Bottles of the drug misoprostol sit on a table at the West Alabama Women's Center on Tuesday, March 15, 2022 in Tuscaloosa, Ala. The drug is one of two used together in "medication abortions." According to Planned Parenthood, misoprostol, taken after mifepristone, causes cramping and bleeding to empty the uterus. (AP Photo/Allen G. Breed)

When a new Mississippi law started requiring doctors to report all abortion-related complications they treated, legislators framed it as a way to shed light on a hidden epidemic of suffering.

“There exists credible evidence that two (2) or three (3) Mississippi women per week suffer complications following abortions sufficient to require hospitalization,” the 2004 bill said

During debate over the bill, then-Rep. Joey Fillingane, R-Sumrall, responded to criticism that it would burden abortion providers by pointing out that all doctors would have to report complications, because women “don’t typically go back to the same doctor who butchered them.”

Yet in the 16 years after the law came into effect, the health department collected just 40 complication reports, according to documents Mississippi Today obtained from the health department through a records request. The complications were almost all for easily treatable conditions and no deaths or comas were reported. 

Between roughly 4,000 and 6,000 Mississippians got an abortion each year during that same period. 

From 2018 to 2020, 33 Mississippians died of pregnancy-related complications. (The Centers for Disease Control and Prevention collects that data annually but to protect confidentiality does not publish the number of maternal deaths by state when the number is less than 10.)

Mississippi Today asked the health department whether there are any known issues with the data or incomplete reporting. The department did not respond. 

The law makes it a misdemeanor to fail to report an abortion complication. 

The Charlotte Lozier Institute, an anti-abortion research group affiliated with Susan B. Anthony Pro-Life America, creates annual reports on states’ abortion reporting. Genevieve Plaster, deputy director of policy at the organization, said the small number of complications reported – in some years zero – suggests some complications are not being reported, especially given the high rate of medication abortion in Mississippi. She pointed to research in California that found a 5% complication rate and a 0.3% major complication rate for medication abortions. 

“It’s highly unlikely that no complications occurred” in 2019, she said.

Fillingane said when the Complication Reporting Act was introduced, he and other lawmakers heard “rumors and stories, anecdotal evidence of abortion doctors performing poorly in the operating room and we didn’t want that to be happening in Mississippi.” In 2003, an Alabama woman died after an abortion performed by a doctor who also worked in Mississippi. He lost his license in both states.

Fillingane has looked at the complication reports occasionally, he said.

“I think we always suspected that the number of complications were few, that there weren't gonna be like this massive number of complications,” he said. “But we didn’t know. You can assume something and be totally wrong in your assumption until you have something like this in place.”

The end of elective abortion in Mississippi doesn’t affect the complications reporting requirement: Doctors will still report any complications to the health department, through a form that does not contain the patient’s name or identifying information like social security number or date of birth.

Elizabeth Nash, state policy analyst at the Guttmacher Institute, a policy organization that supports abortion rights, said many states began passing complication-reporting requirements around 2010. 

“The idea was that there were all these abortion complications that people didn’t know about, and that abortion in and of itself was dangerous, so there must be all of these negative outcomes that people just aren’t aware of,” Nash said. “The problem with that is fundamentally that abortion is safe and effective.”

The anti-abortion organization Americans United for Life has proposed model legislation that, like Mississippi’s law, requires state health departments to track information about complications. Nash said she expects states where abortion is now almost entirely banned to pass laws requiring doctors to report each procedure with documentation to show why it was legal. 

In the 2022 session, both Fillingane, now a state senator, and House Speaker Philip Gunn, R-Clinton, introduced a piece of AUL model legislation that would have required doctors to report detailed information on each abortion they perform. Both bills died in committee. 

The model legislation claims that “Surgical and nonsurgical (chemical) abortion is an invasive procedure that can cause severe, short-term and long-term physical and psychological complications for women, including, but not limited to…” It then lists more than 20 complications, most of which Mississippi doctors have never reported to the state health department. 

Fillingane said new legislation next session could specify what doctors must report when they perform abortions that are still legal in Mississippi, when the pregnant person’s life is threatened or when they have reported a rape to law enforcement.

“What is life threatening, how did you come to that conclusion, what evidence are you putting in your file to back that up?” he said doctors could be asked to report. “Or if it’s based on the allegations that have been made of a rape, what kind of backup information, what kind of follow-up or verification did you do of that alleged rape? Was there a police report filed, has there been an investigation, a prosecution, where are we on that?”

Several OB/GYNs have told Mississippi Today that they anticipate no doctor in the state will perform abortions in cases of rape because of the risk of being sued or criminally investigated.

Gunn, who was also a co-author on the 2004 complications reporting bill, did not respond to a request for comment. 

Now that abortion is banned in nearly all cases in Mississippi, abortion pills – which Mississippians can order online from overseas pharmacies – are likely to be the focus of new legislative efforts. Lawmakers have cited safety concerns about the pills, which have been approved by the Food and Drug Administration and in wide use around the country since 2000.

“… I think that causes some big problems, when you give a woman a handful of medicine to go home and expel a child,” Rep. Becky Currie, R-Brookhaven, told Mississippi Today in early May.

The Mississippi statistics don’t indicate what kind of abortion led to the complication. But more than half of the abortions performed at the Jackson Women’s Health Organization, the state’s only abortion clinic for years, were via medication.

A study published in the medical journal the Lancet earlier this year found that about 1% of people nationally who used pills to self-manage an abortion reported serious complications, with no deaths reported.

See the annual complication reports:










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Isabelle, an Atlanta native, covers health as part of Mississippi Today’s community health team. Prior to joining Mississippi Today, she was a reporter for the Biloxi Sun Herald and a Report for America corps member.