According to 2017 data from the Guttmacher Institute, 88% of abortions took place before the end of the first trimester of pregnancy at 12 weeks. (File/Getty Images)
It’s an oft-repeated talking point of anti-abortion rights groups and Republican politicians, before and after the June 2022 Dobbs decision — that those who are supportive of abortion rights also must be in favor of abortions that happen during the last weeks of pregnancy, or even “after birth.”
Former President Donald Trump brought it up in the June debate against President Joe Biden, saying Biden’s position on restoring abortion access would lead to doctors being able to “take the life of the baby in the ninth month, and even after birth.”
Trump’s vice presidential running mate, Republican Sen. J.D. Vance of Ohio, told Fox News recently that Biden “wants taxpayer-funded abortions up until the moment of birth.”
And candidates in states such as North Dakota and Montana have campaigned on that rhetoric in recent months, saying some states allow “post-birth abortions” or abortion “the day before” a due date.
In reality, abortion “after birth” does not happen, because it would be categorized as murder under all state laws.
And while abortions do occur later in pregnancy, they are exceptionally rare and happen for many diverse reasons, such as a fatal fetal diagnosis and financial or travel barriers that extend timelines.
Abortion-rights advocates say the rhetoric is used because public opinion polls show support becomes more mixed for abortion after 24 weeks, which is the second trimester of pregnancy and the medically recognized point of viability, when a fetus can reasonably be expected to survive outside of the womb with medical interventions.
That argument was seemingly bolstered by an anti-abortion group’s campaign strategy meeting against Amendment 4 in Florida. That ballot question would restore abortion access to 24 weeks in the state where a six-week ban is currently the law, before many people know they’re pregnant. During a presentation, the campaign organizers displayed a slide that said, “How we win: We win by talking about late-term abortion.”
Even before Roe v. Wade was overturned by the Dobbs decision in summer 2022, abortion was only protected as a federal right until viability, at which point it could be restricted by states.
In South Carolina, the so-called 20-week ban signed by then-Gov. Nikki Haley in 2016 actually banned abortions past 22 weeks’ gestation, not 20, due to that law counting pregnancy weeks differently than doctors. It was never challenged in court, partly because 22 weeks is so close to recognized viability, and it still allowed for abortions after that in cases of a fatal fetal anomaly.
Plus, the three clinics that provide abortions in South Carolina already didn’t offer abortions past the first trimester. That 2016 law only affected abortions performed in South Carolina’s hospitals.
If a Democratic presidential administration or Congress were to re-establish and codify Roe as the standard, third-trimester abortion would likely remain restricted in many states. In some states where abortion is legal and there is no restriction by gestational age, such as Alaska, it is still unavailable past the second trimester because there are no clinics that provide it.
According to 2017 data from the Guttmacher Institute, an abortion-rights organization that gathers provider-specific data from across the country, 88% of abortions took place before the end of the first trimester of pregnancy at 12 weeks. A little over 10% happened between 13 and 20 weeks, and 1.3% occurred after 21 weeks, about halfway through the second trimester. Out of 862,320 abortions tracked that year, that means 11,210 happened after 21 weeks.
The Centers for Disease Control and Prevention shows a slightly lower number of 1.1% after 21 weeks, but does not receive abortion data from Maryland, as it is voluntary reporting. Guttmacher reaches out to individual clinics to collect data, and several of the small number of clinics that take patients later in pregnancy are located in Maryland.
‘I don’t need people to feel comfortable with it’
The time between 21 and 40 weeks is a long span in a pregnancy, and in 20 states, abortion is generally banned after 22 or 24 weeks.
Only nine states and the District of Columbia don’t ascribe gestational limits to their abortion laws, and of those, only four — Maryland, New Mexico, Oregon and Colorado — and the District of Columbia have clinics that openly say they will take patients past 28 weeks.
One of those is Partners in Abortion Care in Maryland, where Dr. Diane Horvath is chief medical officer. That clinic opened in October 2022 and saw about 500 patients in its first year of operation.
Horvath told States Newsroom that because there are so few clinics that will take patients at an advanced stage of pregnancy, the people who come to them have generally had to make it through many barriers to access care.
That includes their home state laws, travel barriers, time restrictions and costs. In 14 states, a near-total ban on abortion is the law, and five others have bans before 12 weeks. Since last August, South Carolina has banned abortions past six weeks of pregnancy.
SC abortion law can stand at 6 weeks of pregnancy, judge rules
“Nobody ever thinks they’re going to need a later abortion, but when you need it, you need it 100%,” Horvath said.
The idea of an abortion happening in a person’s third trimester of pregnancy can be uncomfortable for the average person, Horvath said, and for some physicians.
Some doctors may have their own objections to it, or they may just choose not to make their feelings known about it at all for fear of being targeted by anti-abortion activists. Nobody should have to participate in that type of care, she said. But when a position is open at her clinic, she receives hundreds of applications.
Horvath said in all the time she’s been practicing abortion care, she’s never seen a patient who walked in during their third trimester of pregnancy who wanted to terminate simply because they were tired of being pregnant, as some anti-abortion groups might suggest. The idea that people are choosing that path “carelessly” is just wrong, she said.
“The circumstances in which people are seeking abortions later in pregnancy are really dire. This is not to say every abortion has horrible circumstances, but by the time you find yourself later in pregnancy, lots has gone wrong for you, and this may be due to something that was completely out of your control,” Horvath said. “It’s so easy to demonize when you don’t want to understand something.”
The most important point, she said, is that there isn’t a line in pregnancy where the government becomes more well-equipped to make decisions about a pregnancy than the person carrying it, and there is no possible way to fully understand what a person making that decision is going through.
“It’s possible to feel uncomfortable about this care and the circumstances under which it occurs and still support someone’s ability to get that care when they need it,” Horvath said. “I don’t need people to feel comfortable with it.”
Women interviewed about abortions had fetal anomalies, financial difficulties
As States Newsroom has reported through a series called “When and Where: Abortion Access in America,” there are many situations when a clinical diagnosis of severe fetal anomalies happens at a routine anatomy scan, which is typically scheduled at 20 weeks.
That leaves only two weeks to get an appointment in a majority of states with legal access — and post-Dobbs, it can be a tall order to get an appointment that quickly, as clinics have been inundated with patients from other states where no access is available at any stage.
Katrina Kimport, a professor at the Advancing New Standards in Reproductive Health program at the University of California San Francisco, has published at least two studies about abortions that take place in the third trimester, including one that detailed interviews with 28 women of different races between the ages of 18 and 46. Their gestational ages ranged between 24 and 35 weeks.
One woman in Kimport’s study who had already had a complication with a previous pregnancy was assured at 20 weeks that everything was going well this time. But at 29 weeks, her doctors observed problems with the fetus’ brain and initially said she shouldn’t worry too much. But further testing showed pieces of the brain were missing or concave, and specialists eventually told her there was no possibility it was compatible with life.
“There’s a heartbreaking number of ways that pregnancy can go wrong,” Kimport said.
Two women didn’t know they were pregnant until their third trimesters — both of whom were still having regular menstrual cycles, indicating they were not pregnant.
Others reported significant financial difficulties affording the procedure, which can cost at least $500 during the first trimester and increase to tens of thousands of dollars in late stages of pregnancy, on top of the costs of out-of-state travel for some of the women.
One of the women reported that she and her boyfriend were living on the street. To the extent any of them received financial assistance to obtain the abortion, according to Kimport’s research, it was through local or regional abortion funds. Many insurance providers do not cover out-of-state abortion care.
Anti-abortion physician says there is ‘never’ a reason for abortion late in pregnancy
The Charlotte Lozier Institute, a research arm of anti-abortion rights organization Susan B. Anthony Pro-Life America, did not grant an interview for this story, but sent along its own prepared papers on the subject.
In one of those papers, the Institute points out there is some research that indicates fetal anomalies or maternal health conditions make up a minority of abortions that happen late in pregnancy, and more often it is because of unplanned pregnancy, economic considerations and relationship issues.
Horvath said it is true that the circumstances include people who are dealing with complex situations in their own lives, like one patient she could remember whose house burned down. That patient was already in a shelter with her children, Horvath said, and could barely provide for them.
While some might suggest having the child anyway and putting it up for adoption at that point, Horvath said that isn’t something that should be forced on a person.
“The idea that somebody owes society or an infertile couple a baby is not just,” she said. “We have one of the worst maternal and infant mortality rates in the world, so to force someone to continue a pregnancy beyond the point they’ve decided is not the right time is putting them at risk to give a baby to someone else.”
The Institute also quotes an anti-abortion rights physician who says there is never an appropriate situation for an abortion at that stage of pregnancy to take place.
“The infant may need to be delivered prematurely and die as a result of that, but it is not necessary to take the infant’s life,” said Dr. Byron Calhoun, a known anti-abortion activist perinatologist. “Further, if a fetus has an adverse prenatal diagnosis, all patients should be offered perinatal hospice care since this is far better for maternal health than any elective abortion. Perinatal hospice allows the parents to be parents and provide all the love they can for their child.”
The Institute did not provide evidence that hospice care is better for maternal health, but perinatal hospice is an option for anyone who wants to do that rather than have an abortion, when the fetus is typically given an injection to stop the heart and then removed from the uterus.
Kimport said she has also interviewed women who could not deliver a baby vaginally because of a health condition and would be forced to have a Cesarean section surgery if abortion was not available.
Physicians who are affiliated with the Lozier Institute have also told news outlets such as the Washington Post that “up to the moment of birth” means any stage of pregnancy past 22 weeks, whereas others would think of it as the last two to three weeks of a 40-week pregnancy.
“Some of the failure to push back on these really outrageously false claims comes from the fact that there are so many things that are wrong about it and it’s hard to know where to start,” Kimport said.
SC Daily Gazette Editor Seanna Adcox contributed to this report.