This article was updated at 8:58 am on Saturday, July 31, to correct a data error.  The earlier version erroneously stated that one in four women in the US have an unintended pregnancy.  The correct data are that one-half of all women in the US experience an unintended pregnancy in their reproductive lifetimes.

Most of us don’t think we’ll ever have an abortion, until we become one of the half of all women in the US who has an unwanted pregnancy.  And if we think about it at all, we assume we’d get an abortion pretty early in the pregnancy.  While 90 percent of abortions do happen before 12 weeks, some women seek abortions later in their pregnancies.

Most women do not try to have later abortions. In fact, in a study done by Finer et al, nearly three fifths (58 percent) of women in the survey reported that they would have preferred to have had the abortion earlier than they did. In another study done by Drey et al, 29 percent or one third of women who ended up having abortions during their second trimester were in their first trimester when they made the first call to an abortion clinic. If this is the case, what causes women to have second trimester abortions?

First, let’s learn a bit about second trimester abortions. Drey’s study outlines the following basic information:

• One out of every ten abortions performed in the United States happens during the second trimester
• Second trimester abortions carry an increased risk of complications and are more expensive to obtain then first trimester abortions
• The American public tends to favor restrictions on later termination

These restrictions vary state by state. In some states, like California and New York, Medicaid can cover the cost of an abortion. In others, such as Pennsylvania, Medicaid funds are forbidden from covering the procedure unless the woman is a survivor of rape, incest, or has a medical condition that threatens her life. And in other states still, Medicaid and private insurance are banned from covering abortion no matter the situation. This means that if a woman doesn’t live in a progressive state and if she doesn’t have health insurance that covers an abortion, she will have to spend time raising money towards the cost of her procedure. Depending on how long this takes, the cost of the procedure could go up weekly (as it often does in the second trimester). In the world of abortion funding, this is called “chasing the fee” and is kind of a Dante-esque hell. The longer she waits to have the abortion and the more time it takes her to raise the money, the more the abortion will cost, causing her to have to raise more money and further delay the procedure.

There are other types of anti-choice legislation that can affect a woman’s access to abortion services.  She often has to jump through hoops to be able to make an appointment for the procedure. This could be anything from a 24-hour waiting period from the time she makes the appointment to the time of the procedure, getting parental consent, spousal consent, a mandatory counseling session, signed doctor’s notes, or sessions before a committee or before the police. Many women barely have time to schedule a full-day clinic visit, not to mention dozens of hours spent making sure she abides by these laws. This means taking hours or days off of work, arranging childcare, and arranging travel, not to mention other logistics.

Who are these women who have later abortions, and why do they have them? According to Drey’s study, women who have later abortions tend to be young and of low-income status. Specifically, Dryer found that women under 18 took longer to identify pregnancy symptoms and poor women had to delay their abortion because they had to make arrangements, such as raising money, getting childcare, or transportation to the clinic.

Finer found very similar causes of delay. Second trimester abortion patients, according to his study, were significantly more likely to say that it took them a long time to make arrangements to have the abortion. This is because there are many abortion providers who only provide abortions to 12 or 14 weeks, and the number of providers decreases further later in pregnancy. Many states have NO abortion providers after 14 or 16 weeks. In addition, second-trimester patients were significantly more likely to indicate that they were delayed because they needed time to raise money for the procedure and because it took time to talk to their parents.

Other women have abortions in their second trimester because they need more time to make their decision. According to Finer, 60 percent of women stated that someone helped them come to their decision to have an abortion. What these women may not know is that once they go into their second trimester, the cost of an abortion usually increases every week. It is not clear that women with later pregnancies know the consequences of delaying their decision.

The Finer study also finds that:

“poor women took a significantly longer time from thei first attempt to obtain the abortion to actually having it. When compared to white and Hispanic women, black women reported significantly longer time periods.”

Why might this be the case? Poor women, who are often women of color, may have to take more time to raise the money towards the costs of the procedure. The more time they take to raise the money, the further they are in the pregnancy, and the further they are in the pregnancy, the higher the cost of the procedure. Again, this is an example of “chasing the fee.”

Another important part of the Finer study found that women with two or more children took more time to access abortion services. Why? They have to arrange childcare and have childcare-related expense. Higher-income women and women 30 years old and over reported less time between deciding to have an abortion and going through with the procedure. Why? Because these women are more likely to have access to resources (money, transportation, lodging) that erase or ease the boundaries faced by poor women.

Finer also observed that if a woman goes to one clinic and is turned away because she is too far along in the pregnancy to have an abortion there, it may take her twice as long, on average, between initially attempting to make an appointment and having the abortion. This makes sense, as she would likely have to gather more money, take more days off work, arrange for transportation, childcare, and possibly even lodging to go to a different clinic, one that may not even be in her state.

Perhaps a woman lives in a state where there is only one abortion provider. She then has to arrange travel and lodging at this destination, along with coming up with the cost of the procedure. A woman’s ability to take the time off required to get to the clinic, whether this means arranging for transportation, renting a car, flying out of state, arranging childcare, taking time off, arranging lodging, you get the picture. If a woman can’t afford a $350 first trimester procedure at a nearby provider and takes too much time raising that money, she then has to deal with the rising cost of the procedure AND travel and accommodations costs.

In boils down to a few things. Women have second trimester abortions because they need to, not because they want to. Why? Because their insurance doesn’t cover abortion, because they needed time to raise money for the cost of an abortion, because they needed to arrange travel/childcare/time off of work in order to spend a full day at the clinic, because they needed time to make the decision with confidence, because they needed to make time to travel out of state to access an abortion provider.

The Finer study concludes by stating that their findings:

“suggest that gestational age at abortion in the US could be further reduced if financial barriers faced by disadvantaged groups were removed and if women, especially young women, were educated about how to recognize pregnancy.”

The links between sex education and pregnancy are clear. The better women are able to identify pregnancy symptoms, the faster they will take a pregnancy test. The earlier they are in the pregnancy, the more time they have to make a decision about whether or not to carry to term without worrying about a significant rise in the cost of the procedure. A first trimester abortion is a safer and less expensive abortion. We must work to eradicate the barriers women face in abortion services. This means:

• Ensuring that all teens have access to comprehensive sex education
• Requiring that ALL state Medicaid to cover abortion services
• Making sure that medical schools to include abortion care training in their curriculum so women have more providers to choose from
• Lobbying for protections against anti-choice terrorists who endanger abortion doctors and their patients through clinic violence and threats

We are the women who will need abortions, and we need to learn as much as we can about our bodies and about abortion services so that we can get the abortions we need as early as possible in an unwanted pregnancy.  And we need to organize, to make sure that abortions are available as late as we need them.