(CORRECTION) What Everyone Needs to Know About Second Trimester Abortions


This article was updated at 8:58 am on Saturday, July 31, to correct a data error.  The earlier version erroneously stated that one in four women in the US have an unintended pregnancy.  The correct data are that one-half of all women in the US experience an unintended pregnancy in their reproductive lifetimes.

Most of us don’t think we’ll ever have an abortion, until we become one of the half of all women in the US who has an unwanted pregnancy.  And if we think about it at all, we assume we’d get an abortion pretty early in the pregnancy.  While 90 percent of abortions do happen before 12 weeks, some women seek abortions later in their pregnancies.

Most women do not try to have later abortions. In fact, in a study done by Finer et al, nearly three fifths (58 percent) of women in the survey reported that they would have preferred to have had the abortion earlier than they did. In another study done by Drey et al, 29 percent or one third of women who ended up having abortions during their second trimester were in their first trimester when they made the first call to an abortion clinic. If this is the case, what causes women to have second trimester abortions?

First, let’s learn a bit about second trimester abortions. Drey’s study outlines the following basic information:

  • One out of every ten abortions performed in the United States happens during the second trimester
  • Second trimester abortions carry an increased risk of complications and are more expensive to obtain then first trimester abortions
  • The American public tends to favor restrictions on later termination

These restrictions vary state by state. In some states, like California and New York, Medicaid can cover the cost of an abortion. In others, such as Pennsylvania, Medicaid funds are forbidden from covering the procedure unless the woman is a survivor of rape, incest, or has a medical condition that threatens her life. And in other states still, Medicaid and private insurance are banned from covering abortion no matter the situation. This means that if a woman doesn’t live in a progressive state and if she doesn’t have health insurance that covers an abortion, she will have to spend time raising money towards the cost of her procedure. Depending on how long this takes, the cost of the procedure could go up weekly (as it often does in the second trimester). In the world of abortion funding, this is called “chasing the fee” and is kind of a Dante-esque hell. The longer she waits to have the abortion and the more time it takes her to raise the money, the more the abortion will cost, causing her to have to raise more money and further delay the procedure.

There are other types of anti-choice legislation that can affect a woman’s access to abortion services.  She often has to jump through hoops to be able to make an appointment for the procedure. This could be anything from a 24-hour waiting period from the time she makes the appointment to the time of the procedure, getting parental consent, spousal consent, a mandatory counseling session, signed doctor’s notes, or sessions before a committee or before the police. Many women barely have time to schedule a full-day clinic visit, not to mention dozens of hours spent making sure she abides by these laws. This means taking hours or days off of work, arranging childcare, and arranging travel, not to mention other logistics.

Who are these women who have later abortions, and why do they have them? According to Drey’s study, women who have later abortions tend to be young and of low-income status. Specifically, Dryer found that women under 18 took longer to identify pregnancy symptoms and poor women had to delay their abortion because they had to make arrangements, such as raising money, getting childcare, or transportation to the clinic.

Finer found very similar causes of delay. Second trimester abortion patients, according to his study, were significantly more likely to say that it took them a long time to make arrangements to have the abortion. This is because there are many abortion providers who only provide abortions to 12 or 14 weeks, and the number of providers decreases further later in pregnancy. Many states have NO abortion providers after 14 or 16 weeks. In addition, second-trimester patients were significantly more likely to indicate that they were delayed because they needed time to raise money for the procedure and because it took time to talk to their parents.

Other women have abortions in their second trimester because they need more time to make their decision. According to Finer, 60 percent of women stated that someone helped them come to their decision to have an abortion. What these women may not know is that once they go into their second trimester, the cost of an abortion usually increases every week. It is not clear that women with later pregnancies know the consequences of delaying their decision.

The Finer study also finds that:

“poor women took a significantly longer time from thei first attempt to obtain the abortion to actually having it. When compared to white and Hispanic women, black women reported significantly longer time periods.”

Why might this be the case? Poor women, who are often women of color, may have to take more time to raise the money towards the costs of the procedure. The more time they take to raise the money, the further they are in the pregnancy, and the further they are in the pregnancy, the higher the cost of the procedure. Again, this is an example of “chasing the fee.”

Another important part of the Finer study found that women with two or more children took more time to access abortion services. Why? They have to arrange childcare and have childcare-related expense. Higher-income women and women 30 years old and over reported less time between deciding to have an abortion and going through with the procedure. Why? Because these women are more likely to have access to resources (money, transportation, lodging) that erase or ease the boundaries faced by poor women.

Finer also observed that if a woman goes to one clinic and is turned away because she is too far along in the pregnancy to have an abortion there, it may take her twice as long, on average, between initially attempting to make an appointment and having the abortion. This makes sense, as she would likely have to gather more money, take more days off work, arrange for transportation, childcare, and possibly even lodging to go to a different clinic, one that may not even be in her state.

Perhaps a woman lives in a state where there is only one abortion provider. She then has to arrange travel and lodging at this destination, along with coming up with the cost of the procedure. A woman’s ability to take the time off required to get to the clinic, whether this means arranging for transportation, renting a car, flying out of state, arranging childcare, taking time off, arranging lodging, you get the picture. If a woman can’t afford a $350 first trimester procedure at a nearby provider and takes too much time raising that money, she then has to deal with the rising cost of the procedure AND travel and accommodations costs.

In boils down to a few things. Women have second trimester abortions because they need to, not because they want to. Why? Because their insurance doesn’t cover abortion, because they needed time to raise money for the cost of an abortion, because they needed to arrange travel/childcare/time off of work in order to spend a full day at the clinic, because they needed time to make the decision with confidence, because they needed to make time to travel out of state to access an abortion provider.

The Finer study concludes by stating that their findings:

“suggest that gestational age at abortion in the US could be further reduced if financial barriers faced by disadvantaged groups were removed and if women, especially young women, were educated about how to recognize pregnancy.”

The links between sex education and pregnancy are clear. The better women are able to identify pregnancy symptoms, the faster they will take a pregnancy test. The earlier they are in the pregnancy, the more time they have to make a decision about whether or not to carry to term without worrying about a significant rise in the cost of the procedure. A first trimester abortion is a safer and less expensive abortion. We must work to eradicate the barriers women face in abortion services. This means:

  • Ensuring that all teens have access to comprehensive sex education
  • Requiring that ALL state Medicaid to cover abortion services
  • Making sure that medical schools to include abortion care training in their curriculum so women have more providers to choose from
  • Lobbying for protections against anti-choice terrorists who endanger abortion doctors and their patients through clinic violence and threats

We are the women who will need abortions, and we need to learn as much as we can about our bodies and about abortion services so that we can get the abortions we need as early as possible in an unwanted pregnancy.  And we need to organize, to make sure that abortions are available as late as we need them.

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  • suburbangrrrl

    So what’s it going to take to put the Hyde Amendment back on to the table?  Yes, there is not the political/legislative will to even consider it. But the pro-choice movement needs to decide if we are serious about on the offensive and make it a front and center issue to advocate for. This is a long-term strategy that PP, NARAl, etc needs to engage in counter education to the anti’s. Are we going to let fear continue to stop us? Not an easy question to answer and I include myself. But that is a core issue we have to answer. The other issue is whether mainstream DC lobbying prochoice groups will be honest with themselves about whether they really want to advocate for poor women. It seems to me we need to advocate for a uniform policy of abortion rights and access. Similar to the health care reform movement educating the public and advocating for a single payer system to solve the nation’s health care ills. Single payer wasn’t successful legislatively and powerful forces and  billions of dollars were used to defeat it. But it made its way into national consciousness.

  • rage

    Actually, factually, the very real truth is that there could be, in our lifetimes, the end of abortions as we know them, if RU486 and the other, new spermicide is allowed in the country for use by women.  Abortion foes won’t want it, certainly, and will fight it, saying that it’s still an abortion–which we know is blatant nonsense–because they don’t want to lose their single-issue cause.  It’s great for Catholics and the Catholic church and other organizations that use the issue to gin up interest, indignation and emotion and, don’t forget–cold hard cash.  If we take away the problem of abortions, these people won’t have a cause.  In the meantime, women lose their rights and, too frequently, their health, as well as, again, for the umpteenth time, control over their own body.  

     

    Sad.  Pitiful.  Stupid.

     

    Mo Rage

    the blog

    • crowepps

      RU-486 …. Abortion foes won’t want it, certainly, and will fight it, saying that it’s still an abortion–which we know is blatant nonsense–

      Well, of course it’s still an abortion – RU-486 deliberately causes a miscarriage so it is not nonsense to call it an abortion.  However, nobody can stop the continued use of it even by making it illegal — our borders are incredibly porous for far more damaging drugs.

  • prochoiceferret

    Actually, factually, the very real truth is that there could be, in our lifetimes, the end of abortions as we know them, if RU486 and the other, new spermicide is allowed in the country for use by women.

     

    RU486 is good in some cases, but sometimes, an “old-fashioned” surgical abortion or alternate procedure is safer. Having fewer medical options is not a positive for women’s health.

     

    Spermicide is a contraceptive. Contraception can help reduce the abortion rate by reducing the unwanted-pregnancy rate, but it’s not going to be “the end of abortions as we know them.”

    • arekushieru

      And there is the fact that some women will still have wanted pregnancies that need to be terminated.

  • saltyc

    Local abortion funds are getting more funding now, perhaps due to news about insurance covering less, but the call volume is overwhelming volunteers.

    So many women call who need the money for abortions, but half the time we can’t get through, we don’t leave messages unless they tell us we can, they have busy work schedules, etc. It’s just so hard, and women who don’t get funding do miss their appointments and have to reschedule. It’s all because of hydeous Hyde, the Mr. Hyde ammendment as I call it.

    Repeal it, repeail it now.

    I don’t even know, with the bufoon’s executive order, if repealing Hyde will free up federal dollars so that women can get on with their lives.

    • julie-watkins

      And I’m embarrassed to say that until I read a rant a few years ago it hadn’t really gotten on my radar just how hydeous it is. :-(  Having Hyde there just makes it easier for a lot of other barriers to happen.

  • catbus

    The current chairman of the committee, David Obey, is retiring after this term isn’t he? AN option is to have everyone lobby for the new appropriations chairman to be the most staunch pro-choice person possible and straight up rip Hyde out of the initial introduced HHS bill, since in the past few sessions at least there hasn’t been a fight over it.

    Of course this all hinges on a) the democratic party keeping majorities and b) pro-choice lobbyists having the clout to influence democratic leadership to make these calls and c) whatever other peripheral conditions I can’t think of off the top of my head.

  • catbus

    Also if I had a gajillion dollars to spend on some foundation I’d start a grant club that helped recent med school grads set up abortion care facilities if they pledged to first and second trim procedures and offer rh care for like X number of years. Potential short term solution to the provder problem.

  • prowomen

    Abortion is legal but self-appointed religious extremists have influenced politicians to vote to override the religious views of those who are not opposed to abortions.  Religious freedom is part of our Constitution but that hasn’t prevented politicians from catering to them out of fear they won’t be elected.  

     

    Those who say they want government out of our personal lives have forced politicians to make medical decisions for women instead of doctors.  Outrageous!

     

    The Hyde Amendment is an abomination and a dangerous threat to the health of poor women.  It’s a legal death sentence without the benefit of a trial.  No one should vote for any candidate who supports the Hyde Amendment and won’t seek to overturn it.

  • crowepps

    And the fact that wanted pregnancies spontaneously terminate 15 to 20% of the time and the prophilactic operations to prevent possible infection by removing any remaining ‘products of pregnancy’ afterwards are ALSO abortions performed using exactly the same equipment and techniques as those used to terminate an unwanted pregnancy.

  • mariekw

    I understand how hard it can be to wrestle with the psychological, emotional, and moral aspects of deciding to have an abortion. I was there myself.  First, denial.. I couldn’t really be pregnant! I had taken all the precautions! Then admitting to myself that I really, truly, was in such a bad situation. Some people who meet me now and realize how young I had my son, assume that it was never really a question or a decision. They assume, based on how much I love him and care about him, and how long I was married to his father, that my son was wanted from the beginning and that there never was a question that when I got pregnant, I would have a baby.  But, I had to actively decide to carry my son to term and give birth. In all actuality, it was not easy at all. It was an agonizing decision and I just about drove myself insane over it.

     

    I was well into the second trimester of my pregnancy when I made the decision that abortion was not going to be the right choice for me. Before that day, I went back and forth many times…. I felt bad about even thinking about getting an abortion but I also felt bad about derailing my education and my career and starting a family and getting my fiance into this mess with me when we did not have means to support a family.  I conceived by accident but I did not give birth by accident. There were several points where I thought I had decided to have the abortion but new considerations and emotions came into play and I had to deal with those, too.

     

    Likewise, women who choose abortion do not choose it by accident. It is a heartwrenching emotional decision with the potential to find yourself second-guessing and doubting yourself every day for the rest of your life. It would be very easy for a young woman to wrestle with the problem for many weeks and finally be able to make the decision to abort when it’s already the second trimester. I was almost in that position myself, and if any of a number of factors had been any different I would most likely have had a second-trimester abortion. It took some time for me to resolve the different emotional and moral issues to make a decision. It’s not the sort of decision anyone should have to make overnight or even in just one month.

  • grayduck

    As someone who thinks that life begins sometime in the middle of pregnancy, I appreciate the additional information about why women delay into the second trimester. I had not been familiar with those two studies. I expect to have more comments later, but I have not read the Drey study yet.

  • grayduck

    I was not able to get to the Drey link (although I did read the abstract), but I would like to say that I am glad that someone is finally trying to determine why women delay into the second trimester.

     

    “This means that if a woman doesn’t live in a progressive state and if she doesn’t have health insurance that covers an abortion, she will have to spend time raising money towards the cost of her procedure.”

     

    Do you have evidence that “progressive” states have fewer second-trimester abortions?

     

    “There are other types of anti-choice legislation that can affect a woman’s access to abortion services.  She often has to jump through hoops to be able to make an appointment for the procedure. This could be anything from a 24-hour waiting period from the time she makes the appointment to the time of the procedure, getting parental consent, spousal consent, a mandatory counseling session, signed doctor’s notes, or sessions before a committee or before the police.”

     

    Where in those studies did you see any mention of those laws causing delays? And what state requires women to get “signed doctor’s notes” or have “sessions before a committe or before the police?”

     

    “Second trimester abortion patients, according to his study, were significantly more likely to say that it took them a long time to make arrangements to have the abortion. This is because there are many abortion providers who only provide abortions to 12 or 14 weeks, and the number of providers decreases further later in pregnancy.”

     

    But that would presumably only cause a delay once the second trimester is reached, not cause a delay into the second trimester.

     

    “…second-trimester patients were significantly more likely to indicate that they were delayed because they needed time to raise money for the procedure…”

     

    I wished the Finer study had explored the issue of financing in more detail. I would think that the greater cost of later abortions, to some extent, would provide an incentive to get abortions earlier.

     

    “Women have second trimester abortions because they need to, not because they want to.”

     

    The two studies you cited, as well as other studies on late abortions that I have seen, indicate that failure to detect pregnancy is a prominant, if not the dominant, cause of delay into the second trimester. Given that pregnancy detection tests are widely available and inexpensive, their failure would seem to indicate negligence- if not a deliberate preference for late abortions- is a major cause of late abortions. Keep in mind when looking at the Finer study that fifteen percent of the women obtaining second trimester abortions did not even wish to have abortions earlier.

  • crowepps

    Do you have evidence that “progressive” states have fewer second-trimester abortions?

    Second-trimester abortions are done where the provider is located and people travel long distances to get there.  The state in which the provider is located can’t tell us much about what state the patients live in.

    And what state requires women to get “signed doctor’s notes” or have “sessions before a committe or before the police?”

    In some states, women have to get a written agreement from a second doctor that the abortion is medically necessary or that the fetus has anomalies incompatible with life.  In some states, hospital ethics committees have to rule on whether the abortion is ‘permissible’ under the hospital’s rules.  In other states, where abortion is legal in cases of rape, reports have to be made to the police and the police interview the women involved.  I’m surprised you’re surprised — these issues have been discussed here many times.

    I wished the Finer study had explored the issue of financing in more detail. I would think that the greater cost of later abortions, to some extent, would provide an incentive to get abortions earlier.

    If you do not have the money, and have to earn or borrow or beg the money, the incentive of lower cost is irrelevant.  It makes far more financial sense to pay your gas or electric bill on time as well, which theoretically would mean that no one would ever wait until the door has been tagged and the meter shut off to make the payment, however people who don’t have enough money to cover their bills still end up paying huge late fees and reconnect fees because the ‘incentive’ of lower costs does not make money magically appear from nowhere.  On average, about 10% of customers are delinquent on utilities and between 4 and 5% wait until disconnect before they pay the bill.  This is not motivated entirely by irresponsibility but the necessity to chose between water/heat and medication/ food.

    The two studies you cited, as well as other studies on late abortions that I have seen, indicate that failure to detect pregnancy is a prominant, if not the dominant, cause of delay into the second trimester. Given that pregnancy detection tests are widely available and inexpensive, their failure would seem to indicate negligence- if not a deliberate preference for late abortions- is a major cause of late abortions.

    Neligence?  If a woman thinks she’s in menopause, it might not occur to her that she’s pregnant.  If a girl is ignorant because she hasn’t received the information that would inform her, it might not occur to her that she is pregnant.  If a woman has been drugged and raped which she was unconscious, she might not even be aware that she had sex.  Your speculation that there might be “a deliberate preference for late abortions” is bizarre after you just got done talking about the difficulties of finding a provider and the higher cost.  What kind of perversion could you possibly be implied by suggesting “a deliberate preference for late abortions”?

    Keep in mind when looking at the Finer study that fifteen percent of the women obtaining second trimester abortions did not even wish to have abortions earlier.

    Women who have abortions because of fetal malformations don’t start out their pregnancy expecting an abortion.  It is the discovery of the malformation, in the second trimester, that tells them they are not getting what they WISHED they would get, a child.  So just exactly what is it you want us to keep in mind?

  • grayduck

    “Why? Because their insurance doesn’t cover abortion, because they needed time to raise money for the cost of an abortion…”

     

    If a man will not even pay for an abortion- in contrast to owning up to being a good father, why would a woman engage in sexual intercourse with that man?

     

    “The better women are able to identify pregnancy symptoms, the faster they will take a pregnancy test.”

     

    Why not take a pregnancy test before pregnancy symptoms are recognized? Some forms of contraception hide pregnancy symptoms.

     

    Requiring that ALL state Medicaid to cover abortion services…

     

    How would subsidizing second-trimester abortion make it less common? Why not force the fathers to pay instead?

     

  • arekushieru

    If a man will not even pay for an abortion- in contrast to owning up to being a good father, why would a woman engage in sexual intercourse with that man?

     

    Umm, perhaps because the women didn’t know he was an abuser.  Because abusers are really GOOD at hiding their abusive nature??  Derrrr….

     

    Why not take a pregnancy test before pregnancy symptoms are recognized? Some forms of contraception hide pregnancy symptoms.

     

    Way to go erasing the human element again.  If someone doesn’t WANT to be pregnant, they will most likely DENY their pregnant…?  Oy….

     

    How would subsidizing second-trimester abortion make it less common? Why not force the fathers to pay instead

     

    And we see how well THAT works, especially when one is abusive, in court cases involving child support.  Also, nice little add-on, there.  The original quote said NOTHING about subsidizing ONLY second trimester abortions.  It said, and I repeat, subsidizing abortion services.  And crowepps has already exPLAINED to you about why subsidizing abortion services under Medicaid in ALL states will reduce the number of second trimester abortions.  Please, read, before typing, next time….  Thank you, kindly, in advance for that consideration.  

     

     

  • crowepps

    If a man will not even pay for an abortion- in contrast to owning up to being a good father, why would a woman engage in sexual intercourse with that man?

    I can think of three possibilities – it was rape, she was drunk, or he lied.

    Why not take a pregnancy test before pregnancy symptoms are recognized? Some forms of contraception hide pregnancy symptoms.

    Are you suggesting that women purchase and use a pregnancy test once a week or what?  Why would any women who didn’t think she was pregnant test to see if she was pregnant?

    How would subsidizing second-trimester abortion make it less common?

    Subsidizing FIRST-trimester abortions would make second-trimester abortions less common, except in cases of fetal malformation or pregnancy complications.

     Why not force the fathers to pay instead?

    Oh, man, you don’t often tell jokes, but that one is a real knee-slapper!