12. INCREMENTAL EXPANSION OF ABORTION CARE
Updated 2025 by Julia McDonald, DO MPH, Maria Cardenas FNP-BC, Fay Roepcke MD
Adapted from the curriculum Incremental Expansion of Abortion Care from 13.6 weeks through 17 weeks,
authored by Dr. Julia McDonald and the Later Abortion Initiative, a project of Ibis Reproductive Health
This chapter is designed to help providers develop their skills to expand access to abortion by independently and safely expanding their abortion practice to 18 weeks. It is intended for providers already comfortable providing abortion care to 12-14 weeks gestation. It considers challenges to the ability of people seeking abortion to travel distances, the impact of waiting for care, and systemic contributors in restrictive settings.
Chapter Learning Objectives
Following completion of this chapter, you should be able to:
- Identify common reasons and unique challenges for abortion delays
- Explore and clarify values around abortion with advancing gestational duration
- List options and key preparations for providing abortion care > 14 weeks gestation
- List cervical preparation options for procedures > 14 weeks gestation and pros and cons of their use at different gestational durations
- List key instruments, medications and techniques for dilation and evacuation
Videos
- Contextualizing who has Abortions after the First Trimester (IERH)
- Abortion after First Trimester (IERH)
- Dilation and Evacuation Animation (IERH)
- Low tech D&E Training Model Instruction Video (IERH)
Readings / Resources
- Abortion by Dilation and Evacuation (NAF 2024)
- Cervical Preparation for second-trimester surgical abortion prior to 20 weeks’ gestation (Fox 2014)
- Second Trimester Abortion (ACOG 2013)
- Second-trimester abortion care with complex medical conditions (Henkel 2022)
- Misoprostol dose & timing before abortion at 13-16 weeks’ gestation (Dean 2017)
- Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care (Paul 2009) Chapter 11: Dilation and Evacuation