Understanding abortion legality and trimester of abortion care in Ohio, West Virginia and Kentucky, three abortion-restrictive states.

INTRODUCTION

In the era of Dobbs, legality of abortion care in the United States depends upon state law. Even before Dobbs, while abortion remained legal mounting restrictions and debate surrounding legal abortion could have led to confusion about abortion legality and discouraged patients from accessing legal abortion. We hypothesized an association between believing abortion is illegal or uncertainty about legality with later timing of abortion care.

METHODS

We surveyed patients seeking abortion care in Ohio, West Virginia, and Kentucky from April 2020 to April 2021. We asked about their understanding of abortion legality at the time they were first deciding to have an abortion. Using unconditional logistic regression models, we examined associations between beliefs about abortion legality (measured as belief that abortion is legal or sometimes legal versus. illegal or unsure) and timing of abortion care (measured as trimester of abortion).

RESULTS

Over half (57%) of the 1,479 patients who met eligibility criteria and completed the survey believed abortion was always legal, 21% thought abortion was sometimes legal, 12% believed abortion was illegal, and 10% did not know. Most (92%) had a first trimester abortion (<14 weeks gestation). Belief that abortion was illegal, or uncertainty about abortion legality, was not significantly associated with second trimester abortion care (unadjusted odds ratio [uOR]: 0.78, 95% confidence interval [CI]: 0.50-1.20). This association did not change meaningfully after adjusting for demographic and clinical variables (adjusted OR [aOR]: 0.83, 95% CI: 0.51-1.33).

DISCUSSION: More than one in five patients presenting for abortion care in three abortion-restrictive states prior to Dobbs erroneously believed that abortion was illegal or were unsure. Understanding of legality was not significantly associated with timing of abortion care. These misunderstandings could escalate under Dobbs.