During the campaign to pass the Colorado constitutional right to abortion, we heard the mantra “abortion is health care.” Abortion advocates promoted the measure to “preserve the health and lives of women.” We will soon see if their actions match their rhetoric.

House Bill 25-1252 will be considered in the Colorado Assembly. This bill would permit the Colorado Department of Public Health and Environment (CDPHE) to regulate second- and third-trimester abortion facilities as they do most health-care facilities that provide services that entail significant risks to their patients.

Pro-choice and pro-life Coloradans should find common ground and endorse this overdue measure.

Conventional wisdom suggests abortions are safe and there is little need for procedure-specific regulations to ensure public health and safety. This is based on widely cited publications such as the National Academies Report entitled “The Safety and Quality of Abortion Care in the United States.” The problem with these assessments is they don’t differentiate risks based on gestational age or procedure type.

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Since serious complications are uncommon in first-trimester abortions, a global quantification of abortion risk will systematically understate the risk posed by second- and third-trimester abortions. The mortality from an abortion performed at 21 weeks or more is 77 times higher than the mortality from an abortion at eight weeks or less based on data from the CDC. For each additional week of gestation beyond eight weeks, the risk of dying from abortion increases by 38%.

The risk of complications from abortion also increases exponentially with gestation. Minor and major complications of dilation and evacuation (D&E) second-trimester abortions are increased for each additional week of gestation. Some estimate for every woman who dies of a pregnancy complication, there are 20 to 30 women who suffer life-long debilitating complications.

The largest series of second-trimester D&E abortion complications was reported from the University of California-San Francisco, which is recognized for its often-cited abortion research. It demonstrated a 9.8% risk of any complication and a 1.7% incidence of serious, life-threatening complications including those requiring hospitalization, transfusion, or further surgical intervention. Our own University of Colorado reported a 4.2% risk of hemorrhage and a 2.0% risk of hospitalization for surgical abortions performed in the second trimester.

There are other academic centers that have published statistics even more alarming depending on the specific procedure and women’s risk profile. When complications are evaluated for women with previous C-sections or placental abnormalities undergoing second-trimester medical or surgical abortions, complication rates have been cited as high as 56% and transfusion requirements as high as 4%.

Abortion advocates like to compare the risk of early abortion to other common medical procedures to make the case abortions are safe. For abortions performed between 16 and 20 weeks, the mortality rate is 3.4 deaths per 100,000 abortions, but the rate increases to 8.9 per 100,000 at 21 weeks or greater. The risk of dying during natural childbirth is less than the risk for these late abortions.

Another pertinent comparison is the risk relative to ambulatory surgical centers. The mortality rate at ambulatory surgery is 2 per 100,000 based on a study from the United States. A survey of accredited Canadian ambulatory surgical centers indicates an even lower rate of 1 per 100,000. This suggests late abortions are four to eight times more deadly than ambulatory surgeries.

Birthing centers and ambulatory surgical centers are licensed, regulated and inspected in Colorado by the Colorado Department of Public Health and Environment (CDPHE), but second- and third-trimester abortion clinics are not.

Maternal mortality, which includes abortion-associated and abortion-related mortality, is a scourge in our nation and in the state of Colorado. As in the rest of the United States, maternal mortality in Colorado disproportionately affects people of color, individuals living in poverty and those living in “frontier” areas. The challenge is not just with the medical risks from childbirth and abortion, but also the psychological sequelae that can lead to deaths of desperation — from suicide and drug overdose.

The Colorado Maternal Mortality Review Committee (MMRC) reported 174 pregnancy-associated deaths between 2016 and 2020. The MMRC has recommended “health care facilities should implement evidence-based safety bundles.” These bundles include clinical best-practice protocols and screening to look for anxiety, depression, substance abuse and intimate partner violence. The screening is particularly relevant to women seeking abortion since they are four times more likely to suffer from a mood disorder than women who give birth. To ensure compliance with these quality measures, CDPHE oversight is essential.

Mediatrackers first drew attention to the lack of regulation at abortion clinics in Colorado in 2013. This was prompted by a lawsuit against Planned Parenthood of the Rocky Mountains that alleged malpractice and health standard violations. They found Planned Parenthood abortion clinics were not held to the same standards as other facilities, which are regulated by CDPHE. There are no state regulatory or inspection requirements for public health and safety at abortion facilities in Colorado despite receiving millions of dollars of direct aid from the state.

If the state is serious about protecting women’s health and safety and reducing maternal mortality, prudent regulation of second- and third-trimester abortion facilities should be a high priority. If abortion advocates oppose regulations of abortion facilities because they claim it “impedes” access, it tells Coloradans what their principal priority is — abortion and not women.

Colorado legislators will have an opportunity to close this public health gap by voting YES on HB25-1252, which would grant CDPHE regulatory oversight of these facilities.

It should not take a trail of injured or deceased women to prompt action.

Tom Perille, M.D., is president of Democrats for Life of Colorado.