Admitting Privilege Laws: A Solution in Search of a Problem

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Analysis Abortion

Admitting Privilege Laws: A Solution in Search of a Problem

Stanley Henshaw

Twelve states have enacted such policies, which require doctors to obtain admitting privileges at a local hospital, and they are in effect in five states. But the seminal questions are: Does this requirement benefit women? And what are the costs to women and providers?

Over the past year, efforts by lawmakers to restrict access to abortion through what are known as targeted regulations of abortion providers have continued unabated. Many abortion clinics have been forced to close despite the fact that the claim such laws will protect women’s health are belied by the facts.

With so much misinformation out there about abortion care, it can be difficult for people who aren’t working in reproductive health care to know what to believe. Here is what everyone should know about one such law, the so-called admitting privileges requirement that requires doctors to obtain admitting privileges at a local hospital.

Twelve states have enacted admitting privileges requirements and several others have passed laws requiring privileges or another arrangement with a hospital. Admitting privileges requirements are in effect in five states. But the seminal questions are: Does this policy benefit women? And what are the costs to women and providers?

Abortion Is Safe

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On average, a pregnancy carried to term in the United States is about ten times as risky as having an abortion. There are roughly 88 deaths per million pregnancies carried to term compared to seven deaths per every million abortions. The mortality risk of abortion is comparable to the risk of dying while running a marathon and less than the annual risk of perishing in a fire or while riding a bicycle.

First-trimester aspiration abortions are so simple to provide that in California and several other states they can be performed by nurse practitioners and physician assistants, thus expanding access to care. A study of more than 11,000 first-trimester abortions in California found the complication rate to be no higher when performed by nurses and physician assistants than by physicians. The rate of major complications was one per 2,000 patients for both groups.

In the United States, abortion is very safe.

Admitting Privileges Offer Little Benefit

Admitting privileges laws are a solution in search of a problem. Hospital emergency rooms are already required to accept and treat all patients who seek care.

Because of the shortage of providers, many women travel long distances for abortion services. If they need emergency care, they should go to a nearby hospital, not to the one where the provider has privileges.

A physician generally has no control over where an ambulance will take a patient, which will be to the nearest available emergency room, not necessarily to the hospital where the physician has privileges.

In many cases, the abortion provider is not the best person to treat a severe complication.

It is standard practice for abortion providers to consult with the hospital physician treating an abortion complication to provide background information and advice.

It Is Impossible for Many Abortion Specialists to Obtain Hospital Privileges

In some areas, hospitals refuse to grant privileges to any physician who performs abortions. Some specify in their bylaws that their associated physicians may not perform abortions.

To apply for hospital privileges involves considerable effort and expense, and a refusal will remain on a physician’s record for the rest of his or her career and may result in increased malpractice insurance costs.

Hospitals usually grant privileges only to physicians who reside near the hospital, thus excluding the many abortion doctors who travel to other cities to provide services.

Hospitals expect physicians with privileges to admit at least ten patients a year, but a physician who specializes in abortion services likely needs hospital care for fewer than one patient per year.

What If Clinics Are Forced to Close?

In some cities, a hospital admitting privileges requirement has forced the only available abortion providers to close. This means that many women must travel long distances for abortion services.

Most women who seek abortions have low incomes. Studies have found that some women are unable to travel to other cities for abortion services. For example, if women have to travel 100 miles for services, 20 to 25 percent are forced to continue the unwanted pregnancy.

It takes time to arrange for long-distance travel, with the result that abortions occur later in gestation, when they are more risky and expensive.

Even if hospital admitting privileges reduced mortality from early abortion by half (an impossibility) but women had to travel 50 additional miles to an abortion facility, more deaths would be caused by traffic accidents than would be saved by the admitting privileges requirement.

It’s clear that admitting privilege requirements do not benefit women and only serve to increase barriers to abortion care for patients and providers. The women most affected are those with low incomes and little ability to travel long distances and pay additional costs. Unfortunately, a majority of women who need abortion services fall into this category. It is up to each of us to be diligent about the facts, and to hold our lawmakers accountable when they try to distort the truth by saying admitting privileges are necessary for the health of women.