What Happens When It’s Too Late to Get an Abortion

On Dec. 1, the Supreme Court will consider the constitutionality of Mississippi’s ban on abortion after 15 weeks of pregnancy. If the court decides to uphold the Mississippi law — as it may well do — that would mean American abortion rights would no longer be protected up to the point of fetal viability, or about 24 weeks of pregnancy.

Replacing this viability standard, which has been in place since 1992, with some lower threshold is sometimes framedas a necessary compromise between people who oppose abortion rights and those who support them. The suggestion is that Americans should relinquish the right to abortion in the second trimester to preserve access in the first, which is when about 90 percent of abortions take place.

But before the Supreme Court agrees to compromise the rights of tens of thousands of people, Americans need to understand what that would mean for their lives and those of their families.

I led a scientific study designed to answer that question. The Turnaway Study included almost 1,000 women who sought abortions from 30 facilities across the country, including many women who got abortions later in their pregnancies. It is easy to demonize these people. The assumption is that they were irresponsible or simply waited too long to make up their mind.

But my colleagues and I found that women who get abortions beyond 15 weeks often do so because they found out about their pregnancy late and then experienced real obstacles to getting an abortion — like cost, travel needs and legal barriers. If women seeking an abortion were unable to get one, the consequences to their health and their livelihood were often serious — and sometimes even deadly.

Here’s how the Turnaway Study worked: Some of the women in the study were too far along in their pregnancies to receive an abortion at the clinic that they visited — and thus were turned away — while others were just under the clinic’s gestational limit and received an abortion.

We followed the women for five years to ask them about their physical and mental health and learn how pregnancy affected their responsibilities and aspirations. We excluded people seeking abortions for reasons related to a fetal diagnosis or their own imminent health risks, leaving us with a population most likely to be affected by gestational limit bans like Mississippi’s. This allowed us to understand people’s reasons for seeking abortions and how some of them came to be so far along in pregnancy that the choice to have an abortion was no longer theirs to make.

The barriers that can delay an abortion are numerous. They include not having the money to pay for the procedure, not being able to take time off work and the need to find child care and to travel — sometimes hundreds of miles — to find a provider who will perform an abortion. Government restrictions on abortion can make the process even harder. Many states ban public or private insurance coverage of abortion, which forces many patients to pay out of pocket. Some states have mandatory waiting periods between counseling about abortion and the procedure. There are restrictions on who may perform abortions, which can result in shuttered clinics, forcing women to travel farther and wait longer for appointments.

These logistical challenges compound when a woman doesn’t realize she is pregnant until after the first trimester. Late recognition of pregnancy is more common than many people realize. In one 2010 study, more than 7 percent of pregnancies that resulted in birth were first detected after the first trimester. Late detection was more likely when people weren’t trying to become pregnant or if they thought they were protected from the risk of pregnancy because they were using contraception.

But how could you not know you were pregnant? Some people don’t have pregnancy symptoms, or they mistake the fatigue or irregular periods of early pregnancy for other health conditions. For instance, one 23-year-old North Dakotan in my study became pregnant soon after giving birth and chalked up her symptoms to the physiological changes and exhaustion of caring for an infant.

Aside from tending to be younger and poorer, women seeking abortions later in pregnancy are not so different from those seeking them earlier in pregnancy, in their characteristics, health history or reasons for wanting an abortion.

My fellow researchers and I found that women who were unable to get a wanted abortion because they were too far along in pregnancy experienced significant consequences, including the health risks associated with carrying a pregnancy to term, which are often vastly underappreciated by anti-abortion lawmakers. Two women in my study who were denied abortions died from pregnancy complications within days of giving birth. And we found that years later, women who delivered their pregnancies experienced more chronic pain and worse overall health than women who received an abortion just under the facility’s limit. A woman might choose to take these risks if she wants to have a baby. It is a different story to force someone to take these risks if she does not.

Beyond these physical health consequences, we found that women who did not receive a desired abortion experienced economic hardship that lasted for years, and they had a higher chance of living in poverty compared to those who received abortions.

The negative consequences also redounded to the women’s older children; the need to care for existing children is often the reason mothers give for wanting to terminate an unwanted pregnancy. These older children were more likely to live in poverty and less likely to achieve developmental milestones than the children of women who received their abortions. Women denied abortions were also less likely to achieve their own aspirational goals, including having more intended children under better circumstances later.

The woman from North Dakota in our study who was late in discovering her pregnancy was able to get a second-trimester abortion. And when she felt ready, she had another child. Looking back on her experience, she told us, “It would have been probably the worst thing for that child to come into this world because it would have never had the support that it needed. I wasn’t mentally stable for that child. I do have a 1-year-old now, and I am able to support myself, able to support my kids and know the timing is right.”

She also shared something that we see more broadly in the data: that when people are ready for child rearing, they form closer bonds with their children. She said about her new child, “I could actually enjoy the presence of a little one, whereas before, I was just a kid myself.”

In the past decade, there have been many legislative efforts to make abortion more difficult to access. The arbitrary time limits imposed in Mississippi and other states are not a compromise but rather a part of the continuing effort to erode or eliminate abortion rights in the United States. These bans on abortion will exacerbate the struggles of people who are pregnant when they don’t feel ready to have a baby and will jeopardize their health, the well-being of their families and the trajectory of their lives.

Dr. Diana Greene Foster is a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, and the author of “The Turnaway Study: Ten Years, a Thousand Women and the Consequences of Having — or Being Denied — an Abortion.”

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