Although state lawmakers pushing new abortion restrictions often say they’re just looking out for patients’ health, new research shows those concerns may be unjustified.
An Advancing New Standards in Reproductive Health (ANSIRH) study looking at national emergency room data from 2009 to 2013 found that it’s very rare for people to visit emergency rooms for abortion-related reasons. Only 0.01 percent of all those visits by women aged 15-49 were related to abortions. Just .11 percent of abortion-related visits involved major incidents — lower than the rates for pregnancy, colonoscopy, wisdom tooth removal, and tonsillectomy.
Over the last few years, states like Texas and Arkansas have passed laws requiring abortion providers to have hospital admitting privileges or a contract with a backup provider with admitting privileges at a hospital. Burdensome and unnecessary abortion clinic restrictions, part of a strategy known as “Targeted Regulation of Abortion Providers,” or TRAP, have spread quickly across the country. Anti-abortion activists, such as Charmaine Yoest, rebranded much of anti-abortion activism to represent concern about patients’ health rather an attempt to restrict their access to reproductive care.
ANSIRH researchers concluded that because abortion was a small share of women’s emergency department visits and the rate of major incidents, such as those that require blood transfusion, an overnight inpatient stay, or surgery, were quite low, “regulations on abortion are unlikely to have any impact on women’s health outcomes.”
The U.S. Supreme Court struck down these types of restrictions in Whole Women’s Health v. Hellerstedt, saying that it makes it more difficult for people to get an abortion “without providing any benefit to women’s health capable of withstanding any meaningful scrutiny,” but the court refused to hear a case on a similar issue this spring.
Last month, the Supreme Court refused to hear a challenge of Arkansas’ Act 577. The bill, which the Arkansas legislature passed in 2015, requires physicians who perform medication abortion to have a contract with a backup provider with admitting privileges at a hospital. Planned Parenthood has licensed physicians but none have admitting privileges. The decision not to hear the case sent a signal to anti-abortion activists and lawmakers that they can move ahead on abortion restrictions similar to the Arkansas law, which uses faux-concern for patients’ health to justify barriers to abortion.
Perhaps anti-abortion activists focus on safety because cultural portrayals of abortion are already feeding into some of those concerns. In their study, researchers say that post-abortion visits to the ED may also be influenced by stigma and distrust of abortion providers that may be driven in part from popular culture. The study refers to research on abortion-related storylines on TV, which found a major incident rate of 34 percent for characters who had abortions, much higher than 0.11 percent found in the national emergency room data.
Women using Medicaid were more likely to have a major incident at the emergency room than women with private insurance. Some of the incidents involved cases of potential self-induced abortions which use poisoning and other methods of self-harm instead of the safe dosages of mifepristone and misoprostol or misoprostol that physicians use, researchers found. There were 390 ED visits that represented potential self-induced abortion and made up 1.4 percent of abortion-related visits during those years. In the South, where abortion access is more limited and there are fewer providers, there were slightly higher rates of potential self-induced abortion.
According to ANSIRH researchers, this study is important because previous research on abortion-related visits to the ER were only conducted on the state level. The study did not have data on abortion-related visits for gender minorities.
Previous research has found that abortion is less risky to a patient’s health than pregnancy and that abortion methods are very safe. Centers for Disease Control and Prevention data shows that the risk of death from pregnancy and childbirth is 14 times higher than it is for abortion. The National Academies of Sciences, Engineering, and Medicine analyzed data on abortion safety and found that complications from the four major abortion methods rarely result in complications and that they are particularly safe and effective when performed early in a patient’s pregnancy. But the report noted that abortion-specific regulations create barriers to safe and effective care. The report also reviewed which clinical skills are necessary and concluded that OB-GYNs, family medicine physicians and advanced practice clinicians, including certified nurse-midwives, nurse practitioners, and physician assistants, can administer medication and aspiration abortions safely and effectively.
Despite the evidence that a range of health care professionals can provide medication abortion safely, 34 states say that only licensed physicians can provide them, according to the Guttmacher Institute. Nineteen states require the clinician who provides medication abortion is physically with the patient as they undergo the procedure, which makes it impossible to use telemedicine or remotely prescribe medication.