What are “late term” abortions?

Although most abortions in the US occur in the first trimester, there are many reasons why an abortion later in pregnancy may be necessary—including concerns about the health of the pregnant person or the fetus. 

Recently, later abortions have been a major topic in the news and political debates, especially as a conservative talking point in the U.S. presidential race. The Supreme Court’s decision to overturn Roe vs. Wade in 2022 and the introduction of Dobbs vs. Jackson Women’s Health Organization ruling have intensified the restriction and criminalization of abortion in many states, fueling misinformation and stigmatization around later abortions. However, stigma and politicization of later abortions is not new. Let us be clear, later abortions are not “post-birth abortions” as some politicians have claimed—they are a necessary health care service.

In this article, we will address and debunk the myths often repeated in these discussions and clarify the complex, deeply personal reasons why someone might need a later abortion. It's important to understand the real facts, not just the political rhetoric, surrounding this often-misunderstood aspect of abortion care.

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What are “late term” abortions?

Later abortions have no set definition, but can be used to describe abortions where the gestational age of a pregnancy becomes a consideration in a person’s ability to access abortion, often when a pregnancy is 21 weeks or more. Approximately 1% of all abortions in the US happen in this timeframe. The majority of U.S. states restrict abortion based on gestational age to some degree, changing what may be considered a later abortion from state to state.

“Late term” abortion is a political term used by anti-abortion politicians to describe later abortions, or abortions later in pregnancy. “Late term” abortion is not used in the medical field, and is a phrase that anti-abortion groups created to shame people who have abortions past a specific point. This political term leads to misinformation that instills fear, stigmatizes people seeking a later abortion, and makes some health care providers hesitant to educate their patients about abortion care in the later stages of pregnancy. It is important that when discussing later abortions, accurate terminology is used to reduce stigma and foster understanding of why they are an essential health service. Due to the prevalence of the use of “late term” abortion in the media and political discourse, you will continue to see us use this term in quotations to highlight its medical inaccuracy while still ensuring that those who may be looking for accurate and reliable information about later abortion are able to find this guide.

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What does gestational age (GA) mean?

Gestational age, or GA, is an estimate of how far along a pregnancy is based on when the pregnant person’s last period was. A health care provider can confirm a person’s gestational age by performing an ultrasound to measure elements of the pregnancy. For pregnancies carried to term, the due date is set for 40 weeks gestational age, although most people will go into labor and give birth between 37 and 41 weeks. 

So, why does GA matter in abortion care? A health care provider will use GA to determine if a pregnant person is eligible for medication vs. procedural abortion. If someone is going for a procedural abortion, knowing the GA can help their provider choose the best procedure. 

Gestational age is also the basis of most state abortion restrictions. The majority of states in which abortion is still legal limit abortion depending on how far along a person’s pregnancy is. Forty-one states have abortion bans or restrictions in effect, including:

• 14 states with a total abortion ban with limited exceptions
• 27 states with abortion restrictions based on gestational age with limited exceptions:
  • 8 states restrict abortion at or before 18 weeks gestation with limited exceptions
  • 19 states restrict abortion at some point after 18 weeks with limited exceptions:
    • 11 of these ban abortion beyond fetal viability without defining a GA limit

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What is fetal viability, and when does it happen in pregnancy?

Fetal viability, or viability, describes the point in pregnancy where a pre-term baby can survive outside the womb. Viability usually depends on several factors, including sex, weight, genetics, circumstances surrounding delivery, and the availability of highly skilled neonatal health care professionals. 

However, viability is not as clear-cut as many people think it is, nor is it an accurate predictor of a baby’s survival. Though many states consider viability to be around 24 weeks GA, many babies born less than 28 weeks gestational age don’t end up surviving due to complications from being born prematurely; and for those that do survive, they can have life-long complications.

Many people seek later abortion after finding out that their fetus is not developing normally, and in those situations, gestational age doesn’t factor into these survival rates. Others may need to have a later abortion because of pregnancy complications that could impact their own health; if the pregnant person doesn't survive, their fetus likely won't either.

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Why do people have “late term” abortions?

Pregnant people seek later abortions for a variety of reasons, and it’s not as straightforward as some may think. In some cases, ending a pregnancy in the second or third trimester is done because of health concerns, a lack of access to abortion care, or being unaware of the pregnancy until later on. Regardless of the circumstances, a person in need of a later abortion should be treated with care, compassion, and understanding from their loved ones and health care team.

Here’s a deeper look into why someone may pursue an abortion later in pregnancy:

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Pregnant person’s health

Many life-threatening pregnancy complications, such as preeclampsia, infections, gestational diabetes (if left unmanaged), vaginal bleeding, anemia, placenta previa, placenta accreta, or depression and anxiety can develop later in pregnancy. Depending on the severity of these medical conditions, a later abortion may be necessary to save the pregnant person’s life. 

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Fetal abnormalities

Although some fetal abnormalities can be discovered within the first trimester, those that are fatal to the fetus may not appear until an anatomy scan or ultrasound is performed during the 20th week of pregnancy. Because fetuses with lethal abnormalities are more likely to pass away before or right after birth, a pregnant person may decide to terminate the pregnancy rather than take the risk of continuing the pregnancy to term. This can be to avoid risk of developing a life-threatening pregnancy complication, or to move forward with the healing and grieving process on their own terms.

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Pregnancy discovered after the first trimester

There are situations where a later abortion may be pursued because a person didn’t realize they were pregnant until later on. This could be due to a number of factors and health conditions that may mask the presence of a pregnancy. The Turnaway study was the first long term study to examine the impact of receiving (or being denied) later abortion care on mental health, physical health, and socioeconomics. In this study, many participants couldn't pursue abortion care earlier in pregnancy due to significant barriers to accessing care.

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Barriers to obtaining care earlier

In the Turnaway study, participants who sought abortion care later in pregnancy often faced the following challenges:

• They didn’t realize they were pregnant until they were already beyond the gestational age limit of their state
• They didn’t know where to access abortion care
• They couldn’t get transportation
• They didn’t have insurance
• They didn’t have the funds to pay for the procedure. 

Getting an abortion can be quite expensive for many pregnant people, which has been shown to lead to a delay in accessing care as they try to save up the money. A report revealed that the median out-of-pocket costs for medication abortion were $568, $625 for first-trimester procedural abortions, and between $465 to $2,885 for second-trimester procedural abortions in 2021. Due to government regulations, federal health insurance cannot be used to cover abortion care, and many private insurances also do not cover abortion care. This doesn’t factor in other costs like transportation, lodging, childcare, or loss of work—which can inflate the costs and increase the barriers.

States with bans on “late term” abortions

Later abortions aren’t as straightforward as anti-abortion politicians try to make it seem. Many states have exceptions to their gestational age restrictions on abortion, but the realities are much more nuanced than what the exceptions allow for. The most common exceptions for abortions typically fall into three categories: there is a risk to the pregnant person’s health, they’re pregnant from rape or incest, or there are fetal abnormalities that impact its health or viability. Even so, getting approval, financial resources, and support for a later abortion even when qualifying through an exception can further delay treatment.

Want to know how late you can have an abortion in your state? Check out our state guides to get the details on abortion laws and average cost in your state.

Since the passing of Dobbs vs. Jackson Women’s Health Organization, there have been several situations where health care providers have had difficulty determining when an abortion is legal to save a pregnant person’s life. In addition, research reveals that post-Dobbs, pregnant people in states with abortion bans have higher death rates than those living in states with greater abortion access. This demonstrates that restrictions and bans with exceptions for risk to the pregnant person’s life doesn't actually increase safety for pregnant people needing medically necessary later abortion care.

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Are “late term” abortions common?

Ending a pregnancy later in gestational age is very rare in the United States. According to the CDC, 0.9 percent of abortions in 2021 occurred after 21 weeks. 

In the post-Dobbs era, the total number of abortions across all GAs in the United States has actually increased. A report from the Society of Family Planning revealed that in the two months before the overturning of Roe vs. Wade, the average monthly number of abortions was 82,115. Twelve months after the Supreme Court’s decision, that average increased to 82,298. This is thought to be due to states supportive of abortion helping to reduce barriers in addition to an increase in abortions delivered by virtual-only clinics like Hey Jane, with the monthly average increasing from 4,045 abortions per month to 6,950.

Despite the increase in abortions across the country, the specifics regarding later abortions in the post-Dobbs era are unknown at this time. With the proliferation of abortion bans across numerous U.S. states that make accessing abortion more difficult, more expensive, and further from home, later abortions are likely more common than they were before Roe v. Wade was overturned as people need more time to organize and travel for care.

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Are “late term” abortions safe?

Despite the misconceptions surrounding later abortions, they are safe and effective. Cases of complications from later abortions are reported to be less than 5 percent. Another research study revealed that pregnant people were 14 times more likely to die during or after giving birth than to die from abortion complications. 

Getting an abortion later in pregnancy also has long term and generational benefits compared to the demonstrated harms of continuing an unwanted pregnancy. The same Turnaway study revealed that pregnant people who were denied an abortion were more likely to experience serious complications at the end of their pregnancy, face increased mental and physical health conditions, increased rates of poverty that lasted generations, and increased exposure to intimate partner violence compared to those who were able to receive later abortion care.

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“Late term” abortion in the news

Abortion has once again become a major topic in the U.S. news cycle, especially in light of recent political debates and legislative changes. Here is the latest development:

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September 10, 2024: Presidential debate tackles abortion access

During the recent presidential debate, the topic of later abortions took center stage, becoming a heated point of contention among the candidates. Conservative candidate Donald Trump used the issue to paint a stark (and incorrect) picture of abortion care, framing later abortions as extreme and common procedures that should be heavily restricted or outright banned.

In contrast and in favor of abortion rights, Kamala Harris pushed back against this narrative, emphasizing that later abortions are extremely rare and often medically necessary. Vice President Harris underscored the importance of protecting personal health decisions and the need for compassion and understanding for those who find themselves in complex situations that require later abortion care.

The debate highlighted the stark divide in the political landscape over abortion access, with later abortions being used to galvanize support on both sides. As the presidential race continues, later abortions will likely remain a polarizing issue, with candidates using it to define their positions on reproductive rights. For voters, understanding the realities behind these political soundbites is crucial in navigating the future of abortion access in the U.S.

Want to learn more about how you can support reproductive freedom in the 2024 US election this fall? Check out our resource hub with key dates, voter tools, and Hey Jane’s free digital toolkit to energize others to vote on November 5, 2024.

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Resources and support for later abortions

If you or someone you know is seeking more information or support for a later abortion, here are some helpful resources to explore:

• Abortion Finder: A search platform for people to find abortion clinics nationwide.  
• Who Not When: A people-centered resource to help people better understand later abortions.
• Brigid Alliance: A referral-based service that offers help with travel, meals, lodging, and childcare to people who are 15 weeks pregnant or more seeking an abortion. 
• Later Abortion Initiative: A project that helps pregnant people and their families learn more about later abortions and provides resources to help them find an abortion care provider.