220px-Rick_Perry_by_Gage_Skidmore_8According to Rick Perry if only Joan Rivers had her out-patient procedure at an accredited ambulatory surgical care facility she’d be alive. This piece of poorly researched and decidedly in poor taste drivel was a way of defending/bragging about the Texas TRAP law (bill signed into law by Perry requiring that all abortions be performed in accredited surgical facilities but is currently in limbo due to legal appeals).

Despite what Perry likely feels are semantics and others of a more precise nature might consider facts (River’s procedure actually occurred at an ambulatory surgical facility, she didn’t have an abortion, she was 81 and not a woman of reproductive age) Perry’s statement also shows he has no idea about safety data and abortion. After all, if the safety of a procedure needs improving wouldn’t it need to be unsafe in the first place?

Abortion-related deaths in Texas 2008-2012
Abortion-related deaths in Texas 2008-2012

How many women die from abortion-related reasons each year in Texas? Abortion is one of the most regulated procedures in the United States so we have very accurate data both federally and at the state level. The last time a woman died in Texas and it was recorded as abortion-related was 2008. Yes, I had to review 5 years of data to find one death, or one death out of 364,225 procedures (a mortality rate per procedure of 0.0000275%). Using 5 years of data the death rate from abortion is 0.27 per 100,000 procedures, but if I only went back 4 years it would be zero.

Abortion-related death doesn’t mean the death was directly caused by the procedure or that it could have been prevented by occurring in a hospital or surgical center. The CDC definition of abortion-related death is death due to a “complication of an abortion (legal or illegal), an indirect complication caused by a chain of events initiated by an abortion, or an aggravation of a preexisting condition by the physiologic or psychologic effects of abortion,” and “all deaths determined to be related causally to induced abortion are classified as abortion-related regardless of the time between the abortion and death.” In addition, any “pregnancy-related death in which the pregnancy outcome was induced abortion regardless of the causal relation between the abortion and the death is considered an abortion-related death.” Hopefully Mr. Perry is well acquainted with the definitions.

Trying to improve abortion safety is very hard because it is already so safe. Abortion is one of the safest procedures a woman in the United States can have. Nationwide an average of 6-12 women annually die from an abortion-related death. The case-fatality nationwide per 100,000 procedures is 0.67, so abortion in Texas is already safer than the national average. According to the Centers for Disease Control (CDC) the numbers of abortion-related deaths are just too low to draw meaningful conclusions about safety or areas for improvement. There is no data to show the one abortion-related death in the last 5 years in Texas could have been prevented by performing the procedure in a hospital or an accredited surgery facility. In fact no data anywhere shows that complications are lower in accredited surgical facilities versus a clinic or office. Certainly the data show that right now in Texas abortion couldn’t be any safer (0 deaths a year for 4 years). With that in mind, how can any law make the procedure any safer?

For Perry’s TRAP law to be of value safety-wise abortion in free-standing offices would have to be unsafe, but as far more than 90% of procedures are performed in these clinics and the mortality rate is 0% Perry is playing pretty footloose and fancy free with facts about clinic safety versus ambulatory surgical facilities. It is highly likely that he doesn’t know how safe abortion already is for women in Texas or doesn’t care. Or both.

I hope someone pins Perry down (and any legislator who supports the TRAP law) and asks about the case-fatality rate for abortion, because I would really love to know how the legislation he signed hopes to improve on the current safety of abortion in Texas.



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  1. I think you’re shooting yourself in the foot here–Texas goes nuts regulating abortion, abortion is safer in Texas than average–doesn’t that suggest those regulations are doing something at least somewhat useful?

    (Although I rather suspect what they’re actually doing is driving some poor women–who likely don’t get as good care overall and thus are higher risk–over state lines.)

    1. No, it doesn’t. The TRAP law isn’t in practice yet and the regulation is regarding reporting requirements. Mandatory ultrasounds etc were all enacted after this data (or the bulk of it) was collected. Abortion is safe in Texas because abortion is safe.

      1. I realize that the TRAP law has nothing to do with it and I’m not saying the laws have *actually* made things any safer–I’m just saying it looks that way. Something certainly is having an effect as you say Texas is safer than average.

    1. And Texas did nothing to limit abortion providers before the TRAP laws? I find that hard to believe.

      1. “According to the Centers for Disease Control (CDC) the numbers of abortion-related deaths are just too low to draw meaningful conclusions about safety or areas for improvement.”

  2. Enjoyed your “what others of a more precise nature might consider facts”. The media coverage on Joan Rivers’ death seems as though it’s been full of medical misinformation to begin with…..neither our media nor our politicians are bothering to put out accurate information. We’d be better off reading reliable blogs than listening to either of them, it seems.

  3. Wouldn’t Perry’s argument suggest that ALL medical and dental procedures should be performed in ambulatory care facilities? So why isn’t he proposing that?

    (Rhetorical question. We all know the reason.)

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