175 Volume 51, Number 3, September 2019 CONTEXT: Women who seek abortion care beyond the frst trimester of gestation are often in a vulnerable socio- economic position with limited social support, and in Belgium, the details of their circumstances are insufciently understood. A better understanding of this group is essential to a critical evaluation of Belgian abortion policy, which restricts abortions on request after the frst trimester. METHODS: Anonymized patient records were collected between 2013 and 2016 from LUNA centers, which are non- hospital-based abortion clinics in Flanders. Logistic regression analyses were used to identify associations between women’s characteristics and whether they presented within or beyond the legal limit, which was 13 weeks and 1 day at the time of the study. RESULTS: A total of 28,741 women requested an abortion, and 972 individuals (3.4%) presented beyond the legal limit; 29% of these latter women were unable to receive abortion care as a result of the mandatory six-day waiting period. Characteristics positively associated with presenting beyond the limit, instead of beforehand, were being younger than 20, as opposed to 20–24 (odds ratio, 1.7); receiving a primary, lower secondary, upper secondary or special-needs education, rather than a higher education (1.8–3.1); being unemployed, rather than employed (1.3); and holding Belgian rather than a foreign nationality (0.8). Being accompanied by someone to the LUNA center (0.8), hav- ing irregularly (0.6) or regularly used contraceptives (0.7), and having ever had an abortion (0.8) were negatively asso- ciated with presenting beyond, rather than before, the limit. CONCLUSIONS: A fuller consideration of patients’ characteristics when evaluating Belgian abortion policy is needed to ensure that the needs and rights of socioeconomically vulnerable women are addressed. Characteristics of Women Who Present for Abortion Beyond the Legal Limit in Flanders, Belgium One in four pregnancies is unintended in Western Europe, 1 and approximately half of these end in induced abortion. 2 While an increasing proportion of abortions worldwide now take place during the first trimester of pregnancy, 10–15% occur at later gestations. 3 In Belgium, in accordance with the 1990 Law on the Termination of Pregnancy, 4 abortion is available on request during the first 14 weeks of gestation. Abortion must be performed by a physician in a hospital or a clinic that is licensed to perform the procedure. The law also requires a six-day waiting period after the first con- sultation, which means that, to be eligible for abortion on request, the woman has to make her first appointment by 13 weeks and 1 day of gestation, at the latest. Beyond the 14-week limit, abortion is permitted only if carrying the pregnancy to term would pose a severe risk to the health of the woman, or if the fetus sufers from a severe and incurable condition. 5 If the pregnancy exceeds the limit and these criteria are not fulfilled, pregnant women may seek abortion care in neighboring countries, such as the Netherlands, where second-trimester abortion is legal on request. Although Belgian abortion policy recognizes that abortions should be legal and safe, its restrictions on second-trimester abortions encourage medical tourism to neighboring coun- tries. As a result, the public health consequences related to traveling abroad for abortions after the first trimester are obscured. 6 Second-trimester abortions, although generally safe when performed by a skilled health professional, carry more risk and account for a greater proportion of complica- tions than do first-trimester abortions. 7 Moreover, traveling abroad to obtain an abortion carries additional costs and raises access hurdles. 8 This is especially problematic given that women seeking a second-trimester abortion are more likely to be socioeconomically vulnerable—that is, with limited education, impoverished or unemployed—and to experience problems finding and traveling to an abortion clinic, according to research in the United States. 9–11 The higher costs and decreased availability of abortion services at later gestations may make the procedure less accessible to poor women and to those who must pay for services themselves. 12 Women who delay in seeking abortion care are more likely to be younger, single and nulliparous and to have lower levels of social support and higher levels of relational conflict, in comparison with women who seek abortion within the first trimester. 10,13 Compared with women who seek first-trimester abortion, those who do not suspect they are pregnant until later gestational ages are also more likely to delay in seeking care. Contraceptives can cause irregular periods, which can delay a woman’ s suspicion of By Sarah Van de Velde, Nina Van Eekert, Kristof Van Assche, Nina Sommerland and Edwin Wouters Sarah Van de Velde is assistant professor, Nina Sommerland is a Ph.D. candidate and Edwin Wouters is associate professor— all at the Centre for Population, Family and Health and the Department of Sociol- ogy, University of Antwerp, Antwerp, Belgium. Nina Van Eekert, also at the Centre for Population, Family and Health, is a Ph.D. candi- date, Department of Sociology, Univer- sity of Antwerp, and International Centre for Reproductive Health, Ghent Univer- sity, Ghent, Belgium. Kristof Van Assche is assistant professor, Faculty of Law, Uni- versity of Antwerp. Perspectives on Sexual and Reproductive Health, 2019, 51(3):175-183, doi:10.1363/psrh.12116 Additional supporting information may be found in the online version of this article at the publisher’s website.