Care for Women Who Miscarriage May Be Compromised in States Restricting Abortion

Author: University at Buffalo
Published: 2023/02/10
Peer-Reviewed: Yes
Contents: Summary - Main - Related Publications

Synopsis: A female who miscarriages in U.S. states with restrictive abortion policies may be less likely to receive optimal care than in states with supportive abortion policies. Spontaneous pregnancy loss, i.e., miscarriage, in the first trimester occurs in about 10% of all clinically recognized pregnancies, and 25% of all people capable of becoming pregnant will experience a miscarriage in their lifetime. Too often, when we talk about abortion, the conversation becomes about the morality of ending a pregnancy and not about how restricting abortion affects reproductive health.

Abortion

Abortion is the termination of a pregnancy by removing or expulsing an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of pregnancies. When deliberate steps are taken to end a pregnancy, it is called an induced abortion, or less frequently, "induced miscarriage." The unmodified word abortion generally refers to an induced abortion.

Main Digest

Comparison of Early Pregnancy Loss Management Between States With Restrictive and Supportive Abortion Policies - Women s Health Issues.

A study led by a University at Buffalo physician has found that people experiencing a miscarriage in states with restrictive abortion policies may be less likely to receive optimal care than those with supportive abortion policies.

Published online in November in Women's Health Issues, the research was conducted before the Supreme Court's decision last June to overturn Roe v. Wade.

The study was led by Elana Tal, MD, while a fellow at Washington University School of Medicine in St. Louis; she is now an assistant clinical professor in the Department of Obstetrics and Gynecology in the Jacobs School of Medicine and Biomedical Sciences at UB. Tal had concerns about how restrictive abortion policies affect care for people experiencing spontaneous pregnancy loss.

Less Ideal Care

"I had a hunch that is restricting abortion means less ideal care for people experiencing miscarriage," said Tal, who focuses on complex family planning at UB and is a physician with UBMD Obstetrics & Gynecology.

"Too often, when we talk about abortion, the conversation becomes about the morality of ending a pregnancy and not about how restricting abortion affects reproductive health in general," she said. "We know abortion restrictions correlate with higher maternal mortality rates, so it follows that other aspects of health care would be affected, especially miscarriage care, which closely mirrors abortion care. I wanted to find out if that was true."

Spontaneous pregnancy loss, i.e., miscarriage, in the first trimester occurs in about 10% of all clinically recognized pregnancies, and 25% of all people capable of becoming pregnant will experience a miscarriage in their lifetime.

This study is among the first to explore how miscarriages are managed in light of evidence-based, patient-centered guidelines issued in recent years by the American College of Obstetricians and Gynecologists (ACOG). Those guidelines, and the research they were based on, found that optimal care for managing early pregnancy loss includes uterine aspiration in the physician's office and prescribing both mifepristone and misoprostol, which block hormones that are necessary for pregnancy and help clear the uterus.

Because these methods are also used to terminate a pregnancy, Tal and her co-authors wanted to see if access to these methods is compromised for those experiencing a miscarriage.

Physicians Less Likely to Offer Mifepristone

The researchers found that in states with restrictive abortion policies, physicians managing early pregnancy loss were less likely than physicians in supportive states (40.8% vs. 67.5%) to offer mifepristone alone and less likely to offer both mifepristone and office uterine aspiration (33.2% vs. 51.3%). They also found that there was no significant difference in the proportion offering uterine aspiration between physicians in restrictive states and those in supportive states.

In addition, physicians in restrictive states were less likely to report having received abortion training (67.3% vs. 89.6%) and less likely to report perceived institutional support for abortion care (49% vs. 85%).

"Our study is consistent with the notion that general pregnancy care suffers where abortion is restricted," said Tal. "That would apply to routine early miscarriage, more complicated miscarriage like second-trimester fetal demise, and abortion for life-threatening situations."

"Clinicians should be aware of the potential deficiencies in their ability to provide miscarriage care if they train or practice in states with restrictive laws," she said.

In addition to surveying the impact of a state's policies on access to reproductive care, the survey was also aimed at determining how a physician's perception of their institution's support for abortion care, or lack of it, might influence access to reproductive care generally.

The survey was sent to more than 1,500 members of ACOG. Respondents were deemed eligible to respond if they were attending physicians with an academic medical center who provided obstetric and gynecologic care and had provided early pregnancy loss care in the past year.

Eligible responses were received from 350 physicians from every region in the U.S., representing half of the academic medical centers.

Tal noted that the end of Roe v. Wade is expected to impact care access for those experiencing a miscarriage more strongly.

"At the time of our study, access to abortion was constitutionally protected, and we still saw disparities in the management of miscarriage, a prevalent reproductive health issue," she said. "We would expect the disparities we outlined in our study to get worse since the overturning of Roe v. Wade."

She concluded:

"We should recognize that people experiencing miscarriage are at risk of collateral damage from abortion restrictions. We must actively work to destigmatize abortions, be outspoken in support of abortion care, and promote universal access to excellent miscarriage care."

Co-authors are Rachel Paul, Megan Dorsey, and Tessa Madden, MD, all of Washington University in St. Louis School of Medicine. The Society funded the research for Family Planning Research Fund.

Attribution/Source(s):

This peer reviewed publication pertaining to our Pregnancy Information section was selected for circulation by the editors of Disabled World due to its likely interest to our disability community readers. Though the content may have been edited for style, clarity, or length, the article "Care for Women Who Miscarriage May Be Compromised in States Restricting Abortion" was originally written by University at Buffalo, and submitted for publishing on 2023/02/10. Should you require further information or clarification, University at Buffalo can be contacted at the buffalo.edu website. Disabled World makes no warranties or representations in connection therewith.

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