Abortion-related emergency department visits in the United States: An analysis of a national emergency department sample

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.

Texas women’s decisions and experiences regarding self-managed abortion

“…None of the qualitative interview participants here reported that their selfmanaged abortion resulted in medical complications; however, we found in the survey of abortion patients that some women did report getting hit in the abdomen to try to end the pregnancy. Little is known about whether women are presenting to emergency departments or other clinical settings with medical complications after abortion self-induction; one study estimated 1.4% of abortion-related emergency department visits between 2009 and 2013 may be due to attempts at selfmanaged abortion [13].…”

Consideration of and Reasons for Not Obtaining Abortion Among Women Entering Prenatal Care in Southern Louisiana and Baltimore, Maryland

“…We note that the numbers for these outcomes are very small and that cross-state comparisons should be interpreted with caution. In the case of self-induction, in particular, we believe that it is still important to describe women's experiences with self-induction because very little data exist (with few exceptions) (Grossman et al, 2010;Jerman, Onda, & Jones, 2018;Upadhyay et al, 2018) about women's experiences with self-induction, especially unsuccessful self-induction attempts after which women continue their pregnancies. We note that there are some inconsistencies in reporting around self-induction attempts, i.e., that a few women who said they attempted self-induction did not report considering abortion, pointing to the importance of future research on this topic.…”

Perspectives on self-managed abortion among providers in hospitals along the Texas–Mexico border

“…This is in part because complications are rare after abortion: one study in California of over 500,000 abortion patients in 2009–2010 found that 0.9% visited an ED for an abortion-related complication within 6 weeks of the abortion [ 14 ]. A national study found that 0.01% of all ED visits by women aged 15–49 in 2009–2013 were abortion-related, of which 51% required only observation without treatment [ 15 ]. Patients who travel farther to access abortion services are more likely to seek care in an ED in case of a possible complication after returning home, suggesting that as facility-based abortion care becomes more difficult to access—or even non-existent in some states—more patients may present to EDs for abortion-related care [ 16 ].…”

“…National data suggest that ED visits related to SMA in particular are even less common, representing 1.4% of abortion-related ED visits. Higher rates of SMA-related ED visits were documented in the South (2%) compared to the Midwest (1%), West (1.1%), and Northeast (1.3%) [ 15 ]. There are research gaps in our understanding of the provision of SMA-related treatment in the hospital setting.…”