Denial of abortion due to advanced gestational age in the United States

Some women who seek abortions are denied care (“turned away”) because they present for care beyond the facility's gestational limit. These limits are determined by institutional factors (i.e. provider competency) and/or state laws. We use data from UCSF's Turnaway Study to describe the significance and nature of the problem of women being denied a wanted abortion. Women were recruited from 30 abortion clinics across the US, where no clinic within 150 miles performs procedures at a later gestation. We describe the incidence of women being turned away and compare characteristics of women who present just under the clinic's gestational age limit (n=452 abortion controls) with those of women who present just after and who were denied an abortion (n=231 Turnaways).

The clinics in our study had gestational limits from 10 to 26 weeks. Each year the abortion providers in our study turn away about 1% of patients because they presented for care just beyond (<3 weeks) the gestational limit; the total proportion of women turned away is likely greater. Among the Turnaways in the sample 43.5% called and 34.5% visited at least one other clinic and on average they travelled 42 miles to get to this clinic. In a multivariable model, there were no significant sociodemographic differences between abortion controls and Turnaways, except that Turnaways were more likely to be aged 19 or younger. Regulations which impose gestational limits or facility requirements for later abortions will increase the number of turnaways and disproportionately affect young women.