Abortion policies should be based on evidence. Over the past four decades in the United States, we have accumulated more data about the practice of legal abortion than any other surgical procedure. This evidence has documented the public health impact of increased access to safer abortion. In recent years, state laws to restrict abortion access have gained momentum. An accompanying article in this issue of JPHP uses extant data to examine whether two restrictive policies have had a measurable effect on abortion morbidity. The analysis found an unexpected result – states which imposed restrictions had lower levels of abortion complications than those who did not. Various explanations exist for these findings. Caution is needed to interpret observational findings, especially with polarizing issues like abortion.
Abstract to the accompanying article:
Although US federal law requires all American states to permit abortion within their borders, states retain authority to impose restrictions. We used hospital discharge data to study the rates of major abortion complications in 23 states from 2001 to 2008 and their relationship to two laws: (i) restrictions on Medicaid – the state insurance programs for the poor – funding, and (ii) mandatory delays before abortion. Of 131 000 000 discharges in the data set, 10 980 involved an abortion complication. The national rate for complications was 1.90 per 1000 abortions (95 per cent CI: 1.57–2.23). Eleven states required mandatory delays and 12 restricted funding for Medicaid participants. After controlling for socio-economic characteristics and the pregnancy complication rate, legal restrictions were associated with lower complication rates: mandatory delays (OR 0.79 (0.65–0.95)) and restricted Medicaid funding (OR 0.74 (0.61–0.90)). This result may reflect the fact that states without restrictions perform a higher percentage of second-trimester abortions. This study is the first to assess the association between legal restrictions on abortion and complication rates.
Journal of Public Health Policy advance online publication 24 May 2012; doi: 10.1057/jphp.2012.15
Abortion policy and science: Can controversy and evidence co-exist?
Willard Cates Jr.a
University of North Carolina Gillings-Chapel Hill, School of Global Public Health
Journal of Public Health Policy advance online publication 24 May 2012; doi: 10.1057/jphp.2012.12
Legal restrictions and complications of abortion: Insights from data on complication rates in the United States
Joshua A Rolnicka and John S Vorhiesb
Stanford University Department of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
Stanford University Department of Orthopaedics, 450 Broadway Street, Pavilion C, Redwood City, CA 94063, USA.
Correspondence: Joshua A Rolnick, E-mail: Joshr1@stanford.edu