In 2008, more than 4,000 U.S. women were denied abortions because of gestational age limits and, in turn, had to carry unwanted pregnancies to term, according to "Denial of Abortion Due to Gestational Age Limits in the United States," by Ushma D. Upadhyay of the Bixby Center for Global Reproductive Health et al. Travel and procedure costs were the most important reasons women were delayed in seeking abortion care, and many were unable to reach an abortion provider until their pregnancy had exceeded the gestational age after which the provider no longer offered care.

The authors studied women seeking abortion care from "last stop" providers around the U.S., defined as facilities that offer abortion services at the latest gestational age limits among any facility within 150 miles. Women turned away from these providers because they presented too late were asked to list the barriers that prevented them from seeking care earlier in the pregnancy. Nearly six in 10 reported that travel and procedure costs prevented them from seeking an abortion earlier, while about half delayed seeking care because they did not immediately recognize that they were pregnant. Women also cited insurance problems, not knowing where to get care and not knowing how to get to a provider as barriers to accessing abortion services. About one-quarter (28%) of women denied an abortion were eventually able to obtain one from a different provider, while the remaining three-quarters continued their pregnancy.

"Unfortunately, barriers to abortion only worsen as a pregnancy progresses," explains co-author Rachel Jones of the Guttmacher Institute. "There are fewer abortion providers that offer care in the second trimester and the procedure becomes much more expensive. By the time a woman has raised the funds for an abortion, a provider may turn her away because she is past the gestational limit set by the provider. For women denied abortion care, traveling to another provider simply may not be feasible."

These findings come amid a recent wave of state and federal legislation aiming to impose gestational age limits. In the first seven months of 2013, two states banned abortion in the first trimester and three states banned abortion at 22 weeks of pregnancy. The U.S. Supreme Court has held that a state may not ban abortion before fetal viability, which generally begins at about 24–26 weeks, and after viability must at least allow abortion in cases when the woman’s life or health is at risk.

"The implementation of state bans means women in need of second-trimester abortions are increasingly at risk of being denied care," says Guttmacher state policy expert Elizabeth Nash. "Ensuring women have access to abortion means expanding the number of abortion providers in underserved areas, training clinicians to perform later procedures and strengthening financial support and referral systems for women seeking abortions."

Data for the study were collected in 2008–2010. Given that 11 states have imposed gestational limits since 2011, the study authors note that it is likely that the number of women denied abortions each year has increased. "Denial of Abortion Due to Gestational Age Limits in the United States" is currently available online and will appear in a forthcoming issue of the American Journal of Public Health.

The Advancing New Standards in Reproductive Health (ANSIRH) press release on study results is available here.