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.
Article info
Publication history
Published online: April 06, 2018
Accepted:
February 5,
2018
Received in revised form:
January 28,
2018
Received:
July 25,
2017
Footnotes
Funding Statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2018 Jacobs Institute of Women's Health. Published by Elsevier Inc.
