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.
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.