“Both sides realized we needed new rules,” Ms. Phillips said. “But we kept the focus on patient safety.”

The Maryland regulations are not as rigid as those in some states: they do not dictate the width of hallways, the size of janitors’ closets or the number of parking spaces outside. Rather, they look at the goal: Is there a sound plan, for example, for rapid evacuation if a patient has a medical emergency?

The state also did not require abortion doctors to have local hospital admitting privileges, a measure that threatens to shut down clinics in several states. Officials concluded that in emergencies, hospitals are best equipped to provide care anyway, and the clinic doctor can advise the hospital staff without holding admitting privileges. Under the new rules, Dr. Brigham would have been required to seek a clinic license before operating his center in Elkton and his procedures would have been scrutinized.

“Maryland took a thoughtful approach that reflects a balance between ensuring access to service but also protecting public health,” said Heather Howard, a former commissioner of the New Jersey Department of Health and Senior Services and now a lecturer at Princeton University.

A Safe Procedure Over All

While the existence of abortion doctors with illegal or haphazard methods can never be ruled out, the medical record for abortions in the United States indicates the procedure is quite safe over all. Ten women died of abortion-related causes out of 1.2 million procedures in 2010, according to the Centers for Disease Control and Prevention; the number of deaths in 2009 was 12.

For many years, the death rate has hovered around one per 100,000 procedures, according to Dr. David A. Grimes, a professor of obstetrics and gynecology at the University of North Carolina School of Medicine and a former chief of abortion surveillance at the C.D.C.

“Today, having an abortion is safer than an injection of penicillin,” he said.

Risks rise with the length of a pregnancy, with one death occurring for every one million abortions in the first 8 weeks, one per 29,000 at 16 to 20 weeks and one per 11,000 in the small fraction of abortions performed at 21 weeks or more, according to the Guttmacher Institute, a research group that supports abortion rights.