Last month, the National Academies of Science, Engineering, and Medicine released a consensus report called “The Safety and Quality of Abortion Care in the United States.” The committee examined literature related to the six attributes of health care quality (per the 2001 Institute of Medicine report Crossing the Quality Chasm): safety, effectiveness, safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. It’s not surprising that they concluded that abortions are safe and effective, and the summary handout appropriately notes, “Serious complications [from abortion] are rare and occur far less frequently than during childbirth.” What’s noteworthy, though, is the extent to which the committee found the role of state laws to affect the other dimensions of quality.
The past few years have seen a deluge of state laws that narrow the time frame in which women can legally obtain abortions, restrict insurance coverage for abortion services, mandate waits of 18-72 hours between when a woman first presents for care and when she can obtain the procedure, pose non-science-based hurdles to medication abortion, and require abortion facilities and providers to fulfill requirements that are far more burdensome than necessary to ensure patient safety. For details, the Guttmacher Institute breaks down which laws each state has adopted, and the National Partnership for Women and Families’ Bad Medicine report maps where the restrictions are most intense.
The National Academies’ summary of U.S. abortion care on the six quality dimensions explains how these laws affect the quality of care abortion patients receive:
The likelihood that women will receive the type of abortion services that best meets their needs varies considerably depending on where they live. In many parts of the country, abortion-specific regulations on stie and nature of care, provider type, provider training, and public funding diminish this dimension of quality care. The 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.… Patients’ personal circumstances and individual preferences (including preferred abortion method), needs, and values may be disregarded depending on where they live ……State-level abortion regulations are likely to affect women differently based on their geographic location and socioeconomic status. Barriers (lack of insurance coverage, waiting periods, limits on qualified providers, and requirements for multiple appointments) are more burdensome for women who reside far from providers and/or have limited resources.
As states have adopted laws that make abortion care harder to obtain, researchers have been studying the impacts on those who seek abortions. They’ve found clinics closing as new laws make it harder to operate, and women reporting difficulties scheduling appointments and traveling to distant clinics. In states where two visits to the facility are required, those challenges multiply. Women who live in rural areas and have low incomes are particularly affected, and often struggle to raise the necessary funds. Delays can result in women having abortions later in pregnancy than they wanted to, and in some cases prevent them from receiving desired abortions at all.
The long-term consequences of being denied an abortioncan be serious: ANSIRH’s Turnaway Study, which for several years followed women who received abortions shortly before the gestational limit and those who were turned away because their pregnancies were too advanced, found that women who gave birth after being denied an abortion were significantly more likely (compared to those who received abortions) to live below the poverty level four years later. In the 2.5 years following attempts to obtain abortions, physical violence from the man involved in the pregnancy dropped for women who received abortions but not for those who gave birth.
My colleagues and I have just released a new white paper on the public health impacts of state-level abortion restrictions (PDF here). We summarize recently published studies on the impacts of laws that decrease access to abortion care, with the goal of providing accessible information for advocates and policymakers who are considering abortion legislation.
It’s always important for policymakers to consider evidence when passing new laws, and the Supreme Court recently affirmed the importance of evidence-based legislating for abortion specifically. The 2016 decision in Whole Woman’s Health v. Hellerstedt, which struck down provisions of a Texas law that led to abortion clinic closures, noted that compelling evidence of the law’s benefits to women’s health was missing, while evidence that it burdened women seeking abortions was strong.
When lawmakers want to undertake evidence-based policymaking on abortion, there is plenty of research for them to consider.