ORLANDO, Fla. — As a bill that would shrink the time someone can have an abortion progresses toward the governor’s desk, data suggest it may disproportionately impact underprivileged populations and women who don’t know they are pregnant or whose fetuses have serious genetic abnormalities — all groups more likely than others to get later abortions.
The proposal bans most abortions after the fetus reaches 15 weeks of gestation — defined in the bill as 15 weeks from the first day of a person’s last normal menstrual period — is headed to the Florida Senate after the Florida House passed it early Thursday.
Florida’s current cut-off is 24 weeks.
The bill makes exceptions if doctors attest the termination of a pregnancy is necessary to save the mother from death or serious injury, or if the fetus has a “fatal fetal abnormality,” defined as a condition that will result in death at birth or immediately after.
Florida’s Senate is expected to pass the bill and Gov. Ron DeSantis has voiced his support for the legislation. It will take effect July 1 if DeSantis signs off.
Why an abortion after 15 weeks?
The majority of women who terminate pregnancies in Florida do so before the proposed cut-off time: 2% of abortions happen more than 15 weeks after the first day of a woman’s last normal period, according to 2019 data from the Centers for Disease Control and Prevention.
People in their second trimester are more likely to get an abortion due to a serious fetal abnormality, according to data from the Florida Agency for Health Care Administration.
In 2021, about 484 abortions done in Florida because of genetic defects were done in the second trimester, which doctors report as the beginning of the 12th week from fertilization through the 23rd. (Unlike the bill, the AHCA data uses fertilization as a pregnancy’s starting point, not the first day of a woman’s last normal period.)
About 273 of the 757 abortions performed due to a serious fetal abnormality were done in the first trimester, through week 11.
Danielle Tallafuss in Oviedo made the difficult decision to terminate her pregnancy in July 2020.
She already had one child when she got pregnant. She and her husband had been looking forward to the birth of their son, whom they named Nathaniel. She was not able to get a specific type of ultrasound that detects potential heart defects until week 20. Her fetus was then diagnosed at week 22 with a defect called hypoplastic left heart syndrome.
The rare condition leaves the left side of the heart under-developed, according to the National Institutes of Health. Her doctor said her baby would likely be in pain once he was born, be hospitalized, and would require multiple surgeries that have no guarantee of survival, she said.
The NIH says there is a 70% chance of surviving 3 to 5 years after surgery and children who do survive these surgeries often still have complications and die young.
“My husband and I talked about this in-depth and our doctors sat with us for hours on end,” she wrote in an email. “Ultimately, we decided to move forward with termination. All things considered, it was the pain and uncertainty this baby would have to endure that lead us to our decision.”
Tallafuss is still emotional about the decision. It was not easy mentally or logistically. She drove three hours to a clinic in Florida that performs abortions at 22 weeks. The surgical procedure requires two days.
Under the 15-week abortion bill, she wouldn’t have been able to make the decision: hypoplastic left heart syndrome is not considered a “fatal” abnormality.
The bill’s exception for a “fatal fetal abnormality” does not cover all serious and life-threatening fetal conditions, said Dr. Sujatha Prabhakaran, chief medical officer at Planned Parenthood of Southwest and Central Florida and a practicing OB-GYN in Sarasota. Prabhakaran has publicly spoken out against the proposed 15-week limit.
“It will significantly limit the access of care for women who have ... a severe fetal anomaly that may not quite qualify for the definition but that most physicians and patients would agree is the reason that they might want to end a pregnancy,” Prabhakaran said.
Who gets second-trimester abortions?
The majority of people who get abortions in Florida are unmarried and have previously given birth, according to 2019 data from the Centers for Disease Control and Prevention. The majority of the women surveyed, 58%, said this abortion was their first.
Florida women getting abortions in the second trimester last year were more likely to report social or financial issues as the reason for wanting the procedure: 27% in the second trimester versus 21% in the first, according to the AHCA.
A 2017 analysis of national data by the Guttmacher Institute, a reproductive health research and policy organization, found that Black women were more likely than white women to get abortions in the second trimester, replicating prior research.
In addition, women without high school degrees, women relying on financial assistance to pay for an abortion, and women who didn’t realize they were pregnant were more likely to get an abortion in their second trimester when compared to women without these characteristics.
A past study found that, in addition to Black women and women with less education, women with health insurance and women with higher incomes were more likely to get a second-trimester abortion; however, this was in 2008.
The 2017 analysis also found that the further a patient lived from the abortion facility, the more likely they were to obtain a second-trimester abortion, which is backed up by previous data.
“These are just populations that have reduced access to health care, including reproductive health care, including health care that allows them to prevent pregnancies or decide when they want to become pregnant, and once they are pregnant, figuring out what their options are,” said Guttmacher Principal Research Scientist Rachel Jones, who led the analysis.
People who need financial assistance to pay for an abortion may be more likely to get a second-trimester procedure than people paying out-of-pocket because they go through an application process and wait to be approved, Dr. Prabhakaran said. In Florida, women get financial assistance from funds such as the Florida Access Network.
“Understanding that there is even financial assistance, some people struggle to find that out,” Prabhakaran said. “If you don’t have reliable access to the internet or a way to even navigate our healthcare system, that can be really hard.”
It’s also easier than many might think for a woman not to know she’s pregnant, Prabhakaran added. In the Guttmacher study, 29% of women who did not recognize they were pregnant until at least the seventh week of pregnancy obtained second-trimester procedures, compared to 5% of those who recognized the pregnancy earlier.
She recently had a patient who didn’t know she was pregnant until she was 14 weeks along. Her patient had irregular periods. As many as one in four women do, according to the NIH. The patient also had an IUD, a contraceptive device implanted into the uterus, which prevents pregnancy in more than 99 out of 100 cases, according to Planned Parenthood.
By the time the patient scheduled an abortion, she was at 16 weeks, past the cut-off of this bill.
“As a doctor, I’m taking care of the people that are going to have their lives be ... more difficult,” Prabhakaran said. “When you’re in the situation, you understand how awful it really is.”
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