Timing of pregnancy discovery among women seeking abortion,

Diana Greene Foster,Heather Gould,M Antonia Biggs

doi:10.1016/j.contraception.2021.07.110

Abstract

ObjectiveLittle is known about the incidence and causes of delay in recognition of pregnancy. Delay in pregnancy recognition is associated with later presentation for abortion and exacerbates the burdens in accessing care. Using Turnaway study data, this study assessed the prevalence of later pregnancy recognition among a sample of people who obtained or were denied a wanted abortion. Study designThe Turnaway Study included telephone interviews of 956 women who sought an abortion in the first trimester or just over or under the gestational limit of one of 30 abortion facilities across the United States and in-depth interviews with 31 who completed 5 years of surveys. We describe women's experiences discovering pregnancy and conducted multivariate analyses assessing factors associated with later pregnancy discovery (after 13 weeks since last menstrual period [LMP]). ResultsMost women seeking second trimester abortions recognized their pregnancy more than 8 weeks after their LMP; more than 1 in 5 recognized pregnancy after 20 weeks. In interviews, women explained that recognition was delayed because of a lack of pregnancy symptoms or concurrence of other conditions with symptoms similar to pregnancy. According to multivariate analyses, women who had never given birth (adjusted odds ratio [aOR] = 1.71; 95% confidence interval [CI]: 1.24, 2.35) and those who used hormonal contraceptives in the month of conception (aOR = 1.83; 95% CI: 1.35, 2.47) were more likely to discover pregnancy after 13 weeks. ConclusionLaws imposing gestational limits will make abortion unavailable to people who discover pregnancy after the limit. Such bans are likely to disproportionately affect people using contraceptive methods to prevent pregnancy and those who have never given birth. ImplicationsSome pregnant people have few pregnancy symptoms and/or have conditions with symptoms similar to pregnancy, such as irregular periods or chronic pain. Gestational limits to abortion are likely to disproportionately affect people who recognize pregnancy later in pregnancy, particularly those without prior pregnancy experiences and who are using contraception.

Highlights

Not recognizing pregnancy in the first few weeks increases the likelihood of needing an abortion in the second trimester, which can exacerbate barriers to care
In the Turnaway Study, we found that later recognition of pregnancy, beyond weeks, sets off a cascade of delays [2]
This study provides a unique sample of people seeking abortion later in pregnancy

Summary

Introduction

Not recognizing pregnancy in the first few weeks increases the likelihood of needing an abortion in the second trimester, which can exacerbate barriers to care. When a pregnant person is past the first trimester, the logistical barriers to getting an abortion—the cost of the procedure and travel, the time off required, the need for transportation and finding childcare for existing children—increase [1]. The further along they are in pregnancy, the higher the cost of an abortion ∗. In the Turnaway Study, we found that later recognition of pregnancy, beyond weeks, sets off a cascade of delays [2]

Results

Discussion

Conclusion