Since the legalization of abortion throughout the United States in 1973, abortion services have become

Since the legalization of abortion throughout the 

United States in 1973, abortion services have become 

more widely accessible, and knowledge about them 

has grown. As a result, the overwhelming majority 

of abortions are performed in the first trimester of 

pregnancy. For a number of reasons, however, abortion 

after the first trimester remains a necessary option for 

some women. 

Unfortunately, opponents of safe and legal abortion seek 

to limit access through, among other means, laws imposing 

a fixed date for viability and bans that would outlaw safe, 

medically appropriate abortions in the second trimester. 

Their goal is to make all abortions illegal. 

In fact, the same anti-women’s health activists who 

would limit access to abortion after the first trimester 

also oppose access to abortion 

in the first trimester by 

advancing numerous restrictions, including parental 

involvement laws and mandatory waiting period laws. 

Also, by asserting their bias at a local level through 

picketing doctors’ homes and offices, health center 

blockades, threats of violence against doctors, and the 

misapplication of zoning laws, etc., these activists create 

such a threatening climate that the number of qualified 

providers is diminished. These actions endanger the 

health of women and the right of physicians to determine 

the most appropriate treatment for their patients. 

The Number of Abortions After the First Trimester Is 

Relatively Small 

•

In 2011, an estimated 1.1 million abortions were 

performed, a 13 percent decline from 2008. The 

abortion rate in 2011 was the lowest rate since 1973 

(Jones and Jerman, 2014). The U.S. Centers for 

Disease Control and Prevention (CDC) estimates 

that 65 percent of legal abortions occur within the 

first eight weeks of gestation, and 91 percent are 

performed within the first 13 weeks. Only 1.4 percent 

occur at or after 21 weeks (CDC, 2014). 

•

Since the nationwide legalization of abortion in 1973, 

the proportion of abortions performed after the first 

trimester has decreased because of increased access 

to and knowledge about safe, legal abortion (Gold, 

2003). 

•

The number of abortions after the first trimester 

might be even smaller if women had greater access 

to safe and legal abortion. Most women who’ve 

had an abortion say they would have preferred to 

have it earlier, but financial limitations and/or lack of 

knowledge about pregnancy caused them to delay 

(Finer et al. 2006). 

VARIOUS FACTORS REQUIRE WOMEN TO HAVE 

ABORTIONS AFTER THE FIRST TRIMESTER 

Barriers to Service 

•

Geographic 

— A 2005 survey of U.S. abortion 

providers found that among women who have non-

hospital abortions, approximately 19 percent travel 

50 to 100 miles for services, and an additional eight 

percent travel more than 100 miles (Jones et al., 2008). 

It follows that having to travel such distances can 

cause delays in obtaining abortions. 

•

Provider shortage 

— As of 2011, 89 percent of U.S. 

counties had no known abortion provider; these 

counties are home to 38 percent of all women 

of reproductive age. (Jones and Jerman, 2014). 

Furthermore, in 2008, 97 percent of non-metropolitan 

counties have no abortion services, and 92 percent 

of non-metropolitan women live in these unserved 

counties (Jones and Kooistra, 2011). 

ABORTION AFTER THE FIRST TRIMESTER 

in the United States

•

Financial 

— In 2000, the average cost of a first-

trimester, in-clinic, non-hospital abortion with local 

anesthesia was $372 (Henshaw & Finer, 2003). In 2009 

this cost was $451. The median cost of medication 

abortion, which can be done in the first 63 days of 

pregnancy, was $490 (Jones and Kooistra, 2011). 

For low-income and younger women, gathering 

the necessary funds for the procedure often causes 

delays. A recent study found that women at or under 

100 percent of the federal poverty level were more 

likely than women at higher income levels to have 

second-trimester abortions (Jones and Finer, 2012). 

Compounding the problem is the fact that the cost 

of abortion rises with gestational age: in 2009, non-

hospital facilities charged an average of $1,500 for 

abortion at 20 weeks (Jones and Kooistra, 2011). Most 

women are forced to pay for abortions out-of-pocket. 

In 2008, only 20 percent of abortions were paid by 

Medicaid and another 12 percent were billed directly 

to private insurance (Jones et al, 2010). For some 

women, the cost of abortion can pose significant 

barriers to access. Thirty-six percent of women having 

abortions in the second trimester reported that they 

needed time to raise money to have the abortion. In 

addition, 18 percent of women having abortions in the 

second trimester reported that worries about the cost 

of the procedure caused them to take more time to 

make their decision (Finer, et al., 2006). 

•

Legal restrictions — Causing additional delays are 

state laws that mandate parental consent, notification, 

or court-authorized bypass for minors, and laws that 

impose required waiting periods. For example, after 

Mississippi passed a parental consent requirement, 

the ratio of minors to adults obtaining abortions after 

12 weeks increased by 19 percent (Henshaw, 1995). 

Medical indications 

affecting the pregnancy may also 

lead to abortion after 12 weeks. 

•

In a survey of U.S. women deciding to end their 

pregnancies, significantly more women in their second 

trimester cited fetal health concerns than women 

in their first trimester. The fetal health concerns 

they cited included the risk of fetal anomaly due to 

advanced maternal age, a history of miscarriage, 

a lack of prenatal care, and fetal exposure to 

prescription medications and non-prescription 

substances (Finer et al., 2005). 

•

Conditions in which the woman’s health is threatened 

or aggravated by continuing her pregnancy include: 

•

certain types of infections; 

•

heart failure; 

•

malignant hypertension, including preeclampsia; 

•

out-of-control diabetes; 

•

serious renal disease; 

•

severe depression; and 

•

suicidal tendencies. 

These symptoms may not occur until the second 

trimester, or they may become worse as the pregnancy 

progresses (Cherry & Merkatz, 1991; Paul et al., 2009).

Other Reasons for Having an Abortion Past 12 Weeks 

•

Exposure to intimate partner violence. 

•

Absence of partner due to estrangement or death. 

•

Lack of financial and/or emotional support from partner. 

•

Lack of pregnancy symptoms, seeming continuation of 

“periods,” irregular menses. 

•

Psychological denial of pregnancy, as may occur in 

cases of rape or incest (Jones and Finer, 2012; Ingram 

et al., 2007; Paul et al., 2009). 

Adolescents Often Delay Abortion Until After 

the First Trimester 

•

Adolescents are more likely than older women to obtain 

abortions later in pregnancy (Jones and Finer, 2012). 

•

Among women under age 15, one in five abortions is 

performed after 13 weeks’ gestation. Twelve percent 

of teens aged 15 to 19 obtained an abortion after 13 

weeks’ gestation (CDC, 2014). 

•

The very youngest women — those under age 15 — are 

more likely than others to obtain abortions at 21 or 

more weeks’ gestation (CDC, 2014).

•

Common reasons why adolescents delay abortion 

until after the first trimester include fear of parents’ 

reaction, denial of pregnancy, and prolonged 

fantasies that having a baby will result in a stable 

relationship with their partners (Paul et al., 2009). In 

addition, adolescents may have irregular periods 

(Friedman et al., 1998), making it difficult for them to 

detect pregnancy. One study found that teens took 

a week longer to suspect pregnancy than adults 

did; teens also took more time to confirm their 

pregnancies with a pregnancy test (Finer et al, 2006). 

Also, as previously noted, delays are often caused 

by state laws requiring parental consent or court-

authorized bypass for minors. 

Abortion After the First Trimester Is as Safe as/or 

Safer than Carrying a Pregnancy to Term 

•

Overall, abortion has a low morbidity rate. Less than 

0.3 percent of women undergoing legal abortion 

procedures at all gestational ages sustain a serious 

complication requiring hospitalization (Boonstra et 

al., 2006; Henshaw, 1999; Upadhyay,  et al., 2015). The 

rate of complication increases 38 percent for each 

additional week of gestation beyond eight weeks 

(Paul et al., 2009). 

•

The risk of death from medication abortion through 

63 days’ gestation is about one per 100,000 

procedures (Grimes, 2005). The risk of death with a 

surgical abortion is about one per one million through 

63 days’ gestation (Bartlett et al., 2004). The risk of 

death from miscarriage is about one per 100,000 

(Saraiya et al., 1999). But the risk of death associated 

with childbirth is about 14 times as high as that 

associated with abortion (Raymond & Grimes, 2012). 

•

The risk of death associated with surgical abortion 

increases with the length of pregnancy, from one 

death for every one million abortions at eight or fewer 

weeks to 8.9 deaths for every one million abortions 

after 20 weeks’ gestation (Boonstra et al., 2006). In 

comparison, the maternal mortality rate in the U.S. 

in 2007 was 12.7 deaths per 100,000 live births — a 

significant difference in maternal mortality rates 

between deciding to end a pregnancy by abortion or 

carrying it to term (Paul et al., 2009; Xu et al., 2010). 

CURRENT LAW GUARANTEES WOMEN THE RIGHT 

TO ABORTION AFTER THE FIRST TRIMESTER 

Legality of Abortion 

•

In Roe v. Wade (410 U.S. 113 (1973)), the U.S. Supreme 

Court held that the U.S. Constitution protects a 

woman’s personal decision to end a pregnancy. Only 

after viability — being capable of sustained survival 

outside the woman’s body with or without artificial aid 

— may the states ban abortion altogether. Abortions 

necessary to preserve the woman’s life or health must 

still be allowed, however, even after viability. 

•

Prior to viability, states can regulate abortion, but 

only if the regulation does not impose a “substantial 

obstacle” in the path of a woman deciding to have an 

abortion (Harrison & Gilbert, 1993). 

Determination of Viability 

In 

Planned Parenthood of Central Missouri v. Danforth 

(428 U.S. 52 (1976)), the U.S. Supreme Court recognized 

that judgments of viability are inexact and may vary with 

each pregnancy. As a result, it granted the attending 

physician the right to ascertain viability on an individual 

basis. In addition, the court rejected as unconstitutional 

fixed gestational limits for determining viability. The 

court reaffirmed these rulings in the 1979 case 

Colautti 

v. Franklin (439 U.S. 379 (1979)). 

State Laws and Abortion Facilities 

In 

City of Akron v. Akron Center for Reproductive Health 

(462 U.S. 416 (1983)), the U.S. Supreme Court invalidated 

a costly requirement that all second-trimester abortions 

take place in a hospital.

Laws and Specific Abortion Techniques 

•

In Thornburgh v. American College of Obstetricians 

and Gynecologists (476 U.S. 747 (1986)), the U.S. 

Supreme Court ruled that a woman may not be 

required to risk her health to save a pregnancy even 

after viability, and it granted the attending physician 

the right to determine when a pregnancy threatens 

a woman’s life or health. The court also ruled that 

when performing a post-viability abortion, a physician 

must be permitted to use the method most likely to 

preserve the woman’s health. 

•

On April 18, 2007, in Gonzales v. Carhart (550 U.S. 124 

(2007, April 18)) and Gonzales v. Planned Parenthood 

Federation of America, Inc. (550 U.S. ___ (2007, April 

18)), the U.S. Supreme Court ignored 30 years of 

precedent that held women’s health must be the 

paramount concern in laws that restrict abortion 

access, and in a 5–4 decision, upheld the so-called 

Partial-Birth Abortion Ban Act of 2003 (the “federal 

abortion ban”) — the first federal legislation to 

criminalize abortion. 

•

The federal abortion ban, which does not contain an 

exception for the woman’s health, makes it a federal 

crime to take certain steps when performing an 

abortion after the first trimester. The ruling allows 

Congress to ban certain second-trimester abortion 

procedures, despite the fact that doctors and major 

medical organizations, including the American 

College of Obstetricians and Gynecologists, believe 

the banned procedures are sometimes the safest and 

best to protect women’s health. 

•

The Carhart and Planned Parenthood Federation of 

America, Inc. rulings may make it easier for states, 

as well as the federal government, to further limit 

a woman’s ability to end a pregnancy, especially 

after the first trimester. This shift will likely spur state 

efforts to enact new abortion restrictions. Indeed, 

opponents of women’s health continue to work 

tirelessly to chip away at or limit access for women. 

The Guttmacher Institute released a report showing 

that 231 provisions were passed in state legislatures 

in the last four years to restrict access to abortion 

(Nash et al., 2015). 

Protecting the Right to Make Personal Medical 

Decisions — Planned Parenthood Continues Its Fight 

Despite the federal abortion ban taking effect, Planned 

Parenthood will continue to provide high-quality 

care, including second-trimester abortion services, to 

our clients. Planned Parenthood will also continue to 

support vital efforts to protect access to safe and legal 

abortion services at the state and federal levels. 

Currently, seven states — California, Connecticut, Hawaii, 

Maine, Maryland, Nevada, and Washington — have 

passed Freedom of Choice Acts (FOCA), and other 

states are seeking to pass similar legislation (Guttmacher 

Institute, 2015). Although state-level FOCAs have no 

impact on the federal abortion ban, such laws prohibit 

the state government from interfering with the decision 

to continue or end a pregnancy.

Cited References 

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Gynecology, 103(4), 729–37. 

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in Women’s Lives. New York: Guttmacher Institute. [Online]. http://

www.guttmacher.org/ pubs/2006/05/04/AiWL.pdf. 

CDC — Centers for Disease Control and Prevention. (2014, November 

28, accessed 2014, December 23). “Abortion Surveillance — United 

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Cherry, Sheldon & Irwin Merkatz, eds. (1991). Complications of 

Pregnancy: Medical, Surgical, Gynecologic, Psychosocial, and 

Perinatal, 4th Edition. Baltimore, MD: Williams & Wilkins. 

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(1983). 

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Finer, Lawrence B., et al. (2005). “Reasons U.S. Women Have 

Abortions: Quantitative and Qualitative Perspectives.” Perspectives 

on Sexual and Reproductive Health, 37(3), 110–8. 

_____. (2006). “Timing of steps and reasons for delays in obtaining 

abortions in the United States.” Contraception, 74 (4), 334–44.

Friedman, Stanford B., et al. (1998). Comprehensive Adolescent Health 

Care, 2nd Edition. St. Louis, MO: Mosby. 

Gold, Rachel Benson. (2003, accessed 2013, March 4). “Lessons from 

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opinions/06pdf/05-380.pdf. 

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___ (2007, April 18, accessed 2013, March 4). [Online]. http://www.

supremecourt.gov/ opinions/06pdf/05-380.pdf. 

Grimes, D.A. (2005). “Risks of Mifepristone Abortion in Context.” 

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Harrison, Maureen & Steve Gilbert, eds. (1993). Abortion Decisions 

of the United States Supreme Court: The 1990’s. Beverly Hills, CA: 

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Henshaw, Stanley K. (1995). “The Impact of Requirements for Parental 

Consent On Minors’ Abortions in Mississippi.” Family Planning 

Perspectives, 27(3), 120–2. 

_____. (1999). “Unintended Pregnancy and Abortion: A Public Health 

Perspective.” Pp. 11–22 in Maureen Paul, et al., eds., A Clinician’s 

Guide to Medical and Surgical Abortion. New York: Churchill 

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Henshaw, Stanley K. & Lawrence B. Finer. (2003). “The Accessibility of 

Abortion Services in the United States, 2001.” Perspectives on Sexual 

and Reproductive Health, 35(1), 16–24. 

Ingram, Roger, et al. (2007, April, accessed 2013, March 4). Second-

Trimester Abortions in England and Wales. Southampton, UK: Centre 

for Sexual Health Research. [Online]. http://www.soton.ac.uk/

lateabortionstudy/late_abortion.pdf. 

Jones, Rachel K., and Lawrence B. Finer. (2012). “Who has second-

trimester abortions in the United States?” Contraception, 85(6), 544-

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Jones, Rachel K., and Jenna Jerman. (2014, accessed 2015, January 

7). “Abortion Incidence and Service Availability in the United States, 

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[Online]. http://www.guttmacher.org/pubs/journals/psrh.46e0414.

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Jones, Rachel, and Kathryn Kooistra. (2011). “Abortion Incidence and 

Access to Services in the United States, 2008.” Perspectives on Sexual 

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Comparative Safety of Legal Induced Abortion and Childbirth in the 

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