The earlier an abortion is provided the safer it is, because earlier abortions are less complicated. Therefore, it is important that women who decide to get abortions can do so without unnecessary delays. In fact, 88% of all abortions in the United States are obtained within the first 12-13 weeks after the last menstrual period (LMP). Sometimes, however, women have compelling reasons to obtain abortions in later weeks.
Some women do not recognize that they are pregnant until the pregnancy is well advanced. Examples might include:
women who menstruate irregularly or not at all due to illness, medication, or strenuous athletic activity;
women who believe their absent periods reflect the onset of menopause;
women with normally light periods, who mistake spotting that occurs in early pregnancy for menstruation;
women who believe they cannot become pregnant because they are nursing babies or undergoing medical treatment;
women whose pregnancies are initially – sometimes repeatedly – misdiagnosed by physicians or other practitioners.
Like anyone else in the population, pregnant women are susceptible to cancer, heart disease, diabetes, severe depression, addictions, and other serious health problems. Surgery, X-rays, chemotherapy, or other treatment vital to a woman’s health or life may come to a halt once the pregnancy is discovered. A woman might choose abortion if a continued pregnancy would worsen her condition and/or threaten her life, or if she requires further treatments that may damage a developing fetus.
Severe Fetal Abnormalities
When a woman learns from the results of prenatal testing that a fetus has severe abnormalities, such as an undeveloped brain, a severe metabolic disorder, or no working kidney, she may wish to end the pregnancy rather than give birth to a child who will suffer and die in infancy or who will have severe disabilities. Unfortunately, the results of amniocentesis, one of the most important prenatal diagnostic tests, are generally not available until the 15th or 16th week of pregnancy, thus delaying the abortion decision.
A pregnancy may have been planned and very much wanted – until tragedy strikes. For example, the diagnosis of some debilitating disease, a car accident, a job loss, or a natural disaster might lead a woman to decide this is the wrong time to have a baby and to choose abortion, even if the pregnancy has advanced past the first trimester.
Teens at Special Risk
Nearly one-third of all abortions after 12 weeks are obtained by teenagers. Teens face not only state regulatory hurdles, but also delays in recognizing that they are pregnant and taking decisive action. For example, they may:
understand little about how their bodies work and therefore may not recognize signs of pregnancy;
become pregnant before they have begun to menstruate or before their menstrual periods are regular, so they don’t have the signal of a missed period;
believe a variety of myths, such as “You can’t get pregnant the first time”;
keep rape or sexual abuse a secret, denying the possibility of pregnancy.
When such young women do realize they are pregnant, they may panic, fearing their parents will never forgive them or that their parents will force them out of the house. They may hide the pregnancy in secret shame, or spend weeks wishing and hoping it isn’t true, or that it will go away. Of course, when the pregnancy does not go away, the realities of the situation gradually become evident.
Another factor in teenagers’ delay is that few are experienced in using the health care system. They may not know where to go for a pregnancy test, or they may fear that they cannot speak in confidence to a school counselor or nurse for assistance or a referral.
Parental Notification or Consent
Even further delays are introduced by states that require abortion providers to notify or obtain consent from a minor’s parents before proceeding with an abortion. While most teens do tell a trusted adult, those faced with an abusive or absent parent are left with only two choices. They must either:
petition a state court and convince a judge that they are competent to make this decision or that an abortion is in their best interest; or
arrange an abortion in a state without such restrictions, raise extra money, and travel to the out-of-state facility.
Clearly either choice can tax the resources of a teenager, and can create delays that might easily push the abortion past the first trimester.
Lack of Money
In one study of women who were having an abortion at 16 or more weeks, a substantial percentage said the delay occurred because they needed time to raise money.1 Women who depend on the federal government to provide their health insurance coverage must pay for abortion services separately; they may receive Medicaid funding for other medical services, but the federal government and most states have prohibited the use of federal funds to pay for almost all abortions.
In addition, as the pregnancy advances, abortions have a higher risk of complications, require specialized skill from the physician, increased nursing care, and more medications. Therefore, they are more expensive. For a woman who has no savings, gathering enough money can take time and delay her abortion by weeks.
Most abortion providers are concentrated in large cities. Today, 88% of all counties in the U.S. have no abortion provider, and 97% of rural counties have none.
In several states, women in need of abortion care must travel hundreds of miles to reach the nearest provider. Women are often delayed many days or weeks as they arrange transportation, time off from work, and save additional money for travel and lodging costs.
Waiting Period Requirements
Some states require women to wait anywhere from 8 to 27 hours between their first appointment and when the abortion procedure can be provided. These laws can further delay the abortion. For example, a teenager may wait for a time when her absence from school will be less obvious. If a woman must schedule two separate appointments, she may face more delays as she arranges for time off work or school to make two long-distance trips.
Third Trimester Abortions
Despite the claims of some anti-abortion activists, women have access to abortion in the third trimester only in extreme circumstances. Fewer than 2% of abortions are provided at 21 weeks or after, and they are extremely rare after 26 weeks of pregnancy. Very few abortions are provided in the third trimester, and they are generally limited to cases of severe fetal abnormalities or situations when the life or health of the pregnant woman is seriously threatened.