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New Clinic Standards In Texas Won’t Make Abortions Safer

A federal appeals court this month upheld a Texas law requiring clinics that offer abortions to conform to strict new structural standards, effectively forcing all but seven of the state’s providers to close. During the trial, lawyers from the Texas attorney general’s office argued that the law is designed to improve women’s health by holding the clinics to the same standards as ambulatory surgical centers (ASCs). The plaintiffs, who included the proprietors of some of the now-shuttered clinics, dismissed this argument, saying that there is no medical reason to impose more stringent requirements.

Are such clinics that don’t qualify as ASCs putting women at risk? Look at the evidence and there’s a clear answer: No.

In a study published in the journal Contraception this year, Elizabeth Raymond, an ob-gyn and researcher with Gynuity Health Projects, a reproductive health technology research organization, compared mortality rates for abortion with mortality rates for other outpatient medical procedures. The results were striking. She found that abortion is less likely to result in death than outpatient plastic or dental surgery. Raymond also compared mortality rates for abortion with nonmedical activities and found that running a marathon is about as likely to result in death as having an abortion. The mortality rate for RAGBRAI, one of the country’s oldest bicycle races, was more than four times higher.

The goal of the study, Raymond said, was to put statistics about the numbers of deaths or complications from abortion in context. “I can look at abortion statistics and see that the mortality rate from abortion is .7 per 100,000 procedures, but what does that mean?” she said. “Is that bad? Is that high? Is that low? I thought, well, it would be useful to look at other procedures that we think are reasonably safe, we are accepting, to see how abortion mortality compares.” The answer, she said, was clear. “Running a marathon or participating in a bicycle race is something that we would consider reasonably healthy,” she said. “Abortion is equally safe — and, in the case of RAGBRAI, much safer.”

According to Eve Espey, a professor of obstetrics and gynecology at the University of New Mexico School of Medicine, Raymond’s findings should come as no surprise to anyone who works in reproductive health. But, she said, it’s helpful to have a framework in which to understand risk. “This study wasn’t done because anyone in the field of family planning doubted that abortion was safe,” she said. “But it’s helpful because abortion restrictions are often framed as in service of women’s health, which sounds like a good thing. This study clearly communicates that the risk of death from abortion is actually very low.”

There’s also no proof that subjecting abortion providers to stricter regulations will result in better care. Dan Grossman, a doctor and the vice president of Ibis Reproductive Health, a nonprofit reproductive health research organization, analyzed data on the number of major complications — hospitalization, abdominal surgery, intravenous antibiotics or blood transfusion caused by an abortion — from a chain of Texas clinics that included one ASC and three non-ASC facilities. Grossman, who was also a co-author on the study in Contraception and testified as an expert in the suit against the Texas law, found that not only were the major complication rates low at all four of the clinics, women who went to the ASC were slightly more likely to experience a major complication than women who went to one of the non-ASCs.

This doesn’t mean, according to Grossman, that the ASC was less safe. “Higher-risk women were being sent to the ASC, so I think if we could control for risk factors like age and obesity, we’d see that the ASC and the non-ASCs were equally safe,” he said. “What it really shows, though, is that there’s no indication that abortion is associated with a higher risk of complications outside of an ASC.”

Amelia Thomson-DeVeaux is a senior editor and senior reporter for FiveThirtyEight.