Abortions that take place at 13 weeks’ gestation or later—comprising 10% of all abortions—are more common among women who are black, are aged 18–19, have not finished high school, have either a high school diploma or a general equivalency degree (GED), use health insurance to pay for the procedure or have experienced three or more disruptive events in the past year than among others, according to a 2008 national survey of abortion patients.1 Some 40% of second-trimester abortions occur at 16 weeks or later; they are more likely to involve women who are black, have incomes at least 200% of poverty and pay for the procedure with health insurance than women who are white, poor and pay out of pocket.
To augment the scant information that exists about women who terminate a pregnancy in the second trimester, researchers analyzed data from a 2008–2009 survey of 9,493 abortion patients at 95 randomly selected hospitals, clinics and physicians’ offices. Analyses focused on second-trimester abortions overall and on the subset of abortions that occurred at 16 weeks or later. The researchers dated pregnancy according to women’s reports of the first day of their last menstrual period, their number of weeks pregnant and the date that they completed the survey’s written questionnaire. In analyses that adjusted for age, income and other demographic characteristics, researchers tested associations between selected characteristics and women’s odds of having second-trimester abortions and abortions at 16 weeks or later.
The majority of abortion patients were aged 20–29 and were not married or had never been married. Thirty-six percent were white, 30% were black and 25% Hispanic. More than one-third had given birth at least twice, and 39% had never given birth; half had never had an abortion, while half had had at least one. Between 20% and 40% had a high school diploma, a GED or at least some college. Forty-two percent were poor; however, 55% paid for the procedure out of pocket. Finally, 96% of women were terminating pregnancies that had been unintended or caused them ambivalence.
Ten percent of all abortions occurred in the second trimester. In bivariate analyses of all abortion patients by age-group, 14% of teenagers younger than 18 and of those aged 18–19 had abortions in the second trimester, compared with 9–10% of other age-groups. Thirteen percent of abortions among blacks occurred in the second trimester, compared with 8–10% among other racial and ethnic groups. Among women aged 20 and older, second-trimester abortions were more prevalent among those who had not finished high school, or had a high school diploma or GED, than among women who had some college (11–13% vs. 6–9%); they were more common among women who were poor or relied on health insurance to pay for the procedure (13–14%) than among women who had higher incomes or paid for the procedure out of pocket (8% for each). Second-trimester procedures represented a larger proportion of abortions among patients who had experienced physical or sexual abuse by the partner with whom they conceived, or at least three disruptive life events in the past year (e.g., missing rent or mortgage payments, being unemployed for at least one month, separating from a partner, having a baby), than among those who had not (14–15% vs. 9–10%). Moreover, a greater proportion of women with intended pregnancies than unintended pregnancies had second-trimester abortions (14% vs. 10%).
In multivariate analyses, the odds of having a second-trimester abortion were significantly greater among 18–19-year-olds than among 20–24-year-olds (odds ratio, 1.4), and among blacks than among whites (1.5). Women without a high school diploma, and those with a diploma or GED, had greater odds of having a second-trimester abortion than women with some college (1.4). The odds were higher among women who paid for their abortion with insurance than among those who paid out of pocket (1.6), and among those who had experienced three or more disruptive events in the past year than among those who had experienced none (1.5). Finally, women with intended pregnancies were more likely than those with unintended pregnancies to undergo abortion in the second trimester (1.6).
A subset of women who had an abortion in the second trimester—nearly 40%—underwent the procedure at 16 weeks or later. Nearly half of all women who paid for their second-trimester abortion with insurance underwent the procedure at 16 weeks or later. Among second-trimester abortion patients terminating intended pregnancies, more than half were doing so at 16 weeks or later. Blacks had significantly higher odds of having an abortion at 16 weeks or later than whites (odds ratio, 1.9), while the odds were greater among women with the highest incomes (at least 200% of poverty) than among poor women (1.6). Finally, abortions at 16 weeks or later were more likely to be performed among women who paid for them with health insurance than among those who paid out of pocket (2.6).
The researchers acknowledge some limitations of their study, including the potential underestimation of abortions at 16 weeks and later, and the possibility that their profile of these women was less accurate than that of women who had abortions earlier in the second trimester.
Nevertheless, the researchers conclude that increased access to early abortion could reduce the prevalence of second-trimester abortions. They note, however, that the need for these later procedures will continue, since some women do not recognize or decide to terminate a pregnancy until the second trimester, and since fetal anomalies or maternal health indications are not always diagnosed until then.—A. Kott