death and disability, incarceration and homelessness, and increasing frustration and despair for both patients and families,” writes Insel.

But Insel’s book is less about the failure of science in helping people and more a critique of almost every aspect of the mental health system.

NPR sat down with Insel to talk about how he came to realize where America had failed and his journey to find the answers to addressing the country’s mental health crisis.

The interview has been edited for clarity and length.

What were some of the scientific discoveries and developments you oversaw during your time at NIMH?

We did several large clinical trials for depression, for schizophrenia, for bipolar disorder. The bottom line for most of those was that in the real world of care, medical treatments were not as good as we thought. And I think that was an important insight that really charged us to say we’ve got to do better in terms of developing more effective medications.

At the same time, I think we had a greater awareness, particularly in the later years of my tenure, that we could begin to combine treatments in a way that was very effective. And where we saw this the most was in how we began to address the first episode of psychosis for young people with a disorder like schizophrenia or with a form of bipolar disorder. What we began to understand is, that by combining medication and psychological and cognitive therapies, bringing in families and giving agency to the young person involved, providing academic and employment support, we could actually help kids recover. And that we could get to a point where kids who had

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