Elsevier

Contraception

Volume 90, Issue 5, November 2014, Pages 476-479
Contraception

Review article
Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States

https://doi.org/10.1016/j.contraception.2014.07.012Get rights and content

Abstract

Objective

The recent surge of new legislation regulating induced abortion in the United States is ostensibly motivated by the desire to protect women's health. To provide context for interpreting the risk of abortion, we compared abortion-related mortality to mortality associated with other outpatient surgical procedures and selected nonmedical activities.

Methods

We calculated the abortion-related mortality rate during 2000–2009 using national data. We searched PubMed and other sources for contemporaneous data on mortality associated with other outpatient procedures commonly performed on healthy young women, marathon running, bicycling and driving.

Results

The abortion-related mortality rate in 2000–2009 in the United States was 0.7 per 100,000 abortions. Studies in approximately the same years found mortality rates of 0.8–1.7 deaths per 100,000 plastic surgery procedures, 0–1.7deaths per 100,000 dental procedures, 0.6–1.2 deaths per 100,000 marathons run and at least 4 deaths among 100,000 cyclists in a large annual bicycling event. The traffic fatality rate per 758 vehicle miles traveled by passenger cars in the United States in 2007–2011 was about equal to the abortion-related mortality rate.

Conclusions

The safety of induced abortion as practiced in the United States for the past decade met or exceeded expectations for outpatient surgical procedures and compared favorably to that of two common nonmedical voluntary activities. The new legislation restricting abortion is unnecessary; indeed, by reducing the geographic distribution of abortion providers and requiring women to travel farther for the procedure, these laws are potentially detrimental to women's health.

Section snippets

Methods

We calculated the abortion-related mortality rate during the decade 2000–2009 by dividing the number of deaths related to legal abortion in the 50 states and Washington, DC, during those years by the number of legal abortions occurring in the same time period. We obtained the former figure from the Centers for Disease Control and Prevention, which performs active surveillance of multiple sources, including state vital records, public health agencies, maternal mortality review committees,

Results

The mortality rate related to abortion at any time in pregnancy during the years 2000–2009 in the United States was 0.7 per 100,000 abortions (Table).

We found two qualifying studies that provide data on deaths associated with plastic surgical procedures performed outside of a hospital. The first included all operations performed at ambulatory surgical centers (ASCs) licensed by the state of Florida in the year 2000 [5]. The second included all plastic surgery cases at ASCs accredited by the

Discussion

The rate of death from legal induced abortion in the United States over the decade 2000–2009 was 0.7 deaths per 100,000 procedures. This risk has been stable over the past 35 years despite changes in patient demographics and procedural techniques. [3] This mortality rate was at least as low as the mortality rate associated with plastic surgery at licensed or accredited ASCs in the same decade, approximately equivalent to the proportion of marathon runners who died during races in the same time

References (23)

  • H. Vila et al.

    Comparative outcomes analysis of procedures performed in physician offices and ambulatory surgery centers

    Arch Surg

    (2003)
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    Funding: This work was supported by an anonymous donor.

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