Why do women decide to get third-trimester abortions?
Third-trimester abortions are defined as abortions that take place at or after 24 weeks from the last missed period (LMP). Often referred to as "late-term abortions" by anti-abortion activists, third-trimester abortions are substantially more expensive, difficult to obtain, and stigmatized than first-trimester abortions. But the circumstances that lead to someone needing a third-trimester abortion have overlaps with the pathways to abortion at other gestations. This study examines an uncommon and understudied experience: needing a third-trimester abortion.
Two Pathways to Abortion After 24 Weeks
Findings demonstrate the value of understanding abortion as a need throughout pregnancy. There are two pathways by which people come to need a third-trimester abortion: new information and barriers to abortion before the third trimester. The reasons people need third-trimester abortions are not so different from why people need abortions before the third trimester:
- They received new information—including that they were pregnant—that made the pregnancy not (or no longer) one they wanted to continue.
- They tried to obtain an abortion before the third trimester but faced insurmountable barriers (including policy restrictions and stigma) that delayed them into the third trimester.
The New Information Pathway
The limits of medical knowability mean some information about a pregnancy is simply not available before the third trimester. For instance, clinical research shows that some serious fetal health issues are not observable until the third trimester of pregnancy. Consider the case of Kara (a pseudonym), who learned in the third trimester of pregnancy that her fetus had a serious health issue. This information was unavailable earlier in the pregnancy. As Kara explained, “Brain development happens so much in the last second trimester and early third trimester that they really could not confidently tell us more [at those earlier scans].” Simply put, Kara could not have known the severity of this fetal health issue earlier in pregnancy.
Barriers to Abortion Before the Third Trimester
The second pathway involves individuals who faced insurmountable barriers. Victoria (a pseudonym) explained, “My boyfriend was working odd jobs, and I don't have a job, and we were homeless on the street. So, I mean, we would have definitely tried, and we, you know, did try, but there was no way that we could get a couple hundred [dollars], let alone a grand, if not more.” Interviewees needed an abortion in circumstances that were similar to those of people who need abortions in the first and second trimesters.
Study Design and Participant Data
In this study, Katrina Kimport interviewed 28 cisgender women who obtained an abortion after the 24th week of pregnancy by phone. The interviews were analyzed thematically. Data regarding the participants included the following:
- Number of Interviewees: 28
- Age Range: 18 to 46
- Pregnancy Duration: 24 weeks to 35 weeks LMP
- Employment Status: Eight were unemployed at the time of their abortion, including one who was homeless.
While third-trimester abortion may be exceptional in its cost, clinical complexity, logistics, and low social support, the reasons people need third-trimester abortion care are not. Respondent experiences illustrate the limitations of the social and legal organization of abortion care by gestation and point to the value of understanding abortion as a need throughout pregnancy. Instead of a focus on gestation or trimesters, these findings make a strong case for conceptualizing a need for abortion throughout pregnancy.
The article, Is third-trimester abortion exceptional? Two pathways to abortion after 24 weeks of pregnancy in the United States, is available in Perspectives on Sexual and Reproductive Health.