Research witness: mandatory waiting, disclosure requirements offer no mental-health benefit and can harm patients, expert testifies

Antonia (Maria) Biggs, a professor at the University of California, San Francisco and acting director of ANSIRH (Advancing New Standards in Reproductive Health), testified at a Michigan bench trial that the best available research does not show that abortion causes long-term mental-health problems and that state-mandated waiting-period and disclosure requirements do not improve decision-making.

Biggs described the Turnaway Study, a prospective, longitudinal study that recruited people seeking abortion at 30 U.S. facilities and followed them for five years. “We recruited APCs… 956 women were recruited, so nearly a thousand,” she said in direct examination, summarizing the study design and sample size. Using repeated interviews every six months, the Turnaway Study compared people who obtained abortions to those denied abortions because they were past a facility’s gestational limit.

Biggs told the court she and other reviewers found the principal mental‑health result to be that people who were denied wanted abortions fared worse in several domains than people who obtained care. “It was not the abortion. It wasn't the people who had an abortion who were worse off from a mental health perspective. It was people who were denied an abortion,” she said. She testified that higher anxiety, stress and lower self‑esteem were observed in the short term among people denied care, but that abortion itself was not associated with adverse long‑term mental‑health outcomes.

She summarized the Turnaway Study’s strengths — the prospective design, a closely matched comparison group, validated measures and multi‑state recruitment — and acknowledged limitations commonly raised in peer review: a baseline participation rate below 50 percent and cumulative attrition over five years; the team used sensitivity analyses and analytic methods (mixed-effects models) to assess whether those factors biased conclusions. Biggs told the court the study’s principal short-term findings are robust even when sensitivity analyses and higher‑participation sites are analyzed separately.

Biggs further reviewed major evidence syntheses. She told the court the National Academies of Sciences, Engineering, and Medicine and American Psychological Association reviews both concluded that abortion is not shown to increase the risk of adverse mental-health outcomes. She described the Turnaway Study and subsequent literature as reinforcing that consensus.

Biggs criticized the language that Michigan requires in its informed-consent materials — language that says some individuals “may have feelings of sadness, guilt, anger, or trouble sleeping or doing daily activities after an abortion.” She described that mandated disclosure as misleading and stigmatizing, saying it “is not an evidence‑based statement” and that including it risks spreading misinformation and reinforcing stigma. “It is misleading and, and, can reinforce stigma related to abortion and and add to spreading misinformation,” she testified.

On mandatory waiting periods, Biggs said the evidence does not support the proposition that a 24-hour delay improves decision certainty. She testified that most people presenting for abortion care are already “very certain about the decision,” and that mandatory delays commonly add logistical, financial and privacy burdens and may push some patients later in pregnancy, complicating available options.

Biggs also detailed harms documented when people are denied abortions: greater economic hardship, higher rates of poverty for the birthing parent and children, worse physical health outcomes and increased likelihood of remaining in abusive relationships. She told the court that, in the Turnaway cohort, some women who were denied care experienced more negative economic and health outcomes; she noted two maternal deaths in the cohort among women who were denied abortions and later gave birth.

On cross‑examination, defense counsel probed methodological limits — participation and attrition rates and the representativeness of samples — and Biggs reiterated the study team’s sensitivity checks and the rationale for the cohort design. She acknowledged the Turnaway Study oversampled later‑gestation seekers to obtain a matched comparison group, and that those design choices affect generalizability in quantified ways; she also said subsequent publications and reviews further support her opinions.

Biggs was excused after redirect; trial testimony continued with additional witnesses scheduled for follow-up.