No One Wants To Talk About The People Who Get Abortions Later In Pregnancy
Many Republicans want you to believe that women are getting abortions in the eighth and ninth months of pregnancy simply because they can. The right-wing rhetoric has been used to criticize abortion rights supporters and Democrats for years. Even Donald Trump — who up until recently consistently dodged the topic of abortion — has started repeating the myth.
Democrats “support abortion up to and even beyond the ninth month,” the GOP presidential nominee said last month. Democrats can “have [an abortion] in the seventh, eighth, ninth month, and they can kill the baby,” he said in another interview, adding that in some states “they can kill the baby after the baby is born.” Sen. Ted Cruz (R-Texas) said this week that “there are late-term abortions and every single Democrat supported it.” (“Late-term abortion” is a popular right-wing talking point, but HuffPost is not using it because it’s medically inaccurate.)
The belief that pregnant people use abortion like birth control is a well-worn boogeyman that the anti-choice movement has peddled for decades. Though rife with misinformation, the political strategy has been extremely successful, creating cultural stigma so deep around abortions later in pregnancy that many Democrats, including President Joe Biden, and even some pro-choice advocates, are uncomfortable discussing it.
But people do get abortions later in pregnancy — a phrase that generally reflects abortions at or after 21 weeks. Some are women with wanted pregnancies who get a fatal fetal diagnosis. Others are young people who don’t realize they’re pregnant or don’t have a safe way to get an abortion right away. Still, others experience something catastrophic and life-changing later in pregnancy — a partner becoming violent, their home burning down, a job loss — that will make it nearly impossible to safely raise a child. There’s also an increasing number of people pushed further into pregnancy because they experience barriers to care early on: their home state banned abortion forcing them to travel, or their immigration status makes it dangerous for them to seek health care, or they need to save up for the procedure because it’s not covered by insurance.
The belief that pregnant people use abortion like birth control is a well-worn boogeyman that the anti-choice movement has peddled for decades.
No one is getting an abortion in the second or third trimester because they woke up one day, months into being pregnant, and decided they didn’t want to be pregnant anymore. But the politically manufactured shame around later abortion care runs so deep that many Democrats believe it too, in part because of the power of these lies. Biden has centered his reelection campaign around restoring Roe v. Wade, and advocates are building policy around it too, protecting abortion care until viability or around 24 weeks — effectively ignoring those who will need care later in pregnancy.
“One of the mistakes we’ve made as a movement is to not talk about later care,” said Dr. Diane Horvath, an OB-GYN and abortion provider at Partners In Abortion Care, an abortion clinic in Maryland where 90% of her patients receive care in the second and third trimesters.
“I think we thought we were protecting ourselves by being quiet about it,” she said. “But when you leave gaps in the narrative … anti-abortion folks have always been very happy to fill them in with things that are scary and incorrect, and really debase people who have abortions and debase people who provide them.”
Most abortions do happen in the first trimester: Almost 93% of abortions reported to the Centers for Disease Control and Prevention in 2020 were done before the 13th week. Nearly 99% took place by the end of the 20th week. Somewhere around 1% of abortions occur at 21 weeks or later, and the subset of abortions in the third trimester (around 26 weeks) is even smaller.
“One percent of those is not nothing,” said Katrina Kimport, a researcher with Advancing New Standards in Reproductive Health, whose current work focuses on third trimester abortions. “It’s small from a data analysis or statistical perspective, but when you’re thinking about that as real people, that’s a pretty big number.”
Kimport pegs it at around 9,000 people; she applies the 1% figure against the Guttmacher’s Institute’s 2020 data, collected from providers, on how many Americans seek abortions. (The CDC does not collect abortion numbers from a handful of states including California.)
The 1% statistic is often used by abortion rights supporters to debunk Republican rhetoric around later abortion care. It’s a useful number that correctly reflects just how rare abortion care later in pregnancy is, but it fails to mount a value-based defense of those procedures.
“The idea that this is so rare, and that it’s only a certain percent of the abortions that are happening, that’s all well and good. But when it’s you and your pregnancy, it’s 100%,” Horvath told HuffPost.
The politically manufactured shame around later abortion care runs so deep that many Democrats believe it too.
As a New Yorker, Erika Christensen certainly considered herself pro-choice when she got pregnant for the first time in 2016. She had no idea at the time that her home state had an abortion restriction that only protected care until 24 weeks. At 30 weeks pregnant, she was given a fatal fetal diagnosis and had to travel to Colorado to get an abortion in one of the few states that allowed all-trimester care.
Christensen recalled her immediate panic, thinking: “I have really good insurance, but it doesn’t matter if I’m going out of state. I have access to really good information and health care, but it doesn’t matter if I can’t have it in my state.” Christensen and her husband were able to get money from her mom, who took thousands of dollars out of her 401K so they could pay for the costly procedure. Christensen was able to take time off of work, get last-minute plane tickets, book a rental car and hotel. By the time Christensen and her husband were able to access an abortion in Colorado, she was 32 weeks pregnant.
Even under the best of circumstances, with a lot of privilege and resources, getting an abortion in the third trimester when Roe was still intact was extremely difficult. “The whole time we’re asking ourselves, ‘What would we have done if any of these pieces were not in place? What if we couldn’t have accessed that money quickly? What if we didn’t have IDs that allowed us to get on a plane? What if we didn’t read and speak English?’” recalled Christensen, who along with her husband founded the abortion strategy and advocacy group Patient Forward.
In 2020, 9% of people who accessed abortions had to travel out of their home state to receive care, according to The Guttmacher Institute. Three years later, after the Dobbs decision that repealed Roe, that number has doubled with around 20% of patients seeking care across state lines. (That number does not account for the increase in medication abortion by mail, a common access point for pregnant people in the first trimester post-Roe.)
Horvath and Morgan Nuzzo, a certified nurse midwife, opened Partners in Abortion Care shortly after the Supreme Court repealed Roe v. Wade in the summer of 2022. The two met working at a Planned Parenthood clinic, but didn’t become close until Nuzzo was pregnant with her first child, and Horvath offered some hand-me-down baby clothes from her kids.
Partners in Abortion Care in College Park, Maryland, is one of a small handful in the country that offer all-trimester abortion care. During the first year the clinic was opened, they saw patients from 40 different states and three countries.
Their clinic sees about 10 to 15 patients a week ― nearly all of whom are getting abortions after 20 weeks. The clinic caps the number of patients they see weekly because later care takes more time. Unlike early care, which can often be done using abortion pills, abortions in the second and third trimester are more complex. An abortion between 20 and 26 weeks is typically a two-day procedure, and past 26 weeks is a three-day procedure.
Think about what that would feel like to need a later abortion ... it’s the people you know — it’s people who also give birth, the people who also have miscarriages, the people who also need IVF. It’s all the same people.Dr. Diane Horvath, OB-GYN and abortion provider
About 10%, or around one to two patients a week, are minors. Nuzzo, who is also the executive director at the clinic, recalled a recent week where every patient was under 18. “There was literally a fight between a 12, 13, 14 and 15-year-old in the recovery room, like, ‘I want a Capri Sun if she’s going to have a Capri Sun!’” Nuzzo laughed. “That tells you also where these folks are emotionally.”
Late discovery of a pregnancy is common for young people in part because they don’t know much about their bodies yet, or they may not have a regular cycle or know what pregnancy symptoms feel like. “The clock starts for them a lot later,” Horvath said.
The majority of young people bring a trusted adult ― often a parent, aunt or sibling ― when they come to the clinic. Nuzzo recalled going through the intake process with a 12-year-old at a previous clinic she worked for in Washington, D.C.
“I consented a 12-year-old, and I was very concerned about a 12-year-old’s ability to consent. The concern is always their ability to say the thing that they want and to understand the complexity of consenting to a medical procedure,” she said. “She just looked at me and said, ‘I’m 12 ― I don’t want to have a baby.’ People know what’s best for them, even young people.”
The procedure, as well as travel and lodging costs, makes later abortion care incredibly expensive. Horvath and Nuzzo told HuffPost the cost of the procedure at various clinics can range from $10,000 to $30,000 depending on the patient’s medical history, how far along they are, and what insurance they have, if any.
“The cost of travel and lodging and child care and food is right up there with what it costs to get an abortion [later in pregnancy],” Meghan Daniel, director of services at Chicago Abortion Fund, told HuffPost. “When we talk about abortion being accessible, we have to be talking about these other wraparound support costs.”
Partners In Abortion Care has a staff of 22 people, including a team of patient advocates and schedulers whose only job is to help patients figure out the often complicated financial and logistical hurdles of later care. They work with 40 abortion funds across the country to help subsidize the costs for patients, but as abortion funds dry up, Horvath and Nuzzo said they have discounted the procedure up to 40% because they try not to turn patients away.
“Nobody thinks they’re ever going to need a later abortion and so it’s very easy to distance yourself, but then it happens to all of the people we see — all of those people didn’t think they were going to need to come see us and here they are,” Horvath said.
“I would love for us to operate with empathy, for people to pause and think about what that would feel like to need a later abortion,” she added. “Because it’s the people you know — it’s people who also give birth, the people who also have miscarriages, the people who also need IVF. It’s all the same people.”