Abstract
BackgroundMedia depictions and laws passed in state legislatures regulating abortion suggest abortion-related medical emergencies are common. An accurate understanding of abortion-related emergencies is important for informing policy and practice. We assessed the incidence of abortion-related emergency department (ED) visits in the United States (U.S.).MethodsWe used a retrospective observational study design using 2009–2013 data from the Nationwide Emergency Department Sample, a nationally representative sample of U.S. ED visits from 947 to 964 hospitals across the U.S. per year. All ED visits among women of reproductive age (15–49) were included. We categorized ED visits by abortion relatedness and treatments received, and assessed whether the visit was for a major incident (defined as requiring blood transfusion, surgery, or overnight inpatient stay). We estimated the proportion of visits that were abortion-related and described the characteristics of patients making these visits, the diagnoses and subsequent treatments received by these patients, the sociodemographic and hospital characteristics associated with the incidents and observation care only (defined as receiving no treatments), and the rate of major incidents for all abortion patients in the U.S.ResultsAmong all ED visits by women aged 15–49 (189,480,685), 0.01% (n = 27,941) were abortion-related. Of these visits, 51% (95% confidence interval, 95% CI 49.3–51.9%) of the women received observation care only. A total of 20% (95% CI 19.3–21.3%) of abortion-related ED visits were for major incidents. One-fifth (22%, 95% CI 20.9–23.0%) of abortion-related visits resulted in admission to the same hospital for abortion-related reasons. Of the visits, 1.4% (n = 390, 95% CI 1.1–1.7%) were potentially due to attempts at self-induced abortion. In multivariable models, women using Medicaid (adjusted odds ratio, AOR 1.28, 95% CI 1.08–1.52) and women with a comorbid condition (AORs 2.47–4.63) had higher odds of having a major incident than women using private insurance and those without comorbid conditions. During the study period, 0.11% of all abortions in the U.S. resulted in major incidents as seen in EDs.ConclusionsAbortion-related ED visits comprise a small proportion of women’s ED visits. Many abortion-related ED visits may not be indicated or could have been managed at a less costly level of care. Given the low rate of major incidents, perceptions that abortion is unsafe are not based on evidence.
Highlights
Media depictions and laws passed in state legislatures regulating abortion suggest abortion-related medical emergencies are common
70 visits were determined to be unrelated to abortion based on clinician review and 33 visits were duplicates; these 103 visits were excluded, leaving an analytical sample of 6239 unweighted abortion-related emergency department (ED) visits
The final analytical sample corresponded to 27,941 weighted ED visits for abortion-related reasons among 189,480,685 weighted ED visits among women of reproductive age
Summary
Media depictions and laws passed in state legislatures regulating abortion suggest abortion-related medical emergencies are common. Since 2011, state legislatures across the U.S have passed numerous laws that regulate abortion provision, many requiring abortion providers to obtain local hospital admitting privileges and have transfer agreements with nearby hospitals [3]. These laws are passed under a presumption that they are needed to protect women’s health and safety [4, 5] and that hospitalization as a result of abortion is an occurrence frequent enough to necessitate legislation formalizing the relationship between hospitals, abortion providers, and clinics. In a study of outcomes of abortion procedures by family physicians in New York and Philadelphia, 0.3% of first-trimester medication and aspiration abortion patients were referred or went to an ED for assessment [7]
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