Abortion
Publication: Annals of Internal Medicine
Volume 177, Number 10
Submit a Comment
Contributors must reveal any conflict of interest. Comments are moderated. Please see our information for authorsregarding comments on an Annals publication.
Abstract
Induced abortion is safe, is common, and reduces pregnancy-related maternal morbidity and mortality. Internal medicine physicians are uniquely positioned to counsel patients on their pregnancy options, assess medical risks of pregnancy in the context of comorbidities, refer for abortion care when the patient desires it, or provide abortion care themselves. Clinicians can also provide anticipatory guidance about what patients should expect if they seek abortion care.
Get full access to this article
View all available purchase options and get full access to this article.
References
1.
Heuser CC, Sagaser KG, Christensen EA, et al; Reproductive Health Project Advisory Group. Society for Maternal–Fetal Medicine special statement: a critical examination of abortion terminology as it relates to access and quality of care. Am J Obstet Gynecol. 2023;228:B2-B7. [PMID: 36563832] doi: 10.1016/j.ajog.2022.12.302
2.
Dobbs, State Health Officer of the Mississippi Department of Health, et al. v. Jackson Women’s Health Organization et al. 597 U.S. (2022).
3.
Jones RK, Jerman J. Population group abortion rates and lifetime incidence of abortion: United States, 2008–2014. Am J Public Health. 2017;107:1904-1909. [PMID: 29048970] doi: 10.2105/AJPH.2017.304042
4.
Jones RK, Kirstein M, Philbin J. Abortion incidence and service availability in the United States, 2020. Perspect Sex Reprod Health. 2022;54:128-141. [PMID: 36404279] doi: 10.1363/psrh.12215
5.
Ranji U, Diep K, Salganicoff A. Key Facts on Abortion in the United States. KFF; 2023. Accessed at www.kff.org/womens-health-policy/issue-brief/key-facts-on-abortion-in-the-united-states on 5 January 2024.
6.
Finer LB, Frohwirth LF, Dauphinee LA, et al. Reasons U.S. women have abortions: quantitative and qualitative perspectives. Perspect Sex Reprod Health. 2005;37:110-118. [PMID: 16150658] doi: 10.1363/psrh.37.110.05
7.
Guttmacher Institute. Monthly Abortion Provision Study. US Abortion Provision Dashboard. Accessed at www.guttmacher.org/monthly-abortion-provision-study on 6 June 2024.
8.
Society of Family Planning. #WeCount Report: April 2022 to June 2023. 24 October 2023. Accessed at https://societyfp.org/wp-content/uploads/2023/10/WeCountReport_10.16.23.pdf on 6 January 2024.
9.
Forouzan K, Friedrich-Karnik A, Maddow-Zimet I. The High Toll of US Abortion Bans: Nearly One in Five Patients Now Traveling Out of State for Abortion Care. Guttmacher Institute; 7 December 2023. Accessed at www.guttmacher.org/2023/12/high-toll-us-abortion-bans-nearly-one-five-patients-now-traveling-out-state-abortion-care on 7 January 2024.
10.
Trevino J, Paul R, King E, et al. Change in clinic volume and gestational age at time of abortion in southern Illinois before and after Dobbs v Jackson Women’s Health Organization. Contraception. 2023;127:110202. doi: 10.1016/j.contraception.2023.110202
11.
Dench D, Pineda-Torres M, Myers C. The Effects of the Dobbs Decision on Fertility. IZA Institute of Labor Economics; November 2023. Accessed at https://docs.iza.org/dp16608.pdf on 5 January 2024.
12.
Guttmacher Institute. State Funding of Abortion Under Medicaid. Accessed at www.guttmacher.org/state-policy/explore/state-funding-abortion-under-medicaid on 6 January 2024.
13.
Guttmacher Institute. Regulating Insurance Coverage of Abortion. Accessed at www.guttmacher.org/state-policy/explore/regulating-insurance-coverage-abortion on 5 January 2024.
14.
Upadhyay UD, Ahlbach C, Kaller S, et al. Trends in self-pay charges and insurance acceptance for abortion in the United States, 2017–20. Health Aff (Millwood). 2022;41:507-515. [PMID: 35377750] doi: 10.1377/hlthaff.2021.01528
15.
Friedman CF, Chasen ST. Abortion for fetal indications: timing of prenatal diagnosis and abortion for structural and genetic abnormalities. Contraception. 2020;101:293-295. [PMID: 32061568] doi: 10.1016/j.contraception.2020.02.002
16.
ACOG practice bulletin no. 135: Second-trimester abortion. Obstet Gynecol. 2013;121:1394-1406. [PMID: 23812485] doi: 10.1097/01.AOG.0000431056.79334.cc
17.
Guttmacher Institute. Induced Abortion in the United States. Accessed at www.guttmacher.org/fact-sheet/induced-abortion-united-states on 9 February 2024.
18.
Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al; ESC Scientific Document Group. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39:3165-3241. [PMID: 30165544] doi: 10.1093/eurheartj/ehy340
19.
Moussa HN, Rajapreyar I. ACOG practice bulletin no. 212: Pregnancy and heart disease. Obstet Gynecol. 2019;134:881-882. [PMID: 31568352] doi: 10.1097/AOG.0000000000003497
20.
Silverstein J, Van Loon K. The implications of the Supreme Court decision to overturn Roe v Wade for women with pregnancy-associated cancers. JAMA Oncol. 2022;8:1394-1395. [PMID: 35951314] doi: 10.1001/jamaoncol.2022.3785
21.
Davis AR, Horvath SK, Castaño PM. Trends in gestational age at time of surgical abortion for fetal aneuploidy and structural abnormalities. Am J Obstet Gynecol. 2017;216:278.e1-278.e5. [PMID: 27984035] doi: 10.1016/j.ajog.2016.10.031
22.
Blackwell S, Louis JM, Norton ME, et al. Reproductive services for women at high risk for maternal mortality: a report of the workshop of the Society for Maternal-Fetal Medicine, the American College of Obstetricians and Gynecologists, the Fellowship in Family Planning, and the Society of Family Planning. Am J Obstet Gynecol. 2020;222:B2-B18. [PMID: 32252942] doi: 10.1016/j.ajog.2019.12.008
23.
Flink-Bochacki R, McLeod C, Lipe H, et al. Classification of periviable pregnancy-ending interventions for maternal life endangerment as induced abortion. Contraception. 2023;123:110011. [PMID: 36931549] doi: 10.1016/j.contraception.2023.110011
24.
Perry R, Zimmerman L, Al-Saden I, et al. Prevalence of rape-related pregnancy as an indication for abortion at two urban family planning clinics. Contraception. 2015;91:393-397. [PMID: 25636805] doi: 10.1016/j.contraception.2015.01.012
25.
American College of Obstetricians and Gynecologists. Medication Abortion Up to 70 Days of Gestation. Practice bulletin no. 225. October 2020.
26.
Raymond EG, Mark A, Grossman D, et al. Medication abortion with misoprostol-only: a sample protocol. Contraception. 2023;121:109998. [PMID: 36849033] doi: 10.1016/j.contraception.2023.109998
27.
Goldberg AB, Fulcher IR, Fortin J, et al. Mifepristone and misoprostol for undesired pregnancy of unknown location. Obstet Gynecol. 2022;139:771-780. [PMID: 35576336] doi: 10.1097/AOG.0000000000004756
28.
Borchert K, Thibodeau C, Varin P, et al. Medication abortion and uterine aspiration for undesired pregnancy of unknown location: a retrospective cohort study. Contraception. 2023;122:109980. [PMID: 36804050] doi: 10.1016/j.contraception.2023.109980
29.
Guttmacher Institute. Medication Abortions Accounted for 63% of All US Abortions in 2023, an Increase from 53% in 2020. 19 March 2024. Accessed at www.guttmacher.org/news-release/2024/medication-abortions-accounted-63-all-us-abortions-2023-increase-53-2020 on 5 April 2024.
30.
Danco Laboratories. MIFEPREX Prescribing Information and Medication Guide. 2023.
31.
National Academies of Sciences, Engineering, and Medicine. The Safety and Quality of Abortion Care in the United States. National Academies Pr; 2018.
32.
Liu N, Ray JG. Short-term adverse outcomes after mifepristone–misoprostol versus procedural induced abortion: a population-based propensity-weighted study. Ann Intern Med. 2023;176:145-153. [PMID: 36592459] doi: 10.7326/M22-2568
33.
Jatlaoui TC, Shah J, Mandel MG, et al. Abortion Surveillance - United States, 2014. MMWR Surveill Summ. 2017;66:1-48. [PMID: 29166366] doi: 10.15585/mmwr.ss6624a1
34.
Kerestes C, Delafield R, Elia J, et al. Person-centered, high-quality care from a distance: a qualitative study of patient experiences of TelAbortion, a model for direct-to-patient medication abortion by mail in the United States. Perspect Sex Reprod Health. 2022;54:177-187. [PMID: 36229416] doi: 10.1363/psrh.12210
35.
Pearlman Shapiro M, Dethier D, Kahili-Heede M, et al. No-test medication abortion: a systematic review. Obstet Gynecol. 2023;141:23-34. [PMID: 36701607] doi: 10.1097/AOG.0000000000005016
36.
Guttmacher Institute. Requirements for Ultrasound. Accessed at www.guttmacher.org/state-policy/explore/requirements-ultrasound on 6 January 2024.
37.
American College of Obstetricians and Gynecologists. Practice bulletin no. 181 summary: Prevention of Rh D alloimmunization. Obstet Gynecol. 2017;130:481-483. [PMID: 28742667] doi: 10.1097/AOG.0000000000002226
38.
Yazer MH, Panko G, Holcomb JB, et al. Not as “D"eadly as once thought - the risk of D-alloimmunization and hemolytic disease of the fetus and newborn following RhD-positive transfusion in trauma. Hematology. 2023;28:2161215. [PMID: 36607150] doi: 10.1080/16078454.2022.2161215
39.
Horvath S, Huang Z-Y, Koelper NC, et al. Induced abortion and the risk of Rh sensitization. JAMA. 2023;330:1167-1174. [PMID: 37750879] doi: 10.1001/jama.2023.16953
40.
Wiebe ER, Campbell M, Aiken ARA, et al. Can we safely stop testing for Rh status and immunizing Rh-negative women having early abortions? A comparison of Rh alloimmunization in Canada and the Netherlands. Contracept X. 2019;1:100001. doi: 10.1016%2Fj.conx.2018.100001
41.
Horvath S, Goyal V, Traxler S, et al. Society of Family Planning committee consensus on Rh testing in early pregnancy. Contraception. 2022;114:1-5. [PMID: 35872236] doi: 10.1016/j.contraception.2022.07.002
42.
World Health Organization. Abortion Care Guideline. 8 March 2022.
43.
Royal College of Obstetricians and Gynaecologists. Best Practice in Abortion Care. March 2022.
44.
American College of Obstetricians and Gynecologists. Issue Brief: Crisis Pregnancy Centers. Accessed at www.acog.org/advocacy/abortion-is-essential/trending-issues/issue-brief-crisis-pregnancy-centers on 11 February 2024.
45.
Dzuba IG, Chong E, Hannum C, et al. A non-inferiority study of outpatient mifepristone–misoprostol medical abortion at 64–70 days and 71–77 days of gestation. Contraception. 2020;101:302-308. [PMID: 32014520] doi: 10.1016/j.contraception.2020.01.009
46.
Colwill AC, Bayer LL, Bednarek P, et al. Opioid analgesia for medical abortion: a randomized controlled trial. Obstet Gynecol. 2019;134:1163-1170. [PMID: 31764725] doi: 10.1097/AOG.0000000000003576
47.
Raymond EG, Grossman D, Mark A, et al. Commentary: no-test medication abortion: a sample protocol for increasing access during a pandemic and beyond. Contraception. 2020;101:361-366. [PMID: 32305289] doi: 10.1016/j.contraception.2020.04.005
48.
Chen MJ, Creinin MD. Mifepristone with buccal misoprostol for medical abortion: a systematic review. Obstet Gynecol. 2015;126:12-21. [PMID: 26241251] doi: 10.1097/AOG.0000000000000897
49.
Upadhyay UD, Koenig LR, Meckstroth K, et al. Effectiveness and safety of telehealth medication abortion in the USA. Nat Med. 2024;30:1191-1198. [PMID: 38361123] doi: 10.1038/s41591-024-02834-w
50.
National Abortion Federation. 2020 Clinical Policy Guidelines for Abortion Care. Accessed at https://prochoice.org/wp-content/uploads/2020_cpgs_final.pdf on 6 January 2024.
51.
World Health Organization. Clinical Services Recommendation 10: Pre-abortion Ultrasound Scanning (3.3.5). Accessed at https://srhr.org/abortioncare/chapter-3/pre-abortion-3-3/clinical-services-recommendation-10-pre-abortion-ultrasound-scanning-3-3-5 on 10 February 2024.
52.
Grossman DA, Grindlay K, Buchacker T, et al. Changes in service delivery patterns after introduction of telemedicine provision of medical abortion in Iowa. Am J Public Health. 2013;103:73-78. [PMID: 23153158] doi: 10.2105/AJPH.2012.301097
53.
KFF. The Availability and Use of Medication Abortion. Accessed at www.kff.org/womens-health-policy/fact-sheet/the-availability-and-use-of-medication-abortion on 6 January 2024.
54.
Verma N, Goyal V, Grossman D, et al. Society of Family Planning Interim Clinical Recommendations: Self-Managed Abortion. Society of Family Planning; 2022. Accessed at https://societyfp.org/wp-content/uploads/2022/06/SFP-Interim-Recommendation-Self-managed-abortion-09.08.22.pdf on 6 January 2024.
55.
Stenberg v. Carhart, 530 U.S. 914 (2000).
56.
Diedrich JT, Drey EA, Newmann SJ. Society of Family Planning clinical recommendations: cervical preparation for dilation and evacuation at 20–24 weeks’ gestation. Contraception. 2020;101:286-292. [PMID: 32007418] doi: 10.1016/j.contraception.2020.01.002
57.
Zwerling B, Edelman A, Jackson A, et al. Society of Family Planning clinical recommendation: medication abortion between 14 0/7 and 27 6/7 weeks of gestation: jointly developed with the Society for Maternal–Fetal Medicine. Am J Obstet Gynecol. 2023. [PMID: 37821258] doi: 10.1016/j.ajog.2023.09.097
58.
Bayer LL, Edelman AB, Fu R, et al. An evaluation of oral midazolam for anxiety and pain in first-trimester surgical abortion: a randomized controlled trial. Obstet Gynecol. 2015;126:37-46. [PMID: 26241254] doi: 10.1097/AOG.0000000000000913
59.
Zane S, Creanga AA, Berg CJ, et al. Abortion-related mortality in the United States: 1998–2010. Obstet Gynecol. 2015;126:258-265. [PMID: 26241413] doi: 10.1097/AOG.0000000000000945
60.
Kortsmit K, Mandel MG, Reeves JA, et al. Abortion surveillance - United States, 2019. MMWR Surveill Summ. 2021;70:1-29. [PMID: 34818321] doi: 10.15585/mmwr.ss7009a1
61.
Centers for Disease Control and Prevention. Maternal Deaths and Mortality Rates: Each State, the District of Columbia, United States, 2018–2021. Accessed at www.cdc.gov/nchs/maternal-mortality/MMR-2018-2021-State-Data.pdf on 6 January 2024.
62.
Levy BS, Ness DL, Weinberger SE. Consensus guidelines for facilities performing outpatient procedures: evidence over ideology. Obstet Gynecol. 2019;133:255-260. [PMID: 30633142] doi: 10.1097/AOG.0000000000003058
63.
Whole Woman’s Health v. Hellerstedt. 579 U.S. (2016).
64.
Benson LS, Micks EA, Ingalls C, et al. Safety of outpatient surgical abortion for obese patients in the first and second trimesters. Obstet Gynecol. 2016;128:1065-1070. [PMID: 27741198] doi: 10.1097/AOG.0000000000001692
65.
Henkel A, Johnson SA, Reeves MF, et al. Cabergoline for lactation inhibition after second-trimester abortion or pregnancy loss: a randomized controlled trial. Obstet Gynecol. 2023;141:1115-1123. [PMID: 37486652] doi: 10.1097/AOG.0000000000005190
66.
Holmlund S, Kauko T, Matomäki J, et al. Induced abortion - impact on a subsequent pregnancy in first-time mothers: a registry-based study. BMC Pregnancy Childbirth. 2016;16:325. [PMID: 27776483] doi: 10.1186/s12884-016-1109-3
67.
Stoddard A, Eisenberg DL. Controversies in family planning: timing of ovulation after abortion and the conundrum of postabortion intrauterine device insertion. Contraception. 2011;84:119-121. [PMID: 21757051] doi: 10.1016/j.contraception.2010.12.010
68.
Cannon R, Treder K, Woodhams EJ. Contraception. Ann Intern Med. 2023;176:ITC113-ITC128. [PMID: 37549386] doi: 10.7326/AITC202308150
69.
Cansino C, Lichtenberg ES, Perriera LK, et al. Do women want to talk about birth control at the time of a first-trimester abortion? Contraception. 2018;98:535-540. [PMID: 30110618] doi: 10.1016/j.contraception.2018.08.005
70.
Roe AH, Bartz D. Society of Family Planning clinical recommendations: contraception after surgical abortion. Contraception. 2019;99:2-9. [PMID: 30195718] doi: 10.1016/j.contraception.2018.08.016
71.
Biggs MA, Upadhyay UD, McCulloch CE, et al. Women’s mental health and well-being 5 years after receiving or being denied an abortion: a prospective, longitudinal cohort study. JAMA Psychiatry. 2017;74:169-178. [PMID: 27973641] doi: 10.1001/jamapsychiatry.2016.3478
72.
Lichtenberg ES, Paul M; Society of Family Planning. Surgical abortion prior to 7 weeks of gestation. Contraception. 2013;88:7-17. [PMID: 23574709] doi: 10.1016/j.contraception.2013.02.008
73.
Patel D, Liu G, Roberts SCM, et al. Association of provider specialty with abortion-related morbidity and adverse events among patients having procedural and medication abortions. Womens Health Issues. 2022;32:327-333. [PMID: 35437157] doi: 10.1016/j.whi.2022.03.001
74.
Taylor D, Safriet B, Weitz T. When politics trumps evidence: legislative or regulatory exclusion of abortion from advanced practice clinician scope of practice. J Midwifery Womens Health. 2009;54:4-7. [PMID: 19114233] doi: 10.1016/j.jmwh.2008.09.003
75.
Jones RK, Nash E, Cross L, et al. Medication Abortion Now Accounts for More Than Half of All US Abortions. Guttmacher Institute; 24 February 2022. Accessed at www.guttmacher.org/article/2022/02/medication-abortion-now-accounts-more-half-all-us-abortions on 7 January 2024.
76.
Abortion Pill CME website. Accessed at https://abortionpillcme.teachtraining.org on 7 January 2024.
77.
Guttmacher Institute. Interactive Map: US Abortion Policies and Access After Roe. Accessed at https://states.guttmacher.org/policies on 30 June 2024.
78.
KFF. Interactive: How State Policies Shape Access to Abortion Coverage. 2023. Accessed at www.kff.org/womens-health-policy/issue-brief/interactive-how-state-policies-shape-access-to-abortion-coverage on 15 July 2024.
79.
Salganicoff A, Sobel L, Gomez I, et al. The Hyde Amendment and Coverage for Abortion Services Under Medicaid in the Post-Roe Era. KFF; 14 March 2024. Accessed at www.kff.org/womens-health-policy/issue-brief/the-hyde-amendment-and-coverage-for-abortion-services-under-medicaid-in-the-post-roe-era on 15 July 2024.
Comments
Sign In to Submit A CommentInformation & Authors
Information
Published In
Annals of Internal Medicine
Volume 177 • Number 10 • October 2024
Pages: ITC145 - ITC160
History
Published online: 8 October 2024
Published in issue: October 2024
Keywords
Copyright
© 2024 American College of Physicians.
Authors
Author Disclosures
Metrics & Citations
Metrics
Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. For an editable text file, please select Medlars format which will download as a .txt file. Simply select your manager software from the list below and click Download.
For more information or tips please see 'Downloading to a citation manager' in the Help menu.
Download article citation data for:
Abortion. Ann Intern Med.2024;177:ITC145-ITC160. [Epub 8 October 2024]. doi:10.7326/ANNALS-24-01868
Abortion. Ann Intern Med.2024;177:ITC145-ITC160. [Epub 8 October 2024]. doi:10.7326/ANNALS-24-01868
View More
Login Options:
Purchase
You will be redirected to acponline.org to sign-in to Annals to complete your purchase.
Access to EPUBs and PDFs for FREE Annals content requires users to be registered and logged in. A subscription is not required. You can create a free account below or from the following link. You will be redirected to acponline.org to create an account that will provide access to Annals. If you are accessing the Free Annals content via your institution's access, registration is not required.
Create your Free Account
You will be redirected to acponline.org to create an account that will provide access to Annals.
Respect for human right to life
In this extensive review by Drs. Chuang and Horvath on the different techniques of abortion, as well the epidemiological numbers in the United States, there is not any comment on the ethical aspects regarding ending a pregnancy that is ending a human life. If there is such a great debate in the US regarding abortion for the next presidential election, it is because it implies something as important as the right to life. There is no doubt that from the very first moment of conception a new life is initiated that has to be respected and cared for because she or he cannot defend, feed, or nurture by him or herself. In this review it is mentioned that the "medical "reasons to indicate an abortion represents a very low number of the total amount of millions of abortions done. Yet we know that there are many resources curently that can be offered to those women with high risk pregnancies to care for them and their babies. I think that it is time to go deeper in the medical, biological, philosophical, aspects of the life of the HUMAN embryo or fetus, his or her rights and our duty to care for them.
Author Response to "Respect for Human Right to Life"
Dr. Urosa brings up important philosophical and personal questions related to abortion care that were beyond the scope of our review. Our aim was to present the current medical standards of abortion care. As with all health care practices, patients should only opt for care that is aligned with their own personal beliefs and values. Similarly, clinicians can opt out of providing care for moral or religious reasons, so long as their patients still receive the medical care they need.