Since the legalization of abortion throughout the U.S. in 1973, abortion
services have become more widely accessible and knowledge of them has
grown. As a result, the overwhelming majority of abortions are performed
in the first trimester of pregnancy. For a number of reasons, however,
abortion after the first trimester remains a necessary option for some
Unfortunately, anti-choice activists seek to limit access to abortion
through, among other means, bans on postviability procedures, laws
imposing a fixed date for fetal viability, and so-called "partial birth"
abortion bans, many of which could limit access to abortion during
all stages of pregnancy.
In fact, the same anti-choice activists who would limit access to
abortions after the first trimester also oppose access to abortion in
the first trimester by advancing numerous restrictions, including
parental involvement laws and mandatory delay laws. Also, by asserting
their bias at a local level through picketing doctors' homes and offices,
clinic blockades, threats of violence against doctors, and the
misapplication of zoning laws, etc., they create a climate so threatening
that the number of qualified providers is diminished. These actions
endanger the health of women and the right of physicians to determine the
most appropriate treatment for their clients.
The Number of Abortions after the First Trimester Is Relatively
- Between 1990 and 1997, the number of abortions in the United States
fell from 1,429,577 to 1,186,039 (CDC, 2000). The CDC estimates that 55
percent of legal abortions occur within the first eight weeks of
gestation, and 88 percent are performed within the first 12 weeks. Only
1.4 percent occur after 20 weeks (CDC, 2000).
- Since the nationwide legalization of abortion in 1973, the
proportion of abortions performed after the first trimester has
decreased because of increased access to and knowledge about safe, legal
abortion services (Gold, 1990).
Various Factors Require Women to Have Abortions after the First
Barriers to Service
- Geographic A 1993 survey of U.S. abortion providers found
that among women who have non-hospital abortions, approximately 16
percent travel 50 to 100 miles for services, and an additional eight
percent travel more than 100 miles (Henshaw, 1995a). It follows that
having to travel such distances would cause delays in obtaining
- Provider shortage As of 1996, 86 percent of U.S. counties
have no known abortion provider; these counties are home to 32 percent
of all women of reproductive age. Furthermore, 95 percent of
non-metropolitan counties have no abortion services, and 87 percent of
non-metropolitan women live in these unserved counties (Henshaw, 1998).
- Financial In 1993, the average cost of a first-trimester,
non-hospital abortion with local anesthesia was $296. [The New York
Times reports that this cost is currently about $350 (Talbot,
1999).] For low-income and younger women, gathering the necessary funds
for the procedure often causes delays. Compounding the problem is the
fact that the cost of abortion rises with gestational age: in 1993,
non-hospital facilities charged $604 for abortion at 16 weeks gestation
and $1,067 at 20 weeks (Henshaw, 1995a). For various reasons, most
patients pay for abortions out-of-pocket. For example, in 1995,
one-third of women did not have employer-based insurance; most states
did not allow Medicaid funding for abortions; and one-third of private
insurance plans did not cover abortion or covered it only for certain
medical indications (Henshaw, 1995a). For some, these costs can pose
significant barriers to access.
- Legal restrictions Causing additional delays are state laws
such as those mandating parental consent or notification or
court-authorized bypass for minors and those imposing required waiting
periods. For example, after Mississippi passed a parental consent
requirement, the ratio of minors to adults obtaining abortions after 12
weeks increased by 19 percent (Henshaw, 1995b).
Medical indications may lead to abortion after 12 weeks.
Discovery of serious fetal anomalies, such as severe genetic disorders, or
conditions in which the woman's health is threatened or aggravated by
continuing her pregnancy include
- malignant hypertension, including preeclampsia
- out-of-control diabetes
- heart failure
- severe depression
- suicidal tendencies
- serious renal disease
- certain types of infections
These symptoms may not occur until the second trimester, or may become
worse as the pregnancy progresses (Cherry & Merkatz, 1991; Paul et
Other Reasons for Postponing Abortion Past 12 Weeks
- lack of financial and/or emotional support from the male partner
- psychological denial of pregnancy, as may occur in cases of rape or
- lack of pregnancy symptoms, seeming continuation of "periods,"
- absence of partner due to estrangement or death (Paul et al.,
Adolescents Often Delay Abortion Until after the First Trimester
- Adolescents are more likely than older women to obtain abortions
later in pregnancy. Adolescents obtain 29 percent of all abortions
performed after the first trimester (CDC, 2000).
- Among women under age 15, one in four abortions is performed at 13
or more weeks' gestation (CDC, 2000).
- The very youngest women, those under age 15, are more likely than
others to obtain abortions at 21 or more weeks gestation (CDC, 2000).
- Common reasons why adolescents delay abortion until after the first
trimester include fear of parents' reaction, denial of pregnancy, and
prolonged fantasies that having a baby will result in a stable
relationship with their partner (Paul et al., 1999). In addition,
adolescents may have irregular periods (Friedman et al., 1998),
making it difficult for them to detect pregnancy. Also, as previously
noted, state laws requiring parental consent or court-authorized bypass
for minors often cause delays.
Abortion after the First Trimester Is as Safe as or Safer than
Carrying a Pregnancy to Term
- Overall, abortion has a low morbidity rate. Fewer than 1 percent of
women who undergo legal abortion sustain a serious complication (AGI,
1998). The rate of complication increases by about 20 percent for each
additional week of gestation past eight weeks (Paul et al.,
- Presently the death rate from abortion at all stages of gestation is
0.6 per 100,000 procedures (Paul et al., 1999). The risk of death
associated with childbirth is about 10 times as high as that associated
with abortion (AGI, 1998).
- The risk of death associated with abortion increases with the length
of pregnancy, from one death for every 530,000 abortions at eight or
fewer weeks to one per 17,000 at 16-20 weeks, and one per 6,000 at 21 or
more weeks (AGI, 1998). After 20 weeks gestation there is no
statistically significant difference in maternal mortality rates between
terminating a pregnancy by abortion and carrying it to term (Paul et
Current Law Allows for Abortion after the First Trimester
Legality of Abortion
- In Roe v. Wade (410 U.S. 113 (1973)), the U.S. Supreme Court
held that the U.S. Constitution protects a woman's decision to terminate
her pregnancy. Only after the fetus is viable, capable of sustained
survival outside the woman's body with or without artificial aid, may
the states ban abortion altogether. Abortions necessary to preserve the
woman's life or health must still be allowed, however, even after fetal
- Prior to viability, states can regulate abortion, but only if the
regulation does not impose a "substantial obstacle" in the path of a
woman seeking an abortion (Harrison & Gilbert, 1993).
Determination of Viability
- In Planned Parenthood of Central Missouri v. Danforth (428
U.S. 52 (1976)), the U.S. Supreme Court recognized that judgments of
viability are inexact and may vary with each pregnancy. As a result, it
granted the attending physician the right to ascertain viability on an
individual basis. In addition, the Court rejected as unconstitutional
fixed gestational limits for determining viability. The court reaffirmed
these rulings in the 1979 case Colautti v. Franklin (439 U.S. 379
State Laws and Abortion Facilities
- In City of Akron v. Akron Center for Reproductive Health (462
U.S. 416 (1983)), the U.S. Supreme Court invalidated a costly
requirement that all second-trimester abortions take place in a
- In Thornburgh v. American College of Obstetricians and
Gynecologists (476 U.S. 747 (1986)), the U.S Supreme Court ruled
that a state may require that a second physician be present at the
abortion of a viable fetus to care for it should it be born alive, but
that requirement must be waivable in a medical emergency.
Laws and Specific Abortion Techniques
- In Thornburgh v. American College of Obstetricians and
Gynecologists, the U.S. Supreme Court ruled that a woman may not be
required to risk her health to save a fetus even after viability, and it
granted the attending physician the right to determine when a pregnancy
threatens a woman's life or health.
- The court also ruled that when performing a postviability abortion,
a physician must be permitted to use the method most likely to preserve
the woman's health, even if it might endanger fetal survival.
- Anti-choice activists have called for legislation prohibiting
"partial birth" abortions, a political term that has no medical
definition (Paul et al., 1999).
- In Stenberg v. Carhart (530 U.S. 914 (2000)), the U.S.
Supreme Court ruled that Nebraska's so-called "partial birth" abortion
ban was unconstitutional because it failed to include an exception to
preserve the health of the woman, and it imposed an undue burden on a
woman's ability to choose an abortion. The court determined that the law
was so broadly worded that it could be used to prohibit access to the
safest and most common medical procedures for terminating a pregnancy
before fetal viability.
- Bans on so-called "partial birth" abortions have been passed by 31
states, and legal challenges to these laws have been brought in 21
states. The majority of these states passed laws similar to Nebraska's,
and most have been held invalid or are unenforceable (CRLP, 2001).
AGI — Alan
Guttmacher Institute. (1998, accessed 1999, July 16). Facts in Brief:
Induced Abortion [Online]. http://www.agi-usa.org/pubs/ib13.html
— Centers for Disease Control and Prevention. (2000, December 8).
"Abortion Surveillance — United States, 1997."Morbidity and Mortality
Weekly Report, 49(SS-11).
Cherry, Sheldon & Irwin Merkatz,
eds. (1991). Complications of Pregnancy: Medical, Surgical,
Gynecologic, Psychosocial, and Perinatal, 4th Edition. Baltimore:
Williams & Wilkins.
City of Akron v. Akron Center for
Reproductive Health, 462 U.S. 416 (1983).
Franklin, 439 U.S. 379 (1979).
CRLP - Center for Reproductive
Law and Policy. (2001, accessed 2001, March 22). ""Partial-Birth" Abortion
Ban Legislation: By State."
Friedman, Stanford B., et al.
(1998). Comprehensive Adolescent Health Care, 2nd ed. St. Louis:
Gold, Rachel Benson. (1990). Abortion and Women's Health:
A Turning Point for America? New York: The Alan Guttmacher
Harrison, Maureen & Steve Gilbert, eds. (1993).
Abortion Decisions of the United States Supreme Court: The 1990's.
Beverly Hills, CA: Excellent Books.
Henshaw, Stanley K. (1995a).
"Factors Hindering Access to Abortion Services." Family Planning
Perspectives, 27(2), 54-59 & 87.
_____. (1995b). "The
Impact of Requirements for Parental Consent On Minors' Abortions in
Mississippi." Family Planning Perspectives, 27(3),
_____. (1998). "Abortion Incidence and Services in the
United States, 1995-1996." Family Planning Perspectives, 30(6),
263-270 & 287.
Paul, Maureen, et al. (1999). A
Clinician's Guide to Medical and Surgical Abortion. New York:
Planned Parenthood of Central Missouri v.
Danforth, 428 U.S. 52 (1976).
Roe v. Wade, 410 U.S. 113
Stenberg v. Carhart, 530 U.S. 914
Talbot, Margaret. (1999, July 11). "The Little White
Bombshell." New York Times Magazine, 39-43.
American College of Obstetricians and Gynecologists, 476 U.S. 747
Public Policy Contact
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