Legal abortions in the United States are safe and effective, but the quality of abortion care depends on where a woman lives, according to a landmark study released Friday by the National Academies of Sciences, Engineering, and Medicine.

What’s more, placing restrictions on abortion actually makes women less safe. And although Republican lawmakers often cite safety as a reason to restrict abortion access, those claims are not borne out by the evidence.

“In many states, regulations have created barriers to safe, effective, patient-centered, timely, efficient, and equitable abortion services,” the report concluded.

The study also found that access to legal abortion services has continued to decrease across the country. For example, in 2014 there were 17 percent fewer abortion clinics than in 2011, and 39 percent of women of reproductive age resided in a county without an abortion provider.


“This data affirms what the medical community has really known for a long time,” Suzie Prabhakaran, vice president of medical affairs and medical director at the Planned Parenthood of Southwest and Central Florida, told ThinkProgress.

Large swaths of Florida include counties where women have to drive at least 90 miles to get access to legal and safe abortions, she said.

“I’m hopeful that policy-makers will actually look at this data when they’re thinking about the kind of policy that they’re making and the reality of how it affects women’s health,” said Prabhakaran.

The National Academies of Sciences, Engineering, and Medicine are nonprofits that independently analyze problems to inform public policy decisions. The academies convened a committee to conduct the review, which was sponsored by six private foundations, and examined evidence on the safety and quality of abortion methods, health facilities, and types of clinicians, as well as the potential physical and mental health impacts on women.

The report found that regulations obstruct access in many ways, including prohibiting qualified providers from performing abortions, misinforming women of the risks of the procedures they are considering, or requiring medically unnecessary services and delays in care. Some examples of these regulations include mandatory waiting periods, a pre-abortion ultrasound, and a separate in-person counseling visit.


Ned Calonge, an associate professor at the University of Colorado who co-chaired the committee that wrote the study, told National Public Radio that often these regulations are not based on medical research.

“There are some requirements that require clinicians to misinform women of the health risks, that say you have to inform a woman that an abortion will increase her risk of breast cancer,” Calonge, who specializes in family medicine and epidemiology, told NPR.

The committee examined the scientific evidence on the safety and quality of the four abortion methods used in the United States: medication, aspiration, dilation and evacuation, and induction. Most abortions in the United States are performed at an early stage of a pregnancy (in 2014, 90 percent occurred by 12 weeks of gestation), and medication and aspiration abortions are the most common methods, together accounting for about 90 percent of all abortions, according to the report.

The committee also found that serious complications from abortion are rare regardless of the method. Previous studies have also found that abortions are extremely safe and that major complications tied to the medical procedure are extremely rare.

In analyzing trends in abortion, the committee found that between 1980 and 2014, the abortion rate in the United States decreased by more than half. Although the reasons behind this decline are not fully understood, the decrease is partly attributed to the increasing use of contraceptives, historic drops in the rate of unintended pregnancy, and the jump in state regulations that limit the availability of legal abortion services.

In 2017, 25 states had five or fewer abortion clinics, five states had only one abortion clinic, and approximately 17 percent of women traveled more than 50 miles to obtain an abortion, according to the study.


Women are forced to travel long distances because of unnecessary restrictions on access, said Prabhakaran, noting that in Florida only physicians can provide abortion including medication abortion.

The study also concluded that trained physicians as well as advanced practice clinicians, such as certified nurse-midwives, nurse practitioners, and physician assistants, “can safely and effectively provide medication and aspiration abortions.”

“We’ve had data for a very long time about the safety of abortion, so it’s good to have even more data on that, and affirmation of what we know from being on the ground, anecdotally certainly,…that unnecessary restrictions harm women without question,” said Prabhakaran.

Prabhakaran said many of her clinic’s patients have difficulty accessing and paying for transportation. Women who have abortions are disproportionately low income, and almost half live below the poverty level, according to the study.

“So the more distance you add, the harder it is for them to access the care that they need,” said Prabhakaran. “So I’m hopeful that this additional data will help limit the number of unnecessary regulations that legislators around the country, but especially in Florida, feel the need to pass unnecessarily.”