National Partnership for Women & Families

Monthly Women's Health Research Review

Study Evaluates Health Consequences for Women Provided, Denied Abortion Care

Summary of "Side Effects, Physical Health Consequences, and Mortality Associated With Abortion and Birth After an Unwanted Pregnancy," Gerdts et al., Women's Health Issues, Nov. 11, 2015.

"In the context of unwanted pregnancy (defined herein as a pregnancy that the woman wanted to terminate), there are few data that compare the health consequences of having an abortion versus carrying the pregnancy to term," according to Caitlin Gerdts of Ibis Reproductive Health in Oakland, Calif., and colleagues.

The researchers assessed "[d]ata from the Turnaway Study, which follows women seeking abortion just under and just beyond the gestational age limit at abortion facilities across the United States, documents women's own reports of the side effects and physical health consequences experienced after abortion, or, if they were turned away after seeking abortion, ongoing pregnancy and birth." According to the researchers, "By asking women to report on the range of physical health effects of their abortion or birth, the Turnaway Study provides documentation of women's physical health experiences beyond what is captured by medical records of women who seek to terminate a pregnancy."

For the study, the researchers "examine[d] Turnaway Study participants' self-reported physical health consequences following birth and abortion, to document more comprehensively the morbidity and mortality associated with unwanted pregnancy."

Materials and Methods

The Turnaway Study examined women seeking abortion care at 30 clinics throughout the United States; some of the women were unable to obtain an abortion "because of advanced gestational age." Turnaway Study participants were interviewed twice a year by phone for five years. Gerdts and colleagues used data from the Turnaway Study's initial interviews and six-month interviews.

The Turnaway Study participants visited one of the 30 facilities between January 2008 and December 2010. Participants were assigned to one of three groups depending "on their gestational age at the time they sought an abortion":

  • The turnaway group, which included women who were denied an abortion after presenting for abortion care "at a facility up to 3 weeks over the facility's gestational age limit";
  • The near limit abortion group, which included women who obtained an abortion after presenting for abortion care "within 2 weeks under the facility's gestational age limit"; and
  • The first trimester abortion group, which included women who obtained abortion care in the first trimester.

For each study participant from the turnaway group, the researchers "sought two near limit group participants and one first trimester abortion group participant from the same facility." The researchers explained, "The first trimester abortion group was included to assess how the experiences of women in the near limit group compared with the more typical experience of abortion in the United States, where 90% of abortions occur in the first trimester."

Participants in each group were asked open-ended questions to assess the "physical health effects of birth and abortion." Their responses were categorized according to ICD-10 disease classifications. Health issues were considered potentially life-threatening "if any maternal deaths had been recorded in the United States from a related cause in the most recent 5 years of available data." Maternal mortality was defined as "'the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.'"

Results

The final study sample included "868 participants; 452 in the near limit abortion group, 143 in the turnaway group, and 273 first trimester abortion group."

The researchers found that, "[o]n average, turnaway group participants reported 10.1 days of limitations on physical activity ... after giving birth compared with an average 2.9 days of limitations on physical activity reported by women obtaining abortions in both the near limit group ... and an average 3.2 days reported by the first trimester group ... after pregnancy termination."

The researchers also found that "[t]he total percentage of women who reported any side effects or health problems did not significantly differ by whether the pregnancy ended in birth [11.2%], first trimester abortion [10.3%], or abortion later in pregnancy [12.2%]." According to the researchers, "[t]he most common side effects/health problems reported by women following abortion in the near limit and first trimester groups were: pain (4% and 3%), cramps (3% and 3%), abnormal bleeding (2% and 2%), and nausea/vomiting (1% and 3%), respectively."

Among women in the turnaway group, preeclampsia was the most common side effect/health problem (2%). Other health problems reported by women who gave birth included "abnormal bleeding, anemia, blood transfusion, life-threatening eclampsia, extended postoperative wound healing, fractured pelvis, hypokalemia, infection, postpartum hemorrhage, and retained placenta (1% each)." Overall, according to the researchers, "[a] greater percentage of women in the turnaway group [6.3%] who gave birth reported potentially life-threatening conditions, compared with 1.1% of women ... in the near limit group."

The researchers reported one maternal death: A woman who was denied an abortion died "within 10 days of delivery from an infection that is associated with a higher risk of mortality in pregnant women relative to nonpregnant women."

Discussion

According to the researchers, the study findings "are consistent with the large body of evidence documenting both the safety of abortion and the higher rates of morbidity and mortality associated with birth compared with abortion."

The researchers noted that while women in the turnaway group "did not frequently report common side effects from childbirth," women who obtained abortion care "did, however, report common side effects from" the procedure. The researchers explained that women who give birth "expect to experience some level of health complications and changes in their bodies postpartum ... which women who have abortions may less fully expect." Another "possible explanation of this phenomenon is that cultural stigma against abortion, cultural perceptions of abortion as unsafe, along with state-mandated misinformation in abortion consent materials ... may lead women to be more concerned about physical health effects that they experience immediately after an abortion and therefore more likely to report even mild health effects." The researchers suggest that discussing these issues with women seeking abortion care "may help women to better understand the abortion process."

The researchers also found that while "women in the near limit abortion group largely had abortions in the second trimester ... the frequency of side effects/health problems reported by near limit abortion participants was no different from those reported by women after first trimester abortions." Further, the researchers found that no participants who obtained abortion care experienced maternal death or "severe or life-threatening health problems." In addition, "the mean period of limitation on physical activity for women who had abortions was similar whether women were in the first trimester group or the near limit groups," the researchers wrote.

In contrast, the researchers noted that "women in the turnaway group reported potentially life-threatening health problems -- such as eclampsia and postpartum hemorrhage, and more than three times the average length of limitations on physical activity after birth, compared with women who obtained abortions." Further, the researchers wrote that the "finding that one maternal death occurred among women enrolled in [the] study who were denied abortions underscores the reality of an increased risk of death faced by women who are denied abortion services."

The researchers concluded that the findings "reinforce the existing data on the safety of induced abortion when compared with childbirth, and highlight the risk of serious morbidity and mortality associated with childbirth after an unwanted pregnancy."