Originally published in February 2019, this fact sheet was updated on May 16, 2022, and again on January 9, 2025.
What is a Late-Term Abortion?
“Late-term” abortion is an imprecise term used to refer to abortions in the 2nd trimester of pregnancy or later. Some definitions limit the term to the third trimester or root it in the concept of viability, the stage of pregnancy where, on average, an unborn child can survive on his or her own outside the womb, albeit with medical support. Besides being specific to an individual baby’s overall physical condition, “viability” itself is a term whose application varies over time, occurring earlier in pregnancy as active treatment resources increase and medical technology and skills improve.[1] However, “late-term abortion” is commonly understood to describe abortions after 20 weeks of gestation or five months of pregnancy, well past the point at which unborn babies can feel pain.[2] The U.S. Centers for Disease Control and Prevention’s abortion surveillance system categorizes abortions occurring from 21 weeks onward as its highest gestational age category, and the system does not distinguish abortions by week beyond 21 weeks.[3]
How Many Late-Term Abortions Are Performed in the United States Each Year?
There is no comprehensive abortion reporting requirement in the United States, which means that the precise number of abortions performed after 20 weeks is unknown. However, data from the CDC suggests that approximately 1% of abortions are carried out at 21 weeks of gestation and later.[4] The true percentage may be even higher, as the CDC estimate does not include multiple states where a large percentage of the country’s abortions take place (including California, Maryland, and New Jersey).[5] The most recent national abortion estimates from the Guttmacher Institute suggest that over a million abortions occurred in the United States in 2023.[6] When the CDC’s percentage of abortions at or after 21 weeks is applied to this estimate from Guttmacher, this translates into approximately 10,000 late-term abortions every year. As one late-term abortion researcher has described, “One percent of [total U.S. abortions] is not nothing … It’s small from a data analysis or statistical perspective, but when you’re thinking about that as real people, that’s a pretty big number.”[7]
A few states report more granular data on late-term abortions. For example, in Colorado, there were 137 abortions at 28 weeks of pregnancy or later reported in 2023.[8] There are 159 abortion centers and hospitals in the United States that are known to perform abortions at or after 21 weeks of gestation.[9] Of these, 14 facilities perform abortions in the third trimester (27 weeks and later). Each year, over 60,000 abortions are performed after 15 weeks of gestation, when unborn babies can feel pain.[10]
Are the Vast Majority of Late-Term Abortions Performed in Cases of Threat to the Mother’s Life/Fetal Abnormality?
Defenders of late-term abortion frequently make the assertion that late-term abortions are “almost always” carried out in cases of severe fetal abnormality or danger to the mother’s life.[11] In reality, the concept of “medical necessity” in the context of late-term abortion is misleading, and many late-term abortions are elective,[12] frequently complicated by indecision, delays in discovering the pregnancy, and relationship problems.[13] One study analyzed the experiences of 272 women who obtained abortions at or after 20 weeks, excluding an unidentified number who sought abortions for fetal anomaly or life endangerment.[14] The study compared the women who underwent late-term abortions with 169 women who had abortions prior to 20 weeks and found that the rationales cited by the two groups were essentially the same – stressful circumstances of unprepared pregnancy, single-motherhood, financial pressure, and relationship discord. Similar research on women’s experiences obtaining abortions in the third trimester has identified “clear consistencies” between third trimester abortion and abortions earlier in pregnancy.[15]
Late-term abortion specialist Dr. Warren Hern has published research indicating that abortions on babies with abnormalities made up just 30% of the 1,251 abortions his center performed between 2007 and 2012, although he did not share the percentage of specifically late-term abortions that were performed on healthy babies.[16] However, another paper by Hern reviewed 1,040 late-term abortions performed at 18 to 38 weeks of gestation between 1999 and 2004.[17] Of these late-term abortions, just over a fifth were performed because of a prenatal diagnosis. Dr. Hern’s research also shows that of second- and third-trimester abortions performed for a prenatal diagnosis, abortions because the baby had Down Syndrome composed the largest group.[18]
Why is the Data on Late-Term Abortion Inadequate and How Can It Be Improved?
Few states report the reasons why women choose abortion, and even fewer report those reasons by gestational age. Only Florida and Utah report the reasons given for abortions at different gestational ages, including late-term abortions.[19] State abortion reporting is inconsistent, and some states (including California, Michigan, Maryland, and New Jersey, which are states that permit abortion throughout pregnancy)[20] collect no abortion data at all. To improve available data on late-term abortions, states that already collect information on reasons for abortion and the gestational ages at which abortions are performed could cross-tabulate these data. Additionally, states that do not collect this information from abortion providers could add gestational age and reasons for abortion to their state abortion reporting forms. Compounding the problem, the CDC does not request this information from the states, and the standard U.S. Report of Induced Termination of Pregnancy, which many states use as a model, does not collect reasons for abortion.[21] Some pro-choice policy groups consider government tracking of these data to be “intrusive” and “unnecessary”[22] – while acknowledging that information on women’s reasons for abortion is critical to an understanding of abortion trends, public policy, and public opinion.[23]
How Are Late-Term Abortions Performed?
In the past, many late-term abortions were performed via intraamniotic instillation of saline solution, urea, or prostaglandins to induce contractions causing vaginal delivery of the child. Abortionists also performed intact dilation and extraction or “partial-birth” abortions, which involved delivering the child into the birth canal up to his shoulders and killing him through suctioning the brain and crushing his skull.[24] This method was banned by Congress in 2003, and the ban was upheld by the Supreme Court in Gonzales v. Carhart in 2007.
In current practice, starting from about 13 to 14 weeks of gestation in the second trimester, a non-intact dilation and evacuation (D&E) or “dismemberment abortion” procedure is commonly used.[25] Several hours to a day or two before the abortion is performed, the abortionist prepares the cervix with osmotic and/or pharmacologic dilators (e.g., laminaria) to open the cervix. About the same time, he may administer an injection such as potassium chloride or digoxin into the amniotic sac, heart, or head of the unborn child to ensure that he or she is dead upon delivery, although this is practiced inconsistently among abortion centers.[26] On the day of the procedure, if further cervical dilation is needed, this is performed with mechanical dilators just prior to the procedure. Uterine evacuation is then performed. For younger babies this can be primarily accomplished using suction to remove as much of the tissue and soft body parts as possible, followed by forceps for removal of larger and harder body parts. For older and larger babies, dismemberment using forceps is used (grasping and pulling off limbs for removal). The brain may be removed by suction and the skull crushed for removal. Misoprostol or Pitocin may also be given to the mother to induce uterine contractions, especially to help expel all the body parts and placenta. The abortionist then may reassemble the parts to ensure that no body parts have been left in the uterus. The brutality of dismemberment abortion has been acknowledged even by abortionists, with one early adopter of D&E noting that the procedure took a toll on his staff, resulting in stress, nightmares, and relationship problems.[27]
Late-term abortions may also be performed via labor induction, particularly in the third trimester.[28] Although this abortion method has some similarities to induction of labor to produce a live birth, in the case of abortion, the goal is to prevent the unborn child from being born alive. Consequently, similar to the start of a D&E procedure, the abortionist may kill the unborn baby before beginning the abortion.[29] The abortionist may administer mifepristone to prepare the cervix and uterus. The woman will then be administered drugs to induce labor, frequently misoprostol. Repeat doses may be needed to complete the abortion.
Although late-term abortions are intended to be lethal to the unborn child, these methods may fail and the child may survive the attempted abortion. Because most states do not collect this data, the exact number of babies who survive abortions in the United States each year is unknown, but hundreds have been reported to be born alive.[30]
[1] The voyage of life: saving extremely premature babies. Charlotte Lozier Institute. Published June 6, 2023. Accessed December 20, 2024. https://lozierinstitute.org/dive-deeper/saving-extremely-premature-babies/
[2] See, e.g., Gomez I, Salganicoff A, Sobel L. Abortions later in pregnancy in a post-Dobbs era. KFF. Published February 21, 2024. Accessed December 20, 2024. https://www.kff.org/womens-health-policy/issue-brief/abortions-later-in-pregnancy-in-a-post-dobbs-era/; Arnold T. Post-debate explainer: The truth about late-term abortions in the United States. Catholic News Agency. Published September 13, 2024. Accessed December 20, 2024. https://www.catholicnewsagency.com/news/259273/post-debate-explainer-the-truth-about-late-term-abortions-in-the-united-states; The voyage of life: weeks 15 & 16. Charlotte Lozier Institute. Published August 13, 2021. Accessed January 1, 2025. https://lozierinstitute.org/fetal-development/weeks-15-and-16/; Derbyshire SWG and Bockmann JC, Reconsidering fetal pain, J Med Ethics 46, 3-6, 2020.
[3] 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
[4] Ramer et al.
[5] Ramer et al. See “Introduction.” See also Steupert, M. The State of Abortion Reporting in 2024 America: Still Striving Toward a Better National Standard. Charlotte Lozier Institute. Published June 26, 2024. Accessed January 9, 2025. https://lozierinstitute.org/the-state-of-abortion-reporting-in-2024-america-still-striving-toward-a-better-national-standard/
[6] Monthly abortion provision study. Guttmacher Institute. Accessed December 20, 2024. https://www.guttmacher.org/monthly-abortion-provision-study
[7] Vagianos A. No one wants to talk about the people who get abortions later in pregnancy. HuffPost. May 22, 2024. Accessed December 19, 2024, https://www.huffpost.com/entry/people-who-get-abortions-later-in-pregnancy_n_664cecbee4b0f45dcbadc518
[8] Steupert M. Abortion reporting: Colorado (2023). Charlotte Lozier Institute. Published July 29, 2024. Accessed December 20, 2024. https://lozierinstitute.org/abortion-reporting-colorado-2023/
[9] This estimate comes from the database Ineedana.com, which catalogs abortion providers in each state. Ineedana is a point-in-time database that is subject to updates. This estimate is up to date as of December 19, 2024. “Abortion centers” is used here to refer to facilities included in that database: Planned Parenthood centers, independent abortion centers, and hospitals/doctors that the database picks up. It does not include every doctor’s office/hospital that performs elective abortions.
[10] Fact sheet: abortions at or after 15 weeks in the United States. Charlotte Lozier Institute. Published December 19, 2024. Accessed December 20, 2024. https://lozierinstitute.org/fact-sheet-abortions-at-or-after-15-weeks-in-the-united-states/
[11] Quarshie M. Gavin Newsom’s late-term abortion dance a sign of 2024 battles ahead. Washington Examiner. Published December 1, 2023. Accessed December 20, 2024. https://www.washingtonexaminer.com/news/2431892/gavin-newsoms-late-term-abortion-dance-a-sign-of-2024-battles-ahead/
[12] Studnicki J. Late-Term Abortion and Medical Necessity: A Failure of Science. Health Serv Res Manag Epidemiol. 2019;6:2333392819841781. doi:10.1177/2333392819841781
[13] Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM. Timing of steps and reasons for delays in obtaining abortions in the United States. Contraception. 2006;74(4):334-344. doi:10.1016/j.contraception.2006.04.010
[14] Foster DG, Kimport K. Who seeks abortions at or after 20 weeks? Perspect Sex Reprod Health. 2013;45(4):210-218. doi:10.1363/4521013
[15] Kimport K. Is third-trimester abortion exceptional? Two pathways to abortion after 24 weeks of pregnancy in the United States. Perspect Sex Reprod Health. 2022;54(2):38-45. doi:10.1363/psrh.12190. Also see https://lozierinstitute.org/fact-sheet-third-trimester-abortion-and-abortion-up-to-birth/
[16] Hern WM. Fetal diagnostic indications for second and third trimester outpatient pregnancy termination. Prenat Diagn. 2014;34(5):438-444. doi:10.1002/pd.4324
[17] Hern WM. Misoprostol as an adjunctive medication in late surgical abortion. Int J Gynaecol Obstet. 2005;88(3):327-328. doi:10.1016/j.ijgo.2004.12.008.
[18] Hern WM. Fetal diagnostic indications for second and third trimester outpatient pregnancy termination.
[19] See Abortion Data – Induced Terminations of Pregnancy Reports, Florida Agency for Health Care Administration, https://ahca.myflorida.com/health-care-policy-and-oversight/bureau-of-central-services/frequently-requested-data; Utah Vital Statistics: Abortions 2021, Utah Department of Health & Human Services, https://vitalrecords.utah.gov/wp-content/uploads/Abortion-Report-2021.pdf
[20] Pro-abortion laws. Susan B. Anthony Pro-Life America. Accessed December 20, 2024. https://sbaprolife.org/lifesavinglaws#pro-abortion-laws
[21] See Handbook on the Reporting of Induced Termination of Pregnancy. U.S. Department of Health and Human Services; 1997. https://www.cdc.gov/nchs/data/misc/hb_itop.pdf
[22] Dreweke J. Abortion reporting: promoting public health, not politics. Guttmacher Institute. Published June 18, 2015. Accessed December 20, 2024. https://www.guttmacher.org/gpr/2015/06/abortion-reporting-promoting-public-health-not-politics
[23] Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM. Reasons U.S. women have abortions: quantitative and qualitative perspectives. Perspect Sex Reprod Health. 2005;37(3):110-118. doi:10.1363/psrh.37.110.05
[24] Wills S, Aultman K. Does banning abortions after 15 weeks make any sense? Charlotte Lozier Institute. Published September 27, 2021. Accessed December 20, 2024. https://lozierinstitute.org/does-banning-abortions-after-15-weeks-make-any-sense/
[25] See Edelman A, Kapp N. Dilation & evacuation (D&E) reference guide: induced abortion and postabortion care at or after 13 weeks gestation (‘second trimester’). Ipas. 2018. https://www.ipas.org/wp-content/uploads/2020/06/DESTRE18-DilationEvacuationReferenceGuide.pdf; Hammond C. Second-trimester pregnancy termination: dilation and evacuation. UpToDate. 2022.
[26] White KO, Jones HE, Shorter J, et al. Second-trimester surgical abortion practices in the United States. Contraception. 2018;98(2);95-99. doi:10.1016/j.contraception.2018.04.004
[27] 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
[28] See Hammond C. Second-trimester pregnancy termination: induction (medication) termination. UpToDate. 2024; Borgatta L, Kapp N. Clinical guidelines. Labor induction abortion in the second trimester. Contraception. 2011;84(1):4-18. doi:10.1016/j.contraception.2011.02.005; Cox T, Skop I. Fact sheet: third trimester abortion and “abortion up to birth.” Charlotte Lozier Institute. Published September 20, 2024. Accessed December 20, 2024. https://lozierinstitute.org/fact-sheet-third-trimester-abortion-and-abortion-up-to-birth/
[29] Hammond C. Second-trimester pregnancy termination: induction (medication) termination. UpToDate. 2022.
[30] Fact sheet: questions and answers on born-alive abortion survivors. Charlotte Lozier Institute. Published December 19, 2024. Accessed December 20, 2024. https://lozierinstitute.org/fact-sheet-questions-and-answers-on-born-alive-abortion-survivors/
