Omar Bennett
Late-term abortion, also known as third-trimester abortion, refers to the termination of pregnancy after 20 weeks of gestation. However, the exact point at which an abortion is considered late-term is not clearly defined, with different medical publications and countries using varying thresholds. Generally, late-term abortions are only permitted in specific circumstances, such as when the pregnancy poses a serious risk to the physical or mental health of the woman or when severe fetal abnormalities are detected. The debate around late-term abortion is often politicized and controversial, with varying legal restrictions and public opinions across different countries and states.
| Characteristics | Values |
|---|---|
| Definition of late-term abortion | There is no precise definition of "late-term abortion". Different countries and medical publications use varying gestational age thresholds. |
| Gestational age thresholds | In the US, abortions after 21 weeks are considered "late abortions". The third trimester begins around the 27th week of gestation. |
| Reasons for late-term abortions | When the pregnant woman's health is at risk, when lethal fetal abnormalities are detected, or when the pregnancy is a result of rape or incest. |
| Health risks to the pregnant woman | Severe preeclampsia, newly diagnosed cancer requiring prompt treatment, intrauterine infection (chorioamnionitis), premature rupture of the amniotic sac (PPROM), haemorrhaging, infection, damage to surrounding organs. |
| Lethal fetal abnormalities | Serious fetal anomalies incompatible with life. |
| Abortion techniques | Intact dilation and extraction (partial birth), dilation and extraction (D&X). |
| Abortion rates | In the US, about 1% of abortions take place after 21 weeks, and far less than 1% occur in the third trimester. |
| Legal status | The legal status of late-term abortion varies by country and state. Some countries and states have gestational limits or ban abortion at any stage of pregnancy. |
| Supreme Court rulings | The US Supreme Court has held that bans must include exceptions for threats to the woman's life, physical health, and mental health. |
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What You'll Learn
Lethal foetal anomalies
When lethal foetal anomalies are diagnosed, parents are faced with difficult decisions. They may opt for termination of the pregnancy, which sometimes involves feticide, especially in abortions performed after 22 weeks. Alternatively, they may choose to continue the pregnancy and explore options such as perinatal palliative care. This decision-making process is deeply personal and varies across individuals and cultures.
In the context of late-term abortions, the specific lethal foetal anomalies in question can include trisomy (18 and 13), renal tract abnormalities, and major skeletal dysplasia. These anomalies are uncommon, but when they occur, they present a substantial risk of severe mental or physical disability for the child if they are born. In such cases, termination of pregnancy is often considered a viable option to prevent potential suffering for both the child and the parents.
The legal landscape surrounding late-term abortions due to lethal foetal anomalies varies across different regions. In the United States, the Supreme Court's decision in Dobbs v. Jackson Women's Health in 2022 eliminated the federal constitutional standard protecting abortion rights. Consequently, states now have the autonomy to set their own policies, with some banning abortion entirely and others implementing gestational limits. However, even before this decision, access to late-term abortion services was limited, with only a small percentage of physicians providing such services or having knowledge of nearby providers.
In Europe, the approach to late-term abortions varies by country. While most countries do not permit abortions after 10-14 weeks, Sweden and Iceland allow abortions up to 18 weeks, and the Netherlands and the United Kingdom permit them up to 24 weeks. These exceptions are typically made when the pregnancy poses a serious danger to the life or mental and physical health of the woman, or when severe foetal anomalies are diagnosed.
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Maternal health risks
The definition of "late-term abortion" varies across medical publications, with some defining it as an abortion after 20 weeks of gestation, others at 21 weeks, and some at 28 weeks. Generally, a late termination of pregnancy refers to an induced ending of pregnancy after 20 weeks of gestation or a fetal age of about 18 weeks.
- Life-threatening conditions: These include severe preeclampsia, newly diagnosed cancer requiring immediate treatment, and intrauterine infection (chorioamnionitis), often accompanied by premature rupture of the amniotic sac (PPROM).
- Mental health disorders: While there is conflicting evidence regarding the impact of abortion on mental health, some states require patients to be informed of potential mental health risks, such as psychoactive substance use disorder, mood disorder, or neurotic or stress-related disorders.
- Physical health complications: Abortion can help address physical health issues, such as secondary infertility, ectopic pregnancy, spontaneous abortion, stillbirth, and pregnancy complications that can adversely affect maternal health.
- Lethal fetal abnormalities: Abortions may be permitted when lethal fetal abnormalities are detected, as these may also pose risks to the mother's health.
- Domestic violence and socio-economic factors: Social and economic factors can impact a person's overall health. A 2013 study found that women seeking late abortions often fit profiles involving single parenting, substance use, domestic violence, decision-making difficulties, and young age.
It's important to note that the determination of medical necessity for late-term abortions is complex and depends on individual health conditions. While some argue that late-term abortions are never necessary, others emphasize the importance of considering each patient's unique circumstances.
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Rape and incest
The definition of "late-term abortion" varies depending on the source and country. In general, late-term abortions refer to abortions performed after 20 weeks of gestation, but this cutoff is not clearly defined and can range from 18 to 28 weeks.
Even in states with rape and incest exceptions, various barriers can make it extremely difficult for survivors to obtain abortions. For instance, some states require individuals to report the sexual assault to law enforcement and provide a copy of the report to the physician before receiving abortion care. The World Health Organization (WHO) recognizes that these requirements can cause delays that may push women beyond the legal gestational limit, effectively preventing them from accessing abortion services. Additionally, the true number of pregnancies that result from rape or incest is unknown, making it challenging to estimate the impact of these exceptions.
It is important to consider the perspectives of those who have experienced pregnancy as a result of rape or incest. While it is commonly assumed that rape victims would want abortions, studies suggest that a significant percentage choose to continue the pregnancy. Some incest victims may view the pregnancy as a way out of the incestuous relationship or as an opportunity to establish a loving relationship with their child. However, it is essential to respect the autonomy and varying circumstances of each individual, as abortion may be the preferred or necessary course of action in certain cases.
The debate surrounding abortion in cases of rape and incest is complex and multifaceted. While most countries allow abortion in these circumstances, the specific laws, exceptions, and barriers to access vary widely. It is crucial to approach this topic with sensitivity, recognizing that the experiences of sexual assault victims who became pregnant are diverse and unique to each individual.
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Mental health
The topic of abortion and its mental health implications is highly controversial and politicized. While some women experience negative psychological reactions post-abortion, the severity, prevalence, and classification of these reactions are still widely debated. Research suggests that women who abort wanted pregnancies or lack support from their partners or parents may be at a higher risk of mental health issues post-abortion. However, it is important to note that the majority of women feel relief and happiness after the procedure.
There is evidence that people seeking abortions have poorer baseline mental health on average than those who are not. This can be attributed to structural inequities, such as poverty, trauma, adverse childhood experiences, and intimate partner violence. Additionally, women with a history of mental illness are at a higher risk of psychiatric symptom recurrence during pregnancy and the postpartum period.
Some studies have found that abortion contributes to mental health problems for some women. For example, a 2016 analysis showed that each exposure to abortion increases the risk of mental disorders by 23%, even when controlling for other factors. However, other studies have found no conclusive evidence of a direct link between abortion and subsequent mental health issues. It is important to consider pre-existing conditions and other contextual factors that may affect mental health.
The reasons for abortion can impact a woman's mental health. For example, a woman may experience fear and anxiety related to the abortion, guilt and grief, or insecurity and fear of abandonment. These emotions are not unique to women who have had abortions but can also be felt by those who have placed a baby for adoption or raised an unplanned child.
The stigma and discrimination associated with abortion can also adversely affect mental well-being. Abortion restrictions disproportionately impact historically marginalized populations, exacerbating intersecting factors of structural racism, gendered racism, and classism. These restrictions limit access to reproductive healthcare, which is a social determinant of mental and physical health.
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Physical health
The physical health of the pregnant person is a critical factor in determining the necessity of late-term abortion. In the United States, all states that ban abortion or limit it near viability have exceptions when the pregnant person's life is endangered. Additionally, 34 states allow exceptions when the pregnant person's health is at risk. These exceptions are based on "medical necessity," which considers a broad range of physical, emotional, and psychological factors relevant to the individual's well-being. However, the specific clinical criteria for determining medical necessity can be ambiguous, and the interpretation of necessity can be influenced by political contexts rather than solely empirical evidence.
The physical health consequences of abortion have been studied and compared to those of carrying a pregnancy to term. Research suggests that abortion is associated with fewer maternal deaths than carrying a pregnancy to full term. Additionally, women who gave birth reported more limitations on physical activity for a longer duration than those who had abortions. However, it is important to note that the overall mortality rate for legal abortions in the United States is less than 1 in 100,000 procedures performed, and the rate increases with the gestational age of the fetus.
In Europe, late-term abortions are generally not permitted after 10-14 weeks, unless specific circumstances are present. These circumstances vary by country but often include risks to the woman's physical health, fetal malformations, and cases where the pregnancy resulted from rape or sexual crime. For example, Italy allows abortion after 90 days only if the pregnancy or childbirth pose a threat to the woman's life or physical health. Denmark provides a broader range of reasons, including social and economic factors, for abortions sought after 12 weeks.
In summary, the physical health considerations for late-term abortion primarily focus on the well-being of the pregnant person and the presence of any health risks or complications. The specific criteria for determining medical necessity can vary across different regions and states, and the interpretation of these criteria can be influenced by political and social factors. Overall, late-term abortion is a highly regulated procedure, and the physical health of the pregnant person is a crucial factor in determining its necessity.
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Frequently asked questions
Late-term abortion, also referred to as third-trimester abortion, is the termination of pregnancy by inducing labor during a late stage of gestation. The exact point of gestation at which an abortion is considered late-term is not clearly defined and varies across countries and medical publications. In the United States, abortions after 21 weeks of gestation are sometimes referred to as "late abortions".
Health issues that may justify a late-term abortion vary by jurisdiction. In the United States, some states ban abortion except when the life of the pregnant person is in danger, while others also allow exceptions when the pregnant person's health is at risk.
Yes, lethal fetal abnormalities or anomalies are also considered valid reasons for late-term abortions in some places.
Mental health issues may be considered a valid reason for a late-term abortion in some jurisdictions. However, the specific criteria vary, and abortion-rights organizations have criticized some definitions of health as being impermissibly narrow.
The rate of mortality and morbidity increases with the gestational age of the fetus. While abortion is generally associated with fewer maternal deaths than carrying a pregnancy to term, there may be late complications that lead to death. Additionally, some states in the United States require that abortion patients be provided with information suggesting that abortion negatively affects future fertility, increases the risk of breast cancer, or leads to mental health disorders. However, research has found no significant differences between women who undergo abortions and those who give birth regarding the risk of psychiatric disorders.
