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29 September 2006

USA: Access to early abortion

Adolescents and poor women are more likely than other women to have trouble obtaining an abortion early in pregnancy, according to a study published in the October issue of Contraception.

The study found that a woman typically first suspects she is pregnant just over a month after her last period. Once pregnancy is suspected, most women who want an abortion act fairly quickly and are able to obtain an abortion in the first trimester. However Dr L Finer, director for domestic research at the Guttmacher Institute, reports that two groups of women - adolescents and poor women - have greater difficulty obtaining an early abortion, but for very different reasons.

Teens are hampered by a lack of knowledge about the symptoms of pregnancy, while poor women’s financial constraints are often an obstacle to timely receipt of services. For adolescents, the time between their last period and suspecting they are pregnant is significantly longer than for adult women.

The authors assert that a lack of knowledge about the basic aspects and specific signs of pregnancy impedes teens’ ability to recognise a pregnancy, and suggest that increased instruction on such topics in sexuality education programs would help overcome these problems. Poor women take significantly longer than other women from the time they first try to obtain an abortion to when they actually have the procedure, most frequently because they need to raise money for the procedure. In some cases, women make and cancel multiple appointments before they are able to get the necessary funds, or they wait days or even weeks until they can get Medicaid coverage (which is only broadly available in 17 US states).

The authors suggest that these findings indicate the importance of financial support for low-income women when they seek abortion. ‘Abortions obtained earlier in pregnancy are safer, less expensive and less stigmatised than abortions obtained at later gestations,’ says Dr Finer.

Timing of steps and reasons for delays in obtaining abortions in the United States

The study’s objective was to examine the steps in the process of obtaining abortions and women’s reported delays in order to help understand difficulties in accessing abortion services. In 2004, a structured survey was completed by 1209 abortion patients at 11 large providers, and in-depth interviews were conducted with 38 women at four sites.

The median time from the last menstrual period to suspecting pregnancy was 33 days; the median time from suspecting pregnancy to confirming the pregnancy was 4 days; the median time from confirming the pregnancy to deciding to have an abortion was 0 day; the median time from deciding to have an abortion to first attempting to obtain abortion services was 2 days; and the median time from first attempting to obtain abortion services to obtaining the abortion was 7 days. Minors took a week longer to suspect pregnancy than adults did. Fifty-eight percent of women reported that they would have liked to have had the abortion earlier. The most common reasons for delay were that it took a long time to make arrangements (59%), to decide (39%) and to find out about the pregnancy (36%). Poor women were about twice as likely to be delayed by difficulties in making arrangements.

The authors concluded that financial limitations and lack of knowledge about pregnancy may make it more difficult for some women to obtain early abortion.

Timing of steps and reasons for delays in obtaining abortions in the United States. Lawrence B. Finer, Lori F. Frohwirth, Lindsay A. Dauphinee, Susheela Singh, Ann M. Moore. Contraception. Volume 74, Issue 4, Pages 334-344 (October 2006)

Some women face barriers to obtaining safe, early abortions, Guttmacher Institute, 25 September 2006