Isabella Carter
Late-term abortions are a highly contentious issue, with varying definitions, regulations, and perspectives across different countries and states. While the exact point of gestation defining a late-term abortion is debated, it generally refers to terminations occurring after 20 weeks of pregnancy. The reasons for late-term abortions are multifaceted and include delays in pregnancy diagnosis, financial stressors, relationship issues, and the discovery of serious fetal or maternal health issues. In the context of maternal health, late-term abortions are often considered when a woman's life or health is at risk, including mental health, or when lethal fetal abnormalities are detected. However, the availability of data and research funding in this area is limited, impacting the understanding of the physical and mental health implications for women undergoing late-term abortions.
| Characteristics | Values |
|---|---|
| Definition of "late-term abortion" | Varies across countries and medical publications. Generally refers to abortions after 20 weeks of gestation. |
| Gestational age thresholds | In the US, abortions after 21 weeks are considered "later abortions". |
| Reasons for late-term abortions | Risk to the physical or mental health of the pregnant woman, lethal fetal abnormalities or anomalies, financial stressors, relationship problems, education concerns, parenting challenges, etc. |
| Abortion laws | Vary across countries and states. Some allow abortions only when the woman's life is at risk, while others permit them when the woman's physical or mental health is at risk. |
| Abortion rates | Vary by country and year. For example, in the US in 2003, 1.4% of abortions were at or after 21 weeks, while in Canada in 2019, 1.17% occurred after 21 weeks. |
| Demographic characteristics | A study found that women aged 20-24 were more likely than those aged 25-34 to seek late-term abortions. Other characteristics like race, number of live births, mental or physical health history, and substance abuse were similar between first-trimester and late-term abortion recipients. |
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What You'll Learn
A woman's health is at risk
In the United States, the Supreme Court's decision in Dobbs v. Jackson Women's Health Organization in 2022 has resulted in a drastic change to the abortion landscape. While Roe v. Wade (1973) allowed abortion without regulation in the first trimester, the recent ruling has eliminated this federal protection, allowing states to set their own policies banning or permitting abortion at any point in the pregnancy. As a result, 14 states have banned abortion entirely, and 11 others have gestational limits, banning abortion after a certain point. These abortion bans and restrictions have direct implications for women's health, as they limit access to essential healthcare services and can result in unsafe abortions, which carry significant physical health risks.
Unsafe abortions can lead to incomplete abortions, where not all pregnancy tissue is removed from the uterus, and damage to the genital tract and internal organs due to the insertion of dangerous objects. In addition, restrictive abortion regulations can cause distress and stigma, violating human rights, including the right to privacy, non-discrimination, and equality. They also impose financial burdens, especially on women with low resources, as they may be forced to travel to access legal abortion services, incur mandatory counselling or waiting period costs, and face loss of income and other expenses.
The lack of access to safe and legal abortion care can also lead to dangerous pregnancy complications. For example, in Texas, five women were denied abortion care despite facing life-threatening physical conditions, and two OB-GYNs filed a lawsuit to clarify the scope of medical emergency exceptions in the state's abortion bans. While all state abortion bans have an exception for pregnancies that jeopardize the life of the pregnant person, some do not account for situations where an abortion is necessary to preserve the woman's health. This leaves significant gaps in emergency medical care and puts physicians in a challenging position when their patients need an abortion to treat a condition endangering their health.
Furthermore, abortion bans and gestational restrictions also impact the management of pregnancy loss, including miscarriage and stillbirth. The medical interventions used to manage pregnancy losses often overlap with abortion procedures, and restrictive policies may deter pregnant people from seeking timely care, risking criminalization for pregnancy loss. This can have detrimental consequences, particularly for people of color, who already face systemic racism and discrimination in the healthcare system, further exacerbating health inequities.
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Lethal fetal abnormalities are detected
Lethal fetal abnormalities are uncommon, but they do occur and often serve as a reason for late-term abortions. Late termination of pregnancy refers to the induced ending of a pregnancy after the 20th week of gestation, that is, after a fetal age of about 18 weeks. However, the exact point at which an abortion is considered late-term is not clearly defined, with different medical publications and countries using varying gestational age thresholds.
When lethal fetal abnormalities are detected, they pose challenging decisions for parents and clinicians. Lethal fetal abnormalities can include central nervous system issues, cardiac abnormalities, chromosomal abnormalities, skeletal abnormalities, kidney abnormalities, and gastrointestinal abnormalities. In the case of trisomy 18 and 13, renal tract abnormalities, and major skeletal dysplasia, parents may be offered the option of termination or continuation with perinatal palliative care.
Most parents opt for termination when lethal fetal abnormalities are detected, which may include feticide, especially after 22 weeks. Feticide is carried out to prevent the risk of live birth, even when there is diagnostic certainty regarding lethality. Without feticide, there is a risk of live birth, which can be traumatic for parents and clinicians and lead to complications such as birth registration and referral to the coroner.
The decision to terminate a pregnancy due to lethal fetal abnormalities can be emotionally and psychologically challenging for the parents. It involves dealing with the knowledge that the fetus has developed more fully and the potential bonding with the developing fetus. Additionally, there may be external pressures or personal circumstances that further complicate the decision-making process.
In the United States, abortion laws vary by state, and some states allow late-term abortions only when there is a threat to the woman's life or physical health. However, abortion-rights organizations argue that some states use a definition of health that is impermissibly narrow. On the other hand, some people believe that fetal abnormalities are part of God's plan, and the decision to carry the pregnancy to term should be a personal matter between the patient and their physician.
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Financial barriers to accessing abortion services
In the United States, abortion laws and their access vary from state to state. The Supreme Court's decision in Dobbs v. Jackson Women's Health in June 2022 overturned Roe v. Wade (1973), eliminating the federal constitutional standard that protected the right to abortion. This decision has resulted in a drastic change in the landscape of abortion in the country, with 14 states banning abortion at any stage and 11 others imposing gestational limits.
The financial barriers are even more pronounced for certain demographic groups. For example, Latina, Black, and Indigenous women face a double disadvantage due to their position at the lowest end of the wage gap and their increased likelihood of experiencing racism in healthcare. As a result, they may have fewer economic resources to overcome the barriers to abortion care.
The cost of accessing abortion services can be further exacerbated by the need to travel long distances or across state lines to states where abortion is legal. This was particularly evident after the Dobbs decision, as people living in states with restrictive abortion laws had to travel farther to obtain abortion services, incurring additional travel and lodging expenses.
The financial barriers to abortion access can lead to negative consequences, including delays in care and negative mental health impacts. In some cases, individuals may consider self-induction as a result of being unable to afford or access formal abortion services. Overall, financial barriers create significant challenges for individuals seeking abortion services, particularly for those from marginalized communities.
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Viability bans and procedure bans
Viability bans refer to laws prohibiting abortions before the foetus is considered viable outside the womb. In the United States, viability is usually determined to be at around 24 weeks, with 90% of abortions occurring before the 13th week. However, the exact point of viability varies and is not clearly defined.
Viability bans often include exceptions to protect the life and physical and mental health of the pregnant woman. For example, Maine allows abortion after viability when a physician deems it necessary. Nevertheless, abortion bans of all types have been shown to disproportionately impact marginalised groups, with individuals facing systemic racism and other forms of oppression encountering additional barriers to obtaining an abortion.
Procedure bans refer to laws prohibiting specific methods of abortion care. The most commonly targeted procedures are dilation and extraction (D&X) and dilation and evacuation (D&E), which are used in most second-trimester abortions. Courts have ruled that bans on these procedures violate "a woman's right to choose to have an abortion prior to the viability of the fetus" and have deemed them unconstitutional for lacking health exceptions.
Some states have attempted to enforce procedure bans through vague and amorphous language, which courts have rejected as infringing on abortion rights. For example, a federal district court blocked Florida's "partial-birth abortion" ban, finding that it could cover virtually all abortions performed in the second trimester. Similarly, a state district court enjoined Montana's "partial-birth abortion" ban, concluding that it would reduce women's access to abortion services and increase their risk and pain.
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Rape, incest, or threats to mental health
Rape, incest, and threats to mental health are significant factors in the debate surrounding late-term abortions. While some countries and states have laws that allow abortion in cases of rape and incest, the reporting requirements and practical barriers often make accessing these services difficult for survivors.
Rape and incest are severely underreported, with two out of three rapes and 80% of incest cases going unreported. Reasons for this include threats made by perpetrators, fear of retaliation, fear of not being believed, shame, and distress related to reporting. In the United States, only about 10% of rape cases are reported, and approximately 60% of rape victims do not recognise their experience as such. Additionally, the requirement to report these crimes to law enforcement as a condition for accessing abortion services can create confusion and fear among providers, further limiting abortion access.
The psychological impact of rape and incest can be profound, with many survivors experiencing post-traumatic reactions such as fear, confusion, anxiety, depression, denial, difficulty sleeping and eating, withdrawal, hypervigilance, and suicidal thoughts. Denying abortion access in these cases can compound feelings of powerlessness and perpetuate the trauma associated with the non-consensual act.
Supporters of abortion exceptions for rape and incest argue that denying abortion can have long-term physical and emotional health impacts on pregnant individuals. They emphasise the non-consensual nature of the pregnancy and the resulting health issues and trauma. On the other hand, opponents prioritise the protection of the fetus over the potential physical and emotional effects on the pregnant person.
The lack of standardised abortion reporting and research funding in the United States contributes to the politicisation of abortion issues. As a result, abortion laws and access vary significantly across states, and survivors of rape and incest may face significant barriers to obtaining critical healthcare.
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Frequently asked questions
The exact point when an abortion is considered late-term is not clearly defined. In three articles published in 1998 in the Journal of the American Medical Association (JAMA), two chose the 20th week of gestation and one chose the 28th week of gestation as the point where an abortion procedure would be considered late-term. Abortions later in pregnancy are sometimes referred to as "later abortions" by the medical community.
Late-term abortions are performed when a pregnant woman's health is at risk or when lethal fetal abnormalities have been detected. Other reasons include financial stressors, relationship problems, education concerns, or parenting challenges.
The laws regarding late-term abortions vary by country and state. In Europe, abortions after 10-14 weeks are generally not permitted unless specific circumstances are present, such as a threat to the woman's life or health, or a serious fetal anomaly. In the United States, the laws vary by state, with some states banning abortion at any stage of pregnancy and others imposing gestational limits.
