Both medication-based and procedural first-trimester abortions safe and effective, with slightly more complications reported with medicated-based abortion

Abstract: https://www.acpjournals.org/doi/10.7326/M22-2568  

Editorial: https://www.acpjournals.org/doi/10.7326/M22-3634 

URL goes live when the embargo lifts

A cohort study of 39,000 women found that both medication-induced abortions and procedural abortions are safe and effective, with adverse events occurring in fewer than 4 in 1000 procedures. Complications were slightly more common among women having medication-based abortions. The findings are published in Annals of Internal Medicine.

In June 2022, the United States Supreme Court issued in a decision in Dobbs v. Jackson Women’s Health Organization that overturned Roe v. Wade, a previous Supreme Court ruling that enshrined the right for Americans to undergo abortions without state interference or restriction. The new precedent established under Dobbs invites state lawmakers to restrict or eliminate their constituents’ right to undergo an abortion. This includes the right to obtain medications remotely to induce abortion.

Researchers from ICES and the University of Toronto conducted a population-based cohort study of all women who underwent an induced abortion in Ontario, Canada. This included 39,856 women who received mifepristone-misoprostol in an outpatient setting; 65,176 who had an abortion procedure in a nonhospital clinic setting; and 8,861 who had an abortion procedure in a hospital-based outpatient setting. The authors found that severe complications, including the need for a gynecologic procedure, intensive care, bleeding requiring a blood transfusion, and infection, occurred in only 3.3 per 1000 women after medication and 1.8 per 1000 women after a procedure in a hospital-based clinic. The authors highlight that their findings underscore the overall short-term safety of either method to achieve an accessible first-trimester abortion.

An accompanying editorial by Carol Hogue of Emory University highlights the safety of first-trimester abortion procedures and mifepristone-misoprostol managed abortions. She calls attention to misdirected concerns about the mortality rates related to abortion procedures, while maternal mortality rates are currently much higher, and might increase with new abortion restrictions. She also calls for legislators to provide bipartisan support to the Right to Contraception Act, which will affirm a person’s right to access contraceptives and the right of healthcare providers to provide contraceptive services. The author says that while this bill will not end the war on reproductive healthcare, it will prevent unintended and unwanted pregnancies that could severely injure or kill American women.

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected]. To speak with corresponding author Joel G. Ray, MD, MSc, please email [email protected]. To speak with the editorialist, Carol J. Hogue, PhD, MPH, please contact Brian Katzowitz at [email protected].