Joanna is a 17-year-old G2P1 living in Garden City, Kansas who sought a pregnancy test after missed menses and learned that she was 11 weeks pregnant despite placement of an intrauterine device 9 months ago. She moved out of her parents’ home due to domestic violence and lives with her grandmother. They depend on Social Security, Medicaid and Joanna’s part-time job to raise her baby as she works to complete high school. Joanna talked extensively with her grandmother and decided to pursue an abortion. Due to the barriers she encountered (Table 1), Joanna eventually presented to a clinic in New Mexico at 19 weeks for her abortion and paid $2,000 for her care, plus travel costs and time missed from her job and school.
The case study here is not atypical for many women seeking second-trimester abortion, as barriers mount to abortion care access throughout the country. Women face many obstacles to first-trimester abortion; challenges to second-trimester abortion are even greater, with fewer trained and willing providers, increased costs, and gestational age limits. As of July 1, 2019, 17 states had “20-week” abortion bans.1 Access to abortion, including in the second trimester, is critical to maintaining women’s health and autonomy. The timing of a second-trimester abortion may be related to delays in care access, fetal anomalies, or health and life-threatening patient conditions. In this article, we discuss the epidemiology of second-trimester abortion, medical techniques including complex clinical scenarios, and the current status of abortion access in the United States.
Second-trimester abortions account for only a small fraction of all abortions in the United States; as of 2015, 7.6% of all abortions occurred between 14 and 20 weeks and only 1.4% occurred at 21 weeks or more.2 Induced abortion is safer than childbirth, and complications of the procedure are very low even in the second trimester.3,4 While most abortions occur in the first trimester, women like Joanna who seek second-trimester abortion face obstacles such as transportation, financial difficulties, delayed diagnosis (of pregnancy and of fetal abnormalities), and lack of knowledge about how to access the desired procedure.5
The authors report no potential conflicts of interest with regard to this article.
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