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Research study

California Analysis of Abortion Safety

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. To evaluate the incidence of post-abortion emergency department (ED) visits and complications, we conducted a retrospective analysis of 55,000 abortions and all health care for up to six weeks after the abortion at any clinical site, using Medi-Cal billing data from 2009–2010.

Key findings

  • Major complications, defined as hospitalizations, surgeries and transfusions, were rare at a rate of less than a quarter of one percent (0.23%) of all abortions: 0.31% for medication abortion, 0.16% for aspiration abortion, and 0.41% for second-trimester or later procedures. 
  • 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.

These data have helped 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.  This study was explicitly mentioned as a key piece of evidence in the landmark Whole Woman’s Health v. Hellerstedt Supreme Court decision as evidence of abortion safety.

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, many states currently require that abortion care facilities meet the standards for ambulatory surgical centers where costly requirements for care provision (3) will have nominal impact on the types of complications identified in this study. Likewise, the requirements that abortion care facilities have transfer agreements  or each physician have individual hospital admitting privileges  are inconsistent with our finding that almost no women require this care. 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." 

For more information about the safety of medication abortion, see our issue brief titled, "Safety and effectiveness of first-trimester medication abortion in the United States."

The full publication, titled, "Incidence of Emergency Department Visits and Complications After Abortion" is available online from the journal Obstetrics & Gynecology.

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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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