The Full Picture: Understanding Abortion Later in Pregnancy
Key Takeaways
Leading doctors and medical organizations reject the use of the term “late-term abortion.” It is not a medical term, but rather a phrase coined by anti-abortion activists to shame and stigmatize people.
Many states with protections for abortion care access still restrict abortion care after a certain arbitrary point in pregnancy, leaving patients who need that care with no options.
Abortion care after 24 weeks accounts for less than 1% of pregnancy terminations in the United States.
Current “exceptions” frameworks in laws that restrict abortion care throughout pregnancy consistently fail to account for the many unique reasons why patients may need this care.
Voters, physicians, patients, and advocates agree: decisions regarding pregnancy should be made by a patient, with the support of their physician, and not by politicians.
66% of Massachusetts voters support removing restrictions on abortion care later in pregnancy.
Executive Summary
This white paper defines “abortion care later in pregnancy” as assisted or induced pregnancy termination after 24 weeks of pregnancy. Pseudoscientific legal theories of pregnancy have caused states to ban abortion care at arbitrary points in pregnancy, despite the fact that each pregnancy is unique and decisions about pregnancy progression should remain between a patient and their doctor.
There are many reasons patients may seek abortion care later in pregnancy and only some (namely, fatal fetal anomalies or threats to the life of the pregnant person) are named as exceptions to bans on abortion care later in pregnancy, including in states that explicitly protect access to abortion care. These exceptions frameworks fail to account for the numerous other reasons patients may seek abortion care later in pregnancy, and even those that are named cannot possibly capture every nuance or complexity of a pregnancy. These frameworks can put physicians and health care administrators in the difficult position of making case-by-case determinations on the pregnancies of patients with whom they are not familiar.
The abortion care landscape nationwide has dramatically shrunk in the wake of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, which rolled back the national right to abortion care until the point of “fetal viability.” The loss of providers wrought by the Dobbs decision has resulted in delays for abortion care for patients nationwide, leading more patients to seek abortion care further into pregnancy.
In Massachusetts, 66% of voters support removing restrictions on abortion care later in pregnancy and believe that these decisions should be made exclusively between a patient and their doctor.
How to Write About Abortion Care Later in Pregnancy
For the purpose of this white paper, we are defining abortion care later in pregnancy as pregnancy termination after 24 weeks of pregnancy. Despite 24 weeks of pregnancy serving as a point designated by law in many states as the time after which abortion care becomes “late,” this number or period in pregnancy is completely arbitrary and holds no scientific backing.
Neither the concept of “fetal viability” nor the trimester framework are medical benchmarks for pregnancies; both were created in the landmark Roe v. Wade opinion, authored by U.S. Supreme Court Justice Harry Blackmun, creating a litmus test for when the state is empowered by the court to have a vested interest in pregnancy outcomes. [1] There is no defined consensus in the medical community on at what point a pregnancy is considered viable.
It is crucial to avoid the use of the term “late-term” or “later” abortion. Abortion care, miscarriage management, and assisted pregnancy termination can occur at any point in pregnancy. Pregnancies are delicate, complex experiences that are unique to each individual and require different types of care at different points. The phrase “late-term abortion” was coined by anti-abortion activists as a way to stigmatize pregnancy loss that occurs later in pregnancy and shame individuals for their pregnancy outcomes. This term has no medical meaning and has been widely criticized by physicians as well as the American College of Obstetricians and Gynecologists. [2] If necessary, use “abortion later in pregnancy” to describe care that occurs after the 24th week of pregnancy, which was the restriction defined in Roe v. Wade.
Abortion care after 24 weeks accounts for less than 1% of pregnancy terminations in the United States. [3]
No abortion care occurs “after birth” or “just before birth.”
Landscape Analysis
Abortion care throughout pregnancy is legal in nine states—Alaska, Colorado, Maryland, Michigan, Minnesota, New Jersey, New Mexico, Oregon, and Vermont as well as in Washington, D.C. Freestanding clinics in eight states across the United States provide abortion care past 24 weeks: Colorado, Illinois, Maryland, New Jersey, New Mexico, New York, Oregon, Washington, and Washington, D.C. In these states, there are a total of seventeen clinics, of which only a handful consistently provide care after 28 weeks. Learn more by visiting the Later Abortion Initiative at https://laterabortion.org/.
In 19 states, abortion is restricted later in pregnancy, but permissible up to approximately 24 weeks of pregnancy. In all other 22 states, abortion is banned at some point in the first 24 weeks of pregnancy. [4]
In New England, no states restrict abortion care before 24 weeks of pregnancy or “fetal viability,” but several New England states—with the exception of Vermont—have restrictions on abortion care later in pregnancy. Connecticut and Rhode Island set their gestational ban as “after the point of ‘fetal viability’,” (with exceptions and no criminal penalties). New Hampshire restricts abortion care after 24 weeks of pregnancy (with limited exceptions and criminal penalties). Massachusetts restricts abortion care after 24 weeks of pregnancy (with exceptions). Maine retains a viability standard in its statute; care can be provided after 24 weeks based on a physician’s professional judgment. Vermont has no restrictions on abortion care at any point in pregnancy.
A shrinking landscape of care in the post-Dobbs era has resulted in delays across the country for patients seeking abortion care. With fewer physicians and the closures of brick-and-mortar clinics, there are fewer available appointments for abortion care, but the need for abortions has remained steady (or possibly risen, as abortion incidence has risen in the post-Dobbs era). This means that many patients are forced to delay their care due to the lack of availability of appointments, which means more patients are seeking abortion care later in pregnancy.
Why Patients Seek Abortion Care Later in Pregnancy
There are many reasons why patients may seek abortion care later in pregnancy, and no single explanation can account for all of those reasons. Every pregnancy is different; medical trauma, significant material needs, logistical hurdles, and emotional and physical challenges can accompany pregnancy. The broad range of reasons why patients seek abortion care later in pregnancy makes clear that an “exceptions” framework consistently fails to account for each unique patient experience. Here, we highlight a few of the more common reasons why patients may be prompted to seek abortion care later in pregnancy.
Fetal loss, fatal fetal anomaly, and medical conditions that make a fetus incompatible with life. Certain fatal fetal anomalies (FFAs) or conditions that will make a fetus incompatible with life cannot be detected until later in pregnancy. This term describes conditions that cause the death of a fetus in the womb or within 28 days of birth. Some common fatal fetal anomalies include Trisomy 13 and anencephaly. Fatal fetal anomalies impact an estimated 2% of pregnancies yearly.
Fetal anomalies that will significantly shorten or worsen an infant’s quality of life, such as in-utero stroke, genetic or chromosomal abnormalities such as Tay-Sachs, and other developmental irregularities that will potentially result in a live birth, but may result in an extremely short and painful life for the fetus.
Pregnancy-related morbidity, risk to the pregnant person’s life, or continued fertility and health. Patients may experience severe health problems related to pregnancy, including incomplete spontaneous miscarriage leading to sepsis, life-threatening high blood pressure or preeclampsia, spontaneous heavy bleeding and hemorrhaging, and blood clots. These conditions typically require immediate treatment and can require miscarriage management and abortion care.
Sudden severe illness requiring immediate interventionary therapy that will harm a pregnancy. Some people may be diagnosed with a severe acute or chronic illness, such as cancer, during their pregnancy. In these circumstances, physicians may recommend immediate and aggressive treatments that are typically antineoplastic, or incompatible with the growth of a healthy pregnancy. Patients are then faced with the devastating choice between risking their lives to continue a pregnancy and forgoing treatment, or ending a pregnancy to fight back against these diseases.
Delayed ability to seek care resulting from domestic violence, sexual violence, trafficking, abuse, or incest. Some patients may not even know they are pregnant due to their inability to access prenatal care when suffering from abuse, imprisonment in the home, or coercion. Some patients may know they are pregnant with an unintended pregnancy, but are unable to access care early in the pregnancy due to domestic violence or threats to their immediate safety if they were to seek abortion care.
There are many more reasons that patients may seek abortion care later in pregnancy that are not listed above. The bottom line is: their reasons are real, valid, and deserve to be met with compassion and care. Patients need the freedom to make this decision with their doctor—without intervention from their elected officials.
The Problematic “Exceptions” Framework
Many statutes that ban abortion after a certain point in pregnancy include “exceptions” that allow abortion care later in pregnancy under certain conditions. This can include exceptions for survivors of rape and incest, pregnancies that endanger the life of the pregnant person if continued, and tragic circumstances such as fetal death.
As explained above, in the four New England states with restrictions on abortion care later in pregnancy, the law includes narrowly defined exceptions for patients experiencing fatal fetal anomalies or medical emergencies. The specifically defined “exceptions” vary from state to state.
However, these exceptions fail to reflect the full range of pregnancy experiences, and this framework often compels physicians and medical institutions to adopt narrowly defined interpretations—effectively restricting, in practice, access to abortion later in pregnancy. Additionally, these exceptions often force medical institutions like hospitals to convene ethics panels on a case-by-case basis to determine if a certain pregnancy meets the criteria designated for permitted abortion care later in pregnancy. This can delay life-saving care and put the health of a patient in the hands of an anonymous third-party that may not be deeply familiar with that specific pregnancy.
Because of the hoops exceptions frameworks force abortion providers to jump through, some institutions simply elect not to provide abortion care after certain points in pregnancy, even if legally permitted. Unless a patient falls within very narrow legal exceptions that are not designed to capture the complexity of conditions that can arise throughout pregnancy, there are minimal options for abortion care later in pregnancy in New England. For some patients facing life- and/or health-threatening pregnancy complications or fatal fetal anomalies, they will be forced to travel out of the region for urgent medical care.
Public Attitudes Towards Abortion Care Later in Pregnancy
In Massachusetts, we know there is broad support for expanding access to abortion care throughout pregnancy. New 2024 polling from the Reproductive Equity Now Foundation and EMC research shows that 66% of voters support expanding abortion access after 24 weeks when the abortion is provided based on the professional judgment of a licensed physician. There is consistently high support for broadening abortion access across various regions of the state, as well as among Black and Hispanic voters. Forty percent of registered Republicans also support expanding access to care throughout pregnancy when the abortion is provided based on the best professional judgment of a physician.
Legislative Efforts to Remove Restrictions on Abortion Care Throughout Pregnancy
In Maine, during the 2023 legislative session, activists lobbied to remove restrictions on abortion care later in pregnancy altogether. In collaboration with physicians and other stakeholders, legislators advanced legislation that gives physicians the discretion to determine whether or not patients need abortion care after the point of fetal viability. Despite the repeal of their gestational ban, as of this writing, we are unaware of any physician in Maine who provides care after 21 weeks and 6 days of pregnancy.
In Massachusetts, lawmakers are currently considering legislation that would give physicians the discretion to determine whether or not patients need abortion care after 24 weeks of pregnancy. This legislation is called the Prioritizing Patient Access to Care Act (S.1563/H.2370).
In New Hampshire, lawmakers advanced legislation in 2021 banning abortion after 24 weeks of pregnancy with no exceptions. Activists successfully lobbied in 2022 for certain exceptions for cases of fatal fetal anomalies or medical emergencies to be added to the law. Providers who violate this law can be charged with a Class B felony, subject to up to ten years in prison and fines of up to $100,000.
In Vermont, activists successfully codified the right to abortion care throughout pregnancy in 2019 through a constitutional amendment. As of this writing, we are unaware of any physician in Vermont who provides care after 21 weeks and 6 days of pregnancy.
Conclusion
Abortion care later in pregnancy is already extremely difficult to access, and the additional hurdles make an inherently complex and often painful experience even more excruciating for patients. Delays in care can cause serious health complications, and many patients lack the means to travel out of state for the abortion care they need, resulting in even worse health outcomes. New England states can address this problem by removing restrictions on abortion care later in pregnancy and safeguarding physicians’ authority to determine when such care is needed. No one should be forced to leave the region, especially amidst growing threats and surveillance of pregnancy care nationwide, to access the abortion care they want and need.
Citations
Beck, R. (2011). Self-ConsciousDicta:The Origins ofRoe v. Wade’sTrimester Framework. American Journal of Legal History, 51(3), 505–529. https://doi.org/10.1093/ajlh/51.3.505
Abortion and Perinatal Palliative Care. (n.d.). Retrieved July 7, 2025, from https://www.acog.org/advocacy/facts-are-important/abortion-and-perinatal-palliative-care
Gomez, I., Salganicoff, A., & Published, L. S. (2024, February 21). Abortions Later in Pregnancy in a Post-Dobbs Era. KFF. https://www.kff.org/womens-health-policy/issue-brief/abortions-later-in-pregnancy-in-a-post-dobbs-era/
Guttmacher Institute. (2024, May 1). State bans on abortion throughout pregnancy. Guttmacher Institute. Retrieved August 13, 2025, from https://www.guttmacher.org/state-policy/explore/state-policies-abortion-bans.
Additional Sources
Later abortion services—Information on referrals for services for clients and clinicians | Later Abortion Initiative. (n.d.). Retrieved August 12, 2025, from https://laterabortion.org/sites/default/files/documents/lai_referrals_sheet_8.8.2025.pdf
Mangel, C. P. (1988). Legal abortion: The impending obsolescence of the trimester framework. American Journal of Law & Medicine, 14(1), 69–108.
Sella, D. S. (2025, June 11). The Truth About Third-Trimester Abortion Care. TIME. https://time.com/7292801/third-trimester-abortion-care-realities-essay/
Where Can I Get an Abortion? | U.S. Abortion Clinic Locator. (n.d.). Retrieved July 7, 2025, fromhttps://www.abortionfinder.org/
