Second trimester abortion law globally: actuality, trends and recommendations

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Reed Boland
Research Associate, Harvard School of Public Health, Boston MA, USA. E-mail:

Although the great majority of abortions are performed in the first trimester, a significant number are not carried out until the second trimester note.Data on the global incidence of second trimester abortions are difficult to obtain due to the lack of any statistics in countries where abortion is legally restricted.1 However, estimates have placed the percentage at 10–15%of all abortions [2], [3].  For example, studies have indicated a rate of 13% in the United States and Nigeria, 10% in Canada and Singapore, and 25% in India and South Africa [2], [3].  This is a significant number in light of the fact that an estimated 42 million abortions (figure for 2003) are performed every year, of which 21.6 million (figure for 2008) are unsafe [4]. Unsafe second trimester abortions constitute a serious public health problem; they account for two-thirds of the five million estimated admissions to hospital annually for complications of unsafe abortion [4], [5]. They are also responsible for a disproportionate number of abortion-related maternal deaths, even though in some cases they may be misclassified as due to other causes [6], [7].

Historically, there has been little discussion in the literature of second trimester abortions and limited research on the reasons women have them. However, in recent years this has begun to change. In 2008 Reproductive Health Matters published a journal supplement on second trimester abortion,[8] with papers from the 2007 International Conference on Second Trimester Abortion [1] Studies from England and Wales, Mozambique, Netherlands, Spain, South Africa, United States and Viet Nam, demonstrate that the factors influencing the need for second trimester abortions are present in almost all societies [9], [10], [11], [12], [13], [14], [15], [16]. For example, some women do not realize that they are pregnant or are in denial about their pregnancy until the second trimester. Other women face pressure from family members or partners which delays their making a decision, or they are themselves undecided about what course to take. Some decide not to continue a wanted pregnancy after facing difficult altered personal circumstances or a diagnosis of serious fetal anomaly. After the decision to have an abortion is made, other factors can cause delays. These include lack of money to pay for the abortion, lack of information on where it can be obtained, the need to travel long distances, including to another country, to find an abortion provider, concerns about what is involved in undergoing an abortion, and delays in getting a pregnancy test or obtaining a clinic appointment. In addition, the stigma associated with second trimester abortion can cause further delay. These factors are particularly serious for young women, women with little education, poor women, and rural women. Finally, threats to health and life often do not arise until the second or third trimester of pregnancy, and many tests to detect fetal abnormalities cannot be carried out until well into the second trimester [10], [17], [18], [19].

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ExpandExpand all Chapters   |  This information in:
1. Legal status of second trimester abortion
2. Abortion to preserve the life of the pregnant woman
3. Abortion for health reasons
4. Abortion for fetal impairment
5. Abortion for pregnancy resulting from a sex offence
6. Abortion on socio-economic grounds and/or on request
7. Additional legal factors
8. Trends
9. Discussion and recommendations
10. Acknowledgements

Legal indication for second trimester abortion, by country, 2010


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