Our research on abortion laws shows they are not based on facts and can even harm women Our new study shows clinics and offices are as safe for abortion as surgical centers. Laws requiring them aren't rooted in fact and can even harm women.

Sarah Roberts | Opinion contributor

Policymakers tout women’s health and safety when creating restrictive abortion laws, but new research from me and my colleagues unequivocally shows that restricting abortions to one type of facility makes no public health sense. Our work, published Tuesday in the Journal of the American Medical Association, finds that abortion is no safer in an ambulatory surgical center than it is in a clinic or doctor’s office.

ASCs are fully equipped facilities for performing same-day surgeries. The Supreme Court ruling in Whole Woman’s Health vs. Hellerstedt two years ago found that the Texas law requiring that all abortion facilities meet the very specific and often stringent requirements of ASCs was unconstitutional.

Despite this ruling, multiple states still require some or all abortions to be provided in ASCs. Opponents of ASC laws argue that such requirements are not needed because abortion provided in offices and clinics is already safe. They are challenging such laws in Texas and Indiana, and our new research is backing them up.

Our study compared the safety of more than 50,000 abortions provided in ASCs and office-based settings throughout the U.S. We found that abortion is safe in both ASCs and office-based settings and that there is no significant difference in the safety of abortions in the two settings. The similarities in safety also applied to women in different stages of pregnancy.

We found that few women who had abortions in either type of facility had a complication within six weeks of the abortion (about 3 percent). Even fewer women (only 0.3 percent) had a more serious complication (for example, something requiring an overnight hospital stay).

Surgical centers aren't safer for abortions

What’s more, other research consistently backs up these findings. A recent study of publicly funded abortions in California found similarly low complication rates, and our findings are solidly within the range documented in a systematic review of more than 50 studies of abortion complications. Furthermore, research that has compared the safety of other (non-abortion) procedures in ASCs and office-based settings also finds no difference in patient safety between the two.

These findings mean that laws requiring women to have abortions (including second-trimester abortions) at ASCs do not actually protect their safety. Furthermore, they mean that these laws are not based on research evidence.

Ironically, these laws can in fact result in greater harm to women seeking safe health treatments. Why? Because research shows there is a decrease in abortion service availability when, by law, abortions must be performed in ASCs.

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This decrease can occur because existing surgical centers often will not permit abortions for political, philosophical or security reasons, and because it is extremely costly for abortion clinics to meet ASC requirements (which can include substantial building renovations and new staff). And if women are unable to obtain wanted abortions, there can be serious socioeconomic consequences and physical health complications such as eclampsia, hemorrhage or violence. In fact, abortion is considerably safer than childbirth.

With 13 states still requiring that abortions be provided in ASCs, the discrepancy between research evidence and policy-making is disconcerting. Indeed, the lack of evidence-based policy-making is itself a public health problem.

Our public health policies should be based in the best available evidence. When politicians propose abortion policies they say will protect patient safety and health, they should rely on research that demonstrates those policies will achieve their stated goal.

Policies must be driven by facts

Unfortunately, while the Whole Woman’s Health decision struck down Texas’ restrictive ASC law, it did not strike down all such laws across the country. And this means that laws still requiring abortions to be provided in ASCs do not meet the core public health principle of being rooted in research.

No matter what lawmakers may argue or legislate, we and earlier researchers have found that requiring abortions to be performed at ambulatory surgical centers does not improve the safety of abortion. The Texas and Indiana laws being challenged, as well as similar laws in other states, have little benefit to patients seeking this care and can even make women less safe by reducing access.

As the National Academies has concluded, there is simply no current public health problem related to the safety of abortion procedures in office-based settings that needs to be solved through targeted regulation.

Abortion laws and regulations proposed in the name of improving or protecting patient safety must be evaluated using the same approach used to evaluate other laws to protect health. As our research clearly shows, laws requiring that abortions be provided in ASCs are not supported by the best available evidence. They have no apparent patient safety benefit and may very well cause harm to women’s health and well-being. There is no public health justification for them.

Sarah Roberts is an associate professor at Advancing New Standards in Reproductive Health, a research group at the University of California-San Francisco’s Bixby Center for Global Reproductive Health.