Increased complications after 2011 Ohio abortion law

August 30, 2016

Women who had medication abortions were more likely to require additional interventions following implementation of an Ohio law that required abortion providers to adhere to an outdated protocol, according to a study published by Ushma Upadhyay from the University of California, San Francisco, US, and colleagues in PLOS Medicine.

In February 2011, an Ohio law took effect mandating use of the protocol that was approved at that time by the US Food and Drug Administration (FDA) for mifepristone, which is used with misoprostol for medication abortion. This protocol required different dosages of both medications from those supported by several international guidelines and used by most abortion providers throughout the US.

The researchers collected medical record data from 2,783 women who obtained a medication abortion between 2010 and 2014 from four clinics in Ohio, and compared those who had abortions before and after the law took effect. They observed that women who had medication abortions in the post-law period were 3 three times as likely to need additional interventions to complete their abortion compared to women in the pre-law period. Furthermore, side effects such as nausea and vomiting were significantly more likely and costs were higher for women after the law took effect.

While the study's conclusions are limited by the lack of a comparison group of women undergoing medication abortion who were not affected by the law change, the findings suggest that the change in Ohio law did not lead to improved abortion outcomes. The FDA amended its label for mifepristone use nationally for medication abortion in March, 2016.

The lead author, Ushma Upadhyay said: "Ohio's departure from international standards for medication abortion was not associated with improved abortion outcomes. Instead, women actually required more medical interventions, had to make more visits, suffered more side effects and incurred greater costs following implementation."
Research Article


This study was supported by a research grant from the Susan Thompson Buffett Foundation Grant ID 3770 (to UDU). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

The authors have declared that no competing interests exist.


Upadhyay UD, Johns NE, Combellick SL, Kohn JE, Keder LM, Roberts SCM (2016) Comparison of Outcomes before and after Ohio's Law Mandating Use of the FDA-Approved Protocol for Medication Abortion: A Retrospective Cohort Study. PLoS Med 13(8): e1002110. doi:10.1371/journal.pmed.1002110

Author Affiliations:

Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California, United States of America Planned Parenthood Federation of America, New York, New York, United States of America Obstetrics and Gynecology, Ohio State University Wexner Medical Center, Ohio State University, Columbus, Ohio, United States of America



Ushma D. Upadhyay
University of California, San Francisco
Department of Obstetrics, Gynecology, and Reproductive Sciences
1330 Broadway, Suite 1100
Oakland, CA 94612

Alice Cartwright
Project Director


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