Journal of Public Health Policy

, Volume 33, Issue 3, pp 348–362 | Cite as

Legal restrictions and complications of abortion: Insights from data on complication rates in the United States

  • Joshua A RolnickEmail author
  • John S Vorhies
Original Article


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 socio-economic 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.Commentary JPHP.2012.15, available at, relates to this article.


abortion public policy hospital discharge data complications law 



We thank Joey Richards for his input on data analysis; Derek Schachter for his research assistance in collection and management of data; and Jay Bhattacharya and Corinna Haberland for helpful discussions and thoughtful comments on drafts.

Supplementary material

41271_2012_Article_BFjphp201212_MOESM1_ESM.pdf (168 kb)
Supplementary Items 1–4


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Copyright information

© Palgrave Macmillan, a division of Macmillan Publishers Ltd 2012

Authors and Affiliations

  1. 1.Stanford University Department of MedicineStanfordUSA
  2. 2.Stanford University Department of OrthopaedicsRedwood CityUSA

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