Skip to main content

Currently Skimming:

1 Introduction
Pages 17-44

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 17...
... 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. The sponsors -- The David and Lucile Packard Foundation, The Grove Foundation, The JPB Foundation, The Susan Thompson Buffett Foundation, Tara Health Foundation, and William and Flora Hewlett Foundation -- asked that the review focus on the eight research questions listed in Box 1-1.
From page 18...
... o ­ bstetrics and gynecology, nursing and midwifery, primary care, epidemiology of reproductive health, mental health, health care disparities, health care delivery and management, health law, health professional education and training, public health, quality assurance and assessment,
From page 19...
... ABORTION CARE TODAY Since the IOM first reviewed the health implications of national legalized abortion in 1975, there has been a plethora of related scientific research, including well-designed randomized controlled trials (RCTs) , systematic reviews, and epidemiological studies examining abortion care.
From page 20...
... ; communication of information on the risks and benefits of alternative abortion procedures and pain management options; discussion of the patient's preferences based on desired anesthesia and weeks of gestation; discussion of postabortion contraceptive options if desired; counseling
From page 21...
... This report also avoids using the term "trimester" where possible because completed weeks' or days' gestation is a more precise designation, and the clinical appropriateness of abortion methods does not align with specific trimesters. Although the literature typically classifies the method of abortion as either "medical" or "surgical" abortion, the committee decided to specify methods more precisely by using the terminology defined in Box 1-2.
From page 22...
... The regulations range from prescribing information to be provided to women when they are counseled and setting mandatory waiting periods between counseling and the abortion procedure to those that define the clinical qualifications of abortion providers, the types of procedures they are permitted to perform, and detailed facility standards for abortion services. In addition, many states place limitations on the circumstances under which private health insurance and Medicaid can be used to pay for abortions, limiting coverage to pregnancies resulting from rape or incest or posing a medical threat to the pregnant woman's life.
From page 23...
... INTRODUCTION 23 TABLE 1-1  Overview of State Abortion-Specific Regulations That May Impact Safety and Quality, as of September 1, 2017 Number Type of Regulationa States of States An ultrasound must be performed before all AL, AZ, FL, IA, IN, KS, 14 abortions, regardless of method LA, MS, NC, OH, OK, TX, VA, WI Clinicians providing medication abortions AL, AR, AZ, IN, KS, LA, 19 must be in the physical presence of the MI, MO, MS, NC, ND, patient when she takes the medication NE, OK, SC, SD, TN, TX, WI, WV Women must receive counseling before an AL, AK, AR, AZ, CA,b 35 abortion is performed CT,b FL, GA, IA, ID, IN, KS, KY, LA, ME,b MI, MN, MO, MS, NC, ND, NE, NV,b OH, OK, PA, RI,b SC, SD, TN, TX, UT, VA, WI, WV Abortion patients are offered or given inaccurate or misleading information (verbally or in writing) onc •  Reversing medication abortion AR, SD, UT 3 •  Risks to future fertility AZ, KS, NC, NE, SD, TX 6 •  Possible link to breast cancer AK, KS, MS, OK, TX 5 •  Long-term mental health consequences ID, KS, LA, MI, NC, ND, 12 NE, OK, SD, TX, UT, WV All methods of abortion are subject to a mandatory waiting period between counseling and procedure •  18 hours IN 1 •  24 hours AZ, GA, ID, KS, KY, MI, 17 MN, MS, ND, NE, OH, PA, SC, TX, VA, WI, WV •  48 hours AL, AR, TN 3 •  72 hours MO, NC, OK, SD, UT 5 Preabortion counseling must be in person, AR, AZ, IN, KY, LA, 14 necessitating two visits to the facility MO, MS, OH, SD, TN, TX,d UT,e VA, WI continued
From page 24...
... 24 THE SAFETY AND QUALITY OF ABORTION CARE IN THE UNITED STATES TABLE 1-1  Continued Number Type of Regulationa States of States All abortions, regardless of method, must be AL, AK, AR, AZ, DE, 34 performed by a licensed physician FL, GA, IA, ID, IN, KS, KY, LA, MD, ME, MI, MN, MO, MS, NC, ND, NE, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WY Clinicians performing any type of abortion AL, AZ, IN, LA, MS, 10 procedures must have hospital admitting ND, OK, SC, TX, UT privileges or an agreement with a local hospital to transfer patients if needed Abortion facilities must have an agreement FL, KY, MI, NC, OH, PA, 8 with a local hospital to transfer patients if TN, WI needed All abortions, regardless of method, must AL, AR, AZ, IN, KY, LA, 17 be performed in a facility that meets the MI, MO, MS, NC, OH, structural standards typical of ambulatory OK, PA, RI, SC, SD, UT surgical centers Procedure room size, corridor width, or AL, AR, AZ,f FL, IN, LA, 16 maximum distance to a hospital is specified MI, MS, ND, NE, OH, OK, PA, SC, SD, UT Public funding of abortions is limited to AL, AR, CO, DC, DE, 34 pregnancies resulting from rape or incest or FL, GA, IA, ID, IN, KS, when the woman's life is endangeredg KY, LA, ME, MI, MO, MS, NC, ND, NE, NH, NV, OH, OK, PA, RI, SC, SD, TN, TX, UT, VA, WI, WY Insurance coverage of abortion is restricted ID, IN, KS, KY, MI, MO, 11 in all private insurance plans written in the ND, NE, OK, TX, UT state, including those offered through health insurance exchanges established under the federal health care reform lawh Insurance coverage of abortion is restricted AL, AR, AZ, FL, GA, ID, 26 in plans offered through a health insurance IN, KS, KY, LA, MI, MO, exchangeh MS, NC, ND, NE, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI
From page 25...
... hSome states have exceptions for pregnancies resulting from rape or incest, pregnancies that severely threaten women's physical health or endanger their life, and/or in cases of fetal impairment. SOURCES: Guttmacher Institute, 2017b,c,d,e,f,g,h,i, 2018b.
From page 26...
... Nevertheless, in the aggregate, the trends in abortion utilization reported by the CDC and Guttmacher closely mirror each other -- indicating decreasing rates of abortion, an increasing proportion of medication abortions, and the vast majority of abortions (90 percent) occurring by 13 weeks' gestation (see Figures 1-2 and 1-3)
From page 27...
... national legalization, both the number and rate10 of legal abortions steadily increased (Bracken et al., 1982; Guttmacher Institute, 2017a; Pazol et al., 2015; Strauss et al., 2007) (see Figure 1-2)
From page 28...
... ; historic declines in the rate of unintended pregnancy; and increasing numbers of state regulations resulting in limited access to abortion services (Finer and Zolna, 2016; Jerman et al., 2017; Jones and Jerman, 2017a; Kost, 2015; Strauss et al., 2007)
From page 29...
... . In comparison, the 11CDC surveillance reports use the catchall category of "curettage" to refer to nonmedical abortion methods.
From page 30...
... None 40.7 1 26.2 2+ 33.1 Education (a) Not a high school graduate 12.2 High school graduate or GED 29.0 Some college or associates degree 39.2 College graduate 19.7 Family Income as a Percentage of Federal Poverty Level (b)
From page 31...
... As noted in Table 1-1, 33 states prohibit public payers from paying for abortions and other states have laws that either prohibit health insurance exchange plans (25 states) or private insurance plans (11 states)
From page 32...
... . NOTE: Abortion clinics are nonhospital facilities in which 50 percent or more of patient visits are for abortion services.
From page 33...
... The majority of facilities offer early medication and aspiration a ­bortions. In 2014, 87 percent of nonhospital facilities provided early medication abortions; 23 percent of all nonhospital facilities offered this type of abortion (Jones and Jerman, 2017a)
From page 34...
... 34 FIGURE 1-6  The committee's analytic framework for assessing the quality of abortion care. NOTE: OB/GYN = obstetrician/gynecologist.
From page 35...
... Does it lead to serious health risks in the short or long term? Six Dimensions of Health Care Quality The landmark IOM report Crossing the Quality Chasm: A New Health System for the 21st Century (IOM, 2001)
From page 36...
... . Elsewhere in this report, effectiveness denotes the clinical effectiveness of a procedure, that BOX 1-3 The Six Dimensions of Health Care Quality Crossing the Quality Chasm: A New Health System for the 21st Century 1.
From page 37...
... Studies from other countries were excluded from this review if the committee judged those factors to be relevant to the health outcomes being assessed. The committee considered evidence from randomized controlled trials comparing two or more approaches to abortion care; systematic reviews; meta-analyses; retrospective cohort studies, case control studies, and other types of observational studies; and patient and provider surveys (see Box 1-4)
From page 38...
... In a randomized controlled trial (RCT) , the participants are randomly allocated to the experimental group or the comparison group(s)
From page 39...
... ORGANIZATION OF THE REPORT Chapter 2 of this report describes the continuum of abortion care including current abortion methods (question 1 in the committee's statement of task [Box 1-1]
From page 40...
... 2015. Mifepristone with buccal misoprostol for medical abortion: A systematic review.
From page 41...
... 2017b. Bans on specific abortion methods used after the first trimester.
From page 42...
... 2008. CONSORT for reporting randomized controlled trials in journal and conference abstracts: Explanation and elaboration.
From page 43...
... Washington, DC: Guttmacher Institute. https://www.guttmacher.org/article/2017/07/laws-affecting reproductive-health-and-rights-state-policy-trends-midyear-2017 (accessed September 21, 2017)
From page 44...
... 2006. Does the CONSORT checklist improve the quality of reports of randomised controlled trials?


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.