Defenders of legal late-pregnancy abortion tend to draw attention to tragic circumstances families face in which they received a fatal or life-altering diagnosis, putting them in the position of terminating what had otherwise been a wanted pregnancy.
Families and doctors have testified to such stories. But, despite these accounts, there isn’t evidence that most later abortions in the United States happen for medical reasons. Federal data and data from the Guttmatcher Institute, which supports abortion rights, show that roughly 1.3% of overall abortions, or between 9,000 and 11,000 abortions a year, happen after 20 weeks into a pregnancy, but neither those or other related studies established what the motivations were.
Women do receive fatal diagnoses late in a pregnancy. Women have abortions after they learn a fetus has organs that are missing or developing outside the body. They also have abortions after being diagnosed with preeclampsia, a life-threatening condition. While it’s possible such cases make up a large proportion of later abortions, that information can’t be gleaned from current studies.
Despite the scarcity of good information, anti-abortion advocates have pushed Congress to ban abortions after 20 weeks into a pregnancy, trying to put Democrats on the spot at a time when Gallup polling shows most voters would support such a measure. Yet, abortion rights groups say people who oppose later abortions don’t understand the circumstances. They contend there should be no cutoff date for abortion given that such decisions are complicated and families don’t terminate pregnancies lightly.
“Each pregnancy and each circumstance is unique,” Planned Parenthood said in a recent fact sheet. “When people are making personal medical decisions, one-size-fits-all laws don’t work.”
The Senate will take up bills this week to highlight abortions late in pregnancy. One bill, the Born Alive Infant Child Protection Act, would mandate that babies born alive after failed abortions get transferred to a hospital and receive the same care as a premature infant.
There is little reliable information about how often abortions fail, as only eight states mandate reporting of such cases, according to the Family Research Council, which opposes abortion. The information from these states show 170 cases have been reported, though there aren’t any details about the circumstances.
Abortion rights groups and most Senate Democrats have fought the legislation, saying infanticide is already illegal and that cases of live birth during attempted abortions do not occur when credible physicians are involved. They also assert that the bill would force doctors to pursue drastic, futile medical interventions in cases where parents chose to deliver a baby with a severe illness that wouldn’t live.
The other bill up for a vote, the Pain Capable Unborn Child Protection Act, would fine or imprison doctors who perform abortions after 20 weeks into pregnancy. The bill makes exceptions for cases where the pregnancy threatens a woman’s life, but not her health, and for cases of rape or incest.
To bolster the case that such a law is needed, anti-abortion activists often cite a 2013 study from researchers at the University of California, San Francisco, which found that women who obtained abortions later in pregnancy did so for reasons similar to those who sought abortions earlier. The research, often credited by both sides of the abortion debate as the largest study on the matter, excluded women who sought abortions for life endangerment or fetal abnormality. Anti-abortion advocates say that illustrates women are getting abortions after 20 weeks for nonmedical reasons.
“They acknowledge that these later abortions are not for reason of fetal anomaly or life endangerment, which is a direct contradiction of the feature stories that get written” in news reports, said Mallory Quigley, spokeswoman for Susan B. Anthony List, which seeks to elect anti-abortion politicians.
But the lead author of the study, Diana Greene Foster, has urged caution about interpreting her research, noting it only assessed abortions up to the second trimester and not into the third.
“The number of women seeking abortion goes down dramatically with every week of pregnancy,” she tweeted. “So 20-week bans disproportionately affect the women who I profiled in my article. But that doesn’t mean that women seeking abortions in the third trimester are just like those in the second trimester.”
The study found the 218 women involved had various reasons for having the abortion in the second trimester, such as not knowing about the pregnancy, trouble deciding what to do, and disagreeing with a partner over what to do. They also struggled to pay for the abortion, didn’t know where to go, or couldn’t get to the appointment. The findings were cited in a 2018 study from the Congressional Research Service.
Greene Foster, who is director of research for Advancing New Standards in Reproductive Health, was not available to elaborate on the study in an interview, but a spokesperson confirmed she wasn’t aware of a definitive breakdown of reasons for abortion in the third trimester. A clarification article she wrote in 2013 stated, “Little is known about the relatively few abortions occurring in the third trimester, although late detection of fetal anomaly and increasing incidence of maternal health complications with advanced gestation suggest that reasons for abortion in the third trimester may differ from those in the second.”
The Washington Examiner requested details about later abortions from several abortion rights organizations. They either pointed to online summaries about the matter, which did not break down shares of abortions tied to fetal anomalies or life endangerment, or referred to other organizations. A spokesperson from the American College of Obstetricians and Gynecologists, a professional organization, said that identifying life-altering diagnoses “most commonly occurs after 20 weeks, so these account for a higher percentage of abortions than at earlier gestational ages.”
In a brief, ACOG also raised other reasons that women might have a later abortion, including when they tried to end a pregnancy earlier but state restrictions got in the way.
Seven states and the District of Columbia do not have any gestational bans on abortions, according to the Guttmacher Institute. When later abortions do occur, they cost thousands of dollars and can take several days. If women are in an emergency situation, they may be getting care at a hospital, where data aren’t tracked the same way as they would be at an abortion clinic.
ACOG supports abortion prior to viability but “is opposed to abortion of the healthy fetus that has attained viability in a healthy woman.” The group specifies that survival “may vary with each pregnancy and is a matter for the judgment of the responsible healthcare provider.”
Though neither of the bills up for a Senate vote this week are expected to pass, they reflect long-simmering anger from anti-abortion groups about the permissiveness of later abortions. Under the court’s 1973 Roe v. Wade decision, states must allow abortion until at least fetal viability, which is generally understood to be roughly 24 weeks into a pregnancy.
Doe v. Bolton, the court’s lesser-known companion ruling issued on the same day, provided for abortions after viability if the pregnancy threatened a woman’s life or health. The justices defined “health” to refer not only to a woman’s physical and psychological health but her emotional health, familial circumstances, and age. Anti-abortion advocates have long said such a definition is too broad. Quigley described the policy as “legal abortion up until the moment of birth.”
“The idea that babies are born alive during failed abortions is so hard to believe at first, but that’s because Americans are extremely unaware of the permissive abortion policies in this country,” she said.
While anti-abortion advocates acknowledge families receive devastating medical diagnoses later in a pregnancy, they’re against abortion even in these cases. Instead, they favor letting fetuses die naturally or having hospitals provide perinatal hospice, which alleviates the baby’s pain after birth and allows families to spend time with the infant before death.
Dr. Robin Pierucci, director of a neonatal intensive care unit and who is also associate scholar at the anti-abortion research organization Charlotte Lozier Institute, said she was also concerned about doctors getting diagnoses wrong. Her goal in providing care for life-threatening medical conditions was to try to help both moms and babies arrive at a safe delivery, she said.
“My goal is not ever to prolong suffering,” she said.
