Late-Term Abortion in Wanted Pregnancies

Defining “Late-Term Abortion” or “Later Abortion”

from UCSF’s ANSIRH–

http://www.ansirh.org/research/late-abortion.php

A significant number of women need access to abortion care after the first trimester (after 12 weeks of pregnancy) for many different reasons. While later abortions are a small percentage of all abortions performed in the U.S., over 35,000 women each year have abortions at 16-20 weeks gestation, and over 11,000 women need abortions after 20 weeks of pregnancy.

There are no abortion services at all in 87% of U.S. counties, and the number of facilities offering later abortions is even more limited. According to the 2005 survey of abortion providers conducted by the Guttmacher Institute, the majority of abortions between 17 and 24 weeks are performed in a few freestanding abortion clinics.

The assassination of George Tiller, MD, has had a significant effect on access to later abortion in the U.S. His death and the subsequent closing of his clinic bring to light the striking lack of options for a small but significant portion of abortion patients who need later abortions. This website is dedicated to the memory and spirit of Dr. Tiller and is a resource for women, clinicians, researchers and journalists who want to learn more about later abortion care.

• Late termination of pregnancy or late-term abortions are abortions which are performed during a later stage of pregnancy. Late-term abortions are more controversial than abortion in general because the fetus is more developed and sometimes viable.  A late-term abortion often refers to an induced abortion procedure that occurs after the 20th week of gestation. However, the exact point when a pregnancy becomes late-term is not clearly defined. Some sources define an abortion after 16 weeks as “late”.  Three articles published in 1998 in the same issue of the Journal of the American Medical Association could not agree on the definition. Two of the JAMA articles chose the 20th week of gestation to be the point where an abortion procedure would be considered late-term.  The third JAMA article chose the third trimester, or 27th week of gestation.

• The point at which an abortion becomes late-term is often related to the “viability” (ability to survive outside the uterus) of the fetus. Sometimes late-term abortions are referred to as post-viability abortions. However, viability varies greatly among pregnancies. Nearly all pregnancies are viable after the 27th week, and no pregnancies are viable before the 21st week. Everything in between is a “grey area”.

• In 2003, from data collected in those areas that sufficiently reported gestational age, it was found that 6.2% of abortions were conducted from 13 to 15 weeks, 4.2% from 16 to 20 weeks, and 1.4% at or after 21 weeks. Because the Centers for Disease Control and Prevention’s annual study on abortion statistics does not calculate the exact gestational age for abortions performed past the 20th week, there are no precise data for the number of abortions performed after viability. In 1997, the Guttmacher Institute estimated the number of abortions in the U.S. past 24 weeks to be 0.08%, or approximately 1,032 per year.

• The United States Supreme Court decisions on abortion, including Roe v. Wade, allow states to impose more restrictions on post-viability abortions than during the earlier stages of pregnancy.  As of April 2007, 36 states had bans on late-term abortions that were not facially unconstitutional (i.e. banning all abortions) or enjoined by court order.  In addition, the Supreme Court in the case of Gonzales v. Carhart ruled that Congress may ban certain late-term abortion techniques, “both previability and postviability”.  All of the 36 state bans are believed by pro-choice organizations to be unconstitutional.  The Supreme Court has held that bans must include exceptions for threats to the woman’s life, physical health, and mental health, but four states allow late-term abortions only when the woman’s life is at risk; four allow them when the woman’s life or physical health is at risk, but use a definition of health that pro-choice organizations believe is impermissibly narrow. Assuming that one of these state bans is constitutionally flawed, then that does not necessarily mean that the entire ban would be struck down: “invalidating the statute entirely is not always necessary or justified, for lower courts may be able to render narrower declaratory and injunctive relief.”

• 13 states prohibit abortion after a certain number of weeks’ gestation (usually 24 weeks).  The U.S. Supreme Court held in Webster v. Reproductive Health Services that a statute may create “a presumption of viability” after a certain number of weeks, in which case the physician must be given an opportunity to rebut the presumption by performing tests.  Therefore, those 13 states must provide that opportunity. Because this provision is not explicitly written into these 13 laws, as it was in the Missouri law examined in Webster, pro-choice organizations believe that such a state law is unconstitutional, but only “to the extent that it prohibits pre-viability abortions”.

• Ten states require a second physician to approve.  The U.S. Supreme Court struck down a requirement of “confirmation by two other physicians” (rather than one other physician) because “acquiescence by co-practitioners has no rational connection with a patient’s needs and unduly infringes on the physician’s right to practice”. Pro-choice organizations such as the Guttmacher Institute therefore interpret some of these state laws to be unconstitutional, based on these and other Supreme Court rulings, at least to the extent that these state laws require approval of a second or third physician. Nine states have laws that require a second physician to be present during late-term abortion procedures in order to treat a fetus if born alive.  The Court has held that a doctor’s right to practice is not infringed by requiring a second physician to be present at abortions performed after viability in order to assist in saving the life of the fetus.

Compiled from Wikipedia 1/2012