USA – First-trimester aspiration abortion practices: a survey of United States abortion providers

by Katharine O White, Heidi E Jones, Antonella Lavelanet, Wendy V Norman, Edith Guilbert, E Steve Lichtenberg, Maureen Paul

Contraception 2019;99:10-15

Objectives: To assess whether first-trimester aspiration abortion practices of US providers agree with evidence-based policy guidelines.

Study design: We sent surveys by mail or electronically to all abortion facilities in the United States identified via professional networks and websites from June through December 2013. Administrators reported on the volume of procedures performed at their site(s) through 13 weeks 6 days’ gestation and on clinic services. Clinicians reported on personal demographic characteristics and abortion practices. We reviewed guidelines from key US professional organizations to determine how well reported practices aligned with available recommendations and the extent to which guidelines have changed since the time of the survey.

Results: We identified 703 clinical sites in the United States; 383 (54%) sites responded, 256 of which offer first-trimester aspiration abortions. Most providers identified as obstetrician-gynecologists (74%) and female (64%); 52% were less than 50 years old compared to 36% in 2002. Overall, reported practices follow evidence-based guidelines, including routine administration of peri-procedure antibiotics (85%), use of misoprostol for cervical ripening in the late first trimester (94%), pain management practices, and same-day contraception provision (98%) including long-acting devices (76%). Less evidence-based practices include routine pre-procedure ultrasound (99%), not providing abortion before 5 weeks’ gestation (66%), restrictive fasting policies, and prolonged and post-procedure antibiotic provision.

Conclusion: Overall, the first-trimester aspiration abortion practices revealed in our survey agree with professional evidence-based policy guidelines, though some related to pre-procedure ultrasound use, very early abortion provision, pre-anesthesia fasting protocols, and antibiotic regimens deserve attention.

Implications: In this third cross-sectional survey of US abortion practices (prior surveys 1997 and 2002), first-trimester aspiration abortion providers are younger than before, reflecting an improvement in the “graying” of the abortion provider workforce. Research and education are needed to further improve evidence-based practice in abortion care.

INFOGRAPHIC (interactive, data from Google 2017) by 18-year-old Maddy Rasmussen. In: Refinery29, by Shannon Carlin, 11 June 2017