Abortion patients’ characteristics, as well as their financial and life circumstances, are associated with an increased likelihood of having either a very early abortion (six weeks’ gestation or earlier) or a second-trimester abortion (13 weeks’ gestation or later), according to “Characteristics and Circumstances of U.S. Women Who Obtain Very Early and Second-Trimester Abortions,” by Guttmacher Institute researchers Dr. Rachel Jones and Jenna Jerman. The article was recently published in PLOS ONE.

The proportion of abortions obtained very early in pregnancy has been increasing over the last two decades, and Jones and Jerman’s analysis of data from the Guttmacher Institute’s 2014 Abortion Patient Survey is the first study to look at characteristics associated with having an abortion early in pregnancy. In 2014, 36% of all abortion patients obtained very early abortions, but the proportion varied according to patients’ characteristics. For example, the proportion of patients who had a very early abortion was lowest among teens (26­–29%), patients experiencing 2–3 disruptive life events in the previous year (29–30%) and patients living 50–100 miles from the facility where they obtained the abortion (28%).

The authors found that patients who lived in one of the 10 states that required in-person counseling 24 or more hours prior to the procedure were less likely than others to obtain a very early abortion: Only 25% of patients in these states had an abortion at six weeks’ gestation or earlier, compared with 40% of those in states with no waiting period. Since 2014, four additional states have enacted waiting periods with in-person visit requirements.

“State-mandated waiting periods with in-person counseling requirements may prevent some women from obtaining abortions very early in the pregnancy,” says Rachel Jones, lead author of the study. “An increase in these restrictions at the state level could cause more patients to experience delays in accessing the care they need when they need it. It could also reverse the growing trend of patients obtaining very early abortions in the United States.”

Financial assistance, including subsidies provided by grassroots organizations and discounts offered at clinics, enables many women to have abortions they otherwise could not afford. However, the time required to find and apply for financial assistance may result in delays in accessing care. Patients who relied on financial assistance were less likely than those paying out of pocket to obtain very early abortions (24% vs. 35%) and more likely to obtain second-trimester abortions (15% vs. 7%). Jones and Jerman conclude that removing restrictions on insurance coverage of abortion could facilitate broader access to very early abortions and potentially decrease the need for second-trimester abortions.

“Most abortion patients are resolute in their decision and would prefer to have their abortions earlier in pregnancy. Second-trimester abortions are more expensive and are offered by fewer providers,” says Jones. “We hope that an increased knowledge of the characteristics associated with having earlier and second-trimester abortions will inform policies that can facilitate timely access to abortion care.”