The Truth About Late-Term Abortions

In the rhetoric surrounding the abortion debate, there is a claim which has been floating around for quite a while now, but really blew up after the Presidential Debate in September of 2016: abortions done after 20 weeks are usually done to save the life of the woman and/or because of fatal fetal abnormalities.

Former Secretary of State Hillary Clinton used this talking point in a debate with then-candidate, now-President Donald Trump on September 20th, 2016. She said,

“I think that the kind of late-term abortions that take place are because of medical necessity. And, therefore, I would hate to see the government interfering with that decision.”

She meant medical necessity on the part of the pregnant woman, not the human fetus.

Tara Haelle, a Senior Contributor for Forbes, offering “straight talk on science, medicine, health and vaccines,” reported on the Trump-Clinton debate of September 2016.

“Those who seek late-term abortions are seeking them before a pregnancy reaches full term but often and unfortunately after they have discovered in the second or third trimester some problem with the fetus or danger to the mother…,” and, “It [dilation and extraction] refers to a very specific and rare procedure…in which a fetus is partially pulled through the birth canal and then aborted, nearly always when the fetus cannot live outside the womb and typically when the mother’s health is in danger, the fetus has a serious abnormality, or both. Such a procedure is not conducted lightly: the fetus has a fatal defect and will not survive, or the mother is at risk of death herself,” Haelle stated.

“Abortions that occur at this stage in pregnancy are often the result of tragic diagnoses,” said Dr. Jennifer Conti, a clinical assistant professor at Stanford University in obstetrics and gynecology, in response to one of Trump’s comments on late-term abortions.

Another OBGYN, Dr. Jen Gunter, wrote on her blog after the debate,

“For example, Mrs. Clinton made an error speaking about late-term abortion when she said it was a health of the mother issue. Typically it is not (it’s almost always fetal anomalies)…1.3% of abortions happen at or after 21 weeks and 80% are for birth defects…Terminations after 24 weeks are for severe fetal anomalies.”

Such claims are usually made when people talk at all about abortions past the first trimester, and specifically when the discussion is about regulating access to late-term (20+ week gestation) abortions. The person claiming late-term abortions are only done in cases of severe fetal abnormality or in situations threatening to the life of the mother may make additional, similar claims. For example, a person might say:

• “Many late-term abortions were wanted or even planned pregnancies which just went very wrong and therefore must, tragically, be aborted.”
• “Research proves medical necessity is the main reason for late-term abortions.”
• “You must really hate women if you seriously think a woman would get a late-term abortion if it weren’t absolutely necessary.” (my personal favorite)

These arguments, however, are not based in fact. If I’m honest, I have a duty to deal with and explain the evidence either for or against any claim I make. Keeping this in mind, let’s examine the evidence for and against the claim that late-term abortions are done to save the life of the mother or due to fatal fetal abnormalities.

We will begin with research from the pro-choice Guttmacher Institute to explore this claim. If any research entity is going to support abortion access for the health of the mother, it is the former research arm of Planned Parenthood. So if any evidence for this claim exists, they should be the ones pushing it the hardest.

Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives

In 2005, Guttmacher published this paper. Among the structured survey respondents (1,209 patients total), the two most common reasons for having an abortion were “having a baby would dramatically change my life” and “I can’t afford a baby now” (cited by 74% and 73%, respectively). About 13% of women cited “fetal health” and 12% cited “personal health” as reasons for getting an abortion.

However, this data still does not support the claim made by people defending late-term abortions because 20+ week gestational age is not specifically considered. Moreover, it is unknown if the fetal and personal health concerns listed were substantiated by a doctor or any kind of testing, and, even if substantiated, it is unknown whether the concerns could be considered fatal to the life of the human fetus or to the life of the mother if the pregnancy continued.

“Who has second-trimester abortions in the United States?”

This Contraception publication starts to give us a better idea of reasons women choose abortion in the second trimester. This study is also cited by many Guttmacher publications. The data came from “a national sample of 9493 women obtaining abortions in 2008,” and was published in 2012. One of the questions asked was the reasons for the abortion: “APS asked women whether they had experienced any of 11 potentially disruptive life events in the last 12 months, including…having a serious medical problem.”

Even though the authors state, “At least a small number of second-trimester abortions are for reasons of fetal or maternal indications,” they offer no specific data, statistics, or citations for this statement. There is no data from their study specific to “maternal health,” and fatal fetal abnormality was not even an option for women to choose as the reason for their abortion. This paper also actively undermines the additional claim that most late-term abortions are wanted or intended pregnancies since this study found the number of women claiming their second-trimester abortion was for an intended pregnancy was a little less than (but not statistically significantly different from) the number of women saying their pregnancy was unintended – meaning abortions done late in pregnancy are about half and half for intended vs unintended pregnancies.

Who Seeks Abortions at or After 20 Weeks?

Finally, this Guttmacher 2013 paper was published in Perspectives on Sexual Health and Reproduction. If support for the specific claim late-term abortions are done to save the life of the mother or for fatal fetal abnormalities is to be found anywhere, one would think it would be here.

The authors of this study admit even though about 1% of abortions are done at 21+ weeks and 7% done at 14-20 weeks gestation, that is still over 15,000 abortions per year estimated to happen after 20 weeks, and therefore the reasons women seek abortions so late in gestation is still a relevant question.

It helps to know both pro-choice and pro-life people can agree that even 1% is important and those women deserve to be heard.

The authors make a statement which spells disaster for the claim most people make about late-term abortions: “But data suggest that most women seeking later terminations are not doing so for reasons of fetal anomaly or life endangerment.”

Essentially, this paper admits there is no evidence for the common pro-choice claim about late-term abortion. Instead, this paper uses a small data set from the deeply flawed Turnaway Study to explore the reasons women do seek late-term abortions, since it is not for reasons of maternal health or fatal fetal abnormality.

From what limited data there is, the reasons are mostly the same as for women seeking an abortion in their first trimester. Additionally, the same reasons for delay between finding out about the pregnancy and decision to have an abortion and then going through with the abortion were present in both first-trimester and 22+ week abortions.

More women who got a late-term abortion found out about the pregnancy about a month later than women who got a first-trimester abortion (8-9 weeks vs 4-5 weeks, respectively). The paper also pointed out women seeking later abortions compared to women seeking a first-trimester abortion were more likely to be young (20-24 years old), unmarried, and unemployed.

Do medical reasons for later abortion legitimately exist?

Additionally, let’s take a quick look at if it makes sense medically to say abortion can save a woman’s life and if fetal abnormalities can even be diagnosed with certainty.

Dilation and evacuation (D&E) and dilation and extraction (D&X), two methods of abortion which can be used at 20+ weeks gestation, would never be able to save the life of a mother because these procedures can take 12-48 hours to prep for — far too long in an actual life-or-death situation to do any good.

However, if at 20+ weeks a woman’s life was in danger because of her pregnancy, an emergency c-section can be done in 5-60 minutes. An emergency c-section would also allow the child a chance to live. Technology has come sufficiently far that preterm babies born just under 22 weeks and older now have at least a fighting chance at life in neonatal intensive care units, or a chance of comfort in neonatal palliative care. The American Association of Pro-Life Obstetricians and Gynecologists put together a resource outlining the numerous reports, research, and data showing abortion of a still-living human fetus is never necessary to save the mother’s life.

Even most abortion advocates can agree a human fetus should have the right to life at the point he or she can feel pain or is viable outside the woman’s body. A 21+ week old fetus fulfills both those criteria.  

Detection of fetal anomalies is not a perfect science, either. False–positive rates using ultrasounds to find structural abnormalities range from 5-20%, even into the third trimester. One study done on aborted fetal remains after a diagnosis of a fetal abnormality found 4% of the children had no abnormality and 11% of the children had less severe abnormalities than diagnosed. The most common over- or mis-diagnosed abnormalities were brain and central nervous system disorders such as hydrocephalus. Other similar studies have shown similar results.

Genetic screening tests using maternal blood can also show false positives, leading women to consider and undergo an abortion when in reality, their baby may have no genetic anomaly at all. Genetic screens only tell the likelihood of the possibility of a genetic anomaly, they are not diagnoses.

However, many women do not understand this fact because their doctors are not telling them or the doctors themselves do not understand the limitations of screens, and many women may be getting abortions done for fetal abnormalities when the child is perfectly healthy. Only more invasive diagnostic testing of fetal cells through amniocentesis or chorionic villus sampling is able to determine with great certainty if a human fetus has the disorder being tested for, and these tests can be very expensive.

We can confidently say the claim, abortions after 20 weeks are usually done to save the life of the woman and/or because of fatal fetal abnormalities, is completely unsubstantiated by available evidence. There is just no data to support it; in fact, there is data to the contrary. Even websites, companies, and researchers (like Dr. Diana Greene Foster, lead researcher of the Turnaway study) who advocate for abortion cannot support this claim.

Part of the issue is that abortion data is not required to be reported at the federal level, and many states do not require reporting from abortion clinics. Additionally, truly life-saving pregnancy terminations so late in pregnancy would most likely be done at a hospital’s ER, not at an abortion clinic offering later-term abortions, according to Dr. Foster; which makes stats on later abortions even more difficult to obtain. We can only make conclusions from the data we have, and the data we have does not at all show that abortions late in pregnancy are mainly or only for reasons of maternal health or fatal fetal abnormality.

Let me be clear: none of this information should imply women seeking abortions so late in their pregnancy are consciously choosing to be selfish or are making these decisions lightly. For many women, the choice to undergo a late-term abortion is very difficult, and they may have to deal with emotional and mental turmoil afterward.

Pro-life people need to remember that although we want to legislate against abortion because of what it is and what it does to a living human organism, we need to also support the women who feel an abortion at 21 or 24 or 32 weeks is their only option so they know their true options. We have studies showing us at least some women seeking a later abortion may be experiencing a lot of conflict in their personal lives and may be in a bad place financially or materially to take care of a child; for them, desperation may be driving their decision.

As mentioned earlier, an estimated 15,000 women — just in the United States — will have a late-term abortion done each year. What are we doing to holistically help these women get the support and education they need at a very vulnerable time in their lives?