Understanding Third-Trimester Abortions: Pathways and Realities
This study examines an uncommon and understudied experience: needing a third-trimester abortion. 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. Findings demonstrate the value of understanding abortion as a need throughout pregnancy.
Pathways to Third-Trimester Abortion
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.
New Information Pathway
One primary reason individuals seek third-trimester abortions is the emergence of new information that was unavailable earlier in the pregnancy. 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. As Kara (a pseudonym) 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. This new information makes the pregnancy not (or no longer) one they wanted to continue.
Barriers to Abortion Before the Third Trimester Pathway
Another significant factor is the presence of insurmountable barriers that delay access to abortion until the third trimester. People 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. 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.”
Study Design and Participant Demographics
Katrina Kimport interviewed 28 cisgender women who obtained an abortion after the 24th week of pregnancy by phone. Interviewees ranged in age from 18 to 46. Most described themselves as able to meet their basic financial needs, but eight were unemployed at the time of their abortion, including one who was homeless. At the time of their abortion, participants’ pregnancy duration ranged from 24 weeks to 35 weeks LMP. The interviews were analyzed thematically.
Key Findings and Implications
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. Interviewees needed an abortion in circumstances that were similar to those of people who need abortions in the first and second trimesters. While third-trimester abortion is relatively uncommon in the United States compared to first-trimester abortion, these findings add to our understanding of why people seek third-trimester abortion care. 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.
Overview of Pathways to Third-Trimester Abortion
The table below summarizes the two main pathways identified in the study that lead individuals to seek third-trimester abortions:
| Pathway Category | Description | Example |
|---|---|---|
| New Information | Discovery of information (e.g., serious fetal health issues) not available earlier in pregnancy, making continued pregnancy undesirable. | Kara learned in the third trimester that her fetus had a serious health issue that was not observable earlier. |
| Barriers to Abortion Before the Third Trimester | Facing insurmountable obstacles (e.g., financial, logistical, policy restrictions, stigma) that prevented obtaining an abortion earlier in pregnancy. | Victoria faced financial and housing instability, making it impossible to afford an earlier abortion. |
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.