In the United States, abortion data is inadequate and incomplete. There is no comprehensive reporting system for all pregnancy outcomes, including those that do not end in live births. States may choose to collect abortion data and share it with the Centers for Disease Control and Prevention (CDC), but not all do so, with approximately a fifth of all abortions going unreported.[1] The CDC aggregates abortion statistics for publication in annual reports but does not make event-level data available for research.

 

 

Consequently, from a research perspective, perhaps the best source of abortion data in the U.S. is the Medicaid system. As a result of the pro-life Hyde Amendment, federal Medicaid does not pay for most abortions, but states may use their own funds to cover abortions for Medicaid-eligible women.[2] A series of papers by Charlotte Lozier Institute (CLI) scholars analyzes Medicaid claims data from 17 states that chose to fund abortion between 1999 and 2015. Together, these studies explore the impact of abortion on low-income women and debunk several myths that abortion is beneficial to women’s health.

 

 

Despite claims to the contrary from the abortion industry, abortion is not a normal part of family planning. In fact, one CLI study using Medicaid claims data found that abortion tends to lead to more abortion.[3] Women whose first known pregnancy ended in abortion were more likely to have more pregnancies and more abortions overall. By increasing the number of pregnancies a woman was likely to experience, abortion placed women at increased exposure to pregnancy-related risks. In contrast, women whose first pregnancy was a live birth were more likely to have additional live births but fewer pregnancies overall.

 

 

These findings were echoed in another study which found that rather than serving as a family planning tool to enable healthy birth spacing and pregnancy intervals, abortion was very rarely used to space live births.[4] Among nearly five million women with at least one pregnancy, only one percent had a birth, followed by an abortion, followed by another birth. In addition, women with the birth-abortion-birth pregnancy outcome sequence were more likely to have received contraceptive counseling, indicating that abortion was not being used as a substitute for contraception. Similarly, another paper found that in contrast to claims that abortion is a regular part of women’s reproductive lives, abortion is not a normal experience for mothers.[5] Women who had both abortions and births represented less than six percent of the study population, while women with only live births and no abortions made up 74 percent of the population and the vast majority of the births (88 percent). Only two percent of women with at least one pregnancy had an abortion that delayed childbearing, and only three percent had an abortion that ended childbearing, suggesting that the vast majority of women did not use abortion to plan or build their families.

 

 

Not only does abortion fail to play a beneficial role in family planning, additional analyses using the Medicaid data show that abortion can put women’s health at risk. In particular, chemical abortion places women at increased risk of visiting the emergency room.[6] In a study of 423,000 abortions and 121,283 emergency room visits, an abortion-related emergency room visit was over 50 percent more likely following a chemical abortion compared to a surgical abortion. Additionally, the risk increased throughout the study period, with the rate of chemical abortion-related ER visits growing by over 500 percent between 2002 and 2015. The study also found that many chemical abortion complications were misreported as miscarriages. By 2015, 61 percent of chemical abortion-related ER visits were miscoded as miscarriages, meaning that women might not have received proper medical treatment for their chemical abortion complications.

 

 

Research using Medicaid data also indicates that abortion can have a negative effect on women’s mental health. Pregnancy loss, including abortion, is a risk factor for postpartum mental health problems. In one study, women with a history of pregnancy loss (both miscarriage and abortion) were 35 percent more likely to need postpartum psychiatric treatment following their first live birth.[7] Furthermore, another study found that abortion places young women at risk of rapid repeat pregnancy: by the second year following an abortion, 37.5 percent of young women had had another pregnancy, compared to just 23.1 percent of young women in the second year following a birth.[8]

 

 

As a group, these studies show that abortion is neither a necessary part of women’s healthcare nor a normal experience in women’s lives. Instead, abortion poses no benefit to women and can place women’s physical and mental health at risk. In the international context, these studies fit with research from countries with comprehensive data showing that mortality rates after abortion are higher than following live birth and that chemical abortion is riskier than surgical abortion.[9],[10] In light of the lack of comprehensive abortion reporting in the United States, Medicaid claims data provides unique insights into the reality of the impact of abortion on women.

 

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[1] Kortsmit K, et al. Abortion surveillance – United States, 2019. MMWR Surveill Summ. 2021;70(9):1-29. doi: 10.15585/mmwr.ss7009a1.

[2] New MJ. Hyde @ 40: analyzing the impact of the Hyde amendment. Charlotte Lozier Institute, On Point Series 12. 2016. Accessed September 9, 2021. https://s27589.pcdn.co/wp-content/uploads/2016/09/OP_hyde_9.28.3.pdf

[3] Studnicki J, et al. Pregnancy outcome patterns of Medicaid-eligible women, 1999-2014: a national prospective longitudinal study. Health Serv Res Manag Epidemiol. 2020;7. doi: 10.1177/2333392820941348

[4] Studnicki J, et al. Estimating the period prevalence of publicly funded abortion to space live births, 1999 to 2014. J Prim Care Community Health. 2021;12. doi: 10.1177/21501327211012182.

[5] Studnicki J, et al. Estimating the period prevalence of mothers who have abortions: a population-based study of inclusive pregnancy outcomes. Health Serv Res Manag Epidemiol. 2021;8. doi: 10.1177/23333928211034993.

[6] Studnicki J, et al. A longitudinal cohort study of emergency room utilization following mifepristone chemical and surgical abortions, 1999-2015. Health Serv Res Manag Epidemiol.

[7] Reardon DC, Craver C. Effects of pregnancy loss on subsequent postpartum mental health: a prospective longitudinal cohort study. Int J Environ Res Public Health. 2021;18(4):2179. doi: 10.3390/ijerph18042179.

[8] Reardon DC, Craver C. Intervals and outcomes of first and second pregnancies in low-income women: a record-linkage longitudinal prospective cohort study. Med Sci Monit. 2021;27. doi: 10.12659/MSM.931596.

[9] Gissler M, Berg C, Bouvier-Colle M-H, Buekens P. Pregnancy-associated mortality after birth, spontaneous abortion, or induced abortion in Finland, 1987-2000. Am J Obstet Gynecol. 2004;190(2):422-427. doi: 10.1016/j.ajog.2003.08.044.

[10] Niinimäki M, et al. Immediate complications after medical compared with surgical termination of pregnancy. Obstet Gynecol. 2009;114(4):795-804. doi: 10.1097/AOG.0b013e3181b5ccf9.