摘要：Objectives. We examined the factors influencing delay in seeking abortion and the outcomes for women denied abortion care because of gestational age limits at abortion facilities. Methods. We compared women who presented for abortion care who were under the facilities’ gestational age limits and received an abortion (n = 452) with those who were just over the gestational age limits and were denied an abortion (n = 231) at 30 US facilities. We described reasons for delay in seeking services. We examined the determinants of obtaining an abortion elsewhere after being denied one because of facility gestational age limits. We then estimated the national incidence of being denied an abortion because of facility gestational age limits. Results. Adolescents and women who did not recognize their pregnancies early were most likely to delay seeking care. The most common reason for delay was having to raise money for travel and procedure costs. We estimated that each year more than 4000 US women are denied an abortion because of facility gestational limits and must carry unwanted pregnancies to term. Conclusions. Many state laws restrict abortions based on gestational age, and new laws are lowering limits further. The incidence of being denied abortion will likely increase, disproportionately affecting young and poor women. The majority of abortions in the United States are in the first trimester of pregnancy, but 8.5% (approximately 100 000) occur after 13 weeks’ gestation. 1 Most women having second trimester abortions would have liked to have had the procedure earlier, 2 and women report a number of delaying factors, including cost and access barriers and late detection of pregnancy. 2–4 These delays can result in women being denied care because they present with pregnancies beyond an abortion provider’s gestational age limit and are unable to obtain an abortion elsewhere. (An “abortion provider” is a facility where abortions are performed. 5 ) Little is known about how frequently this occurs and what happens to women denied abortion care. The 1973 Supreme Court Roe v. Wade 6 decision established the point of potential fetal viability as the threshold after which states could restrict women’s access to abortion care as long as they allowed for exceptions to preserve the life and health of the pregnant woman. However, Roe v. Wade did not specify a gestational age for viability. Many states have established an upper gestational limit, most commonly after 24 weeks from a woman’s last menstrual period, and some states have done so without the required exceptions. 7 At least 8 states have recently reduced or plan to reduce the upper gestational limit to 20 weeks, and 1 state to 18 weeks. 8 Individual abortion providers can set their limits at lower gestational ages, and do so based on the availability of trained physicians, clinician and staff comfort, and facility regulations. According to a national survey of abortion providers, 23% offer abortions after 20 weeks’ gestation, and 11% do so at 24 weeks. 5 Because fewer providers offer abortion care after the first trimester, women must travel longer distances to obtain later abortions. Because later abortions are more complex procedures, often occurring over 2 or more days, they are also more costly; the average charge for an abortion at 10 weeks is $543 compared with $1562 for an abortion at 20 weeks. 5 Some women must also arrange for childcare, take time off work or other responsibilities, and incur transportation and hotel expenses; raising these funds results in additional delays. 9 We sought to describe the characteristics associated with being turned away because of provider gestational age limit, and the efforts such women make to obtain a desired abortion. Additionally, we explored the factors associated with obtaining a desired abortion elsewhere. Finally, we estimated the incidence of women being denied an abortion in the United States because of provider gestational limits.
