There is no quantifiable data to support the idea that all or even most later abortions are medically necessary.
Defining our terms
Here we use the phrases “later abortion” and “late-term abortion” to mean abortions at or after 21 weeks gestation. We use the phrase “medically necessary” to refer to abortions where the reasons cited were risk to the woman’s life, risk to the woman’s physical health, or fetal anomalies.
Objections to the definition of “medically necessary.”
We understand there are objections to characterizing some or all of these situations as “medically necessary” abortions. Some people don’t consider a procedure that destroys a fetus an “abortion” if the procedure is done with the intent of saving the woman’s life and not the intent of destroying the embryo or fetus. Some don’t believe there are any scenarios where a woman’s life or health is better protected by later abortion (i.e. a procedure that does not result in a live birth) than by induction of labor or c-section. Some view abortion due to fetal anomalies as a type of involuntary euthanasia, not medically necessary to the woman and not clearly in the best interest of the fetus. Some object to calling abortions for fetal anomalies “medically necessary” because not all such anomalies are life-threatening to the fetus (possibly the most controversial example being the very high rate of abortion when the fetus has Down syndrome).
SPL recognizes the debates about how to define “medically necessary” abortions. However, here we leave those debates aside in order to demonstrate that even if a person accepts a more flexible definition of “medically necessary” abortions, most later abortions are still not medically necessary.
Most women seeking abortion at 21 weeks or later do so for non-medical reasons, such as:
- Not realizing sooner that they were pregnant,
- Struggling to find the resources (such as time, money, transportation) to abort earlier, or
- Difficulty deciding sooner whether they wanted to continue carrying the pregnancy.
Here we collect resources exploring this issue.
Data and Studies
Perspectives on Sexual and Reproductive Health (2022)
Is third-trimester abortion exceptional? Two pathways to abortion after 24 weeks of pregnancy in the United States Study profiles women who received abortion at 24 weeks or later, and discusses how some sought third trimester abortions because of late recognition of fetal abnormality, whereas others aborted in the third trimester because they didn’t have the resources to abort earlier or because they didn’t find out they were pregnant until the third trimester.
The new information respondents received that led to their decision to obtain an abortion [after 24 weeks gestation] was not exclusively related to fetal health. For some respondents, the new information they obtained was that they were pregnant.Katrina Kimport
Contraceptive plans before preoperative assessment and at procedure in surgical abortion patients: From January 2015 to December 2016, one California university aborted an average of 10 fetuses per month at 20+ weeks who had no fetal anomalies.
Timing of pregnancy discovery among women seeking abortion: More than 1 in 5 women seeking second trimester abortion didn’t realize they were pregnant until after 20 weeks gestation. Study participants were pregnant with no known fetal anomaly.
Arizona Department of Health Services (2012-2017)
Arizona state data over several years indicated approximately 80% of abortions at 21 weeks or later were not for maternal or fetal health issues.
A spokesman for Clinton’s campaign told us that she meant that many late-term abortions — not all or even most — are because of medical reasons. But that’s not what she said. Her statement left the impression that the majority, if not all, late-term abortions are medically necessary. The available evidence does not support that assertion.Dave Levitan, 9/29/15
Perspectives on Sexual and Reproductive Health (2013)
Data suggest that most women seeking later terminations are not doing so for reasons of fetal anomaly or life endangerment.Diana Greene Foster and Katrina Kimport
The Baby Butcher, Revisited: Pro-choice author William Saletan outlines research suggesting later abortions are often not for medical reasons. See parts 8 and 9 of his piece.
Discussion from abortion providers and abortion clinics
[All emphasis added.]
DuPont Clinic (2022)
Abortion After 26 Weeks: Washington D.C. abortion clinic website includes a page on abortion after 26 weeks with the following description:
If you are 26 weeks or later into your pregnancy, we can still see you, regardless of your medical history, background, or fetal indications. We do not require any particular “reason” to be seen here – if you would like to terminate your pregnancy, we support you in that decision.DuPont Clinic, accessed 10/28/22
An all-trimester abortion clinic prepares to open in Maryland, one of few nationally NPR profiles a clinic preparing to offer abortion through 34 weeks of pregnancy, and acknowledges these later abortions won’t be just for medical emergencies.
When their all-trimester clinic opens, Horvath and Nuzzo expect to treat perhaps 10 people each week. It could be someone whose fetus has serious anomalies, which are often only discovered later in pregnancy. It could be a patient whose continued pregnancy threatens their health. It could be someone who didn’t discover they were pregnant until after the first trimester.Melissa Block, NPR reporter
Deposition of Shannon Carr (2019)
Keisha Atkins died after complications from an abortion she sought after 6 months gestation. Her family filed a wrongful death lawsuit (which ultimately settled for over $1M). Under oath, abortion provider Shannon Carr could not identify any specific substantial or irreversible harm to Keisha Atkins’ physical health, mental health, family health, safety, or well-being that led to Atkins’ 6-month abortion. Video here, transcript here. Quote in part:
Attorney: You also indicated that if Keisha were forced to continue the pregnancy, it would cause substantial and irreversible harm to her well-being. What were you referring to?
Carr: To her overall prospects in life if she again wanted to get more education, not just work at Applebee’s for the rest of her life. You know, I can’t know what she’s wanting to do with her life but certainly having a child changes the calculus of what a young Latina woman is able to do in this country.
New York Times (2019)
Our talking point is, most of these procedures are on women who discover abnormalities late in the pregnancy. We don’t know if that is true.Frances Kissling, President of the Center for Health, Ethics and Social Policy and former abortion clinic director
The Daily Camera (2015)
He doesn’t share his clinic’s statistics and rarely speaks of individual cases, but Hern has said he also performs late abortions for women who are not facing any grave medical outcome.Alex Burness describing the work of abortion provider Dr. Warren Hern
The Hairpin (2013)
Interview with Dr. Susan Robinson, One of the Last Four Doctors in America to Openly Provide Third-Trimester Abortions Dr. Robinson describes women who seek third trimester abortions not for medical reasons, but because they didn’t realize they were pregnant earlier:
They think they just got pregnant. They have no idea they’re in their 24th week. So they make an appointment for an abortion, and it takes a few weeks, and they have their ultrasound and find out that they’re at 27 weeks, which is too far for an abortion anywhere. So then what happens? They either give up or have a baby, or they go on the Internet and they find us.Dr. Susan Robinson, abortion provider
The Irish Times (2013)
Abortion ‘is never, ever a casual decision’ Interviewer Kate Holmquist describes why women go to Dr. Shelly Sella for third trimester abortions, according to Sella:
The women Sella treats fall into two categories: those who discover foetal abnormalities; and those with healthy, viable babies whose maternal circumstances mean they could not cope with the baby.Kate Holmquist interviewing abortion provider Dr. Shelly Sella
New York Times (1997)
In the vast majority of cases, the procedure is performed on a healthy mother with a healthy fetus that is 20 weeks or more along. The abortion-rights folks know it, the anti-abortion folks know it, and so, probably, does everyone else.Mr. Fitzsimmons, Executive Director of the National Coalition of Abortion Providers
Examples of women receiving non-medical later abortions
Washington Post (2022)
Couple sues fertility clinic, saying they had to abort stranger’s baby A couple in New York aborted a healthy six-month fetus (past 23 weeks gestation) because they believed the fertility clinic had implanted the woman with someone else’s embryo, and they didn’t want the emotional toll of a potential custody battle.
The couple then hired an independent embryologist as the legal termination date for a pregnancy — six months — was approaching. … On Dec. 1, 2021 — near the end of the woman’s second trimester — the couple had an abortion.Andrea Salcedo
The truth about later abortions, according to someone who actually had one. A woman obtained a $12,000 non-medical abortion around 5.5 or 6 months of pregnancy:
I wanted an abortion because my partner wasn’t supportive and I wanted to finish my studies. And if I didn’t have enough money for me or a place, how could I have a baby, you know? So sometimes it is for our future. It’s not the right time.Amanda Michelle Gomez
…a college student from Portland, Ore., who didn’t learn she was pregnant until she was about 26 weeks along … found a clinic in New Mexico that told her they would end her pregnancy up until 28 weeks — the beginning of the third trimester.Sarah McCammon, reporting the story of Beth Vial
Teen Vogue (2019)
What to Know About So-Called “Late-Term Abortion” A woman obtained a non-medical late second trimester abortion because she didn’t find out she was pregnant until she was already in her second trimester.
Ultimately I knew I just would have no financial stability, and I also knew, too, if I were to have a child I didn’t want, I would definitely drop out of college.Elaina (pseudonym), as quoted by Alex Berg
Unsubstantiated claims about reasons for later abortions
The list below is a sampling, and not at all comprehensive. Note none of these sources include links or citations to any quantifiable evidence.
Let’s Talk About Abortion Rights Dr. Phillips (9m32s): “I don’t think that anyone comes in for prenatal care and at 24 weeks expects to just all of a sudden terminate their pregnancy. That is not something that really happens. And so I think we blow up these microcosm 0.025 events that might happen and make them seem larger than they are. And that’s just not what happens in pregnancy. If a woman comes into a visit and we’re doing an ultrasound and we find something that is just catastrophic to the pregnancy, that is deeply troubling to that person who otherwise in their mind envisioned having a full term pregnancy. So when we talk about the argument that you just explained, unfortunately it just doesn’t happen.”
Later Abortion: A Love Story. “Few people get [later abortions] (only one percent of abortions happen after 21 weeks), and nearly all of the parents who do are grappling with devastating diagnoses like mine.”
Hillary Clinton tweet: The former Presidential candidate claimed “Only about 1% of abortions happen later in pregnancy—almost always because a woman’s health or life is at risk, or the pregnancy is no longer viable.”
Before judging ‘late-term abortion,’ understand what it means, doctors say Dr. Barbara Levy of American Congress of Obstetrics and Gynecologists: “Abortions later in pregnancy typically occur because of two general indications: lethal fetal anomalies or threats to the health of the mother.”
New York Times (2019)
What Is Late-Term Abortion? Trump Got It Wrong “When they occur, it is usually because the fetus has been found to have a fatal condition that could not be detected earlier, such as a severe malformation of the brain, or because the mother’s life or health is at serious risk.”
Huffington Post (2016)
What Doctors Want Politicians To Know About Abortion. “Only 1.3 percent of abortions take place at or after 21 weeks, pointed out [Dr. Sarah] Horvath, and the majority are conducted because the fetus has severe birth defects.”
Huffington Post (2016) 2.0
Donald Trump confuses birth with abortion. And no, there are no ninth month abortions. Dr. Jennifer Gunter: “1.3 percent of abortions happen at or after 21 weeks and 80 percent are for birth defects.”
Face The Nation, Hillary Clinton: “I think that the kind of late-term abortions that take place are because of medical necessity.”
Yahoo Health (2015)
Congress introduced 6 anti-abortion bills in its first 7 days, “Again, the majority of late-term abortions are performed because of tremendous dangers posed to the health of the mother.”
New York Times (2012)
Anti-abortionists on Trial, “Later abortions mostly often involve severely troubled pregnancies that pose risks to a woman’s health or life.”
Abortion After 13 Weeks
Here are resources discussing the reasons women seek abortion after the first trimester (13 weeks gestation) rather than only after 21 weeks gestation.
PLoS One (2017)
Characteristics and Circumstances of U.S. Women Who Obtain Very Early and Second-Trimester Abortions. Study found “Timing of pregnancy recognition was the factor most strongly associated with obtaining a very early or second trimester abortion.”
Prenatal Diagnosis (2014)
Fetal diagnostic indications for second and third trimester outpatient pregnancy termination Dr. Warren Hern, who operates a clinic that performs 21+ week abortions, explains that at most 30% of his patients seek 2nd and 3rd trimester abortions for reasons of fetal abnormality.
Perspectives on Sexual and Reproductive Health (2012)
Attitudes and decision making among women seeking abortions at one U.S. clinic. In this study, 81% of abortions were sought in the first trimester and 1% of abortions were sought for fetal anomaly. Even assuming all of the fetal anomaly abortions were in the second trimester, it would still mean only ~5% of second trimester abortions were sought for fetal anomaly.
Women’s Health Issues (2011)
Later Abortions and Mental Health: Psychological Experiences of Women Having Later Abortions–A Critical Review of Research “Research suggests that the overwhelming majority of women having later abortions do so for reasons other than fetal anomaly.”
Predictors of delay in each step leading to an abortion. Study found that regardless of the gestational age at the time of the abortion, women were delayed more often by not taking a pregnancy test sooner than by delays in contacting a clinic or obtaining an abortion. “Our findings suggest that interventions which are aimed at improving women’s ability to identify a pregnancy at an earlier gestation could be helpful in facilitating women obtaining abortions earlier in their pregnancy.”
Timing of steps and reasons for delays in obtaining abortions in the United States. Study of women obtaining second trimester abortions found the top reasons for delay were the time it took to learn they were pregnant/how far along they were, the time it took to raise money for the abortion, and the difficulty of making the decision to abort. See Table 1.
Obstetrics & Gynecology (2006)
Risk Factors Associated With Presenting for Abortion in the Second Trimester Study finding that later suspicion of pregnancy and delaying factors such as difficulty obtaining state insurance were major influences on obtaining second rather than first trimester abortions.