Abortion and Post-Abortion Care
INTRODUCTION
Greater use of modern contraception decreases the need for abortion by reducing unintended pregnancy and by replacing high-failure contraceptives with more reliable methods. However, contraceptives may not be accessible, often are not used perfectly and even when used conscientiously, modern contraceptives sometimes fail. Additionally, many women, especially young women, do not have full control of sexual decision-making. For these reasons, access to abortion is needed to allow women to control the number and timing of childbearing.
In the U.S., almost half of the 6.3 million pregnancies each year are unintended, and about 1.3 million end in abortion. If current trends continue, 35 percent of U.S. women will have at least one abortion in their life. [1,2] While the US has experienced an overall decline in unintended pregnancies in recent years, low-income women and women of color experienced substantially less decline, and abortion rates among poor teenagers increased significantly in 2000. [1] Unfortunately, in the US, the number of abortion providers continues to decline. Today, 87% of U.S. counties and 31% of metropolitan areas have no abortion provider. One-quarter of all women who have abortions in non-hospital facilities (the majority) travel 50 miles or more to receive these services. Women who need second trimester abortions often need to travel long distances, since only a small number of providers perform these procedures. [2]
Of the estimated 46 million abortions worldwide each year, about 26 million take place under unsafe conditions, often in countries where abortion is illegal, resulting in the death of 78,000 women. Millions of more women experience medical complications. Almost all of these deaths occur in developing countries where of 154 million pregnancies each year, 65 million are unplanned. Thirteen percent of all pregnancies in Africa, 40 percent in Latin America, and 29 percent in Asia end in abortion—a total of 36 million. [3]
Despite the continued demand for abortion, abortion remains a highly controversial heath issue. As such, research to improve methods of abortion and training programs to alleviate the shortage of trained practitioners in the U.S. and in developing countries continues to receive inadequate financial support.
RESEARCH
The Bixby Center is one of few institutions conducting research and training to improve abortion technology and services. Current research addresses care delivery systems for both medication (medical) and aspiration (surgical) methods of abortion and conducting extensive programs to train providers in the U.S. and from developing countries. For a history of UCSF’s involvement and commitment to abortion, see the 2003 publication "Honoring San Francisco’s Abortion Pioneers."
Researchers at the UCSF Bixby Center are conducting a study to understand and document the consequences of abortion for women who have an unwanted pregnancy. This study explores the experiences and outcomes of women who obtain abortions, as well as women who are denied abortions because they present for care after the clinic’s gestational limit. Although our primary focus is on women’s experiences, we will also gather information about the health and wellbeing of children born to women who continued their pregnancies because they were not able obtain an abortion.
The Turnaway Study has three major aims:
- To describe the mental health, physical health and socioeconomic outcomes of receiving an abortion compared to carrying an unwanted pregnancy to term,
- To understand effect of access to abortion services on women’s lives, and
- To address the recent spate of low quality research and paucity of high quality research on the sequelae of abortion.
Clinical Trials to Improve Abortion Methods and Services
UCSF has been a leader in research to develop and improve various methods of medication abortion. Prior to its approval by the FDA, UCSF research demonstrated the efficacy, safety and acceptability of the combined use of mifepristone and misoprostol for early abortion. UCSF clinical trials of methotrexate and misoprostol provided US women with a medication abortion alternative while awaiting approval of mifepristone. Current abortion studies include a comparison of manual and electrical equipment for uterine aspiration, the use of IUDs for post-abortion contraception, an examination of the causes for delay in seeking abortion, and clinical trials of various routes of administration of misoprostol for medical abortion. Misoprostol is also being studied for other uses including labor induction, postpartum hemorrhage, and for controlling the bleeding associated with progestin-only contraceptives. Misoprostol is used extensively in the U.S. and may be life saving in countries without access to other medications for safe abortion or to treat post-partum hemorrhage.
- Misoprostol versus Placebo with Laminaria for Cervical Ripening before Late Second Trimester Abortion A placebo-controlled, randomized trial used to determine the effectiveness of buccal misoprostol as an adjunct to cervical ripening before late second-trimester abortion by dilation and evacuation (D&E) by comparing to placebo. Misoprostol's effectiveness relative to placebo will be assessed in terms of procedure duration, cervical dilation, blood loss, morbidity, complications and patient acceptability in women undergoing pregnancy termination between 21-23 1/7 weeks gestation.
References
[1] Jones RK, Darroch JE, Henshaw SK. Patterns in the socioeconomic characteristics of women obtaining abortions in 2000-2001. Perspect Sex Reprod Health. Sep-Oct 2002;34(5):226-235.
[2] Henshaw SK, Finer LB. The accessibility of abortion services in the United States, 2001. Perspect Sex Reprod Health. Jan-Feb 2003;35(1):16-24.
[3] Henshaw, Stanley K., Susheela Singh, and Taylor Haas. 1999. “The Incidence of Abortion Worldwide.” International Family Planning Perspectives 25 (Supplement): S30–S38. Presented also in Alan Guttmacher Institute. 1999. Sharing Responsibilities: Women, Society and Abortion Worldwide. New York: Alan Guttmacher Institute. Appendix Table 3, p. 53.