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.


 

The committee delineated safeguards that are necessary to manage emergencies that might arise from an abortion procedure, such as resuscitation and monitoring equipment to be located in a facility for procedures involving moderate and deep sedation. However, they did not find any evidence that it is necessary for clinicians performing abortions to have hospital admitting privileges. In the Whole Woman’s Health v. Hellerstedt decision in 2016, the U.S. Supreme Court ruled that the admitting privileges requirement in Texas was an undue burden on access to care. The committee wrote that it is sufficient for the facility to have an emergency transfer plan in place.

The committee also identified areas for further evaluation. First, whether the Food and Drug Administration should expand the distribution of mifepristone, the only drug currently approved for medication abortions, but which can only be dispensed to patients in clinics, hospitals, or medical offices under the supervision of a certified prescriber. The committee also called for examining more effective methods of pain management, whether advanced practice clinicians can be trained to perform D&Es, and ways to provide more social and psychological supports for lower-income women or who are at risk of intimate partner or other forms of violence.

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