Abortion providers often abandon women who suffer complications from their procedures to be treated by other facilities.[1] This problem has grown since the reversal of Roe v. Wade, as abortion centers in pro-abortion states seek to attract out-of-state women seeking abortions.[2] These centers do not bear the burden of caring for out-of-state women suffering complications. Instead, they increasingly foist this responsibility onto non-abortion-performing healthcare providers, often those in the pro-life states from which these women came. This has resulted in a chaotic situation both for women who require coordinated post-abortion care, and for states attempting to gather accurate information about abortion complications for state residents, suggesting that some form of federal action is necessary.
Charlotte Lozier Institute’s Vice President and Director of Medical Affairs, Dr. Ingrid Skop, has firsthand knowledge of two recent examples illustrating this problem.
A young Black woman traveled from Texas to an out-of-state Planned Parenthood, where she received chemical abortion pills. She took mifepristone the first day and misoprostol the second. The third day, she bled heavily and passed an embryo in the shower. She immediately began to experience left leg pain. After traveling home, the pain worsened, and she began to feel sick. In a Texas emergency room, she was diagnosed with a left deep venous thrombosis and sepsis, a serious infection in her blood. She was admitted to the ICU where she received anticoagulants and antibiotics. Ultrasound revealed remaining pregnancy tissue in her uterus, requiring an additional course of misoprostol. She spent a week in the hospital.
In another case, a young Hispanic woman traveled out of state from Texas for an abortion. She stated the provider did not counsel her about the option of surgical abortion, merely recommending abortion pills. She took the regimen and began bleeding. The bleeding persisted as she drove home and continued daily for two months. Finally, she went to an emergency room, but the physician did not recognize the nature of her problem. Her pregnancy test was negative, but this did not reveal the retained dead pregnancy tissue in her uterus. Returning to the ER several days later, ultrasound revealed the retained tissue. Dr. Skop performed a surgical suction aspiration to remove the tissue, finally resolving the patient’s prolonged ordeal.
Similar scenarios likely play out countless times each year, as doctors and emergency rooms are left to care for women neglected by the abortion industry. The precise number of complications is impossible to measure because U.S. abortion complication data is so poor and the aftermath of chemical abortions taken at home is not easily identified: the Food and Drug Administration[3] requires only reporting of deaths from chemical abortions, while there is no national complication reporting requirement for surgical abortion.[4] However, some state data corroborates Dr. Skop’s experience.
Just 150 abortions were performed in Missouri in 2021,[5] but abortion centers across state lines in Kansas and Illinois draw thousands of Missouri residents.[6] Consequently, of 54 abortions resulting in complications identified and treated in Missouri, only three were performed in the state. The vast majority of complications – including those that left women hospitalized – resulted from out-of-state abortions.
In Indiana, too, most complications are not treated by the doctor who performed the abortion.[7] Out of 100 complication reports filed in Indiana in 2022, just 26 were submitted by the abortion provider. The remaining 74 were submitted by healthcare providers who did not perform the abortions but were left to treat resulting complications. Indiana reports the name of the original abortion facility for each abortion resulting in complications, and some of the reported facilities are located in other states.
While these trends have likely accelerated since Dobbs, this is far from a new development. Although chemical abortion adverse event data compiled by FDA is lacking, statistics from before 2016 confirm the same pattern. An analysis of more than 2,000 follow-up surgical procedures for incomplete chemical abortions shows that just 40 percent of the procedures were performed by the abortion provider.[8] In contrast, 60 percent were performed by other healthcare providers, mainly those covering emergencies in hospitals and emergency rooms.
Due to the voluntary and short-term nature of U.S. abortion complication reporting, there will be no documentation of the long-term effects of these complications for these women. Will they suffer mental health complications from these experiences? Will they have difficulty achieving a future pregnancy or giving birth to a desired child? Or will cervical or uterine damage cause future pregnancy complications, increasing the risks for both mother and child (risks including chronic inflammation leading to infertility, incompetent cervix leading to premature delivery, and abnormal placental attachment leading to premature placental separation (abruption) or invasion (placenta accreta spectrum disorder)).
Federal reporting is necessary to ensure that all complications are counted, and the long-term impacts of abortion are measured. At minimum, states must maintain their own complication reporting requirements. Even if a state’s laws ensure that virtually no abortions will be performed within its borders, doctors and policymakers need to know the contribution of out-of-state abortions to the maternal mortality and morbidity rates, the burden this poses to the state healthcare system, and the risks to women and girls.
[1] For example, a 2019 analysis of abortion providers in Florida found that approximately half did not possess hospital admitting privileges (See Studnicki et al., “Doctors Who Perform Abortions: Their Characteristics and Patterns of Holding and Using Hospital Privileges,” Health Serv Res Manag Epidemiol 6, 2333392819841211 (2019), doi: 10.1177/2333392819841211.
[2] White, Jennifer. “Remaking America: Crossing State Lines For Abortion Care.” NPR: 1A, May 11, 2023. Podcast, website, 44:41. https://www.npr.org/2023/05/11/1175530713/remaking-america-crossing-state-lines-for-abortion-care.
[3] Tessa Longbons and Mia Steupert, “Five Things We Don’t Know about Abortion in the U.S. (but Could with Better Reporting),” Charlotte Lozier Institute, March 30, 2023, https://lozierinstitute.org/five-things-we-dont-know-about-abortion-in-the-u-s-but-could-with-better-reporting/.
[4] Dr. Ingrid Skop, “Immediate Physical Complications of Induced Abortion,” Charlotte Lozier Institute, December 8, 2022, https://lozierinstitute.org/immediate-physical-complications-of-induced-abortion/
[5] “Graph D. Resident Abortion Ratios per 1,000 Live Births: Missouri, 1971-2021,” Vital Statistics, Missouri Department of Health & Senior Services, accessed August 25, 2023, https://health.mo.gov/data/vitalstatistics/mvs21/GraphD.pdf.
[6] “Missouri Vital Statistics 2021,” Vital Statistics, Missouri Department of Health & Senior Services, accessed August 25, 2023, https://health.mo.gov/data/vitalstatistics/mvs21/2021MissouriVitalStatistics.pdf.
[7] “2022 Terminated Pregnancy Complications Report,” Vital Records, Indiana Department of Health, accessed August 25, 2023, https://www.in.gov/health/vital-records/files/2022-Complications-Report.pdf.
[8] Aultman et al., “Deaths and Severe Adverse Events after the use of Mifepristone as an Abortifacient from September 2000 to February 2019,” Issues in Law & Medicine 36, no. 1 (2021): 3-26, PMID: 33939340.
