Demographic and medical factors associated with later presentation among women seeking abortion for reason of fetal anomaly: Assessing the potential implications of abortion bans

Background: Twenty-three US states have passed bans on abortion after a specific gestational age (GA), including two after 20 weeks since the last menstrual period (LMP). As laws restricting abortion at earlier GAs continue to proliferate, we assessed the potential impact of a 20-week LMP abortion ban on patients presenting for terminations for reason of fetal anomaly.

Methods: Retrospective cohort study of 395 women presenting from 2005-2011 for second trimester abortion for reason of fetal anomaly at a hospital or nearby outpatient clinic in a Northeast city. We assessed whether demographic and medical factors differ between women presenting at < 20 weeks LMP vs. ≥ 20 weeks LMP using chi-square, Fisher’s exact, and t-tests.

Results:  Mean time lapsed between diagnosis of anomaly and presentation for care was significantly greater for women presenting at ≥ 20 weeks LMP (15.4 vs. 10.1 days, p<0.001). Women presenting at ≥ 20 weeks LMP were younger than women presenting earlier (mean 31.6 years vs. mean 33.5 years, p<0.001). Among women for whom data on race were available (n=216), more non-white than white women presented at ≥ 20 weeks LMP; this difference was not significant (64% vs. 50%, p=0.06).

Discussion: Though timing of diagnosis has been assumed to determine GA at presentation among women seeking abortion for fetal anomalies, we found that women presenting at ≥ 20 weeks LMP experienced a longer gap from diagnosis to abortion. Further research is merited to assess whether this delay is attributable to vulnerable women encountering structural barriers to care.