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Tough questions — and answers — on ‘late-term’ abortions, the law and the women who get them

Abortions late in pregnancy are rare but politically charged.

Abortion rights activists protest outside the Supreme Court during the March for Life in Washington on Jan. 18. (Jose Luis Magana/AP)

What are 'late-term’ abortions?

“Late-term” abortions are generally understood to take place during or after the 21st to 24th week of gestation, which is late in the second trimester. That gestational period roughly corresponds to the point of “fetal viability” or when a fetus might be able to survive outside the womb with or without medical assistance. However, there is no precise medical or legal definition of “late-term,” and many doctors and scientists avoid that language, calling it imprecise and misleading. They say “late-term” may imply that these abortions are taking place when a woman has reached or passed a full-term pregnancy, which is defined as starting in the 37th week.

How common is the procedure?

According to the Centers for Disease Control and Prevention, about 1.3 percent of abortions were performed at or greater than 21 weeks of gestation in 2015. In contrast, 91.1 percent were performed at or before 13 weeks and 7.6 percent at 14 to 20 weeks.

These percentages are similar to estimates by the Guttmacher Institute, a nonprofit research center that supports abortion rights. Guttmacher found that 1.3 percent of abortions took place at or over 21 weeks out of a total of 926,200 abortions in 2014.

Can a woman really get an abortion 'moments before birth’?

The idea that new legislation under consideration or that passed in several states would allow this to happen made headlines after a video of Virginia Del. Kathy Tran (D-Fairfax) went viral. In the 30-second clip, a Republican asked Tran whether a woman in labor would be allowed to have an abortion, and she answered yes. Tran later said she misspoke and that such a procedure would not be allowed: “Clearly, no, because infanticide is not allowed in Virginia, and what would have happened in that moment would be a live birth.”

“No, absolutely, no if she is in the middle of giving birth. That’s not how medical care works,” said Jenn Conti, an abortion provider in San Francisco and fellow with Physicians for Reproductive Health. She called the idea “sensationalized fake news" and said she believes a lot of the confusion comes from the use of the term “late-term” abortions. It’s “intentionally vague,” she said, so even though later abortions typically take place at the end of the second trimester people may believe they are much later in pregnancy.

President Trump repeated the misleading assertion in his State of the Union address, stating, “New York cheered with delight upon the passage of legislation that would allow a baby to be ripped from the mother’s womb moments before birth.” The New York law allows for women after 24 weeks of pregnancy to get an abortion if “there is an absence of fetal viability, or the abortion is necessary to protect the patient’s life or health.”

Fact Check: Abortion legislation in New York wouldn’t do what Trump said

I thought Roe v. Wade gave women the right to have abortions. Why do we need new state laws?

The 1973 U.S. Supreme Court decision recognized abortion as “a fundamental right” nationwide but stated that after the stage of viability, states could regulate abortions with the exception of when they were “necessary, in appropriate medical judgement'' to preserve the life or health of the pregnant woman.

The United States today contains a patchwork of restrictions and prohibitions on abortions that occur later in pregnancy. According to Guttmacher, 43 states prohibit some abortions after a certain point in pregnancy. Some use fetal viability as the cutoff, others the third trimester (which begins in the 28th week), and others a certain number of weeks post-fertilization or after a woman’s last menstrual period or of gestation.

States have imposed many other kinds of restrictions such as having a second physician attend the procedure or to have multiple doctors sign off that a later abortion is medically necessary.

With the appointment of conservative Justice Brett M. Kavanaugh to the Supreme Court in October, abortion activists have been trying to codify reproductive rights in state law in case the federal law falls.

But I read in a tweet that there are no medical reasons affecting a pregnant woman that would require a later abortion rather than delivery

Hamada, an obstetrician-gynecologist and theologian who has spoken out against abortion on Christian radio stations and Fox News, was echoing an idea expressed by some abortion opponents.

The American College of Obstetricians and Gynecologists (ACOG) refuted that idea in a statement released this week, stating that pregnant women may experience conditions such as “premature rupture of membranes and infection, preeclampsia, placental abruption, and placenta accreta” late in pregnancy that may endanger their lives.

“Women in these circumstances may risk extensive blood loss, stroke, and septic shock that could lead to maternal death. Politicians must never require a doctor to wait for a medical condition to worsen and become life-threatening before being able to provide evidence-based care to their patients, including an abortion,” the ACOG said.

Numerous groups that oppose abortion, including the National Right to Life Committee, allow for exceptions when the pregnant woman’s life is in danger. Many also accept it in cases of incest or rape.

Jen Villavicencio, an obstetrician-gynecologist in the Midwest, explained that, in the vast majority of cases in which a woman becomes seriously ill late in pregnancy, doctors are working to save both the woman and the fetus. But in rare situations, it’s clear the fetus will not survive, and then the patients and their loved ones must make a decision about whether to put a sick woman at further risk with a delivery.

“This is incredibly complex. This is not something that can be litigated on Twitter,” she said, adding that “one of the things I’m concerned in all the rhetoric is that we’re missing compassion and empathy for that patient and what she’s going through.”

Jennifer Gunter, obstetrician and gynecologist practicing in California, offered this scenario on her blog: “A good example is a woman at 26 weeks who needs to be delivered for her blood pressure — that is the cure, delivery. However, because of her high-blood pressure fetal development has been affected and her fetus is estimated to weigh 300 g, which means it can not live after delivery. She will be offered an abortion if there is a skilled provider. This is safer for her and her uterus than a delivery.”

Who is obtaining later abortions?

There isn’t a lot of research on the subject, but the best information we have comes from a study from the University of California at San Francisco. It found women who got later abortions were similar in “race, ethnicity, number of live births or abortions, mental or physical health history or substance use” to women who got an abortion in the first trimester. They were mostly unmarried, and many were already mothers.

What percentage of women getting later abortions are doing it to protect their own health or life or because of a fetal abnormality?

A Congressional Research Service report published in April 2018 quoted Diana Greene Foster, the lead investigator on the study above and a professor at UCSF’s Bixby Center for Global Reproductive Health as saying “[t]here aren’t good data on how often later abortions are for medical reasons.”

“Based on limited research and discussions with researchers in the field, Dr. Foster believes that abortions for fetal anomaly ‘make up a small minority of later abortion’ and that those for life endangerment are even harder to characterize,” the report stated.

What are other reasons women are getting later abortions?

In a paper published in 2013 by Foster and Katrina Kimport on women who got abortions for reasons other than a danger to life or health or a fetal anomaly, they cited logistical delays such as difficulty finding a provider, raising funds for the procedure and travel costs.

Foster and Kimport described five “profiles” of women in the study: “They were raising children alone, were depressed or using illicit substances, were in conflict with a male partner or experiencing domestic violence, had trouble deciding and then had access problems, or were young and [experiencing their first pregnancy].”

Kimport, a medical sociologist at UCSF whose research focuses on gender, sexuality and social movements, followed up on the research in 2018 with 28 new interviews of women who got later abortions. She said about half were lacking critical health information about their fetus earlier in their pregnancy. Kimport described in an interview how one woman was told by her doctors that something in her 20-week scan looked suspicious but it wasn’t until weeks later that it was clear the fetus had significant abnormalities.

The other half of the women had challenges finding a provider, getting necessary approvals from doctors in states that require them, or had financial constraints. All the women in the study traveled to other states to get the procedure done.

“These are people who wanted an early abortion and tried to get one but were unable to do so because of the substantial obstacles that were placed in their path,” Kimport said.

This post has been updated.