Notes on Engineering Health, June 2022

Abortion is Healthcare

Given the ruling by the US Supreme Court in Dobbs v. Jackson Women’s Health Organization that overturns a woman’s constitutional right to an abortion which has been settled law in the United States for almost 50 years, it is impossible for us not to turn our attention to the facts about abortion and abortion rights. 

At its core, abortion is a healthcare procedure. While its ethical dimension is undeniable, it is worth spending some time on the data collected and the experiments conducted to understand how abortion has evolved in the US since 1973. 

How Many?
While the exact number of abortions in the US is hard to determine, the Center for Disease Control and Prevention (CDC) estimated there were 629,898 abortions nationally in 2019, slightly up from 2018 and 2017. The Guttmacher Institute, a nonprofit research organization in the field of reproductive health published a report in 2022 that confirms the slight upward trend after years of steady decline (there were 765,651 in 2010 and 1.4 million in 1990).

How Often?
In terms of the share of the population, the Guttmacher Institute estimates that despite the decline in abortion, it is still a common procedure. Indeed, a study published in the American Journal of Public Health shows that nearly 1 in 4 women in the US will have the procedure by the time they reach 45, and about 18% of pregnancies end in induced abortion. The vast majority of abortions happen before the 10th week of pregnancy and 93% before the 13th week. Abortions after 21 weeks of pregnancy are exceedingly rare (about 1% of procedures), heavily restricted, and mostly occur when something has gone dramatically wrong. 

Abortions can be done medically or surgically.  Medical abortion ends a pregnancy through the use of medications while surgical abortion, sometimes called procedural abortion, ends a pregnancy through a procedure performed by a healthcare provider in a clinical setting.
Whether a patient gets a surgical or medical abortion comes down to factors including the stage of pregnancy, the patient’s preference and state restrictions. The use of medications steadily increased since their approval by the FDA in the early 2000s reaching more than 50% of all abortions in 2020. 

Who is Getting it?
The Pew Research Center asserts that, based on government data, about 60% of women who sought an abortion in 2019 had gone through one or more live births already. The majority of women (57%) were in their 20s, while 31% were in their 30s and the vast majority of them were unmarried (85%). According to the same data, abortion rates and ratios differ across racial groups. For example, in 2019, compared to White women, abortion rates were 3.6 times higher among Black women and 1.8 times higher among Hispanic women. The factors leading to higher abortion rates among certain minority groups are complex but structural factors, including unequal access to quality family planning services, economic disadvantage, and distrust of the medical system might contribute to observed differences. 

What are the Effects on Women?
Given the importance to understand the outcomes of any healthcare procedure, the question of the effects of abortions on women’s physical, mental and financial health matters a great deal. A recent study conducted at the University of California, San Francisco helps answer the central question of the effects abortion has on women. The Turnaway Study is a large-scale ANSIRH’s prospective longitudinal study examining the effects of unwanted pregnancy on women’s lives. To summarize, this study demonstrates that, in general, abortion does not wound women physically, psychologically, or financially but that carrying an unwanted pregnancy to term does. The researchers were able to isolate the impact of abortion itself by comparing people who were “turned away” by a provider because they were too far along with people who had an abortion at the same clinics. The women who got an abortion would be similar, in terms of demographics and socioeconomics, to those who were turned away; what would separate the two groups was only that some women got to the clinic on time, and some didn’t. The researchers worked with 30 abortion providers, interviewed more than 1,000 women every six months for five years, and four dozen papers analyzing the findings have been published in peer-reviewed journals. 

Researchers found, among other things, that women who were denied abortions were more likely to end up living in poverty, be unemployed, go through bankruptcy or eviction, be with a partner who abused them, end up as single parents. The women denied an abortion were also in worse health, experiencing more hypertension and chronic pain. This confirms other research showing that the procedure has extremely low complication rates, as well as no known negative health or fertility effects. While these findings are averages and do not easily speak of the personal journey of each woman, they bring invaluable insights, instrumental in shaping policy. 

At a time when Black mothers already die at a higher rate than their White counterparts in the US, mostly because of lack of access to quality care, there is no denying that revoking the right to abortion will inevitably lead to limited access or even the criminalization of abortion in large swathes of the country. It is tragic that it will amount to a denial of what should be considered an essential part of healthcare. We fully know what the consequences will be from the Turnaway Study: more pain and more death. Our role as investors and company builders has been and will continue to be to seek ways to increase the quality and reach to care for everyone, especially those who need it the most. 

Jonathan Friedlander, PhD & Geoffrey W. Smith