Abstract
Trends in abortion care in the United States are changing quickly, affected by many epidemiological factors as well as a varying political climate. Surgical abortions are the more common method of conducting abortion care. Recent CDC National Surveillance Data has shown an increase in second-trimester abortion, correlating to an increased need for providers experienced in surgical abortions and cervical preparation agents, such as misoprostol, mifepristone, and laminaria. Furthermore, recent studies have shown an increase in long-acting reversible contraceptive options including post-abortion contraceptive use. We hoped to compare the trends in abortion of pregnancy in our low-resource urban environment against the national trends to better understand what demographic factors might influence decision-making. We identified a need for studies on trends in abortions of pregnancy in a low-resource urban setting which can become applicable across similar neighborhoods, some of which might not participate in CDC abortion surveillance reports. Our study shows an increase in dilation and evacuation procedures, correlating with an increase in the use of misoprostol and laminaria for cervical preparation as well as digoxin for induction of fetal demise, both of which would occur at higher frequency in the second trimester. We also found a preference towards no contraception after abortion, which slightly differs from national trends in recent years. Our study aims to evaluate these trends and identify the need for further quality assurance and improvement in this care.
Highlights
The landscape of abortion care in the US has changed significantly over the past decade
Recent CDC National Surveillance Data has shown an increase in second-trimester abortion, correlating to an increased need for providers experienced in surgical abortions and cervical preparation agents, such as misoprostol, mifepristone, and laminaria
We identified a need for studies on trends in abortions of pregnancy in a low-resource urban setting which can become applicable across similar neighborhoods, some of which might not participate in CDC abortion surveillance reports
Summary
The landscape of abortion care in the US has changed significantly over the past decade. According to the 2018 CDC Abortion Surveillance Report, while the total number of abortions in the US has decreased, the number of second-trimester abortions has increased [1]. It is important to consider that the data is incomplete, as many states do not mandate reporting of abortion data. This disparity further highlights the need for identification of nationally generalizable community-based trends. While the rate of medication abortions has increased over the years, surgical abortions remain the more popular choice in the US [1]. Misoprostol is an especially popular choice for second trimester abortion cervical preparation, when the risk of complications due to manual dilation of the cervix during a surgical abortion is higher. The recent increase in proportion of second trimester abortions may have contributed in part to the rise of misoprostol use [4, 5]
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