Research Article|Articles in Press, 110011

Classification of periviable pregnancy-ending interventions for maternal life endangerment as induced abortion1



      To explore how U.S. OB/GYNs classify periviable pregnancy-ending interventions for maternal life endangerment.

      Study Design

      From May-July 2021, we performed an explanatory sequential mixed methods study of U.S. OB/GYNs, recruited through social media and professional listservs. We administered a cross-sectional survey requesting institutional classification of labor induction or surgical evacuation of a 22-week pregnancy affected by intrauterine infection, using chi-square tests and logistic regression to compare determinations by physician and institutional factors. We then conducted semi-structured interviews in a diverse nested sample to explore decision-making, merging quantitative and qualitative data in a mixed methods analysis.


      We received 209 completed survey responses, with 101 (48.3%) current abortion providers and 48 (20.1%) never-providers, and completed 21 qualitative interviews. Fewer than half of respondents reported that pregnancy-ending intervention for 22-week intrauterine infection would be classified as induced abortion at their institution (induction: 21.1%, dilation & evacuation: 42.6%, p<0.001). In addition to procedure method, decision-making factors for classification as abortion included personal experience with abortion (with more experienced participants more likely to identify care as abortion) and state and institutional abortion regulations (“I have to call it a medical [induction]…I’m not allowed to use the word abortion”).


      Most OB/GYNs do not classify periviable pregnancy-ending interventions for life-threatening maternal complications as induced abortion, especially when physicians and institutions have less abortion expertise. Differential classification of pregnancy-ending care may lead to under-counting of later abortion procedures, masking the impact of abortion restrictions.


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