Denial of abortion care due to gestational age limits.

Many women are denied wanted abortions in the US. This happens for medical, personal and financial reasons and because women are just too far advanced in pregnancy by the time they present at the abortion facility near them. In the US, each abortion facility sets their own gestational limits, based on physician training, clinician and staff comfort, facility regulations, institutional policy and legal restrictions. Although the phenomenon of women presenting at an abortion facility beyond the gestational limit is not uncommon, it has not been well documented or studied. The Title X Family Planning Program, the only dedicated source of federal funding for family planning services in the US, requires all subsidized facilities to provide “factual information...on each of the [pregnancy] options, and referral upon request” [1]. While many professional health care associations offer more specific guidance for pregnancy options counseling [2–5], only very rarely do they advise clinicians to assess gestational age prior to making referrals for abortion [6]. For a clinician, the experience of counseling women who are past the gestational limit can be memorable. In her first year of the family nurse practitioner program at the University of California, San Francisco, Loren Dobkin remembers counseling a teenaged woman about her pregnancy options, overlooking the possibility that the woman might be too far along to receive an abortion.