Delayed and Turned Away: How Access to Abortion Can Depend on Your Weight

This story was originally reported by Gabriella Gladney of The 19th, and republished through Rewire News Group‘s partnership with the 19th News Network.

When Elie Liakopoulos discovered she was pregnant, she knew immediately that she wanted to have an abortion. A surgical abortion to be specific—a prior distressing miscarriage experience made her wary of taking the abortion pill at home, since both miscarriage and medication abortion are managed using mifepristone. She lived in Portland, Oregon, where abortion access is legally protected by the state. She assumed that meant the hardest part of the process would be scheduling the appointment. She called the Lilith Clinic—an independent abortion provider in the city—completed the intake process and set her date. 

Then, a phone call changed the course of her plans.

“They returned my phone call to tell me that they wouldn’t be able to perform the abortion. I had no idea at that time that you could be turned away from an abortion at any size for any reason,” Liakopoulos said. “They just said that they had a limit for BMI.”

Body mass index (BMI) is a screening tool to estimate a patient’s body fat. Patients over a certain BMI seeking surgical abortions can face substantial limits and delays (medical abortions however, are not impacted by BMI). Those barriers can lead to a scramble to find alternative care, leaving patients with lingering frustration, physical discomfort, and emotional distress.

The Lilith Clinic said that while they could not comment directly about Liakopoulos’s experience, citing health privacy laws, its policy was to “assess each patient from an anesthesia perspective, as well as a gynecological perspective, as to their eligibility for a safe outpatient procedure,” and to refer them to a hospital if they felt that was needed.

For Liakopoulos, the denial meant she would have to remain pregnant longer, pushing her into the 12th week of her first trimester.  

“My first trimester was marred with horrific morning sickness that lasted all day,” Liakopoulos said. “Having to deal with another week and a half of not being able to eat anything or smell anything was really horrible.”

She eventually secured care at Planned Parenthood Columbia Willamette, a northeast Portland location. But there, her body size also shaped her experience.

“They did not sedate me the way they told me they would, nor did they manage my pain the way it was managed during my last abortion procedure,” Liakopoulos said. “They said this was because my neck was larger than 19 inches around and because my BMI is high.”

Planned Parenthood Columbia Willamette does not comment on individual patient experiences, but a spokesperson did say “anesthesia and sedation policies are based on evidence‑based medical standards and designed to ensure patient safety. Clinicians assess each patient’s health needs, including factors such as BMI.”

Her prior surgical abortion at a similar gestational stage had been painful but brief. This time, she said, she was sobbing. The difference in sedation meant she could feel much of the procedure.

“My abortion was noticeably much worse, materially, much worse, because of my BMI,” she said. “The difference three years of getting a little fatter made.”

Size as proxy

There are no comprehensive statistics on how often patients are denied surgical abortions because of BMI or body size. Obesity is typically defined in medical research as a BMI of 30 or higher, but studies consistently show abortion is safe across weight categories. With medical abortions, BMI does not impact dosing or successful outcomes. 

“There’s nothing physiologically that should keep you from being able to perform these safe procedures or medications,” said Dr. Noora Siddiqui, a family medicine physician in Philadelphia and a fellow with Physicians for Reproductive Health. 

She added, “Strictly from a clinical standpoint, there is no difference in outcomes for someone over a BMI of 30 and someone under a BMI of 30.”

Recent research backs that up. A 2025 study published in the journal Obstetrics and Gynecology found that obesity was not associated with increased risk of complications from surgical abortion, even when accounting for age, gestational age, and prior cesarean delivery. 

An earlier 2019 study in Perspectives on Sexual and Reproductive Health found that complication rates did not differ by BMI, yet patients with higher BMIs were more likely to be referred out of clinics, often resulting in delays and higher out-of-pocket costs.

Yet BMI limits act as a proxy for other concerns. Clinics may turn away obese patients seeking abortions because of a lack of training or equipment, experts said. 

“The history behind BMI was based on white, Scandinavian, European men,” she said. “It wasn’t made for guiding medical management.”

Siddiqui cited anesthesia as an example. Some anesthesia providers rely on insurance policies or older risk models that treat BMI as a disqualifier, even when evidence shows moderate sedation is safe. 

“If the person providing sedation is not educated or trained in caring for people with higher weights, that feeds into bias,” Siddiqui said.

Another common reason is equipment.

“That could be the bed that somebody lays on or the chairs that they are expected to sit in,” said Meghan Daniel, senior director of programs at the Chicago Abortion Fund, the largest abortion fund in the country. “Whether or not the literal physical structure of the clinic is made to accommodate their physical body.”

Siddiqui said BMI cutoffs are not without consequences. 

“When we use these numbers to prevent folks from getting essential, safe, time-sensitive care, we’re causing delays,” she said. “We’re causing increasing costs like travel, child care, loss of work, or income.”

Lexis Dotson-Dufault had an abortion years ago in Massachusetts while in college. Access was straightforward, even if emotionally difficult. Medicaid covered the cost. The clinic visit itself, she said, was the easiest part.

Years later, living in California and working in reproductive justice, Lexis found out she was pregnant again.

“I knew immediately that I wanted a surgical abortion,” she said. “I just wanted quick, in and out, done.”

She scheduled an appointment at FPA Women’s Health in Long Beach, where she had previously gone for routine care. She took time off work and flew her best friend in from across the country because she would need someone to drive her home after sedation.

During the appointment, after the ultrasound, a nurse returned to the room.

“She was like, we can’t do it today,” Dotson-Dufault said. “We have a visiting doctor, and they’re not comfortable with doing a surgical abortion on you because of your BMI.”

When Dotson-Dufault asked whether the regular doctor could perform the procedure later, the nurse left and returned again.

“She just hands me a bunch of different papers with different hospitals on it,” Dotson-Dufault said. “I immediately black out. I’m like, what are you handing me?”

She said she was later told the denial was not about the visiting physician, but rather that it was part of their policy.

When asked for comment, FPA women’s health pointed to their guidelines listed on their website which says that individuals with a BMI above 60 are considered high risk and will be referred to hospitals for their safety. Dotson-Dufault says that at the time, her BMI was 53.

“I wasn’t expecting it with abortion care, because abortion is just so low risk, so safe,” Dotson-Dufault said. “All you looked at was my weight and said, ‘That’s not OK.’”

Barriers to care

Abortion services are one area where size-based barriers surface, but not the only one.

“The fatter I’ve gotten, the worse my care has gotten,” Liakopoulos said. “My fatness does not signify anything related to my health.”

Christina Hughes, a size-inclusive doula who runs their company Big Fat Pregnancy out of Seattle, said these experiences mirror what many fat patients encounter throughout pregnancy and reproductive care.

“We start at a disadvantage from chairs squeezing into us, gowns not being big enough, tables not fitting our bodies,” she said. “We’re physically uncomfortable and mentally being perceived as not enough.”

They added that fear and shame shape how patients experience care.

“When we’re scared that our body can’t do it, can’t have a baby, can’t be a parent, we are already physiologically signaling to our body that we can’t do this,” they said.

That fear can make it harder for patients to ask questions or advocate for themselves when denied care. 

Abortion funds help connect patients with providers and coordinate care. Some are working to act as a buffer for patients by identifying clinic restrictions ahead of time. Daniel said the Chicago Abortion Fund surveys clinics about BMI limits, equipment constraints, and sedation policies so callers are directed to providers who can meet their needs. She said that among the dozens of clinics surveyed, a handful explicitly said they had restrictions about who they could serve.

“Everything that we do is guided by our callers,” Daniel said. “We want to make sure that the place they’re going to get abortion care is truly the best fit for them.”

Siddiqui said broader change requires provider education and accountability.

“There should be more provider education around this, and more research done for all body sizes,” she said. “Safe, accessible, effective reproductive care.”

Liakopoulos said what she wants is simpler.

“I just want fat people to be included. Fat people make up more than a third of this country. If all of us are being treated more poorly simply because our bodies are larger, that’s obviously a systemic problem,” she said. “If for abortion access, you have to kick a few fatties off the medical table, I think in the grand scheme, I think people think that’s worth it. And you know, being in that statistical margin is not a fun place to be.”

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