P17 Examining attitudes toward abortion: Do people’s attitudes change when considering gestational age and fetal development?

Making a third-trimester abortion referral: Learning from patients

OBJECTIVES

Research on abortion referral practices has focused on referral to first-trimester abortion care. Research has not examined whether and how these recommendations apply to referrals for abortion later in pregnancy.

METHODS

We conducted a secondary analysis of semi-structured interviews with thirty third-trimester abortion patients of their experiences of referral from prenatal and/or pre-third-trimester abortion care. We used thematic coding to identify referral-related actions participants desired or wished providers would avoid.

RESULTS

Participants reported needs in referral for information that third-trimester abortion was a possibility and about third-trimester providers and funding resources. Several also reported a need for emotional support from the prenatal or abortion care provider who denied them abortion care.

CONCLUSIONS

Many factors important for first-trimester abortion referral are important in third-trimester abortion referral, but the specifics of third-trimester care (namely the paucity of clinics, need for travel, and possibility of strong emotional attachment to the pregnancy) require additional practice actions.

PRACTICE IMPLICATIONS

Providers can support their patients in need of third-trimester abortion care by proactively providing: information that third-trimester abortion is available; information on third-trimester providers and funding support (e.g., an abortion referral hotline); and clear, non-judgmental emotional support.

Is third-trimester abortion exceptional? Two pathways to abortion after 24 weeks of pregnancy in the United States

CONTEXT

In the United States, third-trimester abortions are substantially more expensive, difficult to obtain, and stigmatized than first-trimester abortions. However, the circumstances that lead to someone needing a third-trimester abortion may have overlaps with the pathways to abortion at other gestations.

METHODS

I interviewed 28 cisgender women who obtained an abortion after the 24th week of pregnancy using a modified timeline interview method. I coded the interviews thematically, focusing on characterizing the experience of deciding to obtain a third-trimester abortion.

RESULTS

I find two pathways to needing a third-trimester abortion: new information, wherein the respondent learned new information about the pregnancy-such as of an observed serious fetal health issue or that she was pregnant-that made the pregnancy not (or no longer) one she wanted to continue; and barriers to abortion, wherein the respondent was in the third trimester by the time she was able to surmount the obstacles to abortion she faced, including cost, finding a provider, and stigmatization. These two pathways were not wholly distinct and sometimes overlapped.

CONCLUSIONS

The inherent limits of medical knowledge and the infeasibility of ensuring early pregnancy recognition in all cases illustrate the impossibility of eliminating the need for third-trimester abortion. The similarities between respondents' experiences and that of people seeking abortion at other gestations, particularly regarding the impact of barriers to abortion, point to the value of a social conceptualization of need for abortion that eschews a trimester or gestation-based framework and instead conceptualizes abortion as an option throughout pregnancy.