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Effects of Legislation Regulating Abortion in Arizona

Published:April 06, 2018DOI:https://doi.org/10.1016/j.whi.2018.02.002

      Abstract

      Introduction

      Abortion is a common and safe procedure in the United States, the regulation of which varies by state. Since 2011, hundreds of state-level abortion restrictions have been enacted by legislatures across the country. This study describes the effects of two such regulations enacted in 2011 in Arizona, (A.R.S.) 36-2153 and 36-2155, that imposed a 24-hour waiting period requiring two separate in-person clinic visits before obtaining an abortion and banned advanced practice clinicians such as physician assistants, nurse practitioners, and nurse midwives from inducing medication abortions by prescribing mifepristone.

      Materials and Methods

      We conducted a pre–post study to describe the effect of Arizona's scope of practice law on abortion provision by county. Using publicly available data, we compared patterns of abortion provision in 2009 and 2010 (before the laws) with 2012 and 2013. Our primary objective was to compare the proportion of abortions performed with medication by prescription of mifepristone (versus abortions performed surgically, known as aspiration abortions) before and after the laws were enacted. Our secondary objectives were to report the number of counties that lost an abortion provider and the change in the proportion of abortions performed before 14 weeks' gestation of pregnancy after the enactment of the laws.

      Results

      After enactment of the laws, the proportion of Arizona's 15 counties with abortion clinics decreased from 33% to 13%. Over this time, the proportion of abortions performed with medication in Arizona decreased by 17.4% (95% CI, 16.6%–18.3%; p = .0002), from 47.6% to 30.2%. Similarly, the proportion of abortions performed before 14 weeks' gestation in Arizona decreased by 3.3% (95% CI, 2.8%–3.8%; p = .0002) after the enactment of these laws.

      Discussion

      The proportion of abortions performed with medication and the proportion of abortion performed before 14 weeks’ gestation in Arizona were negatively affected by the enactment of these laws. These findings are not explained by national temporal trends in abortion, because the proportion of abortions performed with medication increased and early abortions remained stable over the same time period in the United States as a whole.

      Conclusions

      Proponents of laws restricting the provision of abortion such as these claim to improve the safety of abortion, but they actually seem to decrease access to abortion, as defined by the number of counties with abortion providers, and subsequently lead to delays in abortion. These data should inform future policies by providing an example of how such laws affect women seeking abortion.
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      Biography

      Sigrid G. Williams, MD, MPH, is an obstetrician/gynecologist at the University of California, San Diego. Her clinical and research interests include public health, health policy and advocacy, providing care for the underserved, and the prevention of legal discrimination against pregnant women.

      Biography

      Sarah Roberts, DrPH, is Associate Professor at ANSIRH in the Department of Obstetrics, Gynecology, and Reproductive Sciences at University of California, San Francisco. She studies ways policies and the health care system punish, rather than support, vulnerable pregnant women.

      Biography

      Jennifer L. Kerns, MD, MPH, is Associate Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco. She is a generalist/family planning subspecialist and conducts research on abortion complications and shared decision making with second trimester abortion.