title: Abortion barriers and perceptions of gestational age among women seeking abortion care in the latter half of the second trimester.
abstract: OBJECTIVE
  Later second-trimester abortion (gestational age ≥ 19 weeks) is higher risk, more expensive and more difficult to access than abortion earlier in pregnancy. We sought to enumerate barriers to care described by women seeking abortion in the latter half of the second trimester. We also assessed the accuracy of later second-trimester abortion patients' perceptions of their pregnancies' gestational ages.
  
  
  METHODS
  A retrospective analysis of data from 232 women served by a referral program for women seeking abortion care between 19 and 24 weeks of gestational age was performed. Data collected included demographics, pregnancy history, gestational age by ultrasound, perceived gestational age, barriers to abortion care experienced and time lapsed from pregnancy recognition to presentation for care.
  
  
  RESULTS
  Difficulty deciding whether to terminate (44.8%), financial barriers to care (22.0%) and the patient having recently realized she was pregnant (21.6%) were the most common delaying barriers cited. Nearly half (46.6%) of women underestimated their own gestational ages by greater than 4 weeks. Risk factors for experiencing at least 3 months time lapsed from pregnancy recognition to program referral included difficulty deciding whether to terminate [odds ratio (OR) 4.08, 95% confidence interval (CI) 2.51-8.70] and nonwhite race/ethnicity (OR 2.04, 95% CI 1.16-3.57).
  
  
  CONCLUSIONS
  Women seeking abortion care in the latter half of the second trimester encounter many of the same barriers previously identified among other abortion patient populations. Because many risk factors for delayed presentation for care are not amenable to intervention, abortion must remain available later in the second trimester.
  
  
  CONCLUSIONS
  Women presenting for abortion in the later second trimester are delayed by structural and individual-level barriers, and many substantially underestimate their own gestational age. Removing financial barriers may help reduce abortion delay; however, many risk factors are nonmodifiable, underscoring the need to ensure access to later second-trimester abortion.
authors: Harvard School of Public Health, Boston, MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: ejaniak@partners.org.
authors: Elizabeth
authors: E
authors: Janiak
authors: Harvard School of Public Health, Boston, MA, USA.
authors: Ichiro
authors: I
authors: Kawachi
authors: Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Planned Parenthood League of Massachusetts, Boston, MA, USA.
authors: Alisa
authors: A
authors: Goldberg
authors: Harvard School of Public Health, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors: Barbara
authors: B
authors: Gottlieb
mesh_terms: D000028:Abortion, Induced / Q000523:psychology*; D000293:Adolescent; D000328:Adult; D005260:Female; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011262:Pregnancy Trimester, Second / Q000523:psychology*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Abortion barriers; Second-trimester abortion