Abortion care in the United States is safe for women and results in few complications, but state laws and regulations the limit or delay access can pose barriers to quality care, according to a new report by the National Academies of Sciences, Engineering and Medicine.
The more than 200-page report examines the safety and quality of abortion care in the United States.
Looking at 2014 data, the researcher found that 95% of U.S. abortions occurred in clinics and other office-based settings. The researchers found that in 2014 about 90% of all U.S. abortions occurred during the first 12 weeks of pregnancy and that complications for all types of abortions were "rare."
The researchers found no evidence of long-term physical or mental health effects from abortion care. They did, however, find an association between very preterm birth of a first-born child and a woman having had two or more aspiration abortions.
The researchers said abortion care can be provided at the highest levels of quality and safety when completed early in pregnancy. However, they wrote, "Abortion specific regulations in many states create barriers to safe and effective care."
The report noted that some state laws delay access to abortion care, such as by requiring mandatory waiting periods, pre-abortion ultrasound requirements, and separate counseling visits. According to the Guttmacher Institute, 27 states require a woman seeking abortion care to wait at least 24 hours before undergoing the procedure, and 11 states require a woman to first have an ultrasound. The report states, "Delays put the patient at greater risk of an adverse event."
The report also noted that some states impose requirements on abortion providers. For instance, some states require a provider of abortion care to have hospital admitting privileges, although the report found no evidence that such laws increase patient safety. The report also found that NPs and physician assistants can provide abortion care at the same quality and safety level as physicians.
The report found the number of abortion clinics in the United States has fallen since 2011, and that in 2014, 39% of reproductive-age women lived in a county without an abortion provider. In 2017, the report found five states had one abortion clinic, and 17% of women had to travel more than 50 miles to access abortion care—which can be difficult for women who must make multiple provider visits.
Ned Calonge, the co-chair of the committee that authored the report, said, "I would say the main takeaway is that abortions that are provided in the United States are safe and effective."
Hal Lawrence, CEO of the American College of Obstetricians and Gynecologists, said of the report, "Abortion is safer when it's performed earlier in gestation. ... And so delaying and making people wait and go through hoops of unnecessary, extra procedures does not improve the safety."
Meanwhile, Donna Harrison, executive director of the American Association of Pro-Life Obstetricians and Gynecologists, defended state laws restricting abortion care and suggested that data on abortion-related complications is incomplete. She said, "There is no good data collection," in part because providers and patients do not consistently report abortion-related complications (Kodjak, "Shots," NPR, 3/16; Preidt, HealthDay/U.S. News & World Report, 3/16).
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