Abortion access in the United States
The 1973 Roe v. Wade Supreme Court decision established the constitutional right to abortion. In 1992, the Supreme Court allowed states to create restrictions that did not place an “undue burden” on women’s access to abortion. Since Roe, 1200 restrictions have been enacted; recently the pace of abortion restrictions has accelerated, and the nature of the restrictions more severely curtails access.33 Nearly 60% of US women live in a state with significant abortion restrictions.33 As Joanna found (Table 1), many restrictions target the woman seeking abortion.
Other restrictions focus on limiting abortion provision, including facility and provider requirements. A case study of the impact of abortion provision restrictions occurred in Texas with the passage of House Bill 2 (HB2) in 2012. HB2, an omnibus law, required admitting privileges at a nearby hospital for physicians providing abortions and required clinics to meet ambulatory surgical center standards for all abortions, including medication abortions. HB2 also banned most abortions after 20 weeks and imposed medically unnecessary restrictions on medication abortion. The impact was dramatic: by 2014, only 19 of the previous 43 clinics remained open. Although key parts of HB2 were reversed by a Supreme Court decision in 2016, the damage was done; few closed clinics have been able to reopen.
Restrictions targeting patients, providers, and facilities have already created significant barriers that reduce abortion access in many states. Furthermore, the true intent of recent aggressive anti-abortion legislation is less likely than in the past to be cloaked as improving patient safety; current proponents of restrictive legislation articulate the purpose of eliminating legal abortion. Illegal abortion is highly associated with maternal mortality, both in the United States pre Roe v Wade and throughout the world where abortion is illegal.34 It is no surprise that our leading US medical journals have published cautionary editorials sounding the alarm about the ramifications of gutting or reversing Roe v Wade.33,35 We echo these calls to action and strongly support continued access to safe, legal, and equitable abortion, including evidence-based patient-centered second-trimester abortion care.
The authors report no potential conflicts of interest with regard to this article.
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- Fox MC, Krajewski CM. Society of Family Planning guideline: cervical preparation for second-trimester surgical abortion prior to 20 weeks’ gestation. Contraception. 2014;89(2):75-84.
- Goldberg AB, Fortin JA, Drey EA, et al. Cervical preparation before dilation and evacuation using adjunctive misoprostol or mifepristone compared with overnight osmotic dilators alone: a randomized controlled trial. Obstet Gynecol. 2015;126(3):599-609.
- American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 195: Prevention of infection after gynecologic procedures. Obstet Gynecol. 2018;131(6):e172-e189.
- Schulz KF, Grimes DA, Christensen DD. Vasopressin reduces blood loss from second-trimester dilatation and evacuation abortion. Lancet. 1985;2(8451):353-356.
- Whitehouse K, Tschann M, Soon R, et al. Effects of prophylactic oxytocin on bleeding outcomes in women undergoing dilation and evacuation: a randomized controlled trial. Obstet Gynecol. 2019;133(3):484-491.
- Darney PD, Sweet RL. Routine intraoperative ultrasonography for second trimester abortion reduces incidence of uterine perforation. J Ultrasound Med. 1989;8(2):71-75.
- Abbas DF, Blum J, Ngoc NTN, et al. Simultaneous administration compared with 24-hour mifepristone-misoprostol interval in second-trimester abortion: a randomized controlled trial. Obstet Gynecol. 2016;128(5):1077-1083.
- Ngoc NTN, Shochet T, Raghavan, et al. Mifepristone and misoprostol compared with misoprostol alone for second-trimester abortion. Obstet Gynecol. 2011;118(3):601-608.
- Borgatta L, Kapp N. Society of Family Planning guideline: labor induction abortion in the second trimester. Contraception. 2011;84(1):4-18.
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- Jackson RA, Teplin VL, Drey EA, Thomas LJ, Darney PD. Digoxin to facilitate late second-trimester abortion: a randomized, masked, placebo-controlled trial. Obstet Gynecol. 2001;97(3):471-476.
- Dean G, Colarossi L, Lunde B, Jacobs AR, Porsch LM, Paul ME. Safety of digoxin for fetal demise before second-trimester abortion by dilation and evacuation. Contraception. 2012;85(2):144-149.
- Akkurt MO, Akkurt I, Yavuz A, Yalcin SE, Coskun B, Sezik M. The utility of feticide procedure to shorten the induction-to-abortion interval in medical abortion. Gynecol Obstet Invest. 2019;84(1):64-70.
- McNamara B, Russo J, Chaiken S, Jacobson J, Kerns J. A qualitative study of digoxin injection before dilation and evacuation. Contraception. 2018;97(6):515-519.
- White KO, Nucatola DL, Westhoff C. Intra-fetal compared with intra-amniotic digoxin before dilation and evacuation. Obstet Gynecol. 2016;128(5):1071-1076.
- Molaei M, Jones HE, Weiselberg T, McManama M, Bassell J, Westhoff C. Effectiveness and safety of digoxin to induce fetal demise prior to second-trimester abortion. Contraception. 2008;77(3):223-225.
- Frick AC, Drey EA, Diedrich JT, Steinauer JE. Effect of prior cesarean delivery on risk of second-trimester surgical abortion complications. Obstet Gynecol. 2010;115(4):760-764.
- Andrikopoulou M, Lavery JA, Ananth CA, Vintzileos AM. Cervical ripening agents in the second trimester of pregnancy in women with a scarred uterus: a systematic review and metaanalysis of observational studies. Am J Obstet Gynecol. 2016;215(2):177-194.
- Fontenot Ferriss AN, Weisenthal L, Sheeder J, Teal SB, Tocce K. Risk of hemorrhage during surgical evacuation for second-trimester intrauterine fetal demise. Contraception 2016;94(5):496-498.
- Edlow AG, Hou MY, Maurer R, Benson C, Delli-Bovi L, Golberg AG. Uterine evacuation for second-trimester fetal death and maternal morbidity. Obstet Gynecol. 2011;117(2):307-316.
- Bryant AG, Grimes DA, Garrett JM, Stuart GS. Second-trimester abortion for fetal anomalies or fetal death. Obstet Gynecol. 2011;117(4):788-792.
- Nakintu N. A comparative study of vaginal misoprostol and intravenous oxytocin for induction of labor in women with intrauterine fetal death in Mulago Hospital, Uganda. Afr Health Sci. 2001;1(2):55-59.
- Goldberg AB, Carusi D, Westhoff C. Pregnancy Loss. In: Paul M, et al, eds. Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care. Chichester, UK: Wiley-Blackwell; 2009:264-279.
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- Cohen SA. Facts and consequences: Legality, incidence and safety of abortion worldwide. Guttmacher policy review. 2009;12(4). Accessed 8-18-19 at https://www.guttmacher.org/gpr/2009/11/facts-and-consequences-legality-i....
- Reingold RB, Gostin LO. State abortion restrictions and the new Supreme Court: Women’s access to reproductive health services. JAMA. 2019;322(1)21-22.