OBJECTIVE: To conduct a retrospective observational cohort study to estimate the abortion complication rate, including those diagnosed or treated at emergency departments (EDs). METHODS:Using 2009-2010 abortion data among women covered by the fee-for-service California Medicaid program and all subsequent health care for 6 weeks after having an abortion, we analyzed reasons for ED visits and estimated the abortion-related complication rate and the adjusted relative risk. Complications were defined as receiving an abortion-related diagnosis or treatment at any source of care within 6 weeks after an abortion. Major complications were defined as requiring hospital admission, surgery, or blood transfusion. RESULTS:A total of 54,911 abortions among 50,273 feefor-service Medi-Cal beneficiaries were identified. Among all abortions, 1 of 16 (6.4%, n53,531) was followed by an ED visit within 6 weeks but only 1 of 115 (0.87%, n5478) resulted in an ED visit for an abortionrelated complication. Approximately 1 of 5,491 (0.03%, n515) involved ambulance transfers to EDs on the day of the abortion. The major complication rate was 0.23% (n5126, 1/436): 0.31% (n535) for medication abortion, 0.16% (n557) for first-trimester aspiration abortion, and 0.41% (n534) for second-trimester or later procedures. The total abortion-related complication rate including all sources of care including EDs and the original abortion facility was 2.1% (n51,156): 5.2% (n5588) for medication abortion, 1.3% (n5438) for first-trimester aspiration abortion, and 1.5% (n5130) for second-trimester or later procedures.CONCLUSION: Abortion complication rates are comparable to previously published rates even when ED visits are included and there is no loss to follow-up. 1 accurate estimates of abortion complications are paramount to assess and improve quality of care and determine how public policies can most effectively safeguard women's health. Although national abortion-related mortality data exist for the United States, 2 no surveillance system captures abortion-related morbidity. Studies find varying complication rates 3-7 depending on the procedure, weeks of gestation, length of follow-up, and protocols used to detect complications. Furthermore, complication rates are underestimated by low followup rates. 5,[7][8][9] Published complication rates are considered incomplete because they usually do not include those diagnosed at sites other than the original source of care. 10From the Advancing New Standards in Reproductive Health

PurposeThe decline in U.S. adolescent fertility has accelerated since 2007. Modeling fertility change using behavioral data can inform adolescent pregnancy prevention efforts.MethodsWe used data on sexual activity and contraceptive use from National Surveys of Family Growth for young women 15–19 years of age, and contraceptive failure rates, to estimate a Pregnancy Risk Index (PRI) for the periods 2007, 2009, and 2012. Logistic regression was used to test for change over time in sexual activity, contraceptive use, and PRI. Statistical decomposition was used to calculate attribution of change in the PRI to changes in sexual activity or contraceptive method use.ResultsSexual activity in the last 3 months did not change significantly from 2007 to 2012. Pregnancy risk declined among sexually active adolescent women (p = .046), with significant increases in the use of any method (78%–86%, p = .046) and multiple methods (26%–37%, p = .046). Use of highly effective methods increased significantly from 2007 to 2009 (38%–51%, p = .010). Overall, the PRI declined at an annual rate of 5.6% (p = .071) from 2007 to 2012 and correlated with birth and pregnancy rate declines. Decomposition estimated that this decline was entirely attributable to improvements in contraceptive use.ConclusionsImprovements in contraceptive use appear to be the primary proximal determinants of declines in adolescent pregnancy and birth rates in the United States from 2007 to 2012. Efforts to further improve access to and use of contraception among adolescents are necessary to ensure they have the means to prevent pregnancy.