WASHINGTON -- So-called Targeted Regulation of Abortion Provider (TRAP) laws that restrict clinics providing abortions lack medical necessity or any substantive evidence basis, according to a medical/legal review of these laws presented here.
The mortality risk of induced abortion at any gestational age is 0.7 per 100,000 procedures and is even lower when it occurs during the first 8 weeks of pregnancy (0.1 per 100,000), said , of Johns Hopkins Bloomberg School of Public Health in Baltimore, at a press briefing at the annual meeting.
Larger mortality risks are associated with outpatient plastic surgery procedures performed at clinics accredited by the and among marathon runners. Childbirth also confers a substantially (8.8 per 100,000 procedures) than induced abortion.
"TRAP laws are not grounded in any kind of evidence that says abortion deserves restrictions more than any other procedure," said Horvath-Cosper at a press briefing. "They're not medically necessary, and there's growing evidence to show they are harmful."
Such laws typically require providers to have admitting privileges and transfer agreements at nearby hospitals and to have equipment not mandated at other outpatient clinics. They may also ban certain procedures, such as second-trimester dilations and evacuations.
At an accompanying poster presentation, Horvath-Cosper noted prior research linking abortions to various mental health issues and increased risk of breast cancer. But most of those studies, she observed, used comparison groups of women who had a wanted pregnancy and went on to have a healthy delivery.
Horvath-Cosper pointed to the , which compared women with successful abortions to women who tried but failed to get abortions.
"They found that people are not able to leave an abusive partner at the same frequency they would if they were able to terminate pregnancy," she said. "We know children born in situations where they are unwanted have poorer health, lower rates of breastfeeding, and their mothers have lower rates of accessing prenatal care. So, this is much more far-reaching than saying they'll have a baby and things will be fine. This has public health implications."
In addition, Horvath-Cosper said that in states with , the number of women who accessed abortions in the second trimester decreased, but the number having abortions in surrounding states increased.
"Women were needing to leave that state and we know this contributes to significant delay, which increases cost, increases risk, and increases likelihood they will not be able to obtain an abortion they need because they will be beyond the gestational age limit, they won't be able to get there and won't be able to afford it," she said.
ACOG fellow , is also examining the issue of women crossing state lines to obtain abortions, specifically from Texas to New Mexico, and discussed her ongoing research at the press briefing.
"I looked for some numbers just from our clinic in New Mexico, and there was an over 400% proportional increase in women coming from Texas, excluding women from all other states," she said.
With the number of medical abortions declining by 70% with the passage of these laws, Bhardwaj specifically decided to examine the impact of on the three main abortion clinics in Albuquerque. She anticipates completing data collection in the next month or so.
In examining the harms of TRAP laws, Horvath-Cosper came across a survey finding that, following the passage of HB2, 7% of Texas women reported ingesting medication on their own to induce an abortion before coming to a clinic. She added that clinics were closed by HB2 that also provided basic healthcare, including screening and contraception, to underserved populations.
"People who were coming to clinics that provide abortion to also get basic healthcare are women of color, women of lower income, people who don't have access to other clinics to get their care, so this is a marginalized group of women who already have disparate health outcomes," said Horvath-Cosper. "This isn't just about abortion -- this isn't just about contraception, this is about access to basic women's healthcare."
Primary Source
American College of Obstetricians and Gynecologists
Horvarth-Cosper D "Setting a TRAP: How women are harmed by targeted regulation of abortion provider laws" ACOG 2016; Abstract 1N.