Dr. Diane Horvath is an OB-GYN who has worked in abortion care over the last 15 years. With training in complex family planning, she has experience seeing patients throughout all three trimesters of pregnancy. But since the Supreme Court Dobbs decision overturned Roe v. Wade, allowing states to deny access to abortion, she’s noticed a trend at her clinic in Maryland: abortion bans and gestational restrictions are forcing people who try to get abortions earlier in pregnancy are being pushed to get them later in pregnancy.
“When people decide they want an abortion, they want to have it as soon as possible — nobody waits until they're 30 weeks and decides, 'Well, I think I'll just have an abortion now.' That just doesn't happen,” Horvath told Salon. “What has happened with a lot of our patients is that they've been trying to have an abortion for months, and the costs and barriers start to compound and become insurmountable until people are later in pregnancy.”
Horvath elaborated that a common situation is this: somebody lives in a state with a near-total abortion ban, for example, Alabama or Florida, which has a six-week limit, a cut-off that occurs before many people even know they're pregnant. Abortion in their state isn’t an option by the time they find out they are pregnant, and for one reason or another, they don’t have access to medication abortion. They start researching getting access to care out of state. They get an appointment a few weeks out, but by that time they will have surpassed that state’s gestational limit. Then they have to start from square one again.
“It’s not hard to imagine how three, four or six weeks could pass while you navigate this,” Horvath said, noting that 60 percent of pregnant people who get an abortion are already parents. Childcare is another factor to consider when arranging travel plans and taking time off work. Plus, the further along in pregnancy a person is, the more complex and costly the procedure can be. “When we view this with empathy, we can absolutely see how somebody could end up later in pregnancy than they had intended to be, because of all of these barriers and because of people's circumstances in their real lives.”
Less than one percent of abortions in the United States occur after 21 weeks of gestation — unlike what many anti-abortion advocates try to portray. However, as Salon previously reported, the phrase “late-term abortion” has made its way into public discourse during this election season. Not only did the first presidential debate between President Joe Biden and former President Donald Trump include a very misinformed discussion about “late-term abortions” before Roe v. Wade was overturned, but the Republican Party adopted a “Make America Great Again” policy platform ahead of its national convention that stated in a 16-page document the party will oppose "late-term abortion.” Yet providers say these very policies being pushed by anti-abortion legislators are anecdotally pushing people to have to terminate their pregnancies in second and third trimesters.
When anti-abortion advocates say “late-term abortion,” an intentionally vague term, they are typically talking about abortions that occur in the second trimester — at or after 13 weeks of gestation. According to the Centers for Disease Control and Prevention (CDC), in 2021 about 81 percent of abortions in the U.S. occurred at nine weeks of pregnancy or earlier; 94 percent happened in the first 13 weeks, 3 percent occurred between 16 and 20 weeks of gestation.
Notably, there isn’t any data post-Dobbs available on the rise of abortions happening later in pregnancy as a result of Dobbs-related restrictions. The Guttmacher Institute told Salon they are looking into it and hope to have data in the near future. But for people who work in abortion care, like Horvath and more, they say they are seeing this trend on the ground and it’s a direct consequence of strict abortion laws following the Dobbs decision.
Dr. Jen Russo, chief medical officer at the DuPont Clinic in California, told Salon all of the barriers that exist right now are likely contributing to people being pushed to terminate later in pregnancy. Fear, and funding, are major barriers, Russo emphasized.
“We are sort of seeing the same types of cases as we've always seen, but the volume that we're seeing has decreased because people are having such trouble accessing funding,” Russo said. As Salon has previously reported, abortion funds are running out of money. “Patients who have fetal anomalies or medical conditions that are dangerous for them in the pregnancy, their doctors might still be afraid to tell them where they can go or how they can access care, and so that leads to delays.”
Sometimes, there are cases where a patient finds out their fetus has a congenital anomaly that isn’t diagnosed until 18 or 20 weeks of pregnancy.
“They had no idea, they had genetic testing, and it was normal, but then they went for their anatomy ultrasound and found out that they had an anatomic abnormality that isn't genetic,” she said. “Or they are diagnosed with a new medical condition.”
A 2022 study of patients seeking abortions after 24 weeks of pregnancy found that they fell into two categories. Either they had learned new information about their pregnancies, such as the emergence of a serious fetal health issue or something that posed a major risk to their health, or they experienced barriers to abortion services earlier in the pregnancy. Certainly, barriers to access were an issue even before the fall of Roe v. Wade. But the repercussions of more restrictions is being felt in abortion clinics that offer abortions later in pregnancy.
Dr. Warren Hern, who specializes in fetal anomaly abortions in Colorado, said he has been seeing patients for over 40 years. He is used to seeing the barriers people face to access abortion care later in pregnancy. Today, he told Salon 30 percent of his patients are from Texas. Another 50 percent, he estimates, come from other red states. Despite so-called exceptions for life-of-the-mother or fetal anomalies, Hern said he sees patients from these states, too.
“Exceptions are meaningless, they’re cosmetic,” Hern said. “It is inexcusable to have any law restricting access to abortion.”
People who are pushing strict abortion laws are “completely disconnected from reality,” he added. “They have no relationship to reality whatsoever; it's about getting elected."
