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Exploring reasons for delayed recognition of pregnancy among people seeking abortion

Delay in pregnancy recognition sets off a cascade of logistical and financial barriers to abortion care, reduces people’s options and increases the likelihood of needing an abortion in the second trimester. The further along people are in pregnancy, the higher the cost of an abortion, the more time off required, and the farther they are likely to have to travel to find one of the few clinics able to provide later abortion care. Using data from the Turnaway Study, researchers found that people who were delayed in recognizing their pregnancies were more likely to lack pregnancy symptoms, to be using hormonal contraception, to have never previously had a birth, and to have health conditions with symptoms similar to pregnancy.

Key Findings

Most people seeking second trimester abortions recognized their pregnancy more than 8 weeks after their last menstrual period.
Women who have never given birth were more likely to be delayed in recognizing pregnancy, perhaps due to a lack of familiarity with pregnancy symptoms.
People who use hormonal contraception were more likely to discover pregnancy later because they didn’t realize they were at risk and/or because they did not have regular menstrual periods due to contraceptive use.

Study Design 

The Turnaway Study included interviewer-administered structured telephone surveys of 956 women who sought an abortion in the first trimester or just over or under the gestational limit of one of 30 abortion facilities across the United States. In-depth, semi-structured interviews were conducted with 31 study participants. Researchers summarized women’s experiences discovering pregnancy and conducted multivariate analyses assessing factors associated with later pregnancy discovery (defined as after 13 weeks since last menstrual period).


With the possibility of the Supreme Court allowing pre-viability bans on abortion (Dobbs vs. Jackson Women’s Health will be decided by the US Supreme Court in 2022), it is important to understand when people discover that they are pregnant and who is more likely to make this discovery later in pregnancy. In some states, new legislation will prevent people from being able to access abortion even before the second trimester, as early as six weeks. These findings suggest that such bans will particularly affect people who were using contraceptive methods to prevent pregnancy and people who have never given birth.

One 18-year-old from California described a common experience among those who discovered pregnancy later in pregnancy. She didn’t recognize the symptoms of pregnancy for many months, until it was too late for an abortion. She said:

“I never have had periods regularly ever. When I had morning sickness, my boyfriend at the time had the flu. I wasn’t aware of the body changes that I was going through. They weren’t familiar to me, so I couldn’t really tell what was going on until finally I realized that pregnancy must be the only answer.”

The researchers describe the importance of understanding later discovery of pregnancy. “Backers of gestational limits may assume that people are delaying their search for abortion services for reasons that are in their control. Yet we find that many people who seek abortion services later in pregnancy seek care as expeditiously as they can after discovering that they are pregnant. In the current policy environment, delay in discovery of pregnancy results in greater costs, farther travel and often precludes the option of abortion altogether. Removing gestational age limits would help to ensure that people who discover their pregnancies at later gestational ages are not excluded from abortion services.”

The article, Timing of Pregnancy Discovery Among Women Seeking Abortion, is available in Contraception.