There’s no significant difference in adverse events for abortions performed in ambulatory surgery centers versus office-based settings.
That’s the conclusion of a new observational study led by Sarah C. M. Roberts, DrPH, an associate professor at the University of California San Francisco (UCSF).
Several states have laws that require abortion facilities to meet the standards of ambulatory surgery centers.
So, Roberts and her colleagues set out to compare abortion-related morbidities and adverse events in the two types of settings.
Their research spanned from 2011 through 2014.
Included were 49,287 women from all 50 states. All had private health insurance.
Of 50,311 induced abortions, about 3 percent involved an adverse event.
Abortion-related complications were listed as infection, hemorrhage, perforation of the uterus, and tissue remaining in the uterus within six weeks of the abortion.
In addition, 0.32 percent involved a major adverse event. This would include hemorrhage requiring a transfusion or infection that resulted in a hospital stay.
There were no maternal deaths among the study cohort.
“These findings, in addition to individual patient and individual facility factors, may inform decisions about the type of facility in which induced abortions are performed,” wrote the study authors.
Full details of the research are published in the Journal of the American Medical Association (JAMA).
Roberts and her colleagues acknowledge that the study is limited in that it only included abortions paid for by private insurance.
Only about 15 percent of abortions in the United States are paid for by private health insurance.
Even among patients who have private insurance, 61 percent pay for an abortion out of pocket.
Dr. Carolyn L. Westhoff and Dr. Anne R. Davis, both from the Columbia University Medical Center in New York, provided an editorial response to the research.
“Thus, we can only assume that the rate of adverse events among self-pay patients would not be different from the women studied and would not be differentially related to their source of care,” they wrote.
They also noted that the study did not include hospital-associated sites. That would include outpatient, inpatient, and emergency department visits.
Eric J. Scheidler, executive director for the Pro-Life Action League, sees these limitations as a problem.
“What is most concerning is that the data comes from insurance carriers,” he told Healthline. “You have to wonder how valid this research is when the vast majority of women getting an abortion don’t have insurance.”
Scheidler believes the study has some questionable objectivity and data.
“Another problem is that we know that women who have a complication will often not disclose if they had an abortion,” he said.
Effects of TRAP law
Westhoff and Davis call the study’s comparison important because 16 states currently have restrictions on abortion clinics requiring adherence to surgery center standards.
Additional states impose other requirements on facilities that are not necessary for patient safety.
And, in some cases, surgery center requirements have been applied to doctors’ offices and clinics that provide only medication abortions.
These additional regulations are known as targeted regulation of abortion providers (TRAP) laws.
Westhoff and Davis say such requirements have no medical justification and will likely restrict women’s access to abortion.
“Office-based abortion care fulfills all domains of healthcare quality: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. Office-based abortion care should remain an available option for women,” they wrote.
Scheidler says he welcomes these restrictions.
“It’s not just a question of health and safety standards. Making abortion safer is not our real goal. It’s making abortion unthinkable,” said Scheidler.
The American College of Obstetricians and Gynecologists (ACOG) has long held the position that TRAP laws create barriers to abortion access.
The organization calls for “advocacy to oppose and overturn restrictions, improve access, and mainstream abortion as an integral component of women’s healthcare.”
In 2013, Texas enacted a law requiring every doctor performing abortions to have admitting privileges at a nearby hospital. The law also required abortion clinics to have facilities comparable to surgery centers.
Three years later, the U.S. Supreme Court decided these two restrictions were unconstitutional under the undue burden standard.
In a statement on that decision, the ACOG wrote:
“As the court found, it was clear that the ambulatory surgical center and admitting privileges requirements at the heart of Texas law HB 2 did not improve the safety of women, and served only as a barrier to women’s ability to access safe, legal abortion when needed.”
Planned Parenthood issued a press release in response to the Roberts study.
“TRAP laws requiring that abortions be performed in ASCs are not based in science and are not written by doctors or medical experts — they’re written by extreme politicians whose real goal is to make it difficult or even impossible for patients to get a safe and legal abortion,” said Dr. Gillian Dean, senior director of medical services for the organization.
The Planned Parenthood statement also addresses how TRAP laws affect patients.
“Because of unnecessary restrictions, patients are forced to travel hundreds of miles, sometimes crossing state lines, and wait for weeks to have an abortion — if they can access services at all. These restrictions often have a disproportionate impact on communities of color, who already face systemic barriers in accessing quality health care,” they wrote.