Mandatory 24-hour waiting periods between consent and abortion visits often resulted in much longer waits than required, a prospective survey study found.
The median interval between the two visits was 3 days (interquartile range 2-7), but for 32% of respondents the interval was more than 7 days and for 6% it was longer than 14 days, reported Ashley Brant, DO, MPH, a Cleveland-based ob/gyn, in a poster presentation at the American College of Obstetricians and Gynecologists (ACOG) annual meeting.
Most respondents (80.7%) said they preferred to get an abortion in a single encounter, though 11.7% did not prefer that option and 7.6% were unsure. Brant told MedPage Today that most of these patients cited decisional certainty reasons or needing time to come up with the money.
"But I think it's really important to note that in the absence of mandatory waiting periods, they wouldn't be forced to proceed before they were ready," she said, adding that without mandatory waiting periods, "people tend to wait to present until they're sure of their decision."
The study was conducted in Ohio from February through September 2023, during which the state had a mandatory 24-hour waiting period, though Brant noted this was also a time when demand for abortion in Ohio was lower and many patients were confused about abortion restrictions in the state. After the 2022 Dobbs decision that overturned federal abortion rights, Ohio briefly had a 6-week abortion ban, which was overturned after a few months.
"I think a lot of people just thought abortion was illegal in Ohio. So our patients were actually presenting really early for care," Brant said.
Indeed, the gestational age at first visit for 59% of patients was between 6 and 9 weeks and less than 6 weeks for 20.7%; only about 15% presented at 10 weeks or later.
More than half of patients said the mandatory waiting period and two-visit requirement were somewhat or very burdensome and about a third said that these requirements were somewhat or very harmful. Notably, regulations prevented 5% of participants from obtaining an abortion in Ohio and 4% from obtaining an abortion at all.
"I actually think that we probably underestimated the impact of the regulations," Brant said.
In November 2023, Ohio voters passed a constitutional amendment protecting abortion access in the state. While Ohio no longer has a waiting period requirement, 23 states still do, ranging from 18 to 72 hours between counseling and obtaining an abortion, according to the Guttmacher Institute. Many states require both visits be in person.
"Most of the studies looking at the impact of those waiting periods look at places where the waiting period is 48 or even 72 hours," Brant said, even though 24 hours is the most common length.
David Hackney, MD, a maternal-fetal medicine physician at Case Western Reserve University in Cleveland, who was not involved in the study, told MedPage Today that "24-hour waiting periods are well known to be of no medical value, as the vast predominance of patients are already certain of their decision and 24-hour waiting periods have not been demonstrated to improve outcomes."
In fact, he said, mandatory waiting periods "are well demonstrated as barriers to access, especially at a time when many patients have to travel increased distances," adding that other equivalent medical procedures do not have mandatory waiting periods.
Hackney noted it was interesting how much more time beyond the mandated 24 hours this requirement added, indicating that "patients may need multiple days to facilitate the logistics of two visits."
This prospective cohort study involved abortion-seeking patients 18 and older at all freestanding abortion clinics in northeast Ohio who could read English -- 198 patients from four clinics in total. Non-Ohio residents were excluded. They completed two REDCap surveys: one at the consent visit and one at the abortion visit. Payment was due in installments. Between the two visits, 81 were lost to follow up, leaving 117 who completed the second survey.
Disclosures
The study was funded by the ACOG Foundation's Warren H. Pearse Women's Health Policy Award.
Brant reported being a consultant for Bayer and receiving honoraria from Organon.
Co-authors reported consulting for Organon and being an employee of Basic Health International.
Hackney had no disclosures.
Primary Source
American College of Obstetricians and Gynecologists
Source Reference: Brant AR, et al "Patient perceptions of Ohio's mandatory 24-hr waiting period and in-person consent" ACOG 2025.
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