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Research study

California Analysis of Abortion Safety

- back to the Evaluation of Abortion Restrictions Project

Background

In recent years, state legislatures have passed a record number of abortion restrictions with the stated intent to protect women’s health and safety.  Accurate evidence on the safety of abortion is needed to inform the need for such policies.

Objective

To evaluate the incidence of post-abortion emergency department visits and complications using data from California’s state Medicaid program, Medi-Cal.

Study design

A retrospective analysis of 55,000 abortions and all health care for up to six weeks after the abortion at any clinical site, using billing data from California’s state Medicaid program, Medi-Cal. (California is one of 17 states that covers abortion and subsequent care for women enrolled in Medicaid.) Using 2009–2010 abortion data among women covered by the fee-for-service California Medicaid program and all subsequent health care for 6 weeks after having an abortion, we analyzed reasons for ED visits and estimated the abortion-related complication rate and the adjusted relative risk.

Key findings

  • Among all abortions, 6.4% (n=3,531) presented at the ED within six weeks of the initial abortion. However, 0.87% (n=478) of all abortions resulted in an ED visit where an abortion-related complication was diagnosed and/or treated, and 0.03% (n=15) resulted in ambulance transfers to emergency departments on the day of the abortion. 
  • Among all abortions, the total complication rate diagnosed and/or treated at all sources of care was 2.1%:  5.2% for medication abortion, 1.3% for aspiration abortion, and 1.5% for second-trimester or later procedures.
  • Major complications, defined as hospitalizations, surgeries and transfusions, were rare at a rate of 0.23% of all abortions: 0.31% for medication abortion, 0.16% for aspiration abortion, and 0.41% for second-trimester or later procedures.

These new data can help inform policy debates regarding the regulation of abortion in the United States. Because California does not specially regulate abortion care provision, it approximates the safety of care when abortion is regulated only as a routine health care service.

As state legislatures across the United States pass and implement new regulations specifically targeted at abortion providers, our data suggest that safety will not be enhanced. For example, 24 states currently require that abortion care facilities meet the standards for ambulatory surgical centers (1) where costly requirements for care provision (2) will have nominal impact on the types of complications identified in this study. Likewise, the requirements that abortion care facilities have transfer agreements (required in 10 states) or each physician have individual hospital admitting privileges (10 states) (1)  are inconsistent with our finding that almost no women require this care. Finally our data show that in practice, the evidence-based protocol for medication abortion results in outcomes as good as or better than published success rates using the FDA-approved protocol which is required in two states (1). Conversely, the reality that state-based targeted regulations actually result in the closure of abortion care facilities could mean that these laws reduce safety by reducing access to care.

For more information about abortion safety, see our issue brief titled, "Safety of abortion in the United States."

  1. Guttmacher Institute. State Policies in Brief Fact Sheets. New York: Guttmacher Institute; April 1 2014.
  2. Jones BS, Weitz TA. Legal barriers to second-trimester abortion provision and public health consequences. Am. J. Public Health. 2009;99(4):623-630.

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ANSIRH is a program within the UCSF Bixby Center for Global Reproductive Health and is a part of UCSF's Department of Obstetrics, Gynecology & Reproductive Sciences.

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