Characteristics of Women Who Present for Abortion Beyond the Legal Limit in Flanders, Belgium

Abstract

CONTEXT : Women who seek abortion care beyond the fi rst trimester of gestation are often in a vulnerable socioeconomic position with limited social support, and in Belgium, the details of their circumstances are insuffi ciently understood. A better understanding of this group is essential to a critical evaluation of Belgian abortion policy, which restricts abortions on request after the fi rst trimester. METHODS :Anonymized patient records were collected between 2013 and 2016 from LUNA centers, which are nonhospital-based abortion clinics in Flanders. Logistic regression analyses were used to identify associations between women ' s characteristics and whether they presented within or beyond the legal limit, which was 13 weeks and 1 day at the time of the study. RESULTS :A total of 28,741 women requested an abortion, and 972 individuals (3.4%) presented beyond the legal limit; 29% of these latter women were unable to receive abortion care as a result of the mandatory six-day waiting period. Characteristics positively associated with presenting beyond the limit, instead of beforehand, were being younger than 20, as opposed to 20-24 (odds ratio, 1.7); receiving a primary, lower secondary, upper secondary or special-needs education, rather than a higher education (1.8-3.1); being unemployed, rather than employed (1.3); and holding Belgian rather than a foreign nationality (0.8). Being accompanied by someone to the LUNA center (0.8), having irregularly (0.6) or regularly used contraceptives (0.7), and having ever had an abortion (0.8) were negatively associated with presenting beyond, rather than before, the limit. CONCLUSIONS : A fuller consideration of patients' characteristics when evaluating Belgian abortion policy is needed to ensure that the needs and rights of socioeconomically vulnerable women are addressed.

Abortion at the edges: Politics, practices, performances

“…Studies conducted elsewhere confirm the link between social disadvantage, including experience of reproductive coercion, and later presentation for abortion (e.g. Price, Sharman, Douglas, Sheeran, & Dingle, 2019;Van de Velde, Van Eekert, Van Assche, Sommerland, & Wouters, 2019).…”

Abortion care in a pandemic: an analysis of the number and social profile of people requesting and receiving abortion care during the first COVID-19 lockdown (March 16 to June 14, 2020) in Flanders, Belgium

“…Additionally, the question arises whether the COVID-19 pandemic and lockdown measures affected all groups equally in terms of their progress through the various steps of the abortion service (abortion request, abortion procedure, and placing long-acting contraceptive devices (LARC)). Under normal circumstances, socioeconomically vulnerable people and people with a migration background were already more likely to experience barriers in accessing abortion care [10][11][12][13]. This risk may have been elevated due to higher COVID-19 infection risk in people living in urban and deprived areas [14,15], and sudden income loss caused by lockdown measures [16].…”

What are the social correlates of subsequent abortions in Flanders, Belgium?

“…It is however not uncommon for women to experience more than one abortion. In Europe, the percentage of women who have subsequent abortions fluctuates between 19,8% and 58% [2][3][4][5][6][7][8][9][10][11][12]. Every unwanted pregnancy is the result of specific circumstances, and decisions regarding how to handle them are made sequentially, based on perceived available options [13].…”

“…In Belgium, under the 1990 Law on the Termination of Pregnancy, abortion is legally available on request during the first 14 weeks of gestation. Women who request an abortion after this legal term (3.4% between 2013 and 2016 [12]) have to consider other solutions or look for abortion care abroad. A physician in a hospital or a licensed abortion clinic must perform the abortion procedure.…”