In certain circumstances, women in prenatal care would not rule out having an abortion in the future.

Seven in 10 women in a diverse sample of prenatal care patients said that they would consider terminating a subsequent pregnancy, but among this group, the proportions who would consider having an abortion for various reasons ranged widely. (1) For example, although three-quarters would think about undergoing the procedure if they knew that their infant would be affected by a chromosomal abnormality, only one-quarter would do so because of financial hardship. Half of women who would consider having an abortion would be open to it only during the first trimester.

The sample consisted of 1,082 women who were less than 20 weeks pregnant and were receiving care at one of several obstetric practices in the San Francisco Bay Area in 1997-1998. During in-home interviews with specially trained researchers, they provided information about their demographic and socioeconomic characteristics; reproductive histories; and attitudes related to pregnancy, prenatal testing, the health care system and abortion. Researchers used multiple logistic regression to identify factors associated with women's abortion attitudes.

On average, participants were 32.7 years old; the majority were married or living with a partner (84%). Thirty-one percent were white, 27% Asian or Pacific Islander, 22% Hispanic, 18% black and 1% members of other races; nearly half were foreign-born. The sample was diverse with respect to educational attainment, household income and a subjective measure of socioeconomic status. Roughly half of the women had given birth, and half had had an abortion. Thirty-eight percent had known someone with Down syndrome.

Virtually all of the women (97%) were happy about being pregnant. Three scaled measures indicated that participants generally placed a high value on pregnancy, had a low level of distrust for the health care system and were not fatalistic about pregnancy outcomes. Fifty-nine percent of the women believed that abortion should be available without restrictions, and 33% supported its availability in specific circumstances (mainly, when a pregnancy endangers a woman's life or health, or resulted from rape or incest); 8% opposed abortion availability under any condition. The majority of participants (72%) said that they would ever consider terminating a pregnancy.

Among women who would be open to considering an abortion, substantial majorities said they would do so if a pregnancy endangered their life or health (84%), if it resulted from rape or incest (84%), or if their infant would be affected by a chromosomal abnormality or would have a mental or physical disability (70-76%). By contrast, only 39% would consider having an abortion because they did not wish to have a child (or an additional child), 25% if they could not afford to raise a child and 20% if having a child would mean they had to leave school or lose their job. Fifty percent would consider terminating a pregnancy only during the first trimester, and 36% would consider it during the first two trimesters; the remaining 15% would consider it at any gestation.

In the multivariate analysis, women's willingness to consider having an abortion was significantly associated with a number of background characteristics and attitudes. The older women were and the greater their distrust for the health care system, the more likely they were to be open to the idea of pregnancy termination (odds ratios, 1.1 per year of age and 1.2 per level of distrust). The odds also were elevated for those who had already had an abortion (2.9). Members of minority groups, married women and women who had had two or more live births had reduced odds of saying they would consider having an abortion (0.4-0.5). The more fatalistic a woman was about her pregnancy, the less likely she was to be open to considering an abortion (0.6).

Similarly, increasing age and having had an abortion were associated with a significantly elevated likelihood that women thought abortion should be available without restrictions (odds ratios, 1.0 and 2.5). Asian women (but not blacks or Hispanics) were less likely than whites to hold this view (0.4), and women who had had at least two live births had a lower likelihood than women who had never given birth of supporting the general availability of abortion (0.6). Increasing scores on the fatalism scale were associated with decreased odds of support (0.8).

The researchers "encourage caution in linking [their] data concerning the conditions for abortion acceptance with data on willingness to have only a first-trimester abortion," because the survey questions did not include scenarios specifying when a chromosomal abnormality is identified. Nevertheless, they emphasize that if women do not know of such an abnormality until the second trimester, as is often the case, many could be left "with a much more difficult decision about continuing the pregnancy than they would have faced earlier in gestation." The researchers conclude that their findings support "the continued development of progressively earlier methods of screening and testing."

REFERENCE

(1.) Learman LA et al., Abortion attitudes of pregnant women in prenatal care, American Journal of Obstetrics and Gynecology, 2005, 192(6):1939-1947.