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Ongoing study Medi-Cal Analyses of Abortion Safety & Access

Medi-Cal is California’s state Medicaid program, and one of 17 state Medicaid programs that covers abortion and subsequent care. Medi-Cal covers 49% of abortions in California and 8% of abortions in the country. Medi-Cal data present a unique opportunity to understand abortion care because it can be used to track all subsequent care among a cohort of patients having an abortion longitudinally after their abortion with virtually no loss to follow-up. We utilized Medi-Cal data to better understand abortion safety, distance traveled for abortion, and sources of care after abortion.

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.
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 hospitalization.
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.
Overall, 12% of California women traveled 50 miles or more and 4% traveled 100 miles or more for Medi-Cal covered abortion.
Some groups of women were more likely to travel long distances: 51% of rural woman, 20% of women obtaining abortions at hospitals, and 22% of women obtaining second trimester or later abortions traveled 50 miles or more.
Women traveling longer distances for an abortion were more likely to seek abortion-related follow-up care at an ED and were less likely to return to their abortion provider.
Follow-up rates and location differed by abortion type: 77% of medication abortion patients (largely for routine follow-up), 4% of 1st trimester patients, and 3% of 2nd trimester or later patients returned to their abortion provider. 4% of medication abor
The cost of follow-up care at EDs (median $961) was significantly higher than follow-up care at the abortion provider (median $536).

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.



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.

Distance to Abortion and Follow-up Care



Many factors affect abortion access in the United States, including the availability of abortion providers and how far women have to travel to reach them. As with any medical procedure, some women want subsequent care after abortion – either routine follow-up to confirm the abortion is complete or because they are concerned about symptoms. When women do seek follow-up care after their abortion, they may return to the original abortion provider or they may go to an emergency department (ED). To evaluate the how far women travel to seek abortion care, factors associated with traveling greater distance, and how distance affects where women seek care after abortion, we conducted a retrospective analysis of 39,747 abortions and all health care for up to six weeks after the abortion at any clinical site, using Medi-Cal billing data from 2011-2012. 

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