Abortion and Maternal Mortality - Revision history

Barb: /* Elevated Risk of Death in Later Pregnancies */

2026-08-17T16:18:00Z

Elevated Risk of Death in Later Pregnancies

← Older revision		Revision as of 11:18, 17 August 2026
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	:Abstract: Although US federal law requires all American states to permit abortion within their borders, states retain authority to impose restrictions.We used hospital discharge data to study the rates of major abortion complications in 23 states from 2001 to 2008 and their relationship to two laws: (i) restrictions on Medicaid – the state insurance programs for the poor – funding, and (ii) mandatory delays before abortion. Of 131 000 000 discharges in the data set, 10 980 involved an abortion complication. The national rate for complications was 1.90 per 1000 abortions (95 per cent CI: 1.57–2.23). Eleven states required mandatory delays and 12 restricted funding for Medicaid participants. After controlling for socioeconomic characteristics and the pregnancy complication rate, legal restrictions were associated with lower complication rates: mandatory delays (OR 0.79(0.65–0.95)) and restricted Medicaid funding (OR 0.74 (0.61–0.90)). This result may reflect the fact that states without restrictions perform a higher percentage of second-trimester abortions. This study is the first to assess the association between legal restrictions on abortion and complication rates.		:Abstract: Although US federal law requires all American states to permit abortion within their borders, states retain authority to impose restrictions.We used hospital discharge data to study the rates of major abortion complications in 23 states from 2001 to 2008 and their relationship to two laws: (i) restrictions on Medicaid – the state insurance programs for the poor – funding, and (ii) mandatory delays before abortion. Of 131 000 000 discharges in the data set, 10 980 involved an abortion complication. The national rate for complications was 1.90 per 1000 abortions (95 per cent CI: 1.57–2.23). Eleven states required mandatory delays and 12 restricted funding for Medicaid participants. After controlling for socioeconomic characteristics and the pregnancy complication rate, legal restrictions were associated with lower complication rates: mandatory delays (OR 0.79(0.65–0.95)) and restricted Medicaid funding (OR 0.74 (0.61–0.90)). This result may reflect the fact that states without restrictions perform a higher percentage of second-trimester abortions. This study is the first to assess the association between legal restrictions on abortion and complication rates.

			== Prospective, Population-based Epidemiological Cohort Studies ==
			'''Association of induced abortion with mental health among rural women: an epidemiological survey study. Li, Z., Zhang, H., Wang, Y., Liu, X., Wang, X., Feng, Q., ... & Wang, C. (2026). ''Current Psychology'', ''45''(2), 189. <nowiki>https://link.springer.com/article/10.1007/s12144-025-08889-3</nowiki>'''<blockquote>
			== Abstract ==
			Previous studies have shown that induced abortion may be a risk factor for mental problems. However, these studies have only examined the association between induced abortion and mental problems, with limited evidence regarding its long-term impact on women’s overall health. In this study, a total of 12,275 women were included in the study from the Henan Rural Cohort. Logistic regression was employed to examine the connection between induced abortion and mental problems. To further explore the potential causal relationship, Mendelian randomization (MR) study was adopted. Additionally, the Sullivan method was used to estimate '''healthy life expectancy (HLE)''' among women with different numbers of induced abortion. The findings revealed that induced abortion was associated with higher risks of depressive symptoms, anxiety symptoms, suicidal ideation and mental disorder. The MR analysis confirmed a '''causal link between induced abortion''' and depressive symptoms. Moreover, women experiencing induced abortion exhibited shorter HLE compared to those without abortion. These results suggest that induced abortion may not only affect mental health but also contribute to a '''reduced the HLE.''' Therefore, greater attention should be devoted to the mental health of women with a history of abortion. It is recommended to incorporate routine mental health screening into post-abortion care, provide comprehensive pre-abortion and post-abortion counseling, especially for high-risk groups, and enhance the training of healthcare providers.

			Note: the '''Henan Rural Cohort Study''' is primarily a '''prospective, population-based epidemiological cohort study''', not a record-based (administrative data) study. However, '''it does incorporate medical records''' as a secondary component to verify and confirm disease diagnoses.</blockquote>

	== Elevated Risk of Death in Later Pregnancies ==		== Elevated Risk of Death in Later Pregnancies ==

Barb: /* Record Based Studies */

2025-10-08T17:13:45Z

Record Based Studies

← Older revision		Revision as of 12:13, 8 October 2025
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	'''Conclusion:''' Pregnancy loss is associated with an elevated risk of premature mortality up to three decades later, particularly cardiovascular, cancer, and suicide-related deaths.</blockquote>		'''Conclusion:''' Pregnancy loss is associated with an elevated risk of premature mortality up to three decades later, particularly cardiovascular, cancer, and suicide-related deaths.</blockquote>

			=== '''Adjusted PAR for all-cause premature mortality''' ===
			{\| class="wikitable"
			!Pregnancy type
			!Adjusted HR
			!Exposure proportion
			!Adjusted PAR (%)
			\|-
			\|Miscarriage
			\|1.48
			\|0.024
			\|'''1.15%'''
			\|-
			\|Induced abortion
			\|1.50
			\|0.041
			\|'''1.98%'''
			\|-
			\|Unspecified abortion
			\|1.77
			\|0.012
			\|'''0.91%'''
			\|-
			\|Ectopic pregnancy
			\|1.55
			\|0.011
			\|'''0.60%'''
			\|-
			\|Molar pregnancy
			\|0.87
			\|0.001
			\|'''≈ 0%'''
			\|-
			\|Stillbirth
			\|1.68
			\|0.002
			\|'''0.14%'''
			\|}
			'''Cause of Death: Adjusted HR and PAR for women who aborted compared to women whose last pregnancy was a live birth'''
			{\| class="wikitable"
			\|'''Cause'''
			\|'''Adjusted HR (from Table 4)'''
			\|'''Adjusted PAR (%)'''
			\|-
			\|Cancer
			\|1.14
			\|0.57
			\|-
			\|Cardiovascular
			\|1.6
			\|2.4
			\|-
			\|Endocrine
			\|1
			\|0
			\|-
			\|Gastrointestinal
			\|1.53
			\|2.13
			\|-
			\|Injury
			\|2.03
			\|4.05
			\|-
			\|Nervous system
			\|1.82
			\|3.25
			\|-
			\|Obstetric
			\|0.86
			\| -0.58
			\|-
			\|Other causes
			\|2.45
			\|5.61
			\|-
			\|Pulmonary
			\|1.37
			\|1.49
			\|-
			\|Renal
			\|2.42
			\|5.5
			\|-
			\|Sepsis/shock/organ failure
			\|1.84
			\|3.33
			\|-
			\|Suicide
			\|2.41
			\|5.47
			\|}

Barb: /* Record Based Studies */

2025-08-21T14:50:51Z

Record Based Studies

← Older revision		Revision as of 09:50, 21 August 2025
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	== Record Based Studies ==		== Record Based Studies ==

			'''[https://pubmed.ncbi.nlm.nih.gov/34773878/ Premature mortality after pregnancy loss: Trends at 1, 5, 10 years, and beyond.] Auger N, Ghadirian M, Low N, Healy-Profitós J, Wei SQ. Eur J Obstet Gynecol Reprod Biol. 2021 Dec;267:155-160. doi: 10.1016/j.ejogrb.2021.10.033. Epub 2021 Nov 1. PMID: 34773878.'''<blockquote>'''Objective:''' Little is known on the long-term risk of mortality following pregnancy loss. We assessed risks of premature mortality up to three decades after miscarriage, induced abortion, ectopic or molar pregnancy, and stillbirth relative to live birth.

			'''Study design:''' We carried out a longitudinal cohort study of 1,293,640 pregnant women with 18,896,737 person-years of follow-up in Quebec, Canada, from 1989 to 2018. We followed the women up to 29 years after their last pregnancy event to determine the time and cause of future in-hospital deaths before age 75 years. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of miscarriage, induced abortion, ectopic pregnancy, molar pregnancy, and stillbirth with premature mortality, compared with live birth.

			'''Results:''' Premature mortality rates were higher for most types of pregnancy loss than live birth. Compared with live birth, pregnancy loss was associated with an elevated risk of premature mortality (HRmiscarriage 1.48, 95% CI 1.33, 1.65; HRinduced abortion 1.50, 95% CI 1.39, 1.62; HRectopic 1.55, 95% CI 1.35, 1.79; and HRstillbirth 1.68, 95%. CI 1.17, 2.41). Molar pregnancy was not associated with premature mortality (HR 0.87, 95% CI 0.33, 2.32). Miscarriage and induced abortion were associated with most causes of death, whereas ectopic pregnancy was associated with cardiovascular (HR 2.18, 95 % CI 1.39, 3.42), cancer (HR 1.38, 95 % CI 1.11, 1.73), and suicide-related mortality (HR 4.94, 95 % CI 2.29, 10.68). Stillbirth was associated with cardiovascular mortality (HR 4.91, 95 % CI 2.33, 10.36).

			'''Conclusion:''' Pregnancy loss is associated with an elevated risk of premature mortality up to three decades later, particularly cardiovascular, cancer, and suicide-related deaths.</blockquote>


	'''[https://pmc.ncbi.nlm.nih.gov/articles/PMC11246836/ Association between Abortion and All-Cause and Cause-Specific Premature Mortality: A Prospective Cohort Study from the UK Biobank.] Yin S, Yang Y, Wang Q, Guo W, He Q, Yuan L, Si K. Health Data Sci. 2024 Jul 15;4:0147. doi: 10.34133/hds.0147. PMID: 39011272; PMCID: PMC11246836.'''<blockquote>		'''[https://pmc.ncbi.nlm.nih.gov/articles/PMC11246836/ Association between Abortion and All-Cause and Cause-Specific Premature Mortality: A Prospective Cohort Study from the UK Biobank.] Yin S, Yang Y, Wang Q, Guo W, He Q, Yuan L, Si K. Health Data Sci. 2024 Jul 15;4:0147. doi: 10.34133/hds.0147. PMID: 39011272; PMCID: PMC11246836.'''<blockquote>

Barb: /* Record Based Studies */

2025-06-03T23:33:48Z

Record Based Studies

← Older revision		Revision as of 18:33, 3 June 2025
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	== Record Based Studies ==		== Record Based Studies ==

			'''[https://pmc.ncbi.nlm.nih.gov/articles/PMC11246836/ Association between Abortion and All-Cause and Cause-Specific Premature Mortality: A Prospective Cohort Study from the UK Biobank.] Yin S, Yang Y, Wang Q, Guo W, He Q, Yuan L, Si K. Health Data Sci. 2024 Jul 15;4:0147. doi: 10.34133/hds.0147. PMID: 39011272; PMCID: PMC11246836.'''<blockquote>
			'''Background:''' Concerns have been raised about the increasing prevalence of both spontaneous and induced abortions worldwide, yet their effect on premature mortality remains poorly understood. We aimed to examine the associations between abortion and all-cause and cause-specific premature mortality, and the potential effect modification by maternal characteristics. '''Methods:''' Women aged 39 to 71 years at baseline (2006 to 2010) with prior pregnancies were derived from the UK Biobank and categorized as no abortion history, spontaneous abortion alone, induced abortion alone, and both spontaneous and induced abortions. All-cause and cause-specific mortality were ascertained through linkage to death certificate data, with premature death defined as occurring before the age of 70. '''Results:''' Of the 225,049 ever gravid women, 43,418 (19.3%) reported spontaneous abortion alone, 27,135 (12.1%) reported induced abortion alone, and 10,448 (4.6%) reported both spontaneous and induced abortions. During a median of 14.4 years of follow-up, 5,353 deaths were recorded, including 3,314 cancer-related and 1,444 cardiovascular deaths. Compared with no abortion history, spontaneous abortion alone was associated with an increased risk of all-cause premature mortality (adjusted hazard ratio [aHR] 1.10, 95% confidence interval [CI] 1.02 to 1.17), and induced abortion alone was associated with increased risks of all-cause (aHR 1.12, 95% CI 1.04 to 1.22) and cardiovascular mortality (aHR 1.27, 95% CI 1.09 to 1.48). The aHRs for all-cause and cardiovascular mortality were higher for recurrent abortions, whether spontaneous or induced (''P'' trend < 0.05). The increased risk of all-cause mortality associated with induced abortion was higher in women with hypertensive disorders of pregnancy than in those without (40% vs. 9%, ''P'' interaction = 0.045). '''Conclusions:''' Either spontaneous or induced abortion alone was associated with an increased risk of premature mortality, with induced abortion alone particularly linked to cardiovascular death. Future studies are encouraged to explore the underlying mechanisms.</blockquote>

Barb: /* Record Based Studies */

2021-03-01T20:32:39Z

Record Based Studies

← Older revision		Revision as of 15:32, 1 March 2021
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	:CONCLUSIONS: Although less permissive states exhibited consistently lower maternal mortality rates, this finding was not explained by abortion legislation itself. Rather, these differences were explained by other independent factors, which appeared to have a more favourable distribution in these states.		:CONCLUSIONS: Although less permissive states exhibited consistently lower maternal mortality rates, this finding was not explained by abortion legislation itself. Rather, these differences were explained by other independent factors, which appeared to have a more favourable distribution in these states.


			:'''NOTE:''' A critique of the above study by Darney et al. titled [https://pubmed.ncbi.nlm.nih.gov/27546094/ Maintaining rigor in research: flaws in a recent study and a reanalysis of the relationship between state abortion laws and maternal mortality in Mexico] was itself so flawed that the journal [https://pubmed.ncbi.nlm.nih.gov/30526954/ Contraception retracted it.]

Barb: /* Loss of Woman-Years Estimate */

2020-05-14T20:26:33Z

Loss of Woman-Years Estimate

← Older revision		Revision as of 15:26, 14 May 2020
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	Reardon (2012) examines a ten year period following first pregnancy outcomes. This study reports that the excess number of deaths within 10 years was 230 per 100,000 abortions of a first pregnancy. The average age of death was 27.4. Ignoring deaths after the 10 year window, and assuming an average life span of 76 years, this translates to 11,178 woman years lost per 100,000 abortions.		Reardon (2012) examines a ten year period following first pregnancy outcomes. This study reports that the excess number of deaths within 10 years was 230 per 100,000 abortions of a first pregnancy. The average age of death was 27.4. Ignoring deaths after the 10 year window, and assuming an average life span of 76 years, this translates to 11,178 woman years lost per 100,000 abortions.

	Projecting the latter (11,178 per 100,000) on the estimated 60 million abortions in the United States since 1973, yields an estimated loss of 6,706,800 woman-years. Projected on the ~~world wide~~ estimated number of ~~abortion since 1980,~~ 1.5 billion, yields an estimated loss of ~~nine~~ million woman-years.		Projecting the latter (11,178 per 100,000) on the estimated 60 million abortions in the United States since 1973, yields an estimated loss of 6,706,800 woman-years.

			Projected on the worldwide estimated number of 1.5 billion, yields an estimated loss of 167.7 million woman-years.

	== Other Peer Reviewed Studies ==		== Other Peer Reviewed Studies ==

Barb: /* Loss of Woman-Years Estimate */

2020-05-13T15:20:20Z

Loss of Woman-Years Estimate

← Older revision		Revision as of 10:20, 13 May 2020
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	:Abstract: Although US federal law requires all American states to permit abortion within their borders, states retain authority to impose restrictions.We used hospital discharge data to study the rates of major abortion complications in 23 states from 2001 to 2008 and their relationship to two laws: (i) restrictions on Medicaid – the state insurance programs for the poor – funding, and (ii) mandatory delays before abortion. Of 131 000 000 discharges in the data set, 10 980 involved an abortion complication. The national rate for complications was 1.90 per 1000 abortions (95 per cent CI: 1.57–2.23). Eleven states required mandatory delays and 12 restricted funding for Medicaid participants. After controlling for socioeconomic characteristics and the pregnancy complication rate, legal restrictions were associated with lower complication rates: mandatory delays (OR 0.79(0.65–0.95)) and restricted Medicaid funding (OR 0.74 (0.61–0.90)). This result may reflect the fact that states without restrictions perform a higher percentage of second-trimester abortions. This study is the first to assess the association between legal restrictions on abortion and complication rates.		:Abstract: Although US federal law requires all American states to permit abortion within their borders, states retain authority to impose restrictions.We used hospital discharge data to study the rates of major abortion complications in 23 states from 2001 to 2008 and their relationship to two laws: (i) restrictions on Medicaid – the state insurance programs for the poor – funding, and (ii) mandatory delays before abortion. Of 131 000 000 discharges in the data set, 10 980 involved an abortion complication. The national rate for complications was 1.90 per 1000 abortions (95 per cent CI: 1.57–2.23). Eleven states required mandatory delays and 12 restricted funding for Medicaid participants. After controlling for socioeconomic characteristics and the pregnancy complication rate, legal restrictions were associated with lower complication rates: mandatory delays (OR 0.79(0.65–0.95)) and restricted Medicaid funding (OR 0.74 (0.61–0.90)). This result may reflect the fact that states without restrictions perform a higher percentage of second-trimester abortions. This study is the first to assess the association between legal restrictions on abortion and complication rates.

			== Elevated Risk of Death in Later Pregnancies ==
			Marmian (2000): "The Placenta Accreta Spectrum (PAS) includes placenta accreta, placenta increta, and placenta percreta. In 1950, the incidence of PAS was 1:30,000 deliveries, but in 2016, the incidence was reported to be 1:272 deliveries (Mogos et al. 2016). This 110-fold increase in incidence raises the risk of pregnancy-related mortality. Occurring in women with a history of uterine surgery, including induced abortion (Baldwin et al. 2018), PAS can cause massive hemorrhage, and deaths occur even in tertiary hospitals (Klemetti et al. 2012).


	== Loss of Woman-Years Estimate ==		== Loss of Woman-Years Estimate ==
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	Reardon (2012) examines a ten year period following first pregnancy outcomes. This study reports that the excess number of deaths within 10 years was 230 per 100,000 abortions of a first pregnancy. The average age of death was 27.4. Ignoring deaths after the 10 year window, and assuming an average life span of 76 years, this translates to 11,178 woman years lost per 100,000 abortions.		Reardon (2012) examines a ten year period following first pregnancy outcomes. This study reports that the excess number of deaths within 10 years was 230 per 100,000 abortions of a first pregnancy. The average age of death was 27.4. Ignoring deaths after the 10 year window, and assuming an average life span of 76 years, this translates to 11,178 woman years lost per 100,000 abortions.

	Projecting the latter (11,178 per 100,000) on the estimated 60 million abortions in the United States since 1973, yields an estimated loss of 6,706,800 woman-years. Projected on the world wide estimated number of abortion since 1980, 1.5 billion, yields an estimated loss of nine million woman-years.		Projecting the latter (11,178 per 100,000) on the estimated 60 million abortions in the United States since 1973, yields an estimated loss of 6,706,800 woman-years. Projected on the world wide estimated number of abortion since 1980, 1.5 billion, yields an estimated loss of nine million woman-years.


	== Other Peer Reviewed Studies ==		== Other Peer Reviewed Studies ==

Barb: /* Review Articles Relative to Maternal Death from Abortion */

2020-02-03T19:52:54Z

Review Articles Relative to Maternal Death from Abortion

← Older revision		Revision as of 14:52, 3 February 2020
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	== Review Articles Relative to Maternal Death from Abortion ==		== Review Articles Relative to Maternal Death from Abortion ==
			[https://www.tandfonline.com/doi/abs/10.1080/07399332.2019.1566332 The risk of cardiovascular disease in women with a history of miscarriage and/or stillbirth.] Asgharvahedi F, Gholizadeh L, Siabani S. Health Care Women Int. 2019 Oct;40(10):1117-1131. doi: 10.1080/07399332.2019.1566332. Epub 2019 Apr 5.

			:Cardiovascular disease (CVD) remains the main cause of morbidity and mortality in women worldwide. Apart from the well-established risk factors, some adverse pregnancy outcomes have been found to be associated with increased risk of CVD in women. We reviewed the literature on the risk of CVD in women with a history of pregnancy loss (miscarriage and/or stillbirth). Electronic databases including MEDLINE and CINAHL were searched for English language articles published from 2000 to July 2016. Following the application of study inclusion and exclusion criteria, we selected seven studies for review. Women with history of miscarriage and/or stillbirth are more likely to develop coronary heart disease (CHD), but not stroke in their later life compared with women without these conditions. The risk is particularly greater in women with multiple miscarriages or stillbirths. Health professionals should be aware of the risk associated with miscarriage and stillbirth, and use maternal history to identify, refer, closely monitor, and engage these high risk women in healthy lifestyle and risk factor modification programs.

	[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5692130/ Pregnancy associated death in record linkage studies relative to delivery, termination of pregnancy, and natural losses: A systematic review with a narrative synthesis and meta-analysis.] Reardon DC, Thorp JM. SAGE Open Med. 2017 Nov 13;5:2050312117740490. doi: 10.1177/2050312117740490. eCollection 2017.		[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5692130/ Pregnancy associated death in record linkage studies relative to delivery, termination of pregnancy, and natural losses: A systematic review with a narrative synthesis and meta-analysis.] Reardon DC, Thorp JM. SAGE Open Med. 2017 Nov 13;5:2050312117740490. doi: 10.1177/2050312117740490. eCollection 2017.

Barb: /* Review Articles Relative to Maternal Death from Abortion */

2018-08-14T16:11:54Z

Review Articles Relative to Maternal Death from Abortion

← Older revision		Revision as of 11:11, 14 August 2018
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	== Review Articles Relative to Maternal Death from Abortion ==		== Review Articles Relative to Maternal Death from Abortion ==


			[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5692130/ Pregnancy associated death in record linkage studies relative to delivery, termination of pregnancy, and natural losses: A systematic review with a narrative synthesis and meta-analysis.] Reardon DC, Thorp JM. SAGE Open Med. 2017 Nov 13;5:2050312117740490. doi: 10.1177/2050312117740490. eCollection 2017.

			:OBJECTIVES: Measures of pregnancy associated deaths provide important guidance for public health initiatives. Record linkage studies have significantly improved identification of deaths associated with childbirth but relatively few have also examined deaths associated with pregnancy loss even though higher rates of maternal death have been associated with the latter. Following PRISMA guidelines we undertook a systematic review of record linkage studies examining the relative mortality risks associated with pregnancy loss to develop a narrative synthesis, a meta-analysis, and to identify research opportunities.

			:METHODS: MEDLINE and SCOPUS were searched in July 2015 using combinations of: mortality, maternal death, record linkage, linked records, pregnancy associated mortality, and pregnancy associated death to identify papers using linkage of death certificates to independent records identifying pregnancy outcomes. Additional studies were identified by examining all citations for relevant studies.

			:RESULTS: Of 989 studies, 11 studies from three countries reported mortality rates associated with termination of pregnancy, miscarriage or failed pregnancy. Within a year of their pregnancy outcomes, women experiencing a pregnancy loss are over twice as likely to die compared to women giving birth. The heightened risk is apparent within 180 days and remains elevated for many years. There is a dose effect, with exposure to each pregnancy loss associated with increasing risk of death. Higher rates of death from suicide, accidents, homicide and some natural causes, such as circulatory diseases, may be from elevated stress and risk taking behaviors.

			:CONCLUSIONS: Both miscarriage and termination of pregnancy are markers for reduced life expectancy. This association should inform research and new public health initiatives including screening and interventions for patients exhibiting known risk factors.


	''''[http://www.aaplog.org/wp-content/uploads/2013/07/LNQ61-Maternal-Mortality-Review-7-17-13.pdf The maternal mortality myth in the context of legalized abortion.] Calhoun B. The Linacre Quarterly, Volume 80, Number 3, August 2013 , pp. 264-276(13)''''		''''[http://www.aaplog.org/wp-content/uploads/2013/07/LNQ61-Maternal-Mortality-Review-7-17-13.pdf The maternal mortality myth in the context of legalized abortion.] Calhoun B. The Linacre Quarterly, Volume 80, Number 3, August 2013 , pp. 264-276(13)''''

Barb: /* Other Peer Reviewed Studies */

2017-07-06T16:00:51Z

Other Peer Reviewed Studies

← Older revision		Revision as of 11:00, 6 July 2017
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	:Abstract: Although US federal law requires all American states to permit abortion within their borders, states retain authority to impose restrictions.We used hospital discharge data to study the rates of major abortion complications in 23 states from 2001 to 2008 and their relationship to two laws: (i) restrictions on Medicaid – the state insurance programs for the poor – funding, and (ii) mandatory delays before abortion. Of 131 000 000 discharges in the data set, 10 980 involved an abortion complication. The national rate for complications was 1.90 per 1000 abortions (95 per cent CI: 1.57–2.23). Eleven states required mandatory delays and 12 restricted funding for Medicaid participants. After controlling for socioeconomic characteristics and the pregnancy complication rate, legal restrictions were associated with lower complication rates: mandatory delays (OR 0.79(0.65–0.95)) and restricted Medicaid funding (OR 0.74 (0.61–0.90)). This result may reflect the fact that states without restrictions perform a higher percentage of second-trimester abortions. This study is the first to assess the association between legal restrictions on abortion and complication rates.		:Abstract: Although US federal law requires all American states to permit abortion within their borders, states retain authority to impose restrictions.We used hospital discharge data to study the rates of major abortion complications in 23 states from 2001 to 2008 and their relationship to two laws: (i) restrictions on Medicaid – the state insurance programs for the poor – funding, and (ii) mandatory delays before abortion. Of 131 000 000 discharges in the data set, 10 980 involved an abortion complication. The national rate for complications was 1.90 per 1000 abortions (95 per cent CI: 1.57–2.23). Eleven states required mandatory delays and 12 restricted funding for Medicaid participants. After controlling for socioeconomic characteristics and the pregnancy complication rate, legal restrictions were associated with lower complication rates: mandatory delays (OR 0.79(0.65–0.95)) and restricted Medicaid funding (OR 0.74 (0.61–0.90)). This result may reflect the fact that states without restrictions perform a higher percentage of second-trimester abortions. This study is the first to assess the association between legal restrictions on abortion and complication rates.

			== Loss of Woman-Years Estimate ==

			According to Gissler (1997), the total age-adjusted mortality rate per 100,000 for a one year period was 58.8 for nonpregnant women, 103.2 for abortion, and 29.4 for birth. Assuming an average life expectancy of 76 for women, and the average premature death occurring at age 28, yields a loss of 2,131 woman-years per 100,000 abortions compared to non-pregnant women, and 3,542 woman-years per 100,000 abortions compared to delivering women. These lost woman-year estimates, however, capture only the losses stemming from excess deaths within the first year of an abortion.

			Reardon (2002) examines an eight year period after pregnancy outcome, reporting approximately 300 excess premature deaths per 100,000 women who had abortions (compared to those who delivered) over an eight year period, with an average age of at death of 28. Deducted from the average life expectancy (around 76), this translates to 48 woman years lost per death or a loss of 14,400 woman-years per 100,000 abortions.

			Reardon (2012) examines a ten year period following first pregnancy outcomes. This study reports that the excess number of deaths within 10 years was 230 per 100,000 abortions of a first pregnancy. The average age of death was 27.4. Ignoring deaths after the 10 year window, and assuming an average life span of 76 years, this translates to 11,178 woman years lost per 100,000 abortions.

			Projecting the latter (11,178 per 100,000) on the estimated 60 million abortions in the United States since 1973, yields an estimated loss of 6,706,800 woman-years. Projected on the world wide estimated number of abortion since 1980, 1.5 billion, yields an estimated loss of nine million woman-years.


	== Other Peer Reviewed Studies ==		== Other Peer Reviewed Studies ==