To our knowledge, this is the first qualitative study undertaken in South Africa exploring the reasons why women delay seeking an abortion until the second trimester. This adds to the body of information addressing the barriers to safe abortion services since the abortion legislation was passed in 1996 [3-6].
A complex set of personal circumstances coupled with structural barriers led women to delay seeking an abortion until the second trimester of pregnancy. Several public health measures may decrease the proportion of second trimester abortions. In addition to improving women's access to contraceptive counselling, including post abortion contraceptive counselling, efforts should be made to improve women's knowledge around pregnancy, reproductive physiology and reproductive health in general. Furthermore, women should be educated about the importance of maintaining menstrual records or diaries. Health care professionals should be encouraged to provide women with comprehensive information before they become pregnant as well as facilitating timely referrals and decision-making after pregnancy has been diagnosed. However, due to the personal and complex nature of many of the reasons for delay, the need for legal and accessible second trimester abortion services will remain necessary to provide safe abortion care services.