Abortion is a legal medical procedure that has been provided to millions of American women. Since the Institute of Medicine first reviewed the health implications of national legalized abortion in 1975, there has been a plethora of related scientific research, including well-designed randomized clinical trials, systematic reviews, and epidemiological studies examining abortion care. This research has focused on examining the relative safety of abortion methods and the appropriateness of methods for different clinical circumstances. With this growing body of research, earlier abortion methods have been refined, discontinued, and new approaches have been developed.

The Safety and Quality of Abortion Care in the United States offers a comprehensive review of the current state of the science related to the provision of safe, high-quality abortion services in the United States. This report considers 8 research questions and presents conclusions, including gaps in research.

Contents

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• COMMITTEE ON REPRODUCTIVE HEALTH SERVICES: ASSESSING THE SAFETY AND QUALITY OF ABORTION CARE IN THE U.S.
• Reviewers
• Acknowledgments
• Summary
  • CONTEXT FOR THIS REPORT
  • CONCLUSIONS
• 1. Introduction
  • ABORTION CARE TODAY
  • STUDY APPROACH
  • ORGANIZATION OF THE REPORT
  • REFERENCES
• 2. The Safety and Quality of Current Abortion Methods
  • PREABORTION CARE
  • INITIAL CLINICAL ASSESSMENT
  • SAFETY AND EFFECTIVENESS OF CURRENT ABORTION METHODS
  • POSTABORTION CARE
  • USE OF ANALGESIA, SEDATION, AND ANESTHESIA IN ABORTION CARE
  • MORTALITY
  • STATE REGULATION OF ABORTION CARE
  • SUMMARY
  • REFERENCES
• 3. Essential Clinical Competencies for Abortion Providers
  • REQUIRED CLINICAL COMPETENCIES
  • WHICH PROVIDERS HAVE THE CLINICAL SKILLS TO PERFORM ABORTIONS?
  • TRAINING OF PHYSICIANS AND ADVANCED PRACTICE CLINICIANS
  • AVAILABILITY OF TRAINED CLINICIANS
  • SUMMARY
  • REFERENCES
• 4. Long-Term Health Effects
  • LIMITATIONS OF THE LITERATURE
  • FUTURE CHILDBEARING AND PREGNANCY OUTCOMES
  • RISK OF BREAST CANCER
  • MENTAL HEALTH DISORDERS
  • PREMATURE DEATH
  • SUMMARY
  • REFERENCES
• 5. Conclusions
  • 1. What types of legal abortion services are available in the United States? What is the evidence regarding which services are appropriate under different clinical circumstances (e.g., based on patient medical conditions such as previous cesarean section, obesity, gestational age)?
  • 2. What is the evidence on the physical and mental health risks of these different abortion interventions?
  • 3. What is the evidence on the safety and quality of medical and surgical abortion care?
  • 4. What is the evidence on the minimum characteristics of clinical facilities necessary to effectively and safely provide the different types of abortion interventions?
  • 5. What is the evidence on what clinical skills are necessary for health care providers to safely perform the various components of abortion care, including pregnancy determination, counseling, gestational age assessment, medication dispensing, procedure performance, patient monitoring, and follow-up assessment and care?
  • 6. What safeguards are necessary to manage medical emergencies arising from abortion interventions?
  • 7. What is the evidence on the safe provision of pain management for abortion care?
  • 8. What are the research gaps associated with the provision of safe, high-quality care from pre- to postabortion?
• APPENDIXES
  • Appendix A. Biographical Sketches of Committee Members
  • Appendix B. Acronyms and Glossary
  • Appendix C. Public Meeting Agenda
  • Appendix D. Literature Search Strategy

Suggested citation:

National Academies of Sciences, Engineering, and Medicine. 2018. The safety and quality of abortion care in the United States. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24950.