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, according to a consensus study report by the National Academies of Science, Engineering, and Medicine.
Six private foundations commissioned a comprehensive report from the National Academies, which focused on eight questions related to the safety and quality of U.S. abortion care. The resulting Committee on Reproductive Health Services limited itself to these questions and did not make specific policy or clinical recommendations, though they did note that “state regulations have created barriers to optimizing each dimension of quality care.” The report was released on March 16.
The committee focused on the four legal abortion methods in the United States – medication, aspiration, dilation and evacuation (D&E), and induction – and concluded that all four are safe, but that induction is so rare that there is a lack of quality research on the procedure’s risks in women with prior cesarean deliveries. D&E, though less painful, costly, and time consuming than induction, is banned in Mississippi and West Virginia (with exceptions for emergencies) and limited elsewhere in the country by a lack of physicians trained to perform the procedure.
In attempting to assess the physical and mental health risks of abortion procedures, the committee found that “much of the published literature on these topics does not meet scientific standards for rigorous, unbiased research.” Surveying research that they considered high quality, the committee concluded that there is no increased risk of secondary infertility, pregnancy-related hypertensive disorders, abnormal placentation, preterm birth, breast cancer, or mental health disorders such as depression, anxiety, or posttraumatic stress disorder associated with a woman having an abortion.
The committee was not able to find high-quality research to evaluate the risk of ectopic pregnancy, miscarriage or stillbirth, or long-term mortality associated with abortion. However, it did find an increased risk of preterm birth before 28 weeks’ gestation in a nulliparous women who had had two or more aspiration abortions, compared with women with no abortion history. The risk of preterm birth is greater in women if the interval between their abortion and their next conception is less than 6 months. The same risk exists for short intervals between pregnancy in general, the committee noted.
Overall, they wrote, “serious complications are rare and occur much less frequently than during childbirth.”
The committee identified several kinds of state-level regulations that are obstacles to effective abortion care in the United States. Such regulations “may limit the number of available providers, misinform women of the risks of the procedures they are considering, overrule women’s and clinicians’ medical decision making, or require medically unnecessary services and delays in care.” Some laws “prohibit the abortion method that is most effective for a particular clinical circumstance” (for example, D&E).
Access to care varies widely geographically, and 17% of women must travel more than 50 miles to obtain an abortion. Regulations that required counseling, whether the woman desires counseling or not, are cited as an example of inferior patient-centered care.
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.
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.
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.
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.
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.
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.
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.
, according to a consensus study report by the National Academies of Science, Engineering, and Medicine.
Six private foundations commissioned a comprehensive report from the National Academies, which focused on eight questions related to the safety and quality of U.S. abortion care. The resulting Committee on Reproductive Health Services limited itself to these questions and did not make specific policy or clinical recommendations, though they did note that “state regulations have created barriers to optimizing each dimension of quality care.” The report was released on March 16.
The committee focused on the four legal abortion methods in the United States – medication, aspiration, dilation and evacuation (D&E), and induction – and concluded that all four are safe, but that induction is so rare that there is a lack of quality research on the procedure’s risks in women with prior cesarean deliveries. D&E, though less painful, costly, and time consuming than induction, is banned in Mississippi and West Virginia (with exceptions for emergencies) and limited elsewhere in the country by a lack of physicians trained to perform the procedure.
In attempting to assess the physical and mental health risks of abortion procedures, the committee found that “much of the published literature on these topics does not meet scientific standards for rigorous, unbiased research.” Surveying research that they considered high quality, the committee concluded that there is no increased risk of secondary infertility, pregnancy-related hypertensive disorders, abnormal placentation, preterm birth, breast cancer, or mental health disorders such as depression, anxiety, or posttraumatic stress disorder associated with a woman having an abortion.
The committee was not able to find high-quality research to evaluate the risk of ectopic pregnancy, miscarriage or stillbirth, or long-term mortality associated with abortion. However, it did find an increased risk of preterm birth before 28 weeks’ gestation in a nulliparous women who had had two or more aspiration abortions, compared with women with no abortion history. The risk of preterm birth is greater in women if the interval between their abortion and their next conception is less than 6 months. The same risk exists for short intervals between pregnancy in general, the committee noted.
Overall, they wrote, “serious complications are rare and occur much less frequently than during childbirth.”
The committee identified several kinds of state-level regulations that are obstacles to effective abortion care in the United States. Such regulations “may limit the number of available providers, misinform women of the risks of the procedures they are considering, overrule women’s and clinicians’ medical decision making, or require medically unnecessary services and delays in care.” Some laws “prohibit the abortion method that is most effective for a particular clinical circumstance” (for example, D&E).
Access to care varies widely geographically, and 17% of women must travel more than 50 miles to obtain an abortion. Regulations that required counseling, whether the woman desires counseling or not, are cited as an example of inferior patient-centered care.
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.
, according to a consensus study report by the National Academies of Science, Engineering, and Medicine.
Six private foundations commissioned a comprehensive report from the National Academies, which focused on eight questions related to the safety and quality of U.S. abortion care. The resulting Committee on Reproductive Health Services limited itself to these questions and did not make specific policy or clinical recommendations, though they did note that “state regulations have created barriers to optimizing each dimension of quality care.” The report was released on March 16.
The committee focused on the four legal abortion methods in the United States – medication, aspiration, dilation and evacuation (D&E), and induction – and concluded that all four are safe, but that induction is so rare that there is a lack of quality research on the procedure’s risks in women with prior cesarean deliveries. D&E, though less painful, costly, and time consuming than induction, is banned in Mississippi and West Virginia (with exceptions for emergencies) and limited elsewhere in the country by a lack of physicians trained to perform the procedure.
In attempting to assess the physical and mental health risks of abortion procedures, the committee found that “much of the published literature on these topics does not meet scientific standards for rigorous, unbiased research.” Surveying research that they considered high quality, the committee concluded that there is no increased risk of secondary infertility, pregnancy-related hypertensive disorders, abnormal placentation, preterm birth, breast cancer, or mental health disorders such as depression, anxiety, or posttraumatic stress disorder associated with a woman having an abortion.
The committee was not able to find high-quality research to evaluate the risk of ectopic pregnancy, miscarriage or stillbirth, or long-term mortality associated with abortion. However, it did find an increased risk of preterm birth before 28 weeks’ gestation in a nulliparous women who had had two or more aspiration abortions, compared with women with no abortion history. The risk of preterm birth is greater in women if the interval between their abortion and their next conception is less than 6 months. The same risk exists for short intervals between pregnancy in general, the committee noted.
Overall, they wrote, “serious complications are rare and occur much less frequently than during childbirth.”
The committee identified several kinds of state-level regulations that are obstacles to effective abortion care in the United States. Such regulations “may limit the number of available providers, misinform women of the risks of the procedures they are considering, overrule women’s and clinicians’ medical decision making, or require medically unnecessary services and delays in care.” Some laws “prohibit the abortion method that is most effective for a particular clinical circumstance” (for example, D&E).
Access to care varies widely geographically, and 17% of women must travel more than 50 miles to obtain an abortion. Regulations that required counseling, whether the woman desires counseling or not, are cited as an example of inferior patient-centered care.
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.