Why do women need later abortion care?

Who seeks later abortion care?

Only 7.3% of abortions in the US were provided between 14-20 weeks gestation and only 1.4% were provided at 21 weeks gestation or later in 2011 [1]. In order to get a better understanding of what may lead some women to seek an abortion during the second trimester, several research groups have surveyed women who have both obtained and been denied later abortions and compared their demographic characteristics with women who have obtained first trimester abortions. In a study of women seeking abortion after 16 weeks LMP but within the second trimester, the groups more likely to obtain an abortion during that time period were black women, women with higher levels of education and women using health insurance to pay for their procedure [2]. In contrast, a 2013 US study comparing women seeking abortion after 20 weeks LMP with those seeking earlier abortion found that women who obtain later abortions in the US are more likely to be younger and to be unemployed [3].

What factors can cause delay?

Several factors have been identified as contributing to delay in seeking abortion until the second trimester or later.  A study of 398 US women who obtained a second trimester abortion found that “half of the time spent between first missed period and abortion occurs prior to the first pregnancy test ”[4]. A subsequent analysis of the same participant group found several risk factors for delayed pregnancy testing, including obesity, substance abuse, previous second trimester abortion, and uncertainty about the date of a woman’s last menstrual period [5]. Women with a history of spotting in-between periods and irregular periods are also more likely to obtain a later abortion, as it may be harder for them to determine when they become pregnant [6] [7]. It can be difficult for women to estimate how far their pregnancy has progressed and this may also contribute to a delay.[8] In a study of 232 women seeking second trimester abortion, 46.6% had underestimated how far their pregnancy had progressed by at least 4 weeks [8]. Women who seek later abortion due to a fetal anomaly may have been unable to discover these anomalies any earlier in their pregnancy because the tests that identify them are not done until the second trimester [9]. Women who obtain second trimester abortions overwhelmingly report a desire to be able to identify a pregnancy and obtain an abortion earlier [6] [10].

Cost and travel

Women have identified common barriers to obtaining an abortion once they know they’re pregnant. Logistical and financial barriers, such as difficulty locating a provider, lack of insurance coverage or adequate funds for the abortion and related travel costs, become even more significant for women who need a later abortion [11]. Fewer providers offer abortions later in pregnancy and the cost may be significantly higher than that of a first trimester abortion. It is estimated that women may have to spend as much as two-thirds of their monthly income for a second trimester abortion [11] [12]. A study of women who obtained abortion in 2008 found that although women traveled an average of 30 miles in each direction to reach an abortion provider, over 30% of women in rural areas had to travel more than 100 miles [13]. This same study found that the distance traveled could be even greater for women obtaining second trimester abortions or crossing state lines to reach their provider’s office [13]. Since this data was collected in 2008, the number of states with mandatory counseling and subsequent waiting periods has increased from 25 to 35, likely resulting in an even greater travel burden for many women [13]. Women also report that they take time to make the decision to have an abortion and this plays an important role in how quickly they seek out services [8]. Whether women obtain an elective abortion or seek an abortion because of a fetal anomaly, researchers have found that the overwhelming majority report feeling that that they made the right decision [14] [15].

For more information about why women need later abortion care see the Related Research in our archives.

References

1. Pazol K, Creanga AA, Burley KD, Jamieson DJ. Abortion Surveillance—United States, 2011. Morbidity and mortality weekly report. Surveillance summaries. 2014; 62(8): 1-44

2. Jones RK,Finer LB. Who has second-trimester abortions in the United States? Contraception. 2012;85(6): 544-551

3. Foster DG,Kimport K. Who seeks abortions at or after 20 weeks? Perspectives on sexual and reproductive health. 2013; 45(4): 210-218

4. Drey EA, Foster DG, Jackson RA, Lee SJ, Cardenas LH, Darney PD. Risk factors associated with presenting for abortion in the second trimester. Obstetrics & Gynecology. 2006; 107(1): 128-135

5. Foster DG, Jackson RA, Cosby K, Weitz TA, Darney PD, Drey EA. Predictors of delay in each step leading to an abortion.Contraception. 2008; 77(4): 289-293

6. Swanson M, Karasek D, Drey E, Foster DG. Delayed pregnancy testing and second-trimester abortion: can public health interventions assist with earlier detection of unintended pregnancy? Contraception. 2014; 89(5): 400-406

7. Ingham R, Lee E, Clements SJ, Stone N. Reasons for second trimester abortions in England and Wales. Reproductive health matters. 2008; 16(31): 18-29

8. Janiak E, Kawachi I, Goldberg A, Gottlieb B. Abortion barriers and perceptions of gestational age among women seeking abortion care in the latter half of the second trimester. Contraception. 2014; 89(4): 322-327

9. Kerns, JL, Swanson M, Pena S, Wu D, Shaffer BL,Tran SH, Steinauer JE. Characteristics of women who undergo second-trimester abortion in the setting of a fetal anomaly. Contraception. 2012; 85(1): 63-68

10. Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM. Timing of steps and reasons for delays in obtaining abortions in the United States. Contraception. 2006; 74(4): 334-344

11. Kiley JW, Yee LM, Niemi CM, Feinglass JM, Simon MA. Delays in request for pregnancy termination: comparison of patients in the first and second trimesters. Contraception. 2010; 81(5): 446-451

12. Roberts SC, Gould H, Kimport K, Weitz TA, Foster DG. Out-of-pocket costs and insurance coverage for abortion in the United States.Women's Health Issues. 2014; 24(2): e211-e218

13. Jones RK, Jerman, J. How far did US women travel for abortion services in 2008? Journal of Women's Health, 2013; 22(8): 706-713

14. Rocca CH, Kimport K, Gould H,, Foster DG. Women's emotions one week after receiving or being denied an abortion in the United States. Perspectives on sexual and reproductive health. 2013; 45(3): 122-131

15. Andersson IM, Christensson K,Gemzell-Danielsson K. Experiences, Feelings and Thoughts of Women Undergoing Second Trimester Medical Termination of Pregnancy. PloS one. 2014; 9(12): e115957

 

 

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