Medical, Surgical Abortions Are Very Safe: Review
When the U.S. Supreme Court overturned the landmark Roe v. Wade ruling last June, many feared that abortion bans would jeopardize the health of pregnant women.
Several months later, a conservative group known as the Alliance Defending Freedom sued the U.S. Food and Drug Administration to reverse their decades-old approval of the abortion pill mifepristone, claiming lingering safety concerns over the medication.
But a new study of more than 39,000 Canadian women shows that both medical (pill-based) and surgical first-trimester abortions are safe and effective, although there were slightly more complications seen with medical abortion, the study showed.
Medical abortion involves two drugs that can end an early pregnancy: mifepristone and misoprostol. Mifepristone blocks the hormone progesterone, which is needed for pregnancy, and the misoprostol brings on cramping and bleeding to empty the uterus.
“Adverse effects are infrequent following both early procedural [surgical] and early medical abortion,” said Dr. Christine Laine, senior vice president of the American College of Physicians. She is also the editor-in-chief of the Annals of Internal Medicine, where the new study was published online Jan. 3.
“While slightly more adverse events occurred following medical abortion, complications were infrequent in this setting where pregnant persons wishing to terminate a pregnancy can get the necessary medication free at an outpatient pharmacy with a prescription from a physician and end the pregnancy safely,” Laine said.
More than half of U.S. abortions are now done using pills rather than surgery, according to information from the Guttmacher Institute, a research group that supports abortion rights.
The FDA just took a big step toward improving access to mifepristone. Drug store chains like CVS and Walgreens can now dispense this medication if they agree to specific rules. Until now, mifepristone could only be dispensed by mail-order pharmacies or certified doctors or clinics.
For the new study, researchers looked at complications among women who underwent a mifepristone-misoprostol medication abortion, an abortion in a clinic, or an abortion in a hospital in Ontario, Canada, from 2017 to 2020.
Severe complications, including the need for a gynecologic procedure, intensive care, bleeding requiring a blood transfusion or infection, occurred in only 3.3 per 1,000 women after medication and 1.8 per 1,000 women after a procedure in a hospital-based clinic, the study showed.
The new study took place in Canada, but both types of abortion can be equally safe in the United States, said Carol Hogue, a professor emeritus of epidemiology at the Rollins School of Public Health of Emory University, in Atlanta.
“Abortion procedures are extremely safe, with a mortality rate in the United States that is comparable to that from common treatments like dental procedures,” said Hogue, who wrote an editorial accompanying the new study.
For comparison, abortion-related deaths were 0.43 per 100,000 procedures from 2013 to 2019, whereas the maternal death rate in 2020 was 23.8 per 100,000 live births, she said.
“If all abortions are denied, maternal mortality would increase by 24% overall and by 39% among non-Hispanic Black women, who have higher rates of unintended pregnancy as well as higher risk of death for a continuing pregnancy,” Hogue said.
The number of pregnant women who die giving birth may decrease with the elimination of existing abortion restrictions, she noted.
The only way to lower abortion rates is to eliminate preventable unintended and unwanted pregnancies, Hogue said. “If all heterosexual couples prevent conception by using the best long-acting reversible contraceptives or permanent contraception, an estimated 80% of unplanned pregnancies and abortions among those couples could be prevented,” she explained.
Unfortunately, many couples can't afford the best methods or live in reproductive health care deserts. The Right to Contraception Act aims to help folks afford and access contraception, she said. This Bill died in the Senate, but may be resurrected in the future.
The Kaiser Family Foundation has up-to-date information on abortion access in the United States.
SOURCES: Carol Hogue, PhD, MD, professor emeritus, epidemiology, Rollins School of Public Health, Emory University, Atlanta; Christine Laine, MD, MPH, editor-in-chief, Annals of Internal Medicine, and senior vice president, American College of Physicians, Philadelphia; Annals of Internal Medicine, Jan. 3, 2023, online