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Pages 1-16

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From page 1...
... With this growing body of research, medical and surgical abortion methods have been refined or discontinued, and new techniques have been developed. In 2016, six private foundations came together to ask the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine to conduct a comprehensive review of the state of the science on the safety and quality of legal abortion services in the United States.
From page 2...
... 5.  What is the evidence on what clinical skills are necessary for health care providers to safely perform the various components of abortion care, in cluding pregnancy determination, counseling, gestational age assessment, medication dispensing, procedure performance, patient monitoring, and follow-up assessment and care?
From page 3...
... 3.  Patient-centeredness -- providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.
From page 4...
... 4 FIGURE S-1  Analytic framework for assessing the quality of abortion care. NOTE: OB/GYN = obstetrician/gynecologist.
From page 5...
... and implants) , historic declines in the rate of unintended pregnancy, and increasing numbers of state regulations that limit the availability of otherwise legal abortion services.
From page 6...
... Federal restrictions on the distribution of mifepristone (one of the drugs used in medication abortion) also merit attention given its increasing use and the extensive body of research demonstrating its safety and effectiveness.
From page 7...
... ; health insurance coverage (e.g., Medicaid or private insurance plans may be prohibited from paying for abortions) ; how the informed consent process is conducted (e.g., providers may be required to inform women that abortion increases their risk of breast cancer or mental illness, despite the absence of valid scientific evidence)
From page 8...
...  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)
From page 9...
... after 14 weeks' gestation. A history of a prior cesarean delivery is not a risk factor for women undergoing medication or aspiration abortions, but it may be associated with an increased risk of complications during D&E abortions, particularly for women with multiple cesarean deliveries.
From page 10...
... If moderate sedation is used, the facility should have emergency resuscitation equipment and an emergency transfer plan, as well as equipment to monitor oxygen saturation, heart rate, and blood pressure. For D&Es that involve deep sedation or general anesthesia, the facility should be similarly equipped and also have equipment to provide general anesthesia and monitor ventilation.
From page 11...
... ; •  rohibit qualified clinicians (family medicine p physicians, certified nurse-midwives, nurse practitioners, and physician assistants) from performing abortions; •  equire the informed consent process to r include inaccurate information on abortion's long-term physical and mental health effects; •  equire individual clinicians to have hospital r privileges; •  ar publicly funded clinics from providing b abortion care to low-income women; or •  andate clinically unnecessary services (e.g., m preabortion ultrasound, in-person counseling visit)
From page 12...
... Patients' patient values ability to be adequately informed in order to guide all clinical make sound medical decisions is impeded when decisions. state regulations require that •  omen be provided inaccurate or misleading w information about abortion's potential harms; and •  omen's preferences for whether they want w individualized counseling not be taken into consideration.
From page 13...
... Required skills  All abortion procedures require competent providers skilled in patient preparation (education, counseling, and informed consent) ; clinical assessment (confirming intrauterine pregnancy, determining gestation, taking a relevant medical history, and physical examination)
From page 14...
... If moderate sedation is used during an aspiration abortion, the facility should have emergency resuscitation equipment and an emergency transfer plan, as well as equipment to monitor oxygen saturation, heart rate, and blood pressure. D&Es that involve deep sedation or general anesthesia should be provided in similarly equipped facilities that also have equipment to monitor ventilation.
From page 15...
... Some women still report high levels of pain, and researchers are exploring new ways to provide prophylactic pain management for medication abortion. The pharmaceutical options for pain management during aspiration, D&E, and induction abortions range from local anesthesia, to minimal sedation/anxiolysis, to moderate sedation/analgesia, to deep sedation/ analgesia, to general anesthesia.
From page 16...
... More research is needed to learn how best to reduce the pain women experience during abortion procedures. Research on prophylactic pain management for women undergoing medication abortions is also needed.


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