Diana Greene Foster

Risk factors associated with presenting for abortion in the second trimester.

OBJECTIVE: To determine factors associated with delay of induced abortion into the second trimester of pregnancy. METHODS: Using audio computer-assisted self-interviewing, 398 women from 5 to 23 weeks of gestation at an urban hospital described steps and reasons that could have led to a delayed abortion. Multivariable logistic regression identified independent contributors to delay. RESULTS: Half of the 70-day difference between the average gestational durations in first- and second-trimester abortions is due to later suspicion of pregnancy and administration of a pregnancy test. Delays in suspecting and testing for pregnancy cumulatively caused 58% of second-trimester patients to miss the opportunity to have a first-trimester abortion. Women presenting in the second trimester experienced more delaying factors (3.2 versus 2.0, P < .001), with logistical delays occurring more frequently for these women (63.3% versus 30.4%, P < .001). Factors associated with second-trimester abortion in logistic regression were prior second-trimester abortion, delay in obtaining state insurance, difficulty locating a provider, initial referral elsewhere, and uncertainty about last menstrual period. Factors associated with decreased likelihood of second-trimester abortion were presence of nausea or vomiting, prior abortion, and contraception use. CONCLUSION: Abortion delay results from myriad factors, many of them logistical, such as inappropriate or delayed referrals and delays in obtaining public insurance. Public health interventions could promote earlier recognition of pregnancy, more timely referrals, more easily obtainable public funding, and improved abortion access for indigent women. However, accessible second-trimester abortion services will remain necessary for the women who present late due to delayed recognition of and testing for pregnancy. LEVEL OF EVIDENCE: II-2

Cost Savings From the Provision of Specific Methods of Contraception in a Publicly Funded Program

OBJECTIVES We examined the cost-effectiveness of contraceptive methods dispensed in 2003 to 955,000 women in Family PACT (Planning, Access, Care and Treatment), Californias publicly funded family planning program. METHODS We estimated the number of pregnancies averted by each contraceptive method and compared the cost of providing each method with the savings from averted pregnancies. RESULTS More than half of the 178,000 averted pregnancies were attributable to oral contraceptives, one fifth to injectable methods, and one tenth each to the patch and barrier methods. The implant and intrauterine contraceptives were the most cost-effective, with cost savings of more than

Predictors of delay in each step leading to an abortion.

7.00 for every

Number of oral contraceptive pill packages dispensed, method continuation, and costs.

1.00 spent in services and supplies. Per

Number of Oral Contraceptive Pill Packages Dispensed and Subsequent Unintended Pregnancies

1.00 spent, injectable contraceptives yielded savings of

The Stigma of Having an Abortion: Development of a Scale and Characteristics of Women Experiencing Abortion Stigma

5.60; oral contraceptives,

Understanding why women seek abortions in the US

4.07; the patch,

Pharmacist interest in and attitudes toward direct pharmacy access to hormonal contraception in the United States

2.99; the vaginal ring,

Women’s Mental Health and Well-being 5 Years After Receiving or Being Denied an Abortion: A Prospective, Longitudinal Cohort Study

2.55; barrier methods,

Women's Emotions One Week After Receiving or Being Denied an Abortion in the United States

1.34; and emergency contraceptives,