Reproductive health and abortion

[00:00:27]

RICK WEISS: Hello, everyone, and welcome to SciLine’s media briefing on reproductive health and abortion. I’m SciLine’s director Rick Weiss. For those of you not familiar with SciLine, we are a philanthropically funded, editorially independent and entirely free service for reporters based at the nonprofit American Association for the Advancement of Science. Our mission is simply to make it as easy as possible for you to include scientist sources and scientifically validated information in your news stories whether those stories are about a science topic or are about things going on in your community where a little bit of extra scientific context or data could make that story stronger.

Today’s briefing is actually the second of six we are hosting this month all on topics that are in the news because they are issues at the top of the political agenda in the leadup to November’s elections. We’re doing this because many of the topics that we hear candidates disagreeing about during this season, topics like immigration policy or the state of the economy, trustworthiness of the electoral system and reproductive health, are too often covered as though they’re simply matters of political opinion when in fact these topics have been rigorously studied by scientists across multiple disciplines. So, our hope is that when you produce stories about these topics and when you write about what candidates are saying or what your audiences are feeling about these issues, you’ll also hopefully be able to include in these stories some of what carefully conducted research has also found to be true. Please check out the link that will go up in the chat here to see the full schedule of the rest of this month’s election-related briefings. A couple of quick logistical details before we get started. We’re going to have two panelists today who will make short presentations of less than 10 minutes each before we open it up for Q&A. While they’re speaking or afterwards, if you want to enter a question, please go to the Q&A icon at the bottom of your screen and enter your name, your news outlet, and the question. And if you want to direct it to one of our two speakers, you can mention that as well. A full video of this briefing is going to be available pretty instantly at the end of the briefing today, and a timestamped transcript will get added a day or two later.

And finally, I want to tell you that I’m not going to introduce and take all the time to do a full introduction of our two speakers, but I do want to tell you who they are and roughly what they’re going to cover. So, you should know that we will hear first from Dr. Sarah Prager who is an OB/GYN physician and a professor of obstetrics and gynecology at the University of Washington, and she’s the director of the family planning division there at UW, and she will give a medical perspective on abortion. So, you have a straight take really on the procedure itself and the medications involved, as well as what the research says about the physical and the mental health implications of either having access to an abortion or not. And second, we’re going to hear from Dr. Amanda Stevenson who is an assistant professor in sociology at the University of Colorado Boulder, and she’s going to share information about current trends with abortion including the demographics of who’s getting abortions, when in their pregnancy they’re doing so, and a comparison of some state-by-state abortion data from before and after the Dobbs decision that overturned Roe v. Wade. And with that introductory material, let’s just get started, and I hand it over to you, Dr. Sarah Prager.

[00:04:01]

SARAH PRAGER: Hi, everybody. Let me share my screen. Is everybody seeing my slides here? Perfect. All right. So, as Rick said, I’m going to be spending about 10 minutes talking to you about just some basic facts about abortion. And so, if questions come up, please put them in the chat and we’ll get to them later. And also, I’m a professor of obstetrics and gynecology and also a subspecialist in complex family planning. So, talking and working with abortion and contraception and miscarriages is what I spend most of my time doing. What is an abortion? An abortion is the act of doing or taking something that ends a pregnancy, and that may sound obvious, but I think it’s worth kind of talking about for a second what is and what is not an abortion and what are we including or what am I including in our conversation today. Generally when we talk about abortion, we are not also including ectopic pregnancy, which is a pregnancy outside of the uterus, or a spontaneous abortion, which is a miscarriage.

So, why do we say induced abortion sometimes? You’ll probably have heard that mentioned as well, and we do that to differentiate from a spontaneous abortion. So, taking something that ends a pregnancy versus a pregnancy ending spontaneously, which is a miscarriage or a pregnancy loss. And generally speaking, we avoid the term elective abortion because that indicates some judgment that this is something that maybe doesn’t need to happen, and all abortions are indicated for some reason. I also just like to remind everybody that language does matter and how we talk about abortion has really wide implications. It can matter to our patients and to other individuals that they’re associated with, both those who have abortions and those who may need one in the future. It also can really matter to people who perform abortions like I do and other colleagues of mine. It has huge implications on legislation and on regulation. So, let’s understand a little bit more. What is a medication abortion? Well, a medication abortion is taking a combination of medications typically in the first 11 to 12 weeks, and that combination includes a mifepristone tablet that a patient swallows, followed usually in 24 to 72 hours by four misoprostol tablets that are administered by themselves at home. If the pregnancy is beyond nine weeks, then generally speaking the dose of misoprostol needs to be repeated at least one time. And the passing of the pregnancy also occurs at home. There are also some misoprostol-only regimens that are available. It typically requires more doses of the misoprostol to achieve a similar efficacy than if using pre-treatment with mifepristone and there are more side effects.

We find in Washington State that it’s been incredibly helpful to have this available, particularly for people who live rurally, and I’ll explain that in just a minute. Mifepristone, the first medication of the medication abortion, is still really highly regulated through a system called the REMS, which stands for Risk Evaluation and Mitigation Strategies. This is an FDA system. This is applied typically to medications that are very dangerous or potentially life affirming and is used to assess safety of use. And then typically, the REMS go away after safety has been confirmed. These REMS have been in place for well over a decade for mifepristone in spite of the fact that it’s an incredibly safe medication. They include restrictions like mifepristone cannot be prescribed through a pharmacy like most other medications. There has to be a provider that is registered to be able to even receive mifepristone to dispense in a clinic. And if they want to prescribe through a pharmacy, both the provider and the pharmacy need to specifically register that medication. Pharmacies also have to consent to carry mifepristone, and only one pharmacy in Washington State for instance currently carries mifepristone. It is possible now through some adjustments to the REMS that happened during and post Dobbs that mifepristone can be mailed from a registered pharmacy to a patient, although that patient still needs to be living in the state where that medication is prescribed and mailed from. So, as I mentioned, mifepristone and misoprostol are incredibly safe medications. They’re safer than ibuprofen. They’re safer than Tylenol. And there was a recent analogy that was made that medication abortion is substantially safer than skydiving, which I think is an event that most of us would think of as being much more dangerous.

Procedural abortion in the first trimester is typically a uterine aspiration, and this can happen with a manual or a handheld vacuum aspirator or an electric vacuum aspirator. Most typically in the United States and around the globe, we use the manual aspirator for the first trimester, and it just looks like a big syringe. This is a procedure that takes under 5 minutes most of the time during this first-trimester time period. First-trimester abortion can also happen in a variety of settings. So, procedural abortion most typically happens in an outpatient clinic. That might be with or without various sedation type medications. However, it can also happen in an emergency department or in an operating room if patients do want or require more anesthesia or supervision. Medication abortion also can happen in outpatient clinics. It can happen through an emergency department, on an inpatient hospital unit if a patient is already admitted when they discover a need for medication abortion. As I mentioned, it could be mailed. And if a pharmacy is registered, it can be dispensed through a pharmacy.

Now, I’m going to switch to talking about abortion after 14 weeks or after the first trimester, and procedural abortion is conducted using a dilation and evacuation or an intact D&E or D&X procedure. Medication abortion instead at these gestational ages looks very much like an induction of labor. We use the exact same medications and the exact same techniques as we would inducing labor at term, although sometimes we use the medications in slightly different doses. Location for abortion beyond 14 weeks can also vary, and the majority of abortions beyond 14 weeks procedurally also happen at outpatient clinics. These are often freestanding clinics like Planned Parenthoods or other independent abortion clinics. And typically, this is happening with anesthesia or sedation on site. They also can occur in an operating room, again particular particularly if there are medical concerns. Medication abortions beyond 14 weeks are typically going to be happening on labor and delivery wards, although in other countries there often are specific wards that are set aside for medication abortion management. Excuse me. Post-abortion care if the abortion is uncomplicated is pretty minimal in terms of what’s required. We don’t require patients to follow up, although we always offer a followup for our patients. Excuse me.

For patients who may live remotely and/or for whom a followup visit might be challenging, they’re always welcome to take a home urine pregnancy test between two and four weeks after the abortion to confirm completion. And then, they can follow up if that test is still positive. Menstruation typically returns one or two months after the abortion, and most people feel able to resume their usual daily activities within just a few days of the abortion. If desired, contraception can start immediately. Excuse me. I apologize. Complications are quite uncommon, generally less than 1% for all abortions. The morbidity—sorry—the mortality of procedural abortion is less than one in one million. The mortality for medication abortion is less than five in one million. And just to compare that to continuing pregnancy, the mortality of pregnancy is greater than one 100 out of 1 million. So, what you’re looking at is really 20 to 100 times less safety continuing a pregnancy than having an abortion. If uncomplicated, an abortion also has no impact on future fertility regardless of how that abortion happens or at what gestational duration. There are, however, complications of not getting an abortion, and there was a really pivotal study called the Turnaway Study, and a link to that is below on this slide. And this was a study that compared those who received a wanted abortion to those who were denied a wanted abortion, and all of those subjects were followed for 5 years. What the study found was that there were more life-threatening conditions like eclampsia, which is dangerously high blood pressure, and postpartum hemorrhage for those who were denied their wanted abortions. There were more chronic headaches and migraines, more joint pain and high blood pressure compared to those who were denied an abortion. There are higher rates of household poverty, lower credits scores, and increased debt for those denied abortions and also more negative outcomes for those children born after abortion denial as compared to people who were able to achieve their abortions and then subsequently went on to have children. Those children actually did much better. So, bottom line of that is that child outcomes are much improved when it’s a wanted pregnancy and a wanted birth.

We often hear about the risk of mental health implications of abortion, but having a wanted abortion is not associated with mental health harms. Compared to receiving an abortion, being denied a wanted abortion is associated with experiencing more symptoms of anxiety and low self-esteem one week after denial. Basically, prior history of a mental health condition is the strongest predictor of mental health conditions after an abortion. And laws that require women to be warned about negative psychological consequences of abortion are not based in evidence. And I’m just going to end by saying abortion is safe and continuing a pregnancy oftentimes is not. Thank you.

[00:16:04]

RICK WEISS: All right. Thank you very much, Dr. Prager. And over to you, Dr. Stevenson.

[00:16:16]

AMANDA STEVENSON: Thank you. We’re well situated to describe the demography of abortion given that very useful introduction. Defining abortion is always really important because there is so much misinformation about abortion contraception and pregnancy swirling around these days. So, I’m going to start by talking about the fact that most abortions happen very early in pregnancy. Almost half, 44% to 42% of abortions in the United States in recent years have occurred at or before six weeks of pregnancy. So, this is four weeks or fewer since fertilization. So, these are very, very early abortions. We measure the gestational duration of the pregnancies that end in abortion from last menstrual period, which is important to note because so many early abortion bans are so early that those two weeks between the menstrual period and fertilization and ovulation are pretty important. The fact that abortions are occurring so early in pregnancy in the contemporary era is a pretty big contrast with the past and the more distant past. So, here, the disaggregation by gestational duration is slightly different.

So, in 2020, over three-quarters of abortions were at or before nine weeks, and we don’t have the same disaggregation in different time periods, so the comparison is a little different in the earlier years, but you can see that about 1/3 of abortions at the time of Roe v. Wade were at or before eight weeks. And it’s especially sort of notable that we have many more abortions at or before six weeks now than we had at or before eight weeks at the time of Roe v. Wade. So, abortions have been occurring earlier and earlier in pregnancy over time, and this is largely due to the fact that abortion can occur earlier because medication abortion enables the provision of this care at earlier gestational durations than were previously possible. Another change in abortion over time has been a very long-term multi-decade decline in the numbers and rates of abortion in the United States and then in recent years a pretty abrupt reversal. Now, these numbers come from four different sources. The incidence of abortion in the United States is not reliably available from the federal government because the CDC abortion surveillance is not mandatory. So, several large states do not report any abortion statistics to the federal government. And as a consequence, CDC statistics on abortion are always incomplete.

So, the blue dots here are the CDC incidence of abortion annually since 1973, and you can see that there’s this sort of irregular pattern. The orange dots are from a much more reliable source, which is the Guttmacher Institute’s estimates of national abortion incidence on the basis of their abortion provider survey. So, these surveys are fielded by the Guttmacher Institute every few years, and they provide a much more reliable, nationally representative estimate of the number of abortions annually in the entire United States. Since Dobbs and a little bit before Dobbs, two other sources of reliable data on abortion incidence have been introduced. Guttmacher has instituted a monthly abortion provision survey, and the Society of Family Planning has instituted a monthly survey called the We Count survey. So, these are the gray and yellow dots that you can see, and there are so many of them there at the end because they’re now monthly data instead of annual data. What these data tell us is that abortion has reversed its multi-decade decline since 2020. We’ve seen a roughly 11% increase in the number of abortions in the U.S. from before Dobbs to after Dobbs. So, from 2020 to 2023. We don’t know exactly why this increase has occurred, and I’m happy to discuss some speculation that scientists have made in the Q&A. Another change since the Dobbs decision is that the type of abortion restrictions that we see implemented has radically changed. So, there were a lot of abortion restrictions implemented in the decade before Dobbs. But in the two years since Dobbs, we’ve seen much more severe abortion restrictions enforced, total bans and near total bans on abortion in several U.S. states. Before Dobbs, the rate of abortion—so, this is the number of abortions per 1000 women of reproductive age—was highly variable across U.S. states. Some states had rates that were many times greater than others. So, the darker colors here are associated with higher rates of abortion before Dobbs. These numbers are from 2020 from the Guttmacher Institute. And lighter colors are lower rates of abortion.

After Dobbs, we saw changes in the number of abortions and the rate of abortions that varied also across states, and these didn’t always vary just according to the types of laws that changed. The changes we see in abortions after Dobbs are also the result of how the laws in the states around a state have changed. So, for example, we saw big increases in abortion in Florida because there were so many bans in other places in the South. These data are comparing April 2022—so, right before Dobbs—to April 2023. And since that time, Florida has changed its laws and would no longer have an increase. We would now see a decrease because of its six-week ban. Data about who gets abortions in the United States are best sought from the Guttmacher Institute abortion patients survey because like I said, the CDC data on abortions are fundamentally incomplete. So, all of California, for example, is excluded. Other states are also excluded. What we do know from the Guttmacher Institute abortion patient survey is that well over half of people getting abortions are in their 20s. Abortion for teenagers have been declining. They were declining before 2020, and they’ve declined since then as well, and they’ve been declining the most rapidly. They’ve been declining for everyone, but most rapidly for teenagers. People who are racialized are disproportionately represented among those who access abortion care, and this is the result of the confluence of variation in access to the means of controlling fertility before pregnancy, so variation in access to contraception, as well as differential ability to withstand the consequences of bringing an unplanned pregnancy to term. So, different people with different levels of resources may be more or less able to navigate that circumstance. So, people make decisions about pregnancy on the basis of their structural conditions.

Three-quarters of people who get abortions are classified as poor, and this is robust across various ways to measure poverty, but I’ll note that both the data about age and the data about patient characteristics that are most reliable are most recently from 2014 because the Guttmacher abortion patient survey from 2021 and 2022, which is the most recent wave, was not nationally representative. So, this is sort of just indicative of the fact that studying abortion is challenging and describing abortion is also challenging. Most people who have abortions are already parents, about 60% or more. So, 59% in 2014 already have at least one child. So, I’m happy to describe any of that in greater detail in the Q&A. Thank you.

[00:24:01]

RICK WEISS: Fantastic. Thank you, Dr. Stevenson. Thank you both for a really strong introduction. The actual introduction, a reminder to reporters that the slides from these presentations will be posted on the SciLine website immediately after the briefing so you have a chance to dig into them a little further. And a reminder that if you have questions, this is a good time to start putting them into the Q&A icon at the bottom of your screen. Typically, I like to get started on these briefings with one question from SciLine before we turn to the reporter’s questions, and I want to ask that now of both of you. But I’d be curious to hear as not just experts in your field, but as news consumers looking at stories written about this topic if there’s any thoughts you’d like to share about either things that you appreciate about the way the media has been handling this topic or things where you think there’s room for improvement and some advice you might want to give to reporters who are covering this. I think even, Dr. Prager, your interesting introduction to language very important for reporters, words we understand mean a lot in the journalism world, but anything else you’d like to add pro or con or plus or minus before we get into the reporter’s questions? Sarah, I’ll start with you.

[00:25:14]

SARAH PRAGER: Great. Thank you, Rick. I am going to circle back actually to something that you said at the beginning, Rick, and to really reflect on the fact that our presentations today, Amanda’s and mine, are very fact-based. There is a huge amount of data around abortion safety and all of the different aspects of abortion. And when I see a lot of reporting, it strikes me that it is a bit similar to the way reporting happened for many, many years around climate change where there is a false equivalency set up between the very clear facts around abortion and other people’s thoughts and feelings that are not fact-based. And I would personally like to see that reflected much more realistically in the reporting that I see so that how somebody feels about abortion and what the facts are about abortion are not being presented with the equivalent weight. So, that would be my feedback about that. Thanks.

[00:26:32]

RICK WEISS: It took about a decade for that message to get across in climate reporting. Maybe we can do this one faster. Amanda.

[00:26:38]

AMANDA STEVENSON: I’m not going to hold my breath on that, but I’ll hope for it too. So, I think that the thing that is most notable to me about the coverage of abortion is how much it has improved in the past decade. Things are so much better now than they were 10 years ago, and I’m very, very grateful. I’m sure many of you here are part of that. I’ll mention something that I meant to say in my presentation, which is that a key difference between the way scientists talk about abortion and the way many journalists write about abortion is that we never use the phrase late term or early term abortion to describe abortions because term is a pregnancy that is ready to deliver. Term means something in pregnancy, and late term and early term are not meaningful. So, instead, we say earlier or later abortions or we specify the gestational duration of the abortions that are at issue. Just precision like that though, it’s really stuff around the edges in some ways compared to the kinds of issues we were seeing in the early 2010s. So, thank you.

[00:27:47]

RICK WEISS: Okay. Well, let’s get into some questions that we have here. And here’s a straight-up medical one that I think is for you, Sarah, from Pablo Pereyra Murray, freelance reporter. Are preventive antibiotics used in procedural abortions?

[00:28:05]

SARAH PRAGER: Yes. Thank you for the question. We do recommend and everyone that I know uses prophylactic antibiotics prior to procedural abortion at any gestational duration.

[00:28:22]

RICK WEISS: OK. And a state specific question that maybe one of you will be able to answer or point to a reference that might answer this question. This is from Maeve Conran from Rocky Mountain Community Radio. Do you have any data on people traveling to Colorado as a result of neighboring states like Wyoming in particular who have banned or restricted abortion or banned and restricted abortion access and the impact on clinics in Colorado, whether there’s an increased demand for services? Amanda, you mentioned this generically in your presentation. Is there a place to get specific data like this?

[00:28:58]

AMANDA STEVENSON: Yes, I have a fact sheet about this being myself a Coloradan that’s based on Colorado Department of Public Health data. So, if you send me an email, I can send you a link to that, but it’s also available on the Colorado Department of Public Health website. It’s not super easy to find. In terms of impacts on providers and patients within Colorado, we have some data about the fact that abortions are happening later in pregnancy since the Dobbs decision has forced so many people to travel to Colorado for care, and wait times are longer as well.

[00:29:36]

RICK WEISS: Interesting. Okay. And a question from freelance reporter Debbie Kaplan. Can you talk about what is at stake on this topic in this 2024 election federally and state-wise? Either one of you want to start with that?

[00:29:55]

SARAH PRAGER: I can start. Everything would not be understating it. So, if we see a Trump presidency, I think we could see potentially a number of different things, which would be expansion of conservatives on the Supreme Court, which would then make it much easier to further codify restrictions or complete lack of access to abortion and contraception and IVF and lots of other different kinds of reproductive health care. I think we also would most likely see a national abortion ban of some sort. I think we would also see IVF bans nationally, and we would see contraception restrictions coming from the very top, from Congress or from the president as well.

I think we would see more pregnant people dying from lack of access both to contraception and lack of access to abortion. And that’s going to be the real consequence of all of these bans that we’re already actually seeing, which is increased rates of infant mortality and increased rates of maternal mortality. If we have a Biden presidency, I think we will continue to see state-level restrictions, but those are pretty effectively so far being combatted when possible by ballot initiatives within the states that have without fail confirmed that voters want to have access to abortion. I’ll stop there, Amanda, if you have anything else to add.

[00:31:51]

AMANDA STEVENSON: I’m not a political scientist, but I am a sociologist, and I do study the social movements around abortion. And one of the things that is most notable about the upcoming election is the very clear and vocal claims of personhood for fetuses and zygotes, blastocysts and everything, 14th Amendment claims of personhood for pregnancy. And what that does is it really puts, as Sarah mentioned, far more than just abortion on the line. Contraception and also just people who might get pregnant, their general liberty is sort of at stake in a really fundamental way. Not to mention democracy.

[00:32:48]

RICK WEISS: OK. We have people ready to answer that question, and let’s keep going on to the question from Amber Gaudet from the Dallas Morning News. Does traveling for abortion increase risks particular for those seeking abortion for complicated pregnancies? Any evidence on that? You said it can delay access.

[00:33:15]

SARAH PRAGER: I’ll start again if that’s okay, Amanda. So, delays in access in and of themselves can increase risk. So, abortion is safer earlier in pregnancy. It is safe throughout, safer throughout than continuing the pregnancy, but safer earlier in pregnancy. So, those delays can have safety impacts for patients. Being away from their support systems also increases the risk. And patients who are being denied access to abortion sometimes are already ill. And so, they are being forced potentially with a uterine infection or with ongoing bleeding or some other pregnancy complication to now seek care elsewhere because the providers in their state fear prosecution from proceeding with an abortion in a situation where there might still be a heartbeat, even though the pregnancy itself is no longer viable from a standpoint of survivability.

[00:34:28]

RICK WEISS: Thank you. Question from Laura Ungar from the Associated Press. You might have touched on this, but maybe you can go a little further. Are there any post-Dobbs numbers on gestational duration of abortions and how those may have changed since before Dobbs?

[00:34:48]

AMANDA STEVENSON: This is a great question, and it goes to why I have four different sources of abortion statistics on the deck here. There are no nationally representative survey data on gestational duration at all. So, we have to rely on the CDC data, which are fundamentally incomplete, to describe the distribution of abortions by gestational duration. And the most recent CDC abortion surveillance report is for 2021. So, the answer is no. What we can say, however, is that based on the #WeCount data from the Society of Family Planning survey, the fraction of abortions that are provided under shield laws and via telemedicine, which are all going to be medication abortions and therefore will be below the gestational duration thresholds applied by the providers. So, there’s some inference that can be made on the basis of those data, but that’s as close as you can get.

[00:35:51]

SARAH PRAGER: I can also give some information about Washington specifically where we’ve seen that the gestational duration is six days later in general than it was pre-Dobbs. So, just about a week later as compared to pre-Dobbs.

[00:36:07]

RICK WEISS: Interesting. OK. That’s helpful. A question from Yvette Fernandez from Nevada Public Radio. This overlaps a bit with the previous question about Colorado, but takes a little different angle asking what has been the impact for example in western states that are essentially surrounded by non-access states, what’s the impact on local medical industry and on physicians and patients. So, not just on access, but for you as a doctor, Dr. Prager, or for other parts of the medical industry, what’s it doing to you and to that?

[00:36:42]

SARAH PRAGER: Thank you for the question. And I will say first that my colleagues who are in no or low access states are really suffering because they are unable to provide evidence-based care to their patients and they are sometimes needing to refer their patients outside of state in order for them to get care. However, my colleagues like in Colorado or Nevada are also suffering to a certain extent because they are seeing increased volumes, some states more than others. And we are starting to hear that it is potentially creating some insurance problems as well because the states where abortion is accessible are taking on a significant increased cost of caring for people. Some states like California and Oregon and Washington have actually—their governors have set aside funds to help care for patients coming in from out of state. Other states may be doing this as well. I’m just aware of those three states. So, it is actually creating significant cost to local governments because we are now caring for patients coming in from out of state. I don’t know if that’s precisely what you’re asking, but that’s what I would say for now. And Amanda, I don’t know if you have other data.

[00:38:15]

RICK WEISS: It looks like not. Okay. Let me go to this interesting journalistic question really from Meghan Bartels from Scientific American asking, “What types of articles or stories about abortion do you think need to be written more?”

[00:38:40]

SARAH PRAGER: That is an interesting question. I partly want to answer it by saying we shouldn’t need to talk about abortion anymore than we talk about an appendectomy. It is a routine healthcare procedure that improves health for the person and shouldn’t be any more interesting than that to be honest with you. That is my feeling. I would also say I think a lot of the focus is on later duration pregnancies, even though that is the significant minority of abortions that happen. And then even within that, there is more focus on very complicated pregnancies, which I think sound more interesting potentially, but also are not representative of the vast majority of abortions. Most abortions happen very, very early. They are not traumatic for patients unless they cannot get them, and they are extremely safe. And I feel that is not emphasized enough.

[00:40:06]

RICK WEISS: Common and safe is not news. So, it points to your suggestion. Amanda, anything to add there about if there’s a news story you wish you would see about abortion?

[00:40:22]

AMANDA STEVENSON: I really agree that we shouldn’t have to talk about abortion so much. It is because it is so politicized that it’s even so widely discussed already. The kinds of stories that I think are not being told as much that would be productive would be the description of the aims of those who would restrict abortion further because those aims are very public and they’re pretty surprising I think to a lot of news consumers. So, because I also study that social movement, it does seem like it would be a useful thing to describe.

[00:41:06]

RICK WEISS: Great. OK. Let’s see, I think I’ve got one other question here. I’ve got a few other questions coming through another stream here. Can you tell us more about the strengths and weaknesses of the recent monthly sources of abortion data? How local is the data? How much can it be trusted? Amanda, do you want to start with that? You’ve been talking about those sources.

[00:41:28]

AMANDA STEVENSON: That’s a great question. They’re both highly rigorous teams of scientists that are working very hard to put out reliable numbers, and they’re also talking to each other, so they’re both reliable. One of the strengths of the #WeCount numbers is that they start before Dobbs. So, they allow comparisons pre and post Dobbs. They’re both monthly. The We Count is based on all providers. So, it’s not a survey, and it’s supposed to be a census. It has many fewer questions though. It’s very, very, very limited in terms of what they’re asking. They’re just asking for volume basically. So, number of abortions per month by clinic. The Guttmacher numbers start later. So, their the monthly counts start after Dobbs. And so, it’s not possible to use them to compare pre and post Dobbs. But they include a rotating suite of other questions. So, they are a place where you can get other information. They’re both only available at the state level. That’s the lowest level of disaggregation. So, they’re not local. If you’re interested in abortion in your state, it is possible that your local public health department has reliable data that it publishes regularly that are disaggregated at lower geographic resolution. And not everybody’s got a local abortion demographer, but if you can find one or reach out to the other—there are a few of us abortion demographers—we are all very familiar with all those different state data and we could potentially support you in that.

[00:43:12]

RICK WEISS: Great. Here’s a medical question for Dr. Prager. All else being equal and regulations aside, are there safety or risk differences between a medication abortion and a procedural abortion before 12 weeks?

[00:43:28]

SARAH PRAGER: Great question. The answer is there are some differences in the risks. We find slightly more pain, patient-reported pain, a little bit more nausea and vomiting, minor increases in minor medical concerns. And there was a fabulous study from almost 20 years ago now in 2005 that showed that patients who were able to choose between a medication abortion and a procedural abortion did report differences and side effects. However, when they were asked about their satisfaction with the procedure, there was no difference. And so, if we can give patients the procedure that they want or the method that they want, they are much more satisfied with their care. So, the minor differences, though statistically significant for not concerning issues, isn’t enough for most people that it’s worth us saying you should choose one method over another. For an individual, there might be specific circumstances where a medication abortion or a procedural abortion might be preferred, but those would be relatively few.

[00:45:10]

RICK WEISS: Thank you. And a question for Dr. Stevenson. Can you tell which states don’t report their abortion data to the CDC? I don’t know if you want to read a long list or if it’s available somewhere that we could put a link up.

[00:45:24]

AMANDA STEVENSON: It changes over time. It changes over time, and that’s part of why it’s so bad. The data are so difficult to use—not bad, just difficult to use. The biggest state that doesn’t report is California, and Maryland doesn’t report. Some states report intermittently or report some things, but not others. And a key piece of the puzzle is that not all states themselves mandate reporting from providers. And so, the states with the most punitive laws requiring providers to report abortions to the state are the states that have now banned abortion. So, as states ban abortion that had the highest quality data in the CDC data, we’re going to see a degradation in the quality of the data that the CDC has, even though was already known to be incomplete. So, there’s a list every year in the abortion surveillance reports.

[00:46:25]

RICK WEISS: That’s fascinating how the data may get even less helpful over time with these changes. There’s a question designated for either of you. Recognizing that there could be a wide array of reasons for getting an abortion, are there any data that break down what motivates people to seek one out? For example, do we know if financial constraints or inability to support a child are a major factor as compared to other drug drivers? Do people report why they’re having abortions?

[00:47:00]

AMANDA STEVENSON: Some states mandate that people receiving abortion care report on a state form their reason for having an abortion. So, yes, we have some data on this, but those state mandated reports are often categories of reasons that are somewhat coercive in nature. They’re not based on good survey design. So, they’re difficult to interpret. There is some older data that is nationally representative on reasons for people seeking abortions. And then, there are some smaller surveys. In general, people who are seeking abortion report more than one reason for needing an abortion, and some of the most common reasons are that they need to focus on the kids they already have—that’s one of the most common—or that they don’t have enough money to provide a stable household, that kind of answer. Those are the two very common ones. Or that they need to focus on their education among young people.

[00:48:08]

RICK WEISS: Dr. Prager, anything to add to that?

[00:48:11]

SARAH PRAGER: No, that encapsulated what I would say.

[00:48:14]

RICK WEISS: Okay. Here, we have question I think for you, Dr. Prager. Can you speak to the reports that OB/GYN residents are choosing not to place into states that have restricted access to abortion? How does this impact women’s health access in those states?

[00:48:37]

SARAH PRAGER: Great question. And these are data also that are a bit challenging to obtain because it means interviewing or surveying medical students who are applying to residency programs. And one of the big limitations for this will be that there is a limited total number of OB/GYN residency spots, and 54% I believe are in states where abortion is still accessible where they can train on that. So, if people were to be making decisions just on, “If I’m going to be an OB/GYN, I only want to go to a program in a state where I can learn how to do abortions,” then half of all medical students wanting to be OB/GYNs would be out of luck. Almost half. So, we don’t see that to that extent. But when medical students are asked their preferences, they are ranking programs in states where they could learn to do abortions much more highly than they are ranking states where they will not be able to access that training in an easy fashion or at all.

[00:49:55]

RICK WEISS: And then, we have a question here from Jessica McDonald from FactCheck.org curious about other terminology considerations. Should surgical abortion presumably for a subset of procedural abortions be avoided? Any other terminology you want to highlight?

[00:50:19]

SARAH PRAGER: Great question. Our medical community is moving towards the phrase procedural abortion as you heard me use as opposed to surgical abortion largely because the vast majority of these are done in an outpatient setting and surgery for most people connotes being in an operating room and having something that is much more complicated or dangerous than an abortion is. So, we do use that term procedural abortion, and that applies to whatever setting those abortions procedural are happening in. We also use the term now medication abortion, not medical abortion, because all of this is medical, but it I think more clearly designates that we are using medication versus some other type of medical intervention.

[00:51:11]

RICK WEISS: Makes sense. There’s another medical question here that might be yours as well. You referenced outcomes being better for children from wanted pregnancies. Can you expand on that? In what ways are these children better off? By what measures?

[00:51:29]

SARAH PRAGER: So, Amanda may know these data as well, and I cannot recite the Turnaway Study data completely specifically, but they’re less likely to be living in poverty and they are more likely to have more—they are less likely to be living in poverty, they are more likely to be like accessing educational opportunities young and that sort of a thing. Amanda, I don’t know if you know more details particularly about that.

[00:52:10]

AMANDA STEVENSON: Yeah. So, this is comparing the kids that are born after abortion denial. So, if someone’s denied abortion then they carry the pregnancy to term and deliver and parent, which the overwhelming majority of people who are denied abortion do as in virtually all, it’s comparing people of the kids born in that circumstance to children born to people who received wanted abortions later. So, it’s comparing people whose mothers are comparable, which is a really, really key piece of this because people who need abortion care are systematically less advantaged than people who don’t need abortion care. So, comparing the outcomes of people who get abortions with people who don’t or their children is not scientifically valid, but this is able to actually be scientifically valid. Comparing the outcomes of those kids who were born later with the kids who were born after abortion denial, the kids fair better on a host of outcomes from psychosocial and economic, educational, some physical health, although it’s pretty much it’s about bonding, it’s about the quality of relationship within the family. People who are denied wanted abortions are more likely to stay in abusive partnerships. And so, that obviously has consequences for kids. So, there are a lot of ways in which these children fair better when their parents were able to get abortions when they needed them before.

[00:53:39]

RICK WEISS: And I should check, is the Turnaway Study results some kind of some aspect of those results or a summary among the references in either of your slides? So, yes. So, journalists can look back and look at those details. I want to get in one more question here before we start to wrap up, and I’ll remind at this moment for reporters as we get ready to wrap, when you do log off, you will get a short survey. I know we’re all tired of surveys about how did you like it, but it really helps us for you to answer the three or four questions we have for you so we can keep designing media briefings that are most helpful to you in your reporting. So, please take the half a minute or so it will take to fill out that survey. We really appreciate it. And now, to get to a last couple of questions, in places with restrictive abortion laws, are rates of uptake of contraception changing? We haven’t talked much about contraception, but what’s going on there?

[00:54:34]

SARAH PRAGER: You go first, Amanda.

[00:54:37]

AMANDA STEVENSON: You have like actual experience. I can just talk to the statistics.

[00:54:42]

SARAH PRAGER: You speak to the statistics, and then I’ll speak to the personal experience.

[00:54:46]

AMANDA STEVENSON: There’s a strong association between restricting abortion and restricting contraception. So, this is difficult to answer because the places where abortion has been most severely restricted, there are pre-existing and also newly implemented restrictions on the provision of contraception. So, it would be difficult to answer even if we had perfect data, but we don’t have perfect data. So, we don’t know at the national level. We have some smaller clinical studies—so, that’s a single clinic or a clinic system—which find that, yes, there has been increased uptake of long-acting reversible as well as permanent contraception in the wake of Dobbs. Whether that is stronger in places with bans is unknown and honestly probably unlikely because there’s so many challenges accessing those most effective methods in those places that restrict abortion.

[00:55:39]

SARAH PRAGER: Thanks. That was exactly what I was going to say. But my addition to that will be that in my clinic personally in the first three to six months post Dobbs, we saw a tenfold increase in the number of patients coming in wanting permanent contraception, and that’s in a state where abortion is highly accessible as are other long acting non-permanent methods of contraception. People were really scared that things would change also in Washington state or if they move out of state for work or school that they would lose this access. And generally speaking, we found that people are really terrified of being forced to have unwanted pregnancies, and that is resulting in patients at much earlier ages choosing to have permanent contraception so they never have an option of being faced with an unwanted pregnancy that they cannot abort. And as Amanda said, we can’t really compare states where abortion and contraception are accessible to states abortion and contraception are less accessible. So, unfortunately, the patients living in those lower access states are also less able to prevent pregnancy if they would choose to. And frankly, we also just to go to the other side of that are seeing much more what we call obstetric deserts in states where abortion is inaccessible. So, people cannot prevent pregnancies. People who get pregnant cannot access abortion. And when forced to carry pregnancies to term, they cannot access safe obstetric care. So, it is terrible for a lot of people living in a lot of areas of the United States right now.

[00:57:36]

RICK WEISS: Very strong and succinct summary of the situation in many of these states. Thank you for that. I want to just end this briefing today as we always do asking each of our experts to just give a take-home message. If there’s one thing you want reporters to walk away with today or to have at top of mind as they think about potential stories they could produce on this topic, what is it that you would leave them with? And Dr. Prager, I’ll start with you.

[00:58:05]

SARAH PRAGER: I’ve already emphasized the safety of abortion, and I want to leave everybody again with that. And also, and this is my opinion, the fact that denying people health care is denying a basic human right and we are doing this to a very specific part of our population, namely women and other people who are pregnancy capable, and that is against any human right that I’ve ever heard of and frankly should be against our Constitution. It is in certain places. But because rights for women have never been codified in our Constitution, we’re continuing to have to fight for this.

[00:58:57]

RICK WEISS: Thank you. And Dr. Amanda Stevenson, a final thought.

[00:59:02]

AMANDA STEVENSON: I would just say don’t use the CDC data unless you have really, really good advice from somebody who really knows what they’re talking about. And actually, be really circumspect about your state public health data too.

[00:59:18]

RICK WEISS: Great. I want to thank both of our panelists today for some really very deep, very candid, and very data-based perspectives on what’s going on in this very charged domain of the political discussion today. A reminder to reporters that there is a lot of science behind here that is worth digging into, that there are experts like these and others who are ready to talk to you and make sure that you include those data without the kind of false equivalency that we’ve talked about a little bit today. It’s a very charged subject. It’s very tempting to make those charges a big part of your story when they may or may not have a factual basis behind them. So, let’s all think about that as we work in this area. Thank you very much for your participation, Dr. Stevenson, Dr. Prager. Thank you, reporters, for your commitment to evidence-based reporting. And we hope to see you at our next media briefing on Tuesday. Thank you.