The case of one refugee has forced us to face the uncomfortable truth about late abortion.

The stigma surrounding late abortions comes largely from the public’s ignorance surrounding the medical and personal tragedies that require such choices.

It is estimated that more than 90 per cent of terminations nation-wide are done before 14 weeks.

Abortions after 20 weeks are extremely rare. Yet, even fervent supporters of choice express incomprehension at the need for timely, skilled and accessible services for the few women who require later terminations. “I don’t get it,” more than one has said to me over the years. “Why did she leave it so late?”

The unfolding tragedy of “Abyan” reveals much about the complex and compelling medical and social circumstances that delay women’s choice and access.

Abyan is a 23-year-old Somali refugee who became pregnant from a rape on Nauru, the desolate and desperately poor island where she has been detained for more than two years as part of Australia’s off-shore processing regime.

She was brought to Australia for a first trimester termination, but was spirited back to Nauru five days later without having undertaken the procedure. This was either because (according to the government) she repeatedly refused it or (according to her lawyers) she requested additional medical and psychological support to make the decision.

She is now more than 17 weeks pregnant.

Refugee expert Ian Rintoul has said that, “The treatment of Abyan is emblematic of the treatment of refugee and asylum seekers in general on Nauru.”

It’s also emblematic of the horrendous circumstances that lead women to seek abortion at later stages of pregnancy.

Disadvantaged women, including recent migrants and refugees, are over-represented in the small group of women seeking later abortions. Language, cultural beliefs about sex and histories replete with loss and violence are the usual backstory of refugees and all serve to complicate a woman’s path to a service provider who can and will help her.

These qualities make her easy prey for anti-choice activists who will seek to discourage or frustrate her, in hope of pushing her past the time period where she can access or afford a safe, legal service.

Rape is the form of trauma most likely to lead to a diagnosis of Post-Traumatic Stress Disorder (PTSD). A European Parliament report lists symptoms of PTSD as nightmares, flashbacks, heightened arousal and/or numbness.

It seems safe to assume that Abyan arrived on Nauru in a fragile state. After her family was killed in a rocket attack, she fled a country terrorised by al-Shabaab. After the long journey to Australia by boat, she was detained on Nauru as part of Australia’s off shore detention policy. Then, she was sexually assaulted.

Abyan has refused to describe her attacker to police. A spokesman for the UN office of the high commissioner of human rights says this is because she is, “understandably afraid of reprisals. She does not feel safe, given that her alleged attacker lives on Nauru, which is a very small island.”

The Australian government seems to have belatedly recognised what the high commissioner described as Abyan’s, “very fragile mental and physical condition,” and the way in which the rape and her ghastly treatment by officialdom since have left her “deeply traumatised.”

Minister Peter Dutton announced last week that they are flying her back to Australia immediately to “see doctors…not only in relation to her decision about whether she wishes to proceed with the termination, but also in relation to the significant ongoing mental health issues”.

It is imperative there are no further delays to Abyan obtaining the compassionate care she so desperately needs. She may decide she doesn’t want to terminate. But if she does want to proceed, every day of delay increases the medical risks she faces as well as the challenge of finding medical institutions and medical staff able to provide the skilled and sensitive service she needs

Of course, migrant and refugee women are not the only Australians who can have their abortion decision or access to quality and affordable abortion care delayed.

Abortion can be delayed because of a late diagnosis of a fetal abnormality in a wanted pregnancy or the failure of very young or menopausal women to recognise early signs of pregnancy. Women with substance abuse problems or mental health issues may require extensive medical advice and support before they make a decision whether to continue the pregnancy.

Pregnant women who fall victim to partner violence or suffer the devastating news that another child has cancer or their breadwinning partner has lost his job may no longer feel they can care for a newborn.

Women’s presentation for abortion can also be delayed by medical incompetence (like a failure to diagnose pregnancy) or obstructed by ignorant or pro-life doctors who wrongly advise that abortion is illegal or that they are too far gone.

Anti-choice activists and politicians invite us to presume women’s reasons for abortion and to judge those reasons as selfish or otherwise wanting.

I believe the truly compassionate must go the other way. As Abyan’s story shows, abortion at later gestations reflect a complex world of pain and hardship. Deciding what the right thing to do for herself and her family is hard enough.

Women should not have to suffer the judgment of others.