Fact Sheet: Dismemberment Abortion
What is Dismemberment Abortion?
“Dismemberment abortion” is a layman’s term describing a dilation and evacuation (D&E) procedure that is intended to end the life of an unborn child via induced abortion and is typically performed in the second trimester. During a dilation and evacuation procedure, the woman’s cervix is dilated, and the unborn baby and other pregnancy tissue are removed in a piecemeal fashion with suction and instruments. Sometimes a D&E procedure is used when a baby has already died in utero and a mother desires surgical resolution as an alternative to labor induction or waiting for passage to occur spontaneously. In this case, the D&E procedure does not kill the unborn child and so is not an induced abortion. However, when the D&E procedure is performed with the intent to kill an unborn baby by way of dismembering, this is a dismemberment abortion.
Supreme Court Justice Anthony Kennedy provided the following description of dilation and evacuation abortion based on testimony from an abortionist: “[T]he D&E procedure requires the abortionist to use instruments to grasp a portion (such as a foot or hand) of a developed and living fetus and drag the grasped portion out of the uterus into the vagina. [The abortionist] uses the traction created by the opening between the uterus and vagina to dismember the fetus, tearing the grasped portion away from the remainder of the body. … The fetus, in many cases, dies just as a human adult or child would: It bleeds to death as it is torn from [sic] limb from limb.”[1]
To perform the actual D&E procedure, the abortionist uses large, crushing forceps to grip portions of the unborn child and dismember them. Several passes may be required to remove all the baby’s body parts, as each pass may result in extracting an arm, leg, or section of torso. The abortionist may conclude with a sharp curette and/or suction curette to ensure that the uterus is empty. It is safest if the procedure is conducted with ultrasound visualization to prevent uterine perforation, but this is not always performed. Once the procedure is thought to be complete, to prevent complications, the abortionist or their staff must sort through the baby’s remains and ensure that nothing was left in the uterus.[2]
In early pregnancy, most abortions are performed using aspiration or abortion drugs.[3] In an aspiration abortion, the abortionist inserts a tube through the cervix into the uterus and uses a vacuum to remove the unborn baby and other tissue. In a drug-induced abortion, the abortionist administers abortion drugs (primarily mifepristone and misoprostol) to block progesterone and expel the unborn baby from the uterus.
However, once the pregnancy has reached the second trimester, the unborn baby’s bones have begun to calcify and he or she is too developed to remove via suction alone. At this point, the abortionist must use D&E to perform a surgical abortion. Dilation and evacuation may be used starting around 12 weeks of gestation, with many abortion centers beginning to use the procedure between 14-16 weeks of gestation.[4] Abortion centers typically use dilation and evacuation throughout the second trimester before transitioning to induction abortion methods in the late second or third trimesters.[5]
Dismemberment abortion is typically unsuited to resolving medical emergencies because it is a multi-step process. By the second trimester, the cervix is firm and may not allow the abortionist to easily insert the tools necessary to dismember the unborn baby, so it can be a lengthy process. Beginning several hours to several days before the dismemberment procedure, depending on gestational age, the abortionist will need to relax and dilate the cervix using abortion drugs and/or mechanical or osmotic dilators.[6]
Abortionists may kill the baby before beginning the dismemberment procedure to prevent any chance of a live birth, meet patient preferences, or to remain in compliance with laws in some states that prohibit performing dismemberment abortions on living unborn babies.[7] This is termed “feticide” or “induction of fetal demise” and can be accomplished with a lethal injection (such as digoxin, potassium chloride, or lidocaine) [8] or by cutting the umbilical cord as a first step in the surgical procedure, allowing the unborn child to die from blood loss.[9] However, abortion centers are inconsistent in their use of feticide, with one survey of abortionists who perform D&Es at 18 weeks or later finding that 69% do not routinely kill the unborn baby prior to starting the dismemberment abortion.[10] Some pro-abortion medical organizations do not recommend feticide for abortions on babies who are not yet viable.[11]
How Many Dismemberment Abortions are Performed in the U.S.?
According to Centers for Disease Control and Prevention (CDC) data, among the 46 areas that reported the methods used to perform abortions, surgical abortions at 14 weeks or later (which would make them predominantly D&Es) comprised 6.9% of all abortions in 2022.[12] Twenty-six states report the number of dismemberment abortions that occur each year, and in these states, dismemberment abortions account for approximately 6.5% of all abortions on average. With over a million abortions estimated to occur in the United States every year,[13] this suggests that at least 60,000 to 70,000 dismemberment abortions are performed annually.
Overall, CDC data from 40 reporting areas shows that approximately 95.2% of abortions at 14 weeks of gestation and later are surgical.[14] As pregnancy advances, dismemberment makes up a progressively smaller percentage of all abortions, as abortionists use other methods like labor induction, although dismemberment still accounts for the majority. CDC data shows that of abortions performed at 21 weeks of gestation or later, around 80% are surgical. Nineteen percent are induced with abortion drugs, and small percentages are performed via intrauterine instillation and hysterotomy/hysterectomy.
No data is available on the use of feticide in conjunction with these dismemberment abortions, so it is unknown precisely how many abortions would be impacted by laws preventing dismemberment abortion from being performed on living unborn babies.
What are the Characteristics of Unborn Babies in the Second Trimester?
There is substantial evidence that unborn babies are capable of experiencing pain by at least 15 weeks of gestation,[15] and as early as 12 weeks,[16] around the point in pregnancy when dismemberment abortions are first performed. By the early second trimester, the unborn baby has begun to develop fingernails,[17] has started practicing breathing in the womb,[18] and begins making conscious movements.[19] At 15 weeks, an unborn baby’s skeleton would be visible on an X-ray.[20]
Even abortionists who perform dismemberment abortions have testified to the brutality of tearing apart an unborn baby at this stage of development. One abortionist recalled performing a dismemberment abortion on a woman who was 23 weeks pregnant, and then rushing to another floor of the hospital to care for a premature baby of the same gestational age.[21] She remarked, “I thought to myself how bizarre it was that I could have legally dismembered this fetus-now-newborn if it were inside its mother’s uterus – but that the same kind of violence against it now would be illegal, and unspeakable.” A high-volume late-term abortionist has described the toll that assisting with dismemberment procedures takes on his staff, including stress, nightmares, and relationship problems, observing, “[D&E] is rapidly becoming recognized as the procedure of choice in late abortion, but those capable of performing or assisting with it are having strong personal reservations about participating in an operation that they view as destructive and violent.”[22]
[1] Stenberg v. Carhart, 530 U.S. 914 (2000) (Kennedy, J., dissenting). See: https://www.law.cornell.edu/supct/html/99-830.ZD2.html
[2] For more information on maternal complications associated with dismemberment abortion, see Skop I. Immediate physical complications of induced abortion. Charlotte Lozier Institute. Published December 8, 2022. Accessed January 2, 2025. https://lozierinstitute.org/immediate-physical-complications-of-induced-abortion/
[3] See Skop I. Immediate physical complications of induced abortion. Charlotte Lozier Institute. Published December 8, 2022. Accessed January 7, 2025. https://lozierinstitute.org/immediate-physical-complications-of-induced-abortion/
[4] See Abortion Care: Abortion in the Second Trimester, “What is a second-trimester abortion?” (hovering on “dilation and evacuation (D&E)),” https://www.acog.org/womens-health/faqs/induced-abortion. Accessed January 22, 2025; Abortion in clinic: what to expect. Dilation and evacuation abortion. National Abortion Federation. Accessed January 2, 2025. https://prochoice.org/patients/abortion-what-to-expect/; In-clinic abortion. What are the types of in-clinic abortions? Planned Parenthood. Accessed January 2, 2025. https://www.plannedparenthood.org/learn/abortion/in-clinic-abortion-procedures; Surgical abortion (second trimester). UCSF Health. Accessed January 2, 2025. https://www.ucsfhealth.org/treatments/surgical-abortion-second-trimester
[5] See Dilation and evacuation. BPAS. Accessed January 7, 2025. https://www.bpas.org/abortion-care/abortion-treatments/surgical-abortion/dilatation-and-evacuation/; Surgical abortion (second trimester). UCSF Health. Accessed January 7, 2025. https://www.ucsfhealth.org/treatments/surgical-abortion-second-trimester; Abortion from 25-32 weeks 6 days. Dupont Clinic. Accessed January 7, 2025. https://dupontclinic.com/abortion-from-25-32-weeks-6-days/.
[6] Fraz F, Liu SM, Shaw KA. Cervical preparation for second-trimester procedural abortion. Curr Opin Obstet Gynecol. 2023;35(6):470-475. doi:10.1097/GCO.0000000000000912; Diedrich JT, Drey EA, Newmann SJ. Society of Family Planning clinical recommendations: Cervical preparation for dilation and evacuation at 20-24 weeks’ gestation. Contraception. 2020;101(5):286-292. doi:10.1016/j.contraception.2020.01.002
[7] Diedrich J, Goldfarb CN, Raidoo S, Drey E, Reeves MF; with the assistance of Jessica Atrio, Vinita Goyal, and Sarah Prager on behalf of the Clinical Affairs Committee and Lorie Harper on behalf of the Society for Maternal-Fetal Medicine. Society of Family Planning Clinical Recommendation: Induction of fetal asystole before abortion Jointly developed with the Society for Maternal-Fetal Medicine. Contraception. 2024;139:110551. doi:10.1016/j.contraception.2024.110551
[8] Tufa TH, Prager S, Lavelanet AF, Kim C. Drugs used to induce fetal demise prior to abortion: a systematic review. Contracept X. 2020;2:100046. doi:10.1016/j.conx.2020.100046
[9] Tocce K, Leach KK, Sheeder JL, Nielson K, Teal SB. Umbilical cord transection to induce fetal demise prior to second-trimester D&E abortion. Contraception. 2013;88(6):712-716. doi:10.1016/j.contraception.2013.08.001
[10] White KO, Jones HE, Shorter J, et al. Second-trimester surgical abortion practices in the United States. Contraception. doi:10.1016/j.contraception.2018.04.004
[11] Diedrich J et al.
[12] Ramer S, Nguyen AT, Hollier LM, Rodenhizer J, Warner L, Whiteman MK. Abortion Surveillance – United States, 2022. MMWR Surveill Summ. 2024;73(7):1-28. doi:10.15585/mmwr.ss7307a1. See Table 12.
[13] Monthly abortion provision study. Guttmacher Institute. Accessed January 2, 2025. https://www.guttmacher.org/monthly-abortion-provision-study
[14] Ramer S, et al. See Table 13.
[15] The voyage of life: prenatal stress and pain. Charlotte Lozier Institute. Updated August 22, 2023. Accessed January 23, 2025. https://lozierinstitute.org/dive-deeper/prenatal-stress-and-pain/
[16] Stuart WG Derbyshire and John C. Bockmann, “Reconsidering Fetal Pain,” Journal of Medical Ethics 46, no. 1 (January 1, 2020): 3–6, https://doi.org/10.1136/medethics-2019-105701.
[17] The voyage of life: week 12. Charlotte Lozier Institute. Updated August 22, 2023. Accessed January 2, 2025. https://lozierinstitute.org/fetal-development/week-12/
[18] The voyage of life: week 13. Charlotte Lozier Institute. Updated August 22, 2023. Accessed January 2, 2025. https://lozierinstitute.org/fetal-development/week-13/
[19] The voyage of life: week 14. Charlotte Lozier Institute. Updated November 22, 2023. Accessed January 2, 2025. https://lozierinstitute.org/fetal-development/week-14/
[20] The voyage of life: weeks 15 & 16. Charlotte Lozier Institute. Updated November 25, 2023. Accessed January 2, 2025. https://lozierinstitute.org/fetal-development/weeks-15-and-16/
[21] Harris LH. Second trimester abortion provision: breaking the silence and changing the discourse. Reprod Health Matters. 2008;16(31 Suppl):74-81. doi:10.1016/S0968-8080(08)31396-2
[22] Hern W, Corrigan B. What about us? Staff reactions to D&E. Advances in Planned Parenthood. 1980;15(1):3–8. https://www.drhern.com/wp-content/uploads/2018/05/staff-reaction-de.pdf