By Lisa Rapaport
(Reuters Health) – – Women who get abortions at clinics or doctors’ offices may be no more likely to experience serious complications than patients who have these procedures at surgery centers, a U.S. study suggests.
Thirteen U.S. states have laws requiring abortions to be provided at surgery centers, the study authors point out in JAMA. These laws include requirements such as specific widths of doors or hallways or separate rooms for procedures and recovery.
“The rationale for these laws is that they are necessary for the safety of abortion patients,” said study leader Sarah Roberts, a researcher at the University of California, San Francisco, in an email. “Our study indicates that these laws are not evidence-based.”
To compare rates of complications within six weeks after an abortion, researchers looked at claims data for women with private health insurance who terminated pregnancies between 2011 and 2014. Overall, they had data on more than 50,000 medical and surgical abortions.
At surgery centers, 3.25 percent of women had complications related to abortions, compared with 3.33 percent at other locations. This difference was too small to rule out the possibility that it was due to chance.
There was no meaningful difference between surgery centers and office-based care for emergency room visits, diagnoses of complications, repeat procedures, or use of injected or intravenous antibiotics to treat infections.
There were no deaths.
Most abortions happened in office-based settings. About 11 percent were performed in surgery centers.
Women were 28 years old on average, although they ranged in age from 11 to 59.
Overall, 47 percent of the patients had first trimester surgical abortions. These procedures typically involved vacuum or suction aspiration to remove uterine contents through the cervix, a type of induced abortion that is common when women have a miscarriage.
Another 27 percent of the women had first trimester medical abortions. With this option, which women can do at home, patients take one drug that breaks down the uterine lining followed by a second drug to empty the uterus. Then, typically they have a checkup two weeks later to confirm that the pregnancy was terminated.
The remaining 26 percent of women in the study had surgical abortions after the start of the second trimester.
The study wasn’t a controlled experiment designed to prove whether or how the location of an abortion might influence safety. Another limitation is that researchers lacked data on the exact week of pregnancy that women had abortions, which can influence their risk of complications.
In addition, only about 15 percent of the almost 1 million abortions performed each year in the U.S. are paid for by private insurance, the study authors note, so the results might be different for women with other forms of coverage like Medicaid, the U.S. health program for the poor.
Even so, the results underscore the safety of abortions provided in office settings as well as surgery centers, Dr. Carolyn Westhoff of Columbia University Medical Center in New York City and colleagues write in an accompanying editorial.
“Abortion care made an early shift to the office setting, for the universal reasons of convenience and cost reduction, and because the majority of abortions are technically simple and safe,” Westhoff and colleagues write. “Office-based abortion care should remain an available option for women.”
In 2016, the U.S. Supreme Court ruled that a Texas law requiring all abortion facilities to meet regulatory standards in place for ambulatory surgery centers was unconstitutional.