Delays in request for pregnancy termination: comparison of patients in the first and second trimesters

doi:10.1016/j.contraception.2009.12.021

Contraception

Volume 81, Issue 5, May 2010, Pages 446-451

https://doi.org/10.1016/j.contraception.2009.12.021 Get rights and content

Abstract

Background

Despite the availability of first trimester abortion services in urban settings, many women request abortion in the second trimester. We identified protective and risk factors associated with women who delay requesting abortions until the second trimester.

Study Design

The study was a cross-sectional survey of 247 patients requesting surgical abortion at an urban family planning clinic. Survey and medical records data were analyzed for associations between 18 risk factors and incidence of second trimester request.

Results

Thirty-two percent of subjects presented in the second trimester. Chi-square analyses revealed that first trimester participants were more often employed (p<.0001), privately insured (p=.01), or had previous abortions (p=.04). Second trimester patients were younger (p<.0001), more often primigravid (p=.04), experienced more difficulty financing the procedure (p<.0001) and finding a surgeon (p<.0001), traveled longer distances (p=.005), and more often feared the procedure (p=.03). Using multiple logistic regression, women requesting second trimester abortions were more likely to report: obstacles financing the abortion (OR 2.34, 95% CI 1.28–4.28); traveling long distances (OR 2.88, 95% CI 1.31-6.31); and fear (OR 2.45, 95% CI 1.17–5.17). These women were less often employed outside the home (OR 0.35, 95% CI 0.19–0.64).

Conclusions

Physicians and advocates must strive to reduce abortion costs, increase access to trained surgeons, and allay women's fears of abortion procedures.

Introduction

Unintended pregnancy is a common problem faced by women and their health care providers, as 49% of all pregnancies in the United States are unintended [1]. Roughly half of these unintended pregnancies end in termination, resulting in high rates of both first and second trimester abortion. In 2005, 1.2 million abortions were performed in the United States [2].

Legal induced abortion at any gestational age is safe, with an overall abortion-related mortality rate of 0.6 per 100,000 procedures. However, the greater safety of first trimester versus second trimester procedures is well documented [3]. Although the overall morbidity and mortality of second trimester abortion is low [4], advancing gestational age increases the risk of medical complications and abortion-related death [5]. In addition, as a pregnancy progresses, the patient may face increasing difficulty finding a trained provider, since fewer physicians are trained to perform surgical abortion at advanced gestational ages than earlier.

The few contemporary studies addressing the issue of abortion delay suggest that certain logistical and medical factors — including financial obstacles, lack of insurance coverage, and substance abuse — contribute to delay and are barriers to abortion access [6], [7], [8]. One recent study found that most women would have preferred to have undergone their abortions earlier in gestation [7]. However, despite the knowledge gained from these studies, the studies are variable in their patient populations and study designs, so a lack of conclusions on abortion delay factors still persists. We conducted a patient survey to expand recent work and to: (1) describe risk factors for obtaining a second trimester abortion and (2) to further elucidate associations between several risk factors and delayed request for abortion among women presenting to a high-volume family planning clinic in the Midwest.

Section snippets

Materials and methods

Between July 2007 and July 2008, English-speaking women ages 18 years and older, presenting for surgical abortion for all indications except fetal anomaly and fetal demise, were recruited for survey participation at a single free-standing family planning clinic in Chicago, IL, USA. Patients requesting procedures for fetal anomalies and fetal demise were excluded on the basis that their decisions were temporally related to the timing of the diagnosis.

A convenience sample of all patients

Results

A total of 247 respondents completed the survey. One hundred sixty-eight (68%) presented in the first trimester, and 79 (32%), in the second trimester. There was a 4.3% (11 of 258 eligible women) incidence of refusal to participate. The 11 who chose not to participate were no different in demographical description than those who participated in the survey. Reasons for declining participation included not having enough time to participate and not wanting to speak with research staff. Twelve

Discussion

This study evaluates associations between sociodemographic; medical and economic, psychological and logistical factors and timing of presentation for abortion at an urban, free-standing family planning clinic providing a high volume of abortion procedures.

Our findings demonstrate that many women experience substantial difficulty obtaining money to pay for their procedures, and this problem was more common among the second trimester respondents. The cost of abortion increases with gestational

Acknowledgments

The authors kindly thank the clinic staff for supporting the study, the participants who generously donated their time, and E. Steve Lichtenberg, MD, MPH, and Cassing Hammond, MD, for their critical guidance.

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Original research articleDelays in request for pregnancy termination: comparison of patients in the first and second trimesters

Abstract

Background

Study Design

Results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Discussion

Acknowledgments

Am J Obstet Gynecol

Contraception

Contraception

Am J Obstet Gynecol

Contraception

Contraception

Disparities in rates of unintended pregnancy in the United States, 1994 and 2001

Perspect Sex Reprod Health

Original research article
Delays in request for pregnancy termination: comparison of patients in the first and second trimesters