SIO340: Are Most Late Term Abortions for Health Reasons? Actually... No

Transcript

This transcript was generated automatically and may contain errors — the audio is the record.

0:00:14 Thomas: And welcome to Serious Inquiries Only. This is episode 340, if my abacus is working.

0:00:21 Thomas: I may need to take it into the shop. Is an abacuse a thing That like it, you get a new update, Apple would update their abacuses and you'd have to get a new one and it wouldn't add right immediately. And you'll be like, why did...

0:00:23 Lindsey: Oh, yeah. Transmissions going out. 100 % all the

0:00:32 Thomas: We got these new and improved, I don't know, beads? What's on an abacas?

0:00:32 Lindsey: Time. Yeah. Beads, yeah!

0:00:39 Thomas: And improved Improved beads. They'll add stuff better than ever. And then you get them replaced and it doesn't work. Or was it back in the day you just you were still using your like great grandfather's abacus that worked for 400 years? It's probably that one.

0:00:50 Lindsey: Yeah, yeah, yeah... They always talk about how they don't make them like they did in his day. Yeah, pretty

0:00:56 Thomas: No, they did make them. Back then, they're like they do make them like they did in your day. And that's why I'm still using this one. That's 400 years they're the same now you update something every four seconds and it never works is my experience with it but anyway episode 340. How's it going, Lindsey? Wow.

0:01:10 Lindsey: Much, yeah Oh, really good. Wasn't expecting all the abacus talk. Do have a hank -shaped hole in my heart that I'm just not sure how to fill at this point, so...

0:01:19 Thomas: This sounds like a country song. Do you want to fill in the listeners or just really leave them with a cliffhanger?

0:01:20 Lindsey: Yeah, let's just not explain it. I think that sounds great.

0:01:34 Lindsey: Yeah... I tried to, I tried to steal your cat, it was, yeah.

0:01:38 Thomas: Of Noodles is even, Noodles will get you even worse. You know, she'll seduce you. Yeah, she just is so lovey. It was fun. Anyway, how's life not professing?

0:01:41 Lindsey: Noodles was good, we bonded Uh, amazing. I like, classes just started, I think, last week, week before, something like that, um.

0:01:55 Thomas: Oh, man. But I realize a common dream that I have that I've heard other people talk about, too, is being in class when you forget about the test. Are you going to have the, like, shit, I forgot to teach the class? You know? Are you gonna have the professor version of that?

0:02:07 Lindsey: Have literally had those dreams, I have absolutely had those dreams where I realized close to the final exam that I was supposed to be teaching all semester and I, I hadn't. And now I have to give a final.

0:02:10 Thomas: Yeah. That's exactly the same thing, except the student. Version of that, that I always used to have.

0:02:19 Lindsey: Yeah. And it doesn't make any sense. I mean, like, But yep. Whatever.

0:02:20 Thomas: Oh, It's the best. It's always some class that I forgot I had and then I find out I have it and I'm trying to figure out how to pass it to graduate or something. Oh, that's the best.

0:02:31 Lindsey: Yep. Love stress dreams. They're my favorite.

0:02:33 Thomas: Of, no, I don't know. Speaking of transitions, we've got part part two in the Turnaway Studies here today. You want to refresh us on part one and then what we left for this part two, what we're going to discuss today?

0:02:46 Lindsey: I Part one, we talked about the evidence from the Turnaway Study that provided insight into the most common reasons that women in their sample sought abortions. We're going to be talking about two, two papers that specifically focus on the reasons that women seek later abortions, and specifically those happening after 20 weeks of gestational age. So that's, that's well into the second trimester, which is 13 to 26 weeks.

0:03:10 Thomas: I remember trying to clarify last time, this is not medically the health of the mother ones or?

0:03:15 Lindsey: Right. Yeah. Cause everybody in the Turnaway Study, like, they specifically include or excluded women who were seeking abortions for reasons of fetal anomaly or health risks. To this is only people who are seeking abortions that late for other reasons.

0:03:16 Thomas: Okay.

0:03:30 Thomas: Are very rare, right? Isn't this a, You know, a much lower sample? Is that going to skew what we're looking at here, the fact that it's a smaller sample that, know, not representative of, like, all of people getting abortions? Okay.

0:03:32 Lindsey: Yes.

0:03:43 Lindsey: It is important to keep that representation piece in mind, and the fact that, you know, this is not a representative group. And I've got some stats in a minute in terms of how common these are. And because of the way that recruited they, their sample in the Turnaway Study, they actually have a very large group of women in their study that sought abortions this late, which is one of the things that kind of sets the Turnaway Study apart from other ones. You know, it's a large sample in that respect. Like it's disproportionately large number of women seeking abortions late. And that's useful because there's not a lot of data on this group.

0:03:52 Thomas: Hmm. Oh, Right, well, let's see what the data says.

0:04:18 Lindsey: So I'm kind, I planned for this to be all one episode, like reasons for abortion and reasons for later abortion. I'm kind of glad that it worked out that we're doing two separate episodes on this, because later abortion has such a unique cultural conversation around it compared to abortion more generally. And I really think that this is going to be interesting and useful for folks in a way that's very distinct from the first episode. So I'm excited about it, that we'll be talking about the most, is by Diana Green Foster, who we talked a lot about last time. She's like one of the lead researchers on the Turnaway Study. So it's by Diana Green Foster and Katrina Kemport. It was published in 2013, and it's called "Who Seeks Abortions After 20 Weeks?"

0:04:56 Thomas: 2013? Oh, and remind me when the original turn away studies the actual data came out, okay?

0:04:56 Lindsey: Yeah, yeah. They recruited women who were seeking abortions between 2008 and 2010, if I'm remembering correctly.

0:05:07 Thomas: Gotcha, yeah.

0:05:08 Lindsey: In the introduction of this paper, they make the point that I think is very worth highlighting, which is that legislation banning abortions after 20 weeks or attention on a very small proportion of abortions. So, in the United States, 91% of abortions take place in the first trimester before the end of the 13th week. Seven percent are performed between weeks 14 and 20, so that's the first half of the second trimester, and only about one percent happen at 21 weeks or later. They're very unusual as a proportion of abortions overall, and yet disproportionately conservative rhetoric highlighting later abortions is used to justify broader abortion restrictions.

0:05:21 Thomas: Yeah. Yeah.

0:05:48 Thomas: Now, Those stats you just gave, that's late abortions for any reason? Right, okay, so that's why, I mean, so we've already got like a very tiny sample, and then you take away the ones that are for medical reasons. And so I guess my point is the women in this particular study are part of that, you Sanders, is the one-tenth of one percent, you know, something like that.

0:05:53 Lindsey: Yes. Mm -hmm. Yeah, Yeah, it's a fraction of a percent that we're talking about here. Yeah, and that's important, right? These are unusual cases as a rate, as a proportion of overall abortions. And yet, you we get this focus on the rhetoric. And that's annoying, to put it mildly. And I think it's intentional to highlight later abortions in these conversations so that those are the things that are salient to people and thus seem more common than they actually are. And the clear false implication that's often being made in this conversation is that there's this pervasive problem of these super irresponsible people. They're very blameworthy. And they're using abortions as their primary form of birth control. And to make matters worse, they also don't give a shit about getting their abortions in a timely manner. And so they're like procrastinating until really

0:06:11 Thomas: Okay. Yeah, absolutely. Mm, yeah. They

0:06:56 Lindsey: Late in their pregnancy to finally get an abortion.

0:06:56 Thomas: Forgot they were in pregnancy class until the end of the semester, and then they had to catch up on the abortion that they needed to get. Yeah, I'm sure that's what it is.

0:07:05 Lindsey: Yeah, I'm sure that's what it is, right? Because it's really fun to be pregnant when you don't want to be, right. So, or even if you do want to be, it's really fun, right? So that that's the clear subtext of the point, as I have heard it often made. Know, my point being that I think focusing attention on later abortions functions well, as a strategy of othering people who seek abortions as being particularly immoral and blameworthy and people whose rights to reproductive choice are not worth protecting. That so worth mentioning that, you know, the rhetoric focused on late abortions often balloons the perception of the rate of these cases relative to abortions overall.

But that's not to diminish the importance of maintaining access to later abortions. So more than 1.2 million abortions are estimated to happen annually in the U.S. And so we may only be talking about a small percentage, but we're still talking about something like 15,000 individuals every year who need access to abortions later in their pregnancy. And that's important. The last episode, we touched on the fact that later abortion kind of feels different to people emotionally as an issue, even people who ultimately favor the protection of abortion rights. Know, we were talking about

0:07:27 Thomas: Yeah. Right. Yeah.

0:08:12 Lindsey: Abortions at like 22 weeks or something, and you mentioned where Lydia is in her pregnancy and like what it would feel like if you all were seeking an abortion right now. And yeah, like that's a pretty unsettling thought, I think. I think that's probably an emotional reaction that most people have, even among people who very strongly favor abortion access. I think about the people in my life who are in fact pro-choice but still have like a lot of Republican talking points in their ear because, you know, they still still got a bunch of like family or high school friends on Facebook that say this stuff. The issue of late abortion is usually the piece of the debate that makes them the most uncomfortable.

0:08:18 Thomas: Yeah.

0:08:49 Lindsey: And I think that's really understandable.

0:08:51 Thomas: And it's important to recognize that these are people there. I know people like this, too. Yeah, that are pro -choice. But this kind of rhetoric that you've just talked about has infected the conversation. So a lot of like well -meaning pro -choice, you know, not like anti -woman kind of people might have an opinion of like, well, I'm I'm you know I'm in favor of abortion pro -Choice except I understand like restrictions on late term abortion kind of thing. And so it's important to realize that I think those people are very reachable with the correct data.

0:09:15 Lindsey: Yes. Yes, right. And I am very much hoping that what we're talking about in today's episode is helpful to those folks, right?

0:09:26 Thomas: All right.

0:09:27 Lindsey: Because unsurprisingly, you just say like fewer people support later abortion than support more broadly the maintenance of abortion rights. And the authors of this paper suggest that that lower rate of favorable attitudes stems from at least two places. One is growing concern over the emerging personhood of the fetus as gestational age advances, and thus the growing need to balance its rights against the rights of the person who's pregnant. We'll talk about this more in just a second, but I think this is why you see the claim brought up a lot that later abortions are mostly these horrific, tragic, medically necessary cases, because it seems like we need something like that to justify maintaining rights to abortion past a particular gestational age. We'll come back to that in a second. So that's one place that that lower favorability might come from. The second is judgments about the women seeking late abortions, which to women who seek early abortions women who seek later abortions may be perceived as failing twice. Once to prevent the unwanted pregnancy. And again, when they fail to terminate the pregnancy early enough.

0:09:35 Thomas: Yep. Yeah. Yeah. They overslept.

0:10:30 Lindsey: Yeah, for It not to be in this morally complicated area in the minds of some people. But at the time that this article was published, research had not yielded data that could speak to what leads women to seek later abortions rather than earlier ones. So the assumption that seeking an abortion late in a pregnancy is de facto evidence of irresponsibility is not a supported claim. But neither is the claim from the other side that later abortions are usually because of fetal anomaly or threat to the life of the pregnant person.

0:10:30 Thomas: Yeah. Yeah. Can I just take a second though? Because I love this idea that we're going to sit here, that the society is like, wait a minute, whose fault was it that you got a late abort? Did you, did you oversleep? Did You mess up? You are irresponsible. Therefore you must have a baby. Like, do we, do you want the reward for being irresponsible is apparently, Hey, let's give you another person to be in charge of. Like just let's, let' go with their They're thinking that like, oh, these people are just irresponsible and that's why they're getting the late term. Those are the people you want to make sure have to have a child. Are you kidding me? That doesn't even make sense. But it's all about the blameworthiness of people for conservatives.

0:11:12 Lindsey: Yeah, correct. Yep, yes, it is. It is. And I think the actual response you would get to that is like, no, I'm not saying that. I just put it it up for adoption because that's fine. But the punishment has to happen.

0:11:49 Thomas: Oh, yeah, of course.

0:11:50 Lindsey: The Punishment absolutely has to happened because blame really, neither of these narratives is supported because there just isn't great data on this. Right? Authors of this study actually say that the very limited existing research prior to the study suggested that these circumstances related to fetal anomaly or medical risk actually may not characterize the majority of later abortions.

0:11:50 Thomas: Yeah. Wow.

0:12:12 Lindsey: And for this claim, the authors provide citations to two reports, one of which examines the characteristics of those seeking abortion at this one particular clinic in the U.S., and another report describing the characteristics of all abortions sought in the United States during 2008. Neither of these papers centrally examines later abortations, but they do report some sort of peripheral numbers that do kind of make it unlikely that the majority of people people seeking abortions well into the second trimester are doing so because of fetal anomaly or medical complication. So the paper that focused on patients at that one abortion clinic showed that while 20% of the abortions sought at that particular clinic were second trimester abortions, and that's a higher rate than the national average because that was one of the few clinics in that area that actually provided abortions that late, right? So that's why that's inflated. But so while 20 percent of the abortion sought at that clinic were were second trimester abortions, fetal anomalies were reported in less than half of a percent of the cases. Yeah. So

0:13:12 Thomas: Huh. Now, not every danger to the mother's life is from a fetal anomaly, right?

0:13:18 Lindsey: True. Right. So these data, again, they're very peripheral, and they're Very limited, like this doesn't help you make the case about what the actual rate of this is. Things like that kind of do push against the talking point that I have repeated. I've heard other people say this a lot that like, Like, when abortions happen later, they're generally because of these cases.

0:13:23 Thomas: Yeah. Yeah.

0:13:35 Thomas: Yeah. I mean, that just seems so intuitively. Let me let me ask this. And there be an effect of, OK, maybe in early second trimester to maybe a little later second trimester? This might be true. But, like, if you were to take the the late, late ones, you know, is that where you would find? OK, that's mainly just health of the mother or fetal anomaly stuff.

0:13:57 Lindsey: That's Possible. So what I do think is true, probably, that the you look at gestational age continuously, that, the proportion of abortions as you get later in the pregnancy probably does increase in Terms of those that Are a result of anomaly or complications, right? That's probably true. But the overall percentage may still stay very low. It could still be the vast majority of abortions well into pregnancy that are not because of these things.

0:14:08 Thomas: If Yeah. That Is just really hard to believe. I don't know, I like one half of One percent. Well,

0:14:26 Lindsey: That's where we're going, though. So, is actually the question that the current papers speak to a little bit, right? It's like, what is happening here if it's not the anomaly thing?

0:14:36 Thomas: Yeah. Yeah, I this guess current paper doesn't speak to like how reliable that data is though. Right? Yeah.

0:14:43 Lindsey: No, it doesn't. Right. I mean, yeah, the overall takeaway about like the literature on, you know, the reasons that people are seeking later abortion is that we I tried so hard to find something that would allow me to cite you a specific stat that would give us give us an estimate of what percentage of later abortions are due to these cases. Just not there. Not exactly sure why that would be so hard to get information about, but it's just not out there.

0:15:09 Thomas: Weird, huh?

0:15:09 Lindsey: It is. It is. Yeah. So that was one of the two papers that they cited. The other paper, which estimated the incidence characteristics of all abortions performed in the U.S. in 2008, doesn't provide anything direct about the incidence of abortion due to fetal anomaly for, you know, again, for whatever reason, this is an impossible stat to. But it did Provide some numbers suggesting that the abortion providers who are like ones that are providing nearly all of those kinds of abortions are a very low percentage of abortion of abortations overall in the US. It's something like 4%, which de facto means that these cases which do not account for the majority of the second trimester abortions, right, that's about 8% of abortions in the US. So, you these kinds of data suggest that like, well, maybe at most, half of those are accounted for by fetal anomaly or maternal health risk. Risk.

0:15:27 Thomas: Is It, do you really need a different abortion provider if it's due to those reasons? Or just, are there abortion providers who, for some reason, are like, I only do it if it's medically necessary?

0:16:09 Lindsey: So from that paper, it seemed like those kinds of abortions typically happen at hospitals, like hospitals generally, like kind of specialize in those kinds of situations, because they're more complicated, I guess. Yeah, so it's but those are very rough estimates. It's not like they're only doing those abortions is just the majority of the ones that they're doing. It'S so anyway, all of this is really indirect evidence. Is You a very hard thing to get data on.

0:16:10 Thomas: Oh, okay.

0:16:32 Thomas: Because, yeah, we don't seem to have the direct evidence for some reasons. That's really weird.

0:16:35 Lindsey: Yeah. Yeah, but what is probably true, and I think this is worth reiterating, is that a higher proportion of pregnancies that are terminated due to these reasons probably happen later because you can only detect certain conditions after a certain gestational age, right? But that doesn't imply the converse. It doesn't apply that most later abortions are due to those things. I think it's important to flag this, that idea that late term abortions are overwhelmingly the result of fetal anomaly or risk to the health of the pregnant individual. That's a very common claim that I hear, and it's a claim I've made myself to justify later abortion access, and it is apparently not supported.

We don't know exactly what that rate is, but we can't be making that claim as though there are stats to support it. And I think it's important to say that because pro-life folks have definitely picked up on the fact that this is not a well-supported claim, and they are using that to their advantage. I read a piece where they sort of highlight the factthat this is referenced so often on the left and that, hey, look, here's this paper that's, you know, from a person who is pro-choice, and they're saying that this actually is not supported stat, that. Anyway, so there is a good response to that kind of point from the pro -life side, and hopefully that's what the takeaway point of this episode will be, right?

On this question of who seeks second trimester abortions, very limited, and it's even more limited if you're asking about who seeks abortions past the middle of the second trimester, so that's about 20 weeks, because the majority of abortions are sought early. So, you know, studies that have obtained random samples of abortion seekers typically include very few cases beyond the middle of the second trimester because they're so rare.

0:16:47 Thomas: Yeah. Yeah. Yeah. Yeah.

0:18:09 Lindsey: Therefore, studies focused on abortions beyond the first trimester typically focus on the early part of the second trimester. What these authors say is that research to understand who seeks later abortions, and particularly those happening at or after 20 weeks, is really critical to understand what effects legislative bans of later abortions will have and who they're going to affect most. So, current study compares the characteristics of women who received abortions at or after 20 weeks for reasons other than fetal anomaly or risk to the life of the woman. As we discussed last time, those folks were excluded from the study, period. You may wonder why they limited this paper only to women who received late abortions, so they didn't include the turnaways in this particular analysis.

0:18:57 Thomas: Right. Yeah.

0:18:57 Lindsey: And there Are two answers to that. So one, there's a separate paper that did include turnaways, and we're going to talk a little bit about that at the end. But two, in this specific paper, their goal was to determine the characteristics of those who are likely to be most impacted by legislation seeking to ban abortion after 20 weeks. And in order to know that, you need to know the characteristics of those who are currently actually getting abortions after 20 weeks, right? So the turnaways would not be an appropriate sort reference group for that kind question. So, well,

0:18:58 Thomas: OK.

0:19:26 Thomas: Why not? Exactly. You still would want to know. I if you're just studying like the reasons why women seek abortions this late, wouldn't it be helpful to have everybody anyway? Anyway, I

0:19:36 Lindsey: Would you in some analysis, right? But I think their point is that, you the turnaways aren't getting their abortions anyway, so they're not the people that are likely to be impacted by new legislation, right, people that are most likely to impacted by a change in legislation, the ones who were able to secure abortions now, but wouldn't be able to secure them if those bans went into effect. Question here is like, what are the reasons that women seek abortions late? But they're sort of framing it in an applied way. Saying like, you know, what Are the characteristics of women who are getting abortions right now, because those are the women that are going to be impacted if this legislation goes into place? Mean they're not going to ignore the turnaways indefinitely, right? Like

0:20:15 Thomas: It's called the turn away study.

0:20:16 Lindsey: Yeah, exactly. Right. They'll come back to the turnaways. It's just, you know, anyway, In order to investigate this question of who seeks later abortions and why, they analyzed data from a subset of women who received abortions at 16 of the 30 abortion clinics that were included in the turndown study. So specifically, these were the 16 clinics that had a gestational limit beyond 20 weeks. And the data they analyzed are from participants' initial interview, which was performed one week after they received their abortion. Measured a lot of the standard stuff, demographics, health indicators, whether or not they had insurance.

But most centrally, they used data from two sets of open open -ended questions. So first, they examined the reasons that women reported seeking an abortion, which we talked about in the last episode. So just ask participants to report exhaustively on all of the reasons that factored into their decision to seek an abortion. Also use data from another pair of open -ended questions, which were, quote, "Did anything slow you down and prevent you from coming to the abortion clinic earlier in your pregnancy?" And, quote.

"What would you say slowed you down the most?" And so this is meant to assess something about the circumstances that have contributed to the later gestational age, at which these women finally presented at the clinic to receive

0:20:19 Thomas: OK, yeah,

0:21:30 Lindsey: An abortion. And in addition to asking about barriers in this more open -ended way, they also asked several more directed questions about how much several specific factors slowed down their ability to obtain an abortion. And these were not knowing whether they were pregnant, not knowing where to go for an abortion, difficulty getting to the abortion facility, difficulty raising money for either either the abortion itself or travel costs, difficulty securing insurance coverage, trouble deciding whether they wanted an abortion, and disagreement with the man involved in the pregnancy as to whether to have an abortion. So they asked about all those specifically. And this is a smart strategy, right? Because they get the free generated information without any prompting, and that's most likely to reflect the things that are most salient to their participants. It's possible that there are other influences out there that just don't occur to those people to mention. So having that standardized set of prompts is helpful in and getting kind comparable yes -no responses from everyone about every factor.

0:21:30 Thomas: Right. Yeah, yeah. My alarm didn't go off. Wasn't wasn't one of the responses. No, OK, wasn't.

0:22:29 Lindsey: Yeah, didn't wake up in time, dad, no.

0:22:31 Thomas: Yeah, no, it wasn't That. All right, weird.

0:22:32 Lindsey: Nope, Nope, doesn't seem to be. Yep. To analyze their data, the researchers compared characteristics of women who received later abortions to those who received first trimester abortions, to see if there were any differences between those subsamples. So the questions that they're answering with this comparison is whether the life circumstances or personal characteristics or reasons for having an abortion differ between women who were seeking abortion during the first trimester versus the second.

Also compare later and first trimester abortions in terms of logistical barriers that these women encountered in seeking an abortion, including average cost of the abortion, number of facilities that patients had to contact and visit, and travel time to the facilities where they they eventually obtained an abortion. So what did they find? Their analyses included 441 women who received abortions at facilities with gestational limits beyond 20 weeks.

272 of those 441 women received a later abortion, and 169 of these women received abortations at those same clinics with later gestational limits, but received them during the first trimester. The average gestational age at the time of study recruitment was 22 weeks in the later abortion group and 8 weeks in the first trimester group. So terms of demographics, the sample was 38% Black, 31% White, 19% Latina, 17% were ages 15 to 19 years old, and 63% were already mothers. And the authors mentioned that these characteristics are comparable to the

0:24:06 Thomas: Right.

0:24:06 Lindsey: Population of women who receive abortions nationally. So first important takeaway from these findings is that in many important respects, women who received later and first trimester abortions were comparable. These groups did not differ significantly with regard to race, ethnicity, number of previous live births or abortions, mental or physical health history, or substance use. We'll get to abuse later, but substance use did not differ between the two groups. They're comparable in all those respects, but there were some important differences. Namely, compared to women receiving first trimester abortions, women receiving later abortions were much more likely to have discovered that they were pregnant at a later gestational age. They realized that they Were pregnant at 12 weeks on average compared to five weeks on average for the first trimester patients.

0:24:55 Thomas: And so all the process of figuring all the stuff out that you might have to figure out to get an abortion is just delayed by, you know, six weeks.

0:25:03 Lindsey: That's part of it. That is a big part of it. And then there's like some snowballing that happens. That's just very unfortunate. But Yeah, so 68% of later abortion patients were already eight or more weeks pregnant before they realized it. And this was true for only 12% of those who received first trimester abortions. Abortion patients were also younger on average, which may contribute to when the pregnancy is detected, right? Right. So not only can menstrual periods be more irregular among younger individuals and thus less likely to register as a pregnancy symptom, but younger folks are less likely to recognize other symptoms of pregnancy for what they are.

So like a 15-year-old may be less likely to recognize the signs of pregnancy than a 25-year old. Abortion seekers were also less likely to be married, less likely to be employed, and less likely to have private health insurance. And these may ultimately relate to abortion timing in a number of complicated ways, which we'll come back to shortly.

Finally, women receiving later abortions were also more likely to have had to travel further to get their abortions, with 21% of women receiving latter abortions having traveled three or more hours to get to the abortion facility compared to only 5% of women received later abortions, who had to travel that far.

0:25:03 Thomas: Yeah. Right. Right, right. Yeah.

0:26:15 Thomas: It is interesting to say that like largely they're comparable to that, to anyone else who gets an abortion. It's just these other factors that, which mainly, I mean, they pretty much all just sound like practical concerns, right?

0:26:23 Lindsey: Yeah, Yeah, from all of this, similar, right? In terms of reasons for getting abortions. They're similar in all kinds of ways, but they happen to get unlucky in these particular respects that make the difficulties more intense for them. Regression analyses are old friends, which included all of these variables that we just talked about and evaluated which ones had unique relationships with the likelihood of seeking a later abortion rather than an earlier one, yeah, showed absolutely.

0:26:54 Thomas: This show brought to you by Regression Analysis, by the way, sponsored by...

0:26:58 Lindsey: Big regression really needs to get in touch with us. We give them so much free coverage.

0:27:00 Thomas: Oh man, we can reclaim the regressive left. Damn it. If only that was more relevant right now. Why didn't we figure this out five years ago?

0:27:09 Lindsey: Oh, my these regression analyses showed that that age, employment, later discovery of pregnancy, and greater travel all uniquely predicted increased odds of seeking a later abortion as opposed to a first trimester one. So there's a real picture emerging here that will continue to come into focus with some of these other details.

First trimester and later abortion patients, as you just said, they don't differ in a lot of respects, but those who receive later abortions are more likely to have realized their pregnancy later, and younger, and are in less stable financial financial situations, and they're likely to have had to overcome some unique barriers in terms of receiving their abortions, like having to travel further, for instance. So what about participants reported reasons for delay in seeking an abortion?

Of the women in this sample were highly likely to Have experienced delays in receiving their abortions. And that's a point worth highlighting in and of itself. It is logistically challenging to receive an abortion abortion in the United States. This was especially true among those who received later abortions.

So 94 % of later abortion patients versus 80 % of those who receive first trimester abortions reported that yes, there was at least something, at least one thing that slowed them down and meant that they got an abortion later than they wanted to.

0:28:22 Thomas: What kinds of things? They have examples.

0:28:23 Lindsey: Wonderful question. One so first, there were three factors that slowed everyone down roughly equivalently, regardless of whether they were later or first trimester patients. The first one was not recognizing pregnancy. So 40% of first trimester patients versus 45% of later abortion patients reported that if they had recognized their pregnancy sooner, they would have sought an abortion sooner. So there was no significant difference there between first trimestern and later abortion patience in terms of women identifying that as something that slowed them down. But as we said a few minutes ago, the women in the later abortion group discovered their pregnancy at a significantly more advanced gestational age.

0:28:38 Thomas: Okay.

0:29:00 Thomas: There's probably a lot of people in there that don't recognize that the late recognition of the pregnancy is a factor in why they got it so late. Like, they might just not realize.

0:29:10 Lindsey: Yes, that is a wonderful point.

0:29:12 Thomas: Because it makes sense, like, if you're not you who gets abortions every day, you might not be sitting around knowing, like, "Oh, I recognize my pregnancy a little bit later than the average person," you know? What I mean, so I just imagined that, like, the self-reporting of this was a reason that I got a late abortion would be much lower than probably what the reality would be, is my guess.

0:29:22 Lindsey: Right. I think that that's reasonable, right? Through direct or indirect means, I thank that the later recognition is interfering with people's ability to get abortions here. So yeah, I I think you're right. I thank more people could have identified that than probably even did. That's So a good point. Factor that seemed to slow people down roughly equivalently in both the first trimester and later group is trouble deciding about the abortion.

0:29:54 Thomas: Yeah.

0:29:55 Lindsey: So 33% of first trimester patients versus 40% of later abortion patients said that this was a factor that slowed them down. So trouble deciding is nominally higher in the later abortion group. But again, that difference is not statistically significant. It does not appear that women who received later abortions had a significantly harder time deciding to abort. And the reason that the authors included this in their questions in particular is that you sometimes hear the point as part of this narrative that people who seek abortions later are just being more indecisive, right? Like, this suggest that that is not the case, right, it's inconsistent with that claim. Yeah.

0:30:30 Thomas: Interesting. Yeah.

0:30:32 Lindsey: Factor that was roughly equivalent was disagreeing with the man involved in the pregnancy. So 16 % said this slowed them down in the first trimester group, 20 % in the later abortion group. So again, nominally higher in the latter group, but that was not a significant difference.

0:30:37 Thomas: Oh.

0:30:46 Thomas: Okay. I thought that was one of the facts, so that's not one of these.

0:30:46 Lindsey: Yeah. Nope.

0:30:48 Thomas: Factors, okay.

0:30:49 Lindsey: Seems to occur at similar rates. Those reasons are offered at similar rates. Yeah, but next we've got four factors that were demonstrated to slow down the first -trimester and later abortion patients patients differentially. So these factors were more likely to be identified as reasons for delay in the later abortion group compared to the first trimester group. The first two are highly interrelated factors. So first, not knowing where to go for your abortion was an issue that slowed down about twice as many women in the latter abortion group versus the first semester all

0:30:49 Thomas: Uh. Yeah. Yeah. Because who knows? Oh, wait, I forget this. Was this in California where they got the data, or all over? I can't remember.

0:31:28 Lindsey: All over the U.S.

0:31:29 Thomas: All over. OK, so there's going to be some of them. I've heard this happen to many people where you don't know where to go and you accidentally go to the pro-life, like, bullshit one and they slow you down and do a bunch of stuff, like, convince you of it. Right. Right. I mean, that could include people who went to the wrong place, went to the accidental pro -life, try to can like, they like give you a, whatever it's with sonogram. I don't know.

0:31:44 Lindsey: Yeah, right. It probably does. I kinds of places are very, very good at what they do in of masquerading as abortion providers. So, mm

0:31:54 Thomas: Yeah. Yeah, and their names will usually sound ambiguous or like they're going to help you. Yeah totally.

0:32:04 Lindsey: -hmm, exactly. Yeah, often they will mimic the names of actual abortion providers to do that. It's really great. Lot of love for those folks. Yeah, so it was like twice the rate. So 38% of the later abortion group versus 18% of the first trimester group said that not knowing where to go was an issue. This slowed them down. And the difference here to me is not surprising because fewer facilities offer later abortions.

0:32:28 Thomas: Then it's that's the snowballing you're talking about where it's like, I don't know where to go. Oh, it got later now. Maybe I found out where to go, but now maybe that place doesn't even accept me because it's later now and now I got to do the the whole process again. Yeah.

0:32:29 Lindsey: Yes. Exactly. Yeah. So 58% of women seeking later abortations had to visit more than one facility before finding one that would perform their procedure compared to only 33% of women who obtained first trimester abortions. Fun. This difficulty in finding a clinic that would perform the procedure likely contributed to the second difficulty that later patients encountered more often than first trimester patients, which was in traveling to the abortion clinic. 12% of the first trimestre group reported difficulty getting to the abortion facility versus 27% for the later abortion group.

That's more than double for the latter abortion group, so yeah, it's if it's harder to find a place that will perform your later abortion, it's likely that you'll have further to travel in order to get there, and the further you have to travel, the more potential difficulties you're going to face.

So for example, one woman who received an abortion at 22 weeks said in her interview that her car was unreliable, and she didn't trust that it was going to make the long drive to the clinic that So she she had to get her car fixed before she could get to the clinic to get an abortion, right? And

0:33:40 Thomas: Yeah.

0:33:40 Lindsey: There's costs involved in that. Yeah.

0:33:40 Thomas: Well, Not to mention, I didn't even think about the fact like just trying to get a doctor's appointment, you know, like that can take weeks and so each of these things, the more snowballing effects is like, crap, a car broke down, got to reschedule, here's the next available one forever from now, or here's next available time I can get off of work, or I guess I didn't realize, I guess I just assumed that these dates, you, how old, the how long the pregnancy was and all that would be based on when people first sought an abortion. But, but is it when they actually got one, like when they got the abortion.

0:33:45 Lindsey: Yeah. Mm -hmm. -huh.

0:34:14 Lindsey: Gestational ages here are like, you you know, the gestational ages at the provider that they finally, yeah.

0:34:21 Thomas: Guess I had assumed it. I don't know why I assumed this, but I assumed we were talking about when they started seeking an abortion, which just seems to be a drastically different thing.

0:34:28 Lindsey: No. Correct. It is. Yeah. Yeah, that travel difficulty piece, that brings us to the next difficulty that slowed later abortion patients down disproportionately, which was money. 65% of the women in the later abortion group said that direct or indirect costs of the abortion slowed down their ability to get one versus only 31% in the first trimester group. And And not only are later abortions more expensive in and of themselves, so participants in the later abortion group reported that their procedure cost $2 ,000 on average versus $520 among the first trimester patients, but longer distances means additional transportation costs. So an average of $100 in travel costs for the later group versus $18 in the first trimester group.

0:34:31 Thomas: Yeah, yeah.

0:35:13 Thomas: It's probably a moving number that you can't, you got to do calculus to figure out what you're eventually going to owe by the time times ever, everything slows you down and then makes it more expensive and then slows you you down. And then, yeah, it's like, yeah. It's just derivatives or whatever.

0:35:25 Lindsey: It's true. Yeah.

0:35:27 Thomas: Integrals. I can't.

0:35:27 Lindsey: Yeah. Cases here of women who approached a clinic in their first trimester but couldn't afford even that less costly procedure. And then by the time they raised the money to pay for it, they were at a substantially later gestational age, which then increased the cost. And yeah, it's awesome, so right? Cost was disproportionately a barrier for the later abortion group. And finally, 41% of the later abortion group reported being slowed down by difficulty securing insurance coverage for their abortion versus 20% in the first trimester group. And there are cases that suggest that the higher costs of later abortions means that women have more trouble securing insurance leverage if they discover their pregnancy late. But also, if someone doesn't have insurance for an abortion period, that lack of coverage means that they may face more hurdles in paying for the procedure out of pocket, out-of-pocket. And thus, when they finally do have the money to pay for it, they may be past the first trimester. And by the way, I don't think I mentioned this in the episode we recorded about my experience doing this, but my private insurance did not cover elective abortion. So and

0:35:35 Thomas: Yeah. Gosh. Yeah. Yeah.

0:36:27 Lindsey: So I was just very lucky that, you know, between me and my partner, that we were able to pay for that out-of-pocket. That very easily could not have been the case, right? Yeah. Okay. So that's that's the first paper. What do these findings tell us? First of all, these findings very much conflict with the popular negative conception of women who seek elective abortions later in pregnancy. They do not suggest, for instance, that women who received abortions leader procrastinated more in seeking abortions compared to women who receive them earlier. The picture that you get when you look at these details is that the women who received later abortions got unlucky once and that they either didn't have or didn't recognize their pregnancy symptoms earlier. And then that bad luck snowballed by presenting logistical barrier after logistical barrier and

0:37:16 Thomas: Yeah, so is more like someone is trying to get an abortion and society is just just like facing them and holding them back, you know, like stopping them from getting it for, you know, weeks and then being like, why are you getting a late abortion? What are you doing? You must be a bad person. Oh.

0:37:25 Lindsey: Yep. Correct. Right. Yeah, yeah, those really, between the the late recognition and the additional logistical barriers, those really were the two factors that distinguish the early and later abortion patients in the Turnaway study. And I do think that that's worth lingering on for a moment. Who received abortions later discover that they were pregnant later. And sometimes I hear people saying that they just don't understand how someone could not realize they're pregnant until late. I get it.

0:37:55 Thomas: You gotta be kidding me. I can absolutely understand that. What

0:37:58 Lindsey: Yeah. I hear that all the time. It's like, I just don't understand.

0:38:01 Thomas: Man. Sorry.

0:38:01 Lindsey: I knew immediately that I was pregnant. How could could somebody not realize that they're pregnant? Yeah.

0:38:05 Thomas: Women that do? I thought it'd just be all dudes who don't understand how it works. Like, I didn't understand how it worked before we had kids, but yeah, five weeks, six weeks, that's nothing. If like, I don't know what percentage of people are perfectly regular with their cycles, but like, it's not a hundred percent. And I it's, I think there are a lot of people who are not regular. And if you're not regular with your cycle and you don't have like overwhelming pregnancy symptoms, how in the world would you know that you were pregnant?

0:38:14 Lindsey: Right.

0:38:24 Lindsey: No, exactly.

0:38:38 Lindsey: Nope. You're exactly right. Yeah. And actually, Diana Green Foster and two co -authors published a paper just in 2021, just last year, that specifically dug into that point. They looked at factors that predicted later detection of pregnancy in the full 956 woman sample in the Turnaway study. And it was mostly irresponsibility. That was mostly what it was. No, no. In that 2021 paper, they showed that the following variables predicted significantly higher likelihood of discovering one's pregnancy later and discovering it in the second trimester in particular. So age was predictor here. So younger women detected pregnancy later. Talked about the fact that periods on average are more likely to be irregular among younger folks.

0:38:57 Thomas: I Alarm clock didn't go off, didn't wake up in time.

0:39:22 Thomas: Hmm.

0:39:22 Lindsey: Previous pregnancy significantly predicted later detection.

0:39:25 Thomas: All right, yeah, they don't know what to look for maybe as much

0:39:26 Lindsey: Exactly. Exactly. Yeah. Higher BMI was associated with later detection and there could be a couple of things here, right? I mean, a you distinctive know, physiological pattern of weight gain that happens around pregnancy that you may be less likely to see if you have a larger body size. But also, there are certain conditions that cause both larger body sizes and irregular periods, which can make pregnancy more difficult to detect.

0:39:28 Thomas: Yeah, sure. All Right. Yeah. Sure, yeah.

0:39:51 Lindsey: Yeah, subjective physical health was a predictor. So individuals, for instance, who had pain chronic conditions were less likely to notice certain pregnancy symptoms.

0:40:00 Thomas: Yeah, it makes sense to me.

0:40:01 Lindsey: Yeah, like cramping is a common early pregnancy symptom that you might not notice if you have chronic pain, for example, right?

0:40:07 Thomas: And tons of stuff causes cramping. You're not just like, cramps, pregnant. There's so many easy ways that you would would not notice you're pregnant.

0:40:09 Lindsey: Yeah. Yep. Exactly. Yeah. Health difficulties and drug and alcohol abuse were also associated with later detection, right. Was use of hormonal contraceptives. Like, obviously, right? First of all, they prevent pregnancy. So you're less likely to expect that you're pregnant.

0:40:15 Thomas: Yeah. Yeah. So you're like, well, it's not that, what else might it be, yeah.

0:40:30 Lindsey: Right. Exactly, right. So that could easily cause people to ignore or misattribute symptoms. But also, you know, folks on hormonal birth control do not have normal menstrual cycles. That's kind kind of the whole point. And many hormonal forms of birth control significantly reduce or completely eliminate bleeding, like implants, right, and IUDs. So yeah, of course, hormonal contraceptives. Yeah. Also, previous pregnancy within a year of seeking an abortion is associated with later detection, right? Because nursing suppresses the menstrual cycle. So missing a period is not likely to register as a symptom of pregnancy.

0:40:50 Thomas: Yeah. Yeah. That's what happened with old Arlo, man. I was a little close to the, still, still nursing. And

0:41:10 Lindsey: Yeah, Yeah. So there's being, how do women miss that they're pregnant? How do people miss that their pregnant? All of those ways. If you're a person who rapidly discovered that you're pregnant, you are luckier than the person who did not make that discovery as earlier. Earlier. And there's just all kinds of factors that can create those differences. Late detection is the first factor distinguishing later in first trimester abortion patients. The second broad distinguishing factor is that women who received abortions later faced more barriers to access.

So if you don't recognize that you're pregnant early, your snowball from there, as we saw, especially if you're already economically disadvantaged because it's harder to find clinics that are going to perform later abortions and it's more expensive to get later abortations. All of that can mean that what was initially a seven week delay, because you've recognized you were pregnant later, can quickly snowball into a much longer delay due to logistical difficulties.

And in fact, these researchers found that on average, second trimester abortion patients discovered their pregnancy seven weeks later than first trimester patients, but that gap widened to an average of 14 weeks in terms of when they were actually able to receive their abortions. Average discovery at weeks five versus 12 weeks for the first trimester versus later. But average gestational age in terms of receiving abortions was eight weeks versus 22 weeks on first trimestre and later abortions.

This was in no small part because of delays due to having to approach multiple clinics and obtain funding. As we mentioned, the women in the sample who received later abortations were significantly less likely to be employed, meaning that these difficulties are disproportionately disproportionately affecting women in lower socioeconomic brackets. So my main takeaway from this study is this.

If people are uncomfortable with later abortions because of concerns about increasing personhood or whatever, the absolute best thing we could do to is to reduce logistical and financial barriers to abortion access. If you get rid of those, you are shaving off an average of seven weeks of developing personhood and and everybody is

0:43:10 Thomas: Yeah.

0:43:10 Lindsey: Much happier, including the person who is pregnant. Nobody wants to carry an unwanted pregnancy longer than they have to.

0:43:13 Thomas: Hold Hold on. You're telling me the Antifa woke left doesn't want to kill like, you know, older fetuses just for sport? Wow.

0:43:23 Lindsey: Surprisingly enough. Yeah.

0:43:25 Thomas: I mean, it's becomes in my mind, like probably as good an argument as the well, it is medically necessary thing that we're talking about apparently isn't supported. I mean, instead of that, it's, well, the overwhelming majority, in fact, like nearly all of the statistical difference in these two groups of people seeking abortions is discovering their pregnancy later and then the barriers to getting an abortion. Like that's I mean, that's that's basically all of it. So, yeah,

0:43:43 Lindsey: Mm-hmm. Mm -hmm, that's right. That's right, yeah, and that is luck all the way down. So this whole blameworthiness thing, right, is particularly, yeah. I don't have a ton on the second paper, but I do want to sort of give you the takeaways So in the second paper, it's essentially very similar goals to this first one, but they also include the turnaways. And essentially what they find in this paper is like the same story. It's just exaggerated for turnaways so like there's no differences between the turn aways and the late abortion group in a lot of respects.

It's just that they faced even more difficulties getting abortions, and they realized they were pregnant even later than the women who received their abortions late, right? So it reinforces the same point, ultimately, which is that, you at the women who have quote unquote elective abortions, It's right? Still luck all the way down. Like there's nothing, there's nothing here that justifies that whole blameworthiness thing as though there ever is. Right. But, but I don't, I dunno. I, I, so I really, I hope that this is useful for people. It definitely was useful to me. I found a lot of this really surprising.

0:43:55 Thomas: Yeah, yeah. Yeah. I think the the major through line and a major takeaway is, okay, it's mostly women who discover they're pregnant later and the barriers, so therefore you... You're not going to totally get rid of the fact that some people discover they're pregnant later, but like if those people were able to get a timely abortion, a timely affordable abortion when they wanted it, that seems like it would cut down on, I don't know, could you ballpark us like how of these second trimester abortions would turn into first trimester abortions?

0:45:10 Lindsey: Sure.

0:45:28 Lindsey: Know if I can ballpark you a specific number here, but I think it would be significant if it was as easy to get access to the two pills you need if you get a medication abortion as if you could just get that over the counter or whatever.

0:45:39 Thomas: Oh, right. Yeah. Yeah, we didn't even, wow. I didn't think of that because there is a movement to make that happen, right?

0:45:45 Lindsey: Yeah. Oh, yeah, and And there should be. I

0:45:49 Thomas: Imagine how much easier. It should, those, oh, my gosh. This medication, it cannot cost that much. Like, there's no way. We ought to be able to provide this free to anyone who needs it instantly. And then wouldn't you know it, we wouldn't have any late term abortions. We wouldn't ever, you know, we'd have a handful of later term abortations.

0:45:56 Lindsey: No. Yeah. Yeah, we should. You would cut it dramatically is I also, you know, I've encountered as I've been digging into some of this stuff, I under the impression that the effectiveness of the medication abortions is like significantly lower if you're past like the first, you little bit of pregnancy. Apparently, that may not be true. And that's something that I think we're going to talk about in the next installment that we do of this stuff. Lot of the restrictions around this seem to have other sources from what I've seen so far. So

0:46:35 Thomas: It is one of those things where it feels like even for you and I and listeners who are pro -choice, like so much of the misinformation is just everywhere that like, you even you or I might be like, oh, yeah, I'll just cite this like commonly held belief. And it's like, well, actually, no, that's might be propaganda.

0:46:53 Lindsey: Yep. Pretty much.

0:46:55 Thomas: Wow. Wow. Well, again, this is already a vanishingly small percentage, right, of these abortions. And it would be even more vanishing. It would vanish even more if people had access to quick, cheap abortions, I mean, just it would it would virtually vanish. So maybe let's do that.

0:47:12 Lindsey: Yeah. This is repeating myself, But when like, I'm thinking about my friend who is pro -choice but uncomfortable about this, it's like, okay, yeah, if you are uncomfortable with later abortions, the response, the thing that's going to address that is not more restrictions. It's

0:47:27 Thomas: Yeah, let's make it even slower for people to get the abortion that they need. Well, great breakdown, as always, um, is a good science thingy I think, right, good science thingy with you know, bad, uh, for you arguments, I Suppose, but it's a good science thinking, and for the breakdown, I want to remind people that the q a thread is up on the Patreon, patreon.com/theorypod We're gonna do that again. Again, we, you know, took a break, but there have been so many episodes. Think of how many there have Been since we were doing Q &As.

0:47:30 Lindsey: Right. Yeah, exactly. I I think it's a good science thingy. Yeah. Yeah?

0:47:56 Lindsey: No, man.

0:47:57 Thomas: So any questions are fair game on those threads. And we look forward to doing that. And of course, please support the show. Support Lindsay's ability to not have to be a professor and keep her nightmares a nightmare. Nightmare. Keeper Nightmare is about not having taught a class all semester what they are, which is merely a nightmare, not reality.

0:47:57 Lindsey: A thousand.

0:48:18 Lindsey: Yes. Thank you.

0:48:19 Thomas: What a pitch. See you next time.

0:48:30 Clip: Thank you so much for listening to Serious Inquiries Only. If you like the show, the absolute best thing you can do is support us at patreon.com/seriouspod. The second best thing you can do, is please share it on social media or by word of mouth. Speaking of social media, follow me on Twitter at Serious Pod. If would like to be Facebook friends, send me a request at facebook.com Thomas podcast. If not up for that level of intimacy, that's fine. Maybe you want to join the discussion at facebook.com slash groups slash SIO members. Thank you again for listening. We'll see you next time.

0:49:47 Lindsey: Less likely to notice certain pregnancy symptoms. Like, Jesus. Sorry. It is.

0:49:50 Thomas: That's not your door thing is it you

0:49:56 Lindsey: I need to smash it.

0:49:57 Thomas: Need to rip that out of

0:49:58 Lindsey: Yes, I do need to mash it.

0:49:58 Thomas: The wall there's no no way that could exist.

0:50:01 Lindsey: It's awful. It the worst. Okay. So individuals who had chronic pain conditions. Fuck.

0:50:10 Thomas: Now it's just fucking with you. It's actually me. I dialed into it.

0:50:13 Lindsey: God damn it. That's ghosts.

0:50:16 Thomas: Would jump out of it. That can't be real. So that noise can just happen anytime in your place of living? No, there's no way.

0:50:30 Lindsey: It Okay, I think they're done.