The Full Picture: Understanding Abortion Later in Pregnancy

Written By Marina Chafa

WHITE PAPER

Key Takeaways

  • 66% of Massachusetts voters support removing restrictions on abortion care later in pregnancy.

  • Leading doctors and medical organizations reject the use of the term “late-term abortion.” It is not a medical term, 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. 

Executive Summary

This white paper defines “abortion care later in pregnancy” as assisted or induced pregnancy termination after 24 weeks 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 mother) 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 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 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.

Introduction: How to define “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 gestation. Despite 24 weeks gestation 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 by Justice Blackmun in his landmark ruling Roe v. Wade, as 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 gestation 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 gestation, 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.”

The Abortion Care Throughout Pregnancy Landscape

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 D.C. In 16 states, abortion is restricted later in pregnancy, but permissible approximately until the 24 weeks LMP (although this somewhat varies state-to-state). In all other 26 states, abortion is banned at some point in the first 24 weeks of pregnancy. 

In New England, no states restrict abortion care before 24 weeks gestation 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 restriction as after the point of “fetal viability,” (with exceptions, and no criminal penalties), New Hampshire restricts abortion care after 24 weeks LMP (with limited exceptions and criminal penalties), and Massachusetts restricts abortion care after 24 weeks pregnancy (with exceptions). While Maine retains a viability standard in its statute, care can be provided after 24 weeks based on a physician’s professional judgement. Vermont has no restrictions on abortion care throughout 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, the closures of brick-and-mortar clinics, and the defunding of Title X providers, there are fewer available appointments for abortion care – but the need for abortions has remained stagnant (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 explainer can account for all of those reasons. Every pregnancy is different, and pregnancy can be accompanied by medical trauma, significant material needs, logistical hurdles, and emotional and physical challenges. The broad range of reasons why patients seek abortion care later in pregnancy makes clear that an “exceptions” framework will consistently fail 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, Trisomy 18, and anencephaly. Fatal fetal anomalies affect 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 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. 

Covert pregnancy. Some patients do not know they are pregnant until the pregnancy is significantly advanced because of a condition called covert pregnancy, in which the patient does not “show” or display any outward symptoms of pregnancy. This can be emotionally traumatic for patients to learn when they are very advanced in their pregnancy, and can also result in pregnancy complications due to a lack of prenatal care. 

Sudden severe illness requiring immediate interventionary therapy that will harm a pregnancy. Some people may be tragically 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, and 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 also know they are pregnant with an unwanted pregnancy but be unable to access care early on 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 not listed above. But the bottom line is: these 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 victims of rape and incest, pregnancies that endanger the life of the pregnant person if continued, and tragic circumstances such as fetal death. 

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 account for the multitude of pregnancy experiences, and this framework often forces physicians and medical institutions to enforce a narrow interpretation of exceptions, which can de facto prevent the practice of 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, which 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 how many hoops exceptions frameworks force physicians and providers to jump through, some institutions simply elect not to provide abortion care after certain points in pregnancy – even if legally permitted – because of the logistical complications. This means that for patients experiencing life-threatening and health-threatening pregnancy complications, fatal and painful fetal anomalies, shocking covert pregnancies, and more, there are no options for care in New England, and those patients must 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 in 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. 40% of registered Republicans also support expanding access to care throughout pregnancy based on the best professional judgment of a physician. The same polling reveals that 89% of Massachusetts voters believe abortion should be legal.

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. There are no known providers in Maine who provide 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 LMP 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. There are no known providers in Vermont who provide care after 21 weeks and 6 days of pregnancy.

Abortion Care Throughout Pregnancy Availability Across the Nation

17 clinics provide abortion care past 25 weeks in the United States – none of which are in New England proper.[4] Only five clinics in the United States provide care after 28 weeks.

Colorado – care is available up to 31 weeks and 6 days at A Women’s Choice Health Care Clinic in Aurora.

Illinois – care is available up to 26 weeks at Equity Clinic in Champaign, Planned Parenthood of Fairview Heights, and 28 weeks at Hope Clinic in Granite City.

Maryland – care is available up to 28+ weeks in CARE in Bethesda and 34 weeks at Partners in Abortion Care in College Park.

New Jersey – care is available up to 27 weeks and 6 days at Cherry Hill Women’s Center in Cherry Hill and Metropolitan Medical Associates in Englewood.

New Mexico – care is available up to 26 weeks and 6 days at Alamo Women’s Clinic in Albuquerque, 28 weeks at Southwestern Women’s Options also in Albuquerque, and 34 weeks at VAG Clinic also in Albuquerque.

New York – care is available up to 27 weeks and 6 days+ at ParkMed NYC.

Oregon – care is available up to 26 weeks and 6 days+ at Lilith Clinic in Portland.

Washington State – care is available up to 26 weeks and 6 days at Lilith Clinic in Seattle and up to 27 weeks and 6 days+ at Cedar Rivers Clinic in both Renton, Seattle, and Tacoma.

Washington, D.C. – care is available up to 27 weeks at the Washington Surgi-Clinic and up to 32+ weeks at the Dupont Clinic.

Conclusion

Abortion care later in pregnancy is extremely cumbersome to access, and hurdles to access make what is already a complex and often painful experience for patients even more excruciating. Delays in care can result in significant health problems for the patients seeking care, and some patients do not have the means to travel out of state for abortion care when they are in need. New England states can alleviate this problem for patients by removing restrictions for abortion care later in pregnancy and protecting physicians’ authority to determine when patients need this care, so that no one has to travel out of the New England region – amidst increased threats and surveillance on pregnancy care nationwide – to access the care they want and need.

Citations

  1. 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

  2. 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

  3. 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/

  4. Later abortion services—Information on referrals for services for clients and clinicians | Later Abortion Initiative. (n.d.). Retrieved July 7, 2025, from https://laterabortion.org/access/later-abortion-services%E2%80%94information-referrals-services-clients-and-clinicians

Additional Sources

Marina Chafa
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