SUMMARY POINTS

Delays underpinned by economic, geographic, and legislative factors can impact abortion care-seeking, affect the type of care sought, and delay when care is sought (Coast 2021).
People delayed in recognizing their pregnancies are more likely to lack pregnancy symptoms, to be using hormonal contraception, to have never given birth, and to have health conditions with symptoms similar to pregnancy (Foster 2021). Interventions to improve early identification of pregnancy should be encouraged, including efforts to educate people about the signs and symptoms of pregnancy (ACOG 2013).
Lower socioeconomic status and poor health increase likelihood of delays in abortion, worse health and economic outcomes, or being denied abortion (Foster 2022, Jones 2012).
Dilation and evacuation (D&E) compared to misoprostol for labor induction in the second trimester is more cost effective, may have less complications and may take less time (ACOG 2023).

Pregnant people presenting for care later in pregnancy may have conditions that make an abortion more technically or medically complex. Clinicians can mitigate increased risk with pre-procedural planning, intraoperative preparedness, and referral as needed to a higher level of care (Henkel 2022). Referral options may require facilitation of cross-state travel and logistics support.
Adequate cervical preparation significantly reduces the risk of complications for abortions beyond 14 weeks (Peterson 1983, Shulz 1983). Routine ultrasound guidance reduces the risk of uterine perforation in training settings, especially > 14 weeks (Darney 1989).
Prior cesarean sections are the most significant risk factor associated with abortion complications >14 weeks due to increased bleeding risk, with or without placenta accreta spectrum (PAS), and perforation in the setting of distorted anatomy (Henkel 2022).
For individuals at risk for PAS >14 weeks gestation, health centers must have clear screening criteria and diagnostic certainty (or appropriate referral for assessment) to decrease intraoperative risks and/or unnecessary referrals (AJOG 2025).
Medication abortion > 14 weeks is safe, effective, and used in many global settings (Lerma 2019). It is also an option in settings where procedural abortion is not available, or due to personal preference (Guttmacher 2023).

Providers play an important role in setting tone, helping with later abortion values exploration, and normalizing the likelihood of seeing more people with more medical complexity arriving without pre-procedure work-up from restrictive or ban settings.
Depending on legal constraints, providers may use formal or informal referral networks.

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