about ipas
newsroom
what we do
where we work
products
publications
contact

August 2, 2007
Vietnamese woman
Many Vietnamese women and girls get later abortions because they fail to recognize pregnancy early; can’t afford the procedure or take time off work; or have difficulty deciding on their options.
Photo courtesy of Richard Lord.

Although most legal abortions are performed in the first trimester of pregnancy, when the procedure is safest, some women do not decide or are unable to terminate unwanted pregnancies until later. A new study by Ipas researchers sheds light on the varied, complex reasons for such delays and underscores the compelling need to ensure that safe second-trimester abortion services are available and accessible to women.

“The study findings help us understand barriers that prevent women and girls from obtaining safe, early abortion,” said Dr. Janie Benson, who oversees Ipas’s global research activities. “While these barriers must be addressed, clearly some women will always need second-trimester services.”

In Vietnam, where pregnancy termination is legally available on request, researchers working at five health facilities interviewed 60 clients seeking abortion between 13 and 24 weeks of pregnancy. They wanted to learn why the adolescents and women, who ranged in age from 14 to 47, had not obtained care earlier.

Authors Maria F. Gallo and Nguyen C. Nghia describe their findings in a recent issue of the journal Social Science & Medicine, in an article called “Real life is different: A qualitative study of why women delay abortion until the second trimester in Vietnam.” Gallo is a former Research & Evaluation Associate at Ipas; Nguyen is affiliated with Hanoi Obstetrics and Gynecology Hospital.

Researchers found three categories of factors influencing delays in obtaining abortion: women’s failure to recognize pregnancy until after the first trimester; structural barriers that delayed receipt of services; and difficulty deciding how to resolve unplanned pregnancies.

The study results underscored a crucial need to improve women’s knowledge of reproduction, fertility and contraception. Underestimation of pregnancy risk was common among the women interviewed, as was misinterpretation of pregnancy symptoms. Some women incorrectly believed that they could not become pregnant while they were breastfeeding or for other reasons and were not using contraception.

“Providers may be missing key opportunities to counsel women,” write Gallo and Nguyen, noting that other studies have shown that many Vietnamese abortion clients do not receive contraceptive counseling.

Structural barriers that prevented study participants from receiving care earlier included inability to take time off from work or household duties; time required to earn or borrow the service fee; and medically unnecessary administrative requirements such as spousal or parental consent. Poor referrals resulted in some women going to several facilities before obtaining care; others experienced poor-quality services, including false-negative pregnancy tests and continued pregnancies after undergoing early abortion.

Also contributing to late abortions was a gap in services for women between 12 and 16 weeks of pregnancy. The Ministry of Health recently approved modified dilatation and evacuation (D&E) for abortion between 12 and 18 weeks gestation, but the procedure has not yet been universally adopted. Women seeking care at facilities that do not use it are told to come back later, at which time they face greater clinical risks and costs.

Delays in deciding on abortion also played a role. Some women who recognized that they were pregnant early initially wanted to keep the pregnancy. They later opted for abortion, however, after changes in life circumstances or after more fully realizing the difficulties that they and their families would encounter if the pregnancy continued.

The study findings suggest ways to improve the quality and accessibility of reproductive health services not only in Vietnam but also globally.

“Comprehensive sex education is needed everywhere, so that women and girls can avoid unplanned pregnancy and recognize when they are pregnant,” said Benson. “They also need to know where and how to obtain early abortion because that’s when it is safest. This study illuminates a number of barriers that must be addressed.

“It also shows, however, that safe, second-trimester abortion services must always be available, because some women decide on abortion only after the first trimester. Every individual’s circumstances are different, and health-care systems worldwide need to be prepared to meet all women’s needs.”

For more information, contact:
Kirsten Sherk
Senior Associate, Media Relations
e-mail: sherkk@ipas.org
phone: 919.960.5612
fax: 919.929.0258