Abortion is generally a safe procedure, but the quality of abortion services varies throughout the United States by location, according to a comprehensive review of scientific data by the National Academies of Sciences, Engineering, and Medicine (NASEM). The last comprehensive report, in 1975, was published two years after abortion was legalized; the new report explores available scientific data on the procedure since then.
Trends. After peaking during the 1980s, the annual rate of legal abortions has been decreasing, from 29.3 per 1,000 women in 1980 to 14.6 per 1,000 women in 2014. The decline is attributed to greater use of long-acting contraception, reduced rates of unintended pregnancy, and increased state regulations limiting abortions.
Most abortions occur early in pregnancy, with 91.6% performed at 13 weeks' gestation or less. Abortion method is determined by length of gestation. Nearly 68% of abortions are performed by aspiration, followed by medication, dilation and evacuation, and induction of labor. The availability of abortion facilities has been decreasing. In 2014, 17% of women who had an abortion traveled more than 50 miles to a facility.
Safety. All four abortion procedures are safe and effective, with serious complications rare. Risks increase as gestational age increases because a more invasive procedure or sedation may be required. Having an abortion doesn't affect future childbearing or pregnancy outcomes, nor does it affect the risk of breast cancer or secondary infertility. Abortion isn't associated with an increased risk of depression, anxiety, or posttraumatic stress disorder.
Quality. Using six dimensions of health care quality-safety, effectiveness, patient centeredness, timeliness, efficiency, and equity-NASEM determined that abortion quality is highly dependent on where women live because "state regulations have created barriers to optimizing each dimension of quality care." For example, regulations can specify the type of clinician authorized to perform abortions, which may bar qualified providers, and they can mandate informed consent procedures that sometimes utilize inaccurate information. Other onerous regulations include restrictions on the abortion method, the timing of the procedure, and public and private insurance coverage.
The NASEM authors concluded that safety and quality are maximized when abortion is performed as early in pregnancy as possible. The Safety and Quality of Abortion Care in the United States is available at http://www.nationalacademies.org/reproductivehealth.-Joan Zolot, PA