The number of abortion facilities in the United States has been declining, and many midwestern and southern states have few abortion clinics left. In response, supporters of legal abortion have advanced some medically risky proposals to expand abortion access. For instance, in 2013, the California state legislature passed a bill allowing nurses and midwives, in addition to doctors, to perform abortions. In 2008, Planned Parenthood in Iowa began offering “telemed” abortions – chemical abortions administered to patients who ingest abortion-inducing medication without a physician physically present. In 2016, abortion facilities in Maine also started offering telemed abortions.
Many people are concerned about the safety of this type of abortion procedure. In fact, 19 states have passed legislation banning the practice, putting supporters of legal abortion on the defensive. Last week, the journal Obstetrics & Gynecology published a study, which purports to show that telemed abortions taking place in Iowa are as safe as medical abortions performed under the supervision of a physician. The study has received sympathetic coverage from a number of media outlets, including HuffPost, Mother Jones, and Iowa Public Radio.
The Obstetrics & Gynecology study analyzes data from over 19,000 women in Iowa who underwent medical abortions between 2008 and 2015. Specifically, the study compares the health outcomes of women who had telemed abortions to those of women who had medical abortions with a physician present. The results indicate that these two groups of women had a similar likelihood of subsequently experiencing an adverse medical event, such as an emergency-room visit, hospitalization, or a blood transfusion.
Even though this study appears to be comprehensive, it has a number of shortcomings. For example, it is well documented in peer-reviewed research that, as a pregnancy progresses, the risk of complications from an abortion procedure increases. This study did not hold constant the gestational age of the unborn child in each case, making it difficult to compare outcomes. Similarly, the chances of an adverse medical event might also be affected by the age of the mother, her income, and her past medical history; the study also failed to hold constant these important factors. Finally, the data on adverse outcomes following abortion procedures were collected from surveys of a wide variety of Iowa hospitals, and the survey reported only a 35 percent response rate. The authors also admit that some of the responders may not have reviewed medical records and instead relied only on their recall of the events in question, making it extremely likely that some adverse events were misremembered or not included.
These flaws in the study make it difficult to take its results at face value, especially given the results of previous studies on this topic. A 2015 study on the safety of medical abortion in California — which obtained comprehensive and reliable data from Medicaid billing records rather than surveys — found that .31 percent of California women who obtained medical abortions experienced a major complication of some kind. Comparing those results to the findings of the Obstetrics & Gynecology study, California women are supposedly 21 percent more likely to experience a major complication after a medical abortion than Iowa women, suggesting that this recent study of medical abortion in Iowa likely missed some instances of complications.
Furthermore, the 2015 study of California — again, which had comprehensive health data on women who obtained abortions – found that medical abortions resulted in four times the complication rate as first-trimester surgical abortions. Given that chemical abortions are already more risky than early surgical abortions, it stands to reason that medical abortions performed without physician supervision can only increase those risks.
Good data on medical abortions show that they pose significant health risks to women. The concerns of pro-lifers and other public-health professionals about the safety of telemed abortions are well founded.