Abortion in the U.S.: safe, declining, and under threat


Between 1980 and 2014, the abortion rate declined by more than half, from 29.3 to 14.6/1000 women, according to a major new consensus study report from the National Academies of Science, Engineering, and Medicine. While the advisory committee said the reason for three-decade decline was not fully understood, it called out the increasing use of contraceptives, especially long-acting methods and historic declines in the rate of unintended pregnancy, which readers may assume go hand-in-hand with more widespread use of contraception and of highly effective contraceptive methods. Additionally, rates have been impacted by more limited access to abortion services in an increasing numbers of states.

The report found that abortion care services—pre-abortion care, medication abortion (accounting for 45% of abortions prior to 9 weeks’ gestation), aspiration abortion (accounting for 68% of all abortions), and post-abortion care—are highly safe and highly effective. Aspiration abortion rarely results in complications, with risk increasing as the gestational age increases. Induction, used in 2% of abortions at 14 weeks’ gestation or later, rarely leads to serious complications.

“The safety and high-quality of abortion care stands in contrast to the extensive regulatory requirements that state laws impose,” according to the consensus report. Some states have instituted regulations that increase risks and costs by requiring unnecessary services and multiple visits and that have led to the closure of clinics. In 2014, half (25) of U.S. states had 5 or fewer abortion clinics. Nearly 39% of women lived in a county without an abortion provider. Nearly 1 in 3 women living in rural communities had to traveled more than 100 miles to have an abortion.

Few women have medical contraindications for obtaining an abortion. These contraindications include confirmed or suspected ectopic pregnancy or undiagnosed adnexal mass, an IUD in place, chronic adrenal failure, concurrent long-term systemic corticosteroid therapy, hemorrhagic disorders or concurrent anticoagulant therapy, inherited porphyria, specific contraindications to using mifepristone, and allergy to mifepristone, misoprostol, or other prostaglandins.

Few women suffer complications following abortion. Obesity— notably a BMI >30 or weight over >200 pounds, or with an abortion performed after 14 weeks’ gestation—could possibly be a risk factor for complications during a D&E abortion, but it is not a risk factor for medication or aspiration abortions. Despite reported findings from a small number of poorly controlled studies, a woman is not more likely to suffer depression, anxiety, or PTSD following abortion. (In contrast, women who have been denied an abortion may be more likely to experience anxiety.] While preterm birth is more likely if pregnancy occurs fewer than 6 months following abortion, this is the same as the risk from pregnancy following childbirth or miscarriage. However, the risk of preterm birth may increase with an increased number of prior abortions.

More than 90% of abortions are performed early, before 13 weeks’ gestation. Currently, 38% are performed < 6 weeks’ gestation, but that percentage will increase as medication abortion becomes more prevalent.

National Academies of Sciences, Engineering, and Medicine, The safety and quality of abortion care in the United States. Washing, DC: The National Academies Press. Accessed Mar. 29, 2018 at www.nap.edu/read/24950/