title: Delays and barriers to care in Colombia among women obtaining legal first- and second-trimester abortion.
abstract: OBJECTIVE
  To evaluate delays before first- or second-trimester legal abortion and barriers to care in Colombia.
  
  
  METHODS
  A secondary analysis was undertaken of data from a prospective cohort study of women undergoing first-trimester (<12 weeks) and second-trimester (12-15 weeks) abortion between February and July 2012. Participants (aged ≥18 years with access to a telephone) reported key dates in their abortion process and barriers to care. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  Overall, 100 women in the first trimester and 200 in the second trimester were included. Second-trimester clients experienced longer delays in each step of the abortion process than did first-trimester clients (P<0.001 for all three intervals examined), with the largest delay being time to suspicion of pregnancy (37 days vs 17 days). Difficulty accessing care was associated with the second trimester (odds ratio 5.1, 95% CI 2.9-9.1) and low socioeconomic status (odds ratio 2.3, 95% CI 1.2-4.3). Financial barriers were the most common (30 [30.0%] first-trimester clients; 86 [43.0%] second-trimester clients).
  
  
  CONCLUSIONS
  Despite partial decriminalization of abortion in 2006, Colombian women still face barriers to legal services that probably contribute to late presentation. Interventions promoting early pregnancy recognition and information about how to access legal abortion could reduce the need for second-trimester services.
authors.affiliation: Ibis Reproductive Health, Oakland, CA, USA. Electronic address: sbaum@ibisreproductivehealth.org.
authors.forename: Sarah
authors.initials: S
authors.lastname: Baum
authors.affiliation: Fundación Oriéntame, Bogotá, Colombia.
authors.forename: Teresa
authors.initials: T
authors.lastname: DePiñeres
authors.affiliation: Ibis Reproductive Health, Oakland, CA, USA; Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Services, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Grossman
mesh_terms: D000029:Abortion, Legal / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003105:Colombia; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D015999:Multivariate Analysis; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult
keywords: Abortion; Colombia; Delay to care; Second trimester