Characteristics and Circumstances of U.S. Women Who Obtain Very Early and Second-Trimester Abortions
January
Characteristics and Circumstances of U.S. Women Who Obtain Very Early and Second- Trimester Abortions
Rachel K. Jones 0 1 2
Jenna Jerman 0 1 2
0 Research Division, Guttmacher Institute , New York, New York , United States of America
1 Funding: This project was funded by an anonymous donor. Additional support was provided by the Guttmacher Center for Population Research Innovation and Dissemination , NIH grant 5 R24 HD074034
2 Editor: Angel M. Foster, University of Ottawa , CANADA
-
Competing Interests: The authors have declared
that no competing interests exist.
Objective
Methods
To determine which characteristics and circumstances were associated with very early and
second-trimester abortion.
Paper and pencil surveys were collected from a national sample of 8,380 non-hospital U.S.
abortion patients in 2014 and 2015. We used self-reported LMP to calculate weeks
gestation; when LMP was not provided we used self-reported weeks pregnant. We constructed
two dependent variables: obtaining a very early abortion, defined as six weeks gestation or
earlier, and obtaining second-trimester abortion, defined as occurring at 13 weeks gestation
or later. We examined associations between the two measures of gestation and a range of
characteristics and circumstances, including type of abortion waiting period in the patients'
state of residence.
Results
Among first-trimester abortion patients, characteristics that decreased the likelihood of
obtaining a very early abortion include being under the age of 20, relying on financial
assistance to pay for the procedure, recent exposure to two or more disruptive events and living
in a state that requires in-person counseling 24±72 hours prior to the procedure. Having a
college degree and early recognition of pregnancy increased the likelihood of obtaining a
very early abortion. Characteristics that increased the likelihood of obtaining a
second-trimester abortion include being Black, having less than a high school degree, relying on
financial assistance to pay for the procedure, living 25 or more miles from the facility and late
recognition of pregnancy.
Conclusions
While the availability of financial assistance may allow women to obtain abortions they
would otherwise be unable to have, it may also result in delays in accessing care. If poor
women had health insurance that covered abortion services, these delays could be
alleviated. Since the study period, four additional states have started requiring that women
obtain in-person counseling prior to obtaining an abortion, and the increase in these laws
could slow down the trend in very early abortion.
Introduction
For individuals who wish to terminate a pregnancy, timely access to abortion care is key.
Access to abortion in the first trimester is particularly important, as second-trimester
procedures are offered by fewer providers, are substantially more expensive [
1
] and introduce a
slightly elevated risk of serious complications [2;3].
Since 1973, when abortion was legalized nationally, around 11% of abortions have occurred
at or after 13 weeks gestation [
4
]. Prior research using data from patients suggests that several
characteristics and circumstances increase the likelihood of obtaining a second-trimester
abortion, including being a teen, being Black, using health insurance to pay for the procedure,
difficulty finding a provider and, in particular, late recognition of pregnancy [5±7]. Several studies
using aggregate state-level data also found that Mississippi's in-person counseling
requirement, implemented in 1992, was associated with a slight increase in second trimester abortions
in the state [8±10]. Subsequent studies have not examined whether waiting periods were
associated with an increase in second-trimester abortion in other states that have since
implemented this type of waiting period.
While the proportion of abortions obtained in the second trimester has remained stable, the
proportion of abortions that were very early, or performed at or before six weeks gestation,
increased from 18% in 1997 [
11
] to 35% in 2012 [
7
]. This is likely due, at least in part, to
increased reliance on manual vacuum aspiration (MVA) and early medication abortion (EMA)
[12;13]. To date there is relatively little information about women who have very early
abortions. Notably, abortions at six weeks gestation pose the same minimal risk of complications as
abortions at 12 weeks gestation [
3
], and most first-trimester abortions typically cost the same
regardless of gestation. In March 2016, the FDA increased the gestational limit for EMA from
seven to 10 weeks, which means more women will have access to this option even if they
experience delays in accessing services. Still, the majority of abortion patients, including 52% of those
obtaining first-trimester abortions, would have preferred to have had their abortion earlier
[
14
]. Additionally, EMA is slightly more successful the earlier in the pr (...truncated)