Predictors of delay in each step leading to an abortion

Foster, Diana G.; Jackson, Rebecca A.; Cosby, Kate; Weitz, Tracy A.; Darney, Philip D.; Drey, Eleanor A.

doi:10.1016/j.contraception.2007.10.010

« Previous Next »Contraception
Volume 77, Issue 4 , Pages 289-293, April 2008

Predictors of delay in each step leading to an abortion☆

Diana G. Foster
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Reproductive Health Research and Policy, University of California, San Francisco, CA 94110, USA
- Corresponding author. UCSF Box 1744, San Francisco, CA 94143-1744, USA. Tel.: +1 415 206 2337.
Rebecca A. Jackson
- Department of Epidemiology and Biostatistics, San Francisco General Hospital, University of California, San Francisco, CA 94110, USA
Kate Cosby
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Reproductive Health Research and Policy, University of California, San Francisco, CA 94110, USA
Tracy A. Weitz
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Reproductive Health Research and Policy, University of California, San Francisco, CA 94110, USA
Philip D. Darney
- Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco General Hospital, University of California, San Francisco, CA 94110, USA
Eleanor A. Drey
- Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco General Hospital, University of California, San Francisco, CA 94110, USA

Received 18 June 2007; accepted 16 October 2007. published online 14 February 2008.

Abstract

Background

Approximately 1 out of 10 abortions in the United States occurs in the second trimester of pregnancy. This study uses survival analysis to identify the factors which delay each step of the process of obtaining an abortion.

Study Design

This is a secondary data analysis of a cross-sectional study investigating a sample of 398 women who presented for elective abortion at an urban hospital. Respondents completed a survey using an audio-assisted self-interviewing program and provided a timeline for their process of obtaining an abortion.

Results

In our analysis, we divided the abortion process into three steps ending in three distinct events (first pregnancy test, calling a clinic, getting an abortion). Factors associated with delay during the first step include obesity [hazard ratio (HR) 0.8, 95% CI 0.6–1.0], abuse of drugs or alcohol (HR 0.7, 95% CI 0.6–1.0), prior second-trimester abortion (HR 0.6, 95% CI 0.4–0.8) and being unsure of last menstrual period (HR 0.6, 95% CI 0.4–0.7) and emotional factors such as being in denial (HR 0.8, 95% CI 0.6–1.0) and fear of abortion (HR 0.7, 95% CI 0.5–1.0).

Conclusion

This study identified key factors associated with delay in obtaining abortion care. Interventions which seek to address these factors, especially those factors associated with later pregnancy suspicion and testing, may reduce abortion delay and facilitate women obtaining their abortions when medical risk and overall cost are lower.

Keywords: Second-trimester abortion, Delay, Survival analysis