Why do women decide to get third-trimester abortions?

Published April 21, 2022

The reasons people need third-trimester abortions are not so different from why people need abortions before the third trimester: 

  1. They received new information—including that they were pregnant—that made the pregnancy not (or no longer) one they wanted to continue
  2. 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.

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.

Key Findings

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 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.
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 may be exceptional in its cost, clinical complexity, logistics, and low social support, the reasons people need third-trimester abortion care are not.
Instead of a focus on gestation or trimesters, these findings make a strong case for conceptualizing a need for abortion throughout pregnancy.

Study Design

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.

New Information Pathway: Kara (a pseudonym) 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: 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.”

Implications

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.

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.

Areas of Research