Feature

Report: Abortion in U.S. is safe and effective

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Restrictions lead to lower-quality care

On March 16, the National Academies of Science, Engineering, and Medicine released a comprehensive report finding that abortion is safe and effective but inaccessible to many women.

Dr. Eve Espey of the department of obstetrics and gynecology at the University of New Mexico, Albuquerque

Dr. Eve Espey

Specifically, the National Academies determined that abortion complications are rare, that abortion does not increase physical or mental health risks, and that a variety of trained clinicians can provide safe abortion care. Using the 2001 Institute of Medicine six dimensions for assessing quality of abortion care, the National Academies determined that in states with the most abortion restrictions, women received lower quality care. Restrictions that require waiting periods, non–evidence based counseling, and medically unnecessary services, among others, significantly reduce access and the quality of care, particularly for low-income women.

A high-quality foundation of evidence, contributed to by many U.S. family planning researchers, provided the studies on which the conclusions of the National Academies are based. We are fortunate that the Society of Family Planning provides research funding and a forum for family planning researchers to continue to produce the high-quality evidence used by policy makers to improve access to and quality of abortion care.

Eve Espey, MD, MPH, is professor and chair of the department of obstetrics and gynecology at the University of New Mexico, Albuquerque. She reported having no relevant financial disclosures.


 

Legal abortions in the United States are safe and effective, and serious complications are rare, according to a consensus study report by the National Academies of Science, Engineering, and Medicine.

Six private foundations commissioned a comprehensive report from the National Academies, which focused on eight questions related to the safety and quality of U.S. abortion care. The resulting Committee on Reproductive Health Services limited itself to these questions and did not make specific policy or clinical recommendations, though they did note that “state regulations have created barriers to optimizing each dimension of quality care.” The report was released on March 16.

The committee focused on the four legal abortion methods in the United States – medication, aspiration, dilation and evacuation (D&E), and induction – and concluded that all four are safe, but that induction is so rare that there is a lack of quality research on the procedure’s risks in women with prior cesarean deliveries. D&E, though less painful, costly, and time consuming than induction, is banned in Mississippi and West Virginia (with exceptions for emergencies) and limited elsewhere in the country by a lack of physicians trained to perform the procedure.

In attempting to assess the physical and mental health risks of abortion procedures, the committee found that “much of the published literature on these topics does not meet scientific standards for rigorous, unbiased research.” Surveying research that they considered high quality, the committee concluded that there is no increased risk of secondary infertility, pregnancy-related hypertensive disorders, abnormal placentation, preterm birth, breast cancer, or mental health disorders such as depression, anxiety, or posttraumatic stress disorder associated with a woman having an abortion.

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