Conditions That Limit Outpatient Abortion Care at Clinics in the United States

While most people in the United States obtain abortion care in outpatient settings, such facilities may limit care for some individuals because of a variety of conditions. The situations when abortion care cannot be obtained in the outpatient setting have not been evaluated, leaving a deficit in understanding the need for hospital-based abortion care.

We obtained outpatient abortion facility care protocols from the Society of Family Planning #We Count project, which, in January 2024, invited participating organizations with outpatient physical facilities to share their protocols for determining when patients were unable to be cared for in their facility(ies). Using summative content analysis, we identified health conditions for which a patient could be deemed ineligible, organizing individual conditions thematically and, as appropriate, by organ system.

We analyzed 20 unique protocols. Protocols delineated ineligibility for temporary conditions (e.g., fever), conditions specific to current pregnancy (e.g., placenta previa), conditions related to the patient's reproductive history or conditions (e.g., history of uterine surgery), and chronic conditions (e.g., hypertension). Protocols varied in quantity of limiting conditions (range: two to 26 conditions) and most frequently included limits to outpatient care for heart disease (15 [75%]), bleeding conditions (15 [75%]), seizure disorders (15 [75%]), hypertension (13 [65%]), anemia (12 [60%]), and asthma (11 [55%]). The definitions for a given condition as a limit for care frequently varied between protocols.

US outpatient abortion clinics commonly define limitations to outpatient care, but the specific limiting conditions and their criteria vary substantially across protocols.