Facts About “Late-Term Abortions” (Including Why We Shouldn’t Call Them That)
No politics or fear-mongering here.
By Ashley Ziegler
Medical Experts: Stephen Todd Chasen, MD, FACOG; Diane Horvath, MD, MPH
Abortion is a hot-button topic in the U.S., and it’s not uncommon for politicians to make it their entire platform when they’re running for office. Unfortunately, once something becomes a political talking point, facts often become skewed—and misinformation has a way of running rampant. And while this is certainly a problem for abortion as a whole, it’s particularly true of abortions performed at a later stage of pregnancy.
Truth be told, there’s a lot we could unpack about abortion even being a political issue, but there’s enough of that going around to last us all a lifetime (and then some), and frankly, we’re tired. We want to take opinions out of the conversation and, instead, put the focus on factual information that will help provide us all with a better understanding of the abortion procedure, especially when (and if) it’s performed later in pregnancy.
We spoke to some of the experts on the topic: Stephen Todd Chasen, MD, FACOG, a maternal and fetal medicine specialist at Weill Cornell Medicine, and Diane Horvath, MD, MPH, an OB-GYN and abortion provider in Baltimore, Maryland, and a fellow with Physicians for Reproductive Health. Here’s what they have to say.
What Does “Late-Term Abortion” Mean and What’s the Correct Terminology?
You’ve probably heard the phrase “late-term abortion” used numerous times, likely from a politician, the media, or even someone you know (like your aunt during a passionate debate at your family’s Thanksgiving dinner table). While the phrase is widely used to argue against abortion rights by those without medical degrees, it’s actually not used within the health care community.
“‘Late-term abortion’ is not a term that is used by physicians who provide care for pregnant individuals,” says Dr. Chasen, “It doesn’t have any clear meaning, and the term is used to deceive the public into thinking that abortions are generally performed much later than they are, even at 8 1/2 or 9 months [pregnant].”
Instead, he says, OB-GYNs simply use gestational age and trimesters to define when an abortion is being performed. “The first trimester is from conception until about 12 weeks later,” he explains, “The second trimester is considered to extend from about 12 weeks until the time when a newborn can survive outside the womb, which is generally considered about 24 weeks of gestation.” (Note that this is the point in a pregnancy that you may hear referred to as “fetal viability.”) “And the third trimester, when an extremely small portion of abortions occur, is the last three months of pregnancy.”
Dr. Horvath agrees, “late-term abortion” is not language that is (or should be) used. She says, “‘Late-term’ confuses later abortion with ‘term pregnancy,’ which is a pregnancy at 37-40 weeks.” She prefers the terminology “later abortion” or simply “abortion later in pregnancy.”
What’s the Difference Between Earlier and Later Abortions?
There are a lot of layers to the abortion debate in the U.S. One is the black and white question of whether abortion should or should not be legal. But as we’ve seen over the weeks since the Supreme Court overturned Roe v. Wade, with new state laws being implemented across the country, there’s a lot more nuance to the issue than some people may have realized before now. This is where the next layer of debate comes in, and questions tend to focus on whether or not there should there be a “cut-off” point for abortions. That’s why you might hear people break abortions up into two categories: “early” or “late.”
Once again, this is a very, very simplified way of looking at the procedure, and it’s not at all how physicians and health care providers approach it.
“There isn’t one uniform definition of what constitutes a later abortion,” says Dr. Horvath, “but most people understand it to mean either abortion after the first trimester (greater than 14 weeks of pregnancy) or at some other [point] in the pregnancy.”
“‘Later term’ and ‘early term’ are not real categories,” explains Dr. Chasen, “and those of us who care for pregnant individuals would never use these terms when talking about abortion.”
While people outside the medical community often categorize abortion timing as a means for moral or ethical argument, abortion providers do not. In fact, if a physician is considering the timing of the abortion, Dr. Chasen says it’s generally because it is “useful in determining what kinds of techniques are used, where they are performed, and (unfortunately) when and where they are legal.” Even when considering these factors, Dr. Chasen notes providers are still discussing the timing in terms of gestational age/trimester, not “early” or “late.”
Terminology aside, as Dr. Chasen says, the biggest difference in the timing of an abortion is how it is performed. He explains that around half of first trimester abortions are “medication abortions,” which are induced abortions by using medications, while the other half are “surgical abortions,” which are medical procedures performed “using a technique commonly called ‘suction dilation and curettage’ (D&C) or ‘vacuum aspiration.’” In the second trimester, he says the surgical technique is “generally known as dilation and evacuation (D&E).”
How Common are Abortions Later in Pregnancy?
Despite what fear-mongering politicians and media outlets would like for you to believe, abortions performed after the first trimester are extremely rare.
“In the U.S., about 50% of abortions happen in the first eight weeks,” says Dr. Chasen, “and about 90% [of all abortions] in the first 12 weeks.” He further explains that less than 1% of all abortions happen at 24 weeks or later.
Though these abortions are uncommon, the medical community treats them with as much care and compassion as they would any other termination of pregnancy.
“Every person I see has a different, deeply personal, and completely valid reason for needing their abortion,” says Dr. Horvath. “It’s not my job to judge a person’s reasons for being here, my life’s work is to make sure people have abortions safely and in a compassionate environment.”
Why Might Someone Undergo an Abortion Later in Pregnancy?
There is no single answer to this question. As with a lot of health care procedures, there are a variety of reasons someone may need to undergo an abortion later in pregnancy. And the later the abortion happens, usually, the more heartbreaking the situation is.
Typically, the further you are into a pregnancy, the more at peace (or even excited) you are about what’s to come. A baby is anticipated, the pregnancy has been announced, parents are planning to bring a baby home, the baby’s gender may have been revealed, and the baby may even already have a name. Then, something terrible happens and the parents find out that for some reason or another they need to make an excruciating, devastating choice. This may come in the form of discovering a fetal anomaly or the life of the birth parent may be endangered if the pregnancy continues or if they undergo childbirth.
“When abortion in the third trimester is necessary, it is almost always due to tragic circumstances—a woman’s life is threatened, or a severe or lethal fetal condition is identified later in pregnancy,” says Dr. Chasen.
In addition to these heartbreaking health situations for the parent or baby, another reason some abortions may happen later in pregnancy is because of legal red tape, mandatory waiting periods, and lack of access to abortion care.
“We know from decades of research that when people are unable to access abortion earlier in pregnancy, largely due to [legal] restrictions, cost, and other practical factors, they end up being further into the pregnancy when they come in for [abortion] care,” says Dr. Horvath.
It is important to note, however, that abortions that occur in the third trimester are not infanticide (or what many call “partial-birth abortions,” another deceiving term that is not used in the medical community). These procedures are highly regulated, with 43 states requiring the life or health of the pregnant person or baby to be endangered in order to undergo the procedure.
Sadly, life-threatening situations that lead to abortions later in pregnancy often cannot be avoided, but there are ways other abortions later in pregnancy can be reduced (beyond the already-tiny portion of all abortions they make up).
“Unplanned pregnancy is the most common indication,” says Dr. Chasen, “We can minimize these by promoting fact-based sex education and making contraception widely available, and ideally cost-free.” (Though he does point out that no contraception is 100% effective, and, sadly, “rape and other forms of sexual coercion are far too common”).
Again, in order to fully understand the “issue” of abortion later in pregnancy, it’s essential to know and understand the facts—not the talking points of politicians on the campaign trail or cable news network anchors. To learn more about abortions later in pregnancy, Dr. Horvath recommends Who Not When, a resource website that focuses on the people and reasons for abortions later in pregnancy (rather than simply focusing on when the abortion takes place).