Who seeks abortions after 20 weeks? Implications for pending U.S. legislation

Introduction: A dozen states are considering restrictions on abortion after 20 weeks of pregnancy. Little is known about who would be affected. Methods: Between 2008 and 2010 we interviewed women seeking abortions at 30 U.S. abortion providers. We examine characteristics of women, reasons for seeking abortion and causes of delay among women seeking earlier and later abortion. Results: 956 women completed interviews, including 426 women seeking later abortions (at or after 20 weeks). Late recognition of pregnancy was a leading contributor to delay in seeking abortion – nearly half (46%) of the women seeking later abortions were in the second trimester and one in five was already past 20 weeks when they discovered their pregnancy. Once women are in the second trimester, finding an abortion provider and raising funds to cover the procedure and travel costs cause significant delay. In a multivariable logistic regression of women seeking later abortion, African American women had 2.5 times higher odds of seeking an abortion after 20 weeks, Latinas were 72% more likely, women under age 20 were 73% and nulliparous women were 61% more likely. Women who report delay due to securing insurance coverage are twice as likely to seek a later abortion. Reporting delay due to trouble deciding is negatively associated with seeking later abortion (OR 0.71). Discussion: Bans on abortion after 20 weeks will disproportionately affect young women and women of color. Later abortions are largely due to delay in recognition of pregnancy and logistical barriers to finding later abortion services.