By Rebecca Bowers

EXECUTIVE SUMMARY

A new report has determined that while abortion in the United States is safe, the quality of abortion care depends on where a woman lives.

  • In 2014, there were 17% fewer abortion clinics than in 2011; 39% of all women of reproductive age resided in a county without an abortion provider. A total of 25 states in 2017 had five or fewer abortion clinics, and five states had only one abortion clinic. Data indicate that 17% of women travel more than 50 miles to obtain an abortion.
  • Abortion-specific regulations in many states create barriers to safe and effective care. Such regulations may stop qualified providers from performing abortions, misinform women of the risks of the procedures they are considering, or call for medically unnecessary services.

A new report from a National Academies of Sciences, Engineering, and Medicine-convened committee has determined that although abortion in the United States is safe, the quality of abortion care depends on where a woman lives. In many states, regulations have created barriers to safe, effective, and timely services.1

According to data from the Centers for Disease Control and Prevention (CDC), most abortions in the United States are performed early in pregnancy. In 2014, 90% of abortions occurred by 12 weeks of gestation.2

To compile the report, the committee examined the scientific evidence on the safety and quality of medication, aspiration, dilation and evacuation (D&E), and induction abortions, which are the four methods used in the United States. Members also looked at data assessing the quality of care according to well-established standards.

In reviewing the medical literature, the report concludes that having an abortion does not increase a woman’s risk of secondary infertility, pregnancy-related hypertensive disorders, abnormal placentation (after a D&E abortion), preterm birth (defined as less than 37 weeks), or breast cancer. Having an abortion also does not increase a woman’s risk of depression, anxiety, and/or posttraumatic stress disorder, the data indicate.1

The analysis indicates that in 2014, there were 17% fewer abortion clinics than in 2011; 39% of all women of reproductive age resided in a county without an abortion provider. A total of 25 states in 2017 had five or fewer abortion clinics, and five states had only one abortion clinic. Data indicate that 17% of women travel more than 50 miles to obtain an abortion.1

State Regulations

Abortion-specific regulations in many states create barriers to safe and effective care, the committee found. Such regulations may stop qualified providers from performing abortions, misinform women of the risks of the procedures they are considering, or call for medically unnecessary services. Such actions include mandatory waiting periods, pre-abortion ultrasound, and a separate in-person counseling visit. Some states require abortion providers to provide women with written or verbal information suggesting that abortion increases a woman’s risk of breast cancer (Alaska, Kansas, Mississippi, Oklahoma, Texas) or stressing negative emotional responses (Kansas, Louisiana, Michigan, Nebraska, North Carolina, South Dakota, Texas, West Virginia), despite the lack of valid scientific evidence of increased risk.3

The new report confirms decades of research that abortion is safe, says Debra Hauser, MPH, president of Advocates for Youth, a Washington, DC-based nonprofit adolescent reproductive health advocacy group. With efforts to further hinder care, the advances in abortion access are being chipped away, she states.

“Every year, hundreds of thousands of women need abortion care,” said Hauser in a press statement. “Medically unnecessary regulations not only threaten their autonomy and ability to plan their futures, but endanger their health. We need to ensure that everyone has access to safe and affordable abortion care, regardless of their age, income, or where they live.”

In November 2018, voters will have an opportunity to elect House and Senate representatives who may be more inclined to protect a woman’s right to terminate a pregnancy, says Robert Hatcher, MD, MPH, professor emeritus of gynecology and obstetrics at Emory University School of Medicine in Atlanta.

New Report Affirms Drug Safety

The federal Government Accountability Office has issued a report reaffirming the steps taken by the Food and Drug Administration (FDA) in its March 2016 relabeling of the medication abortion drug mifepristone.4 The updated labeling was issued to reflect the most current clinical practices and safety and efficacy data. For the new label, the size of the initial dose was reduced to 200 mg and the window for taking it extended to 70 days since the first day of a woman’s last menstrual period. The updated labeling also calls for the second drug in the medication abortion regimen, misoprostol, to be taken “at a location appropriate for the patient.” (Contraceptive Technology Update reported on the label change; see the June 2016 article, “FDA Updates Mifepristone Labeling, Easing Access to Abortion Pill,” at http://bit.ly/2qL2WGP.)

Medication abortions accounted for 31% of all nonhospital abortions in 2014, and for 45% of abortions before nine weeks’ gestation.5 The federal report is another affirmation that medication abortion is a safe and effective option for ending an early pregnancy, says Gillian Dean, MD, MPH, senior director of medical services at Planned Parenthood Federation of America.

“Studies show medication abortion has a 99% safety record, and that medication abortion is up to 98% effective in ending an early pregnancy,” noted Dean in a press statement. “The results underscore that the 2016 label change was rooted in evidence-based medicine.”

REFERENCES

  1. Committee on Reproductive Health Services: Assessing the Safety and Quality of Abortion Care in the United States. National Academies of Sciences, Engineering, and Medicine. The Safety and Quality of Abortion Care in the United States. Accessed at https://bit.ly/2GDUWM2.
  2. Jatlaoui TC, Shah J, Mandel MG, et al. Abortion surveillance United States, 2014. MMWR Surveill Summ 2017;66(SS-24):1-48.
  3. Guttmacher Institute. Counseling and waiting periods for abortion. Fact sheet. Accessed at https://bit.ly/2gb34cV.
  4. United States Government Accountability Office. Report to Congressional Requesters. Food and Drug Administration. Information on Mifeprex Labeling Changes and Ongoing Monitoring Efforts. Available at: https://bit.ly/2HdK3np. Accessed April 19, 2018.
  5. Jones RK, Jerman J. Abortion incidence and service availability in the United States, 2014. Perspect Sex Reprod Health 2017; doi:10.1363/psrh.12015.