Why Did She Wait So Long? Later Abortions and the Implications of the New Nebraska Ban


*The stories in this article are true summaries of women who presented for services at the ParkMed Physicians clinic in New York during 2009.  Details have been changed to protect the anonymity of the women.

At 17, Rachel* was a high school senior when her steady boyfriend forced her to have sex. Rachel’s period was not regular, and like her family, Rachel had always considered herself pro-life. When she finally realized that she was pregnant and thought about her strong desire to go to college and her life goals, she realized that for her, abortion was the right decision.

Rachel called the nearest clinic and was informed that her state had a parental consent law, requiring her to get the consent of a parent or a judge because she was under 18. For the next three weeks Rachel feared telling anyone, especially family, but after much deliberation and anxiety she finally told her mother. While her mother was initially angry, within a few days she agreed to help Rachel get an abortion. They called the nearest clinic and got the first available appointment, one week away.  At the appointment, Rachel and her mother were shocked when the ultrasound showed that Rachel was already five months (20 weeks) pregnant. The clinic did not offer abortions past 14 weeks. They referred her to a clinic five hours away, but because of limited physician availability that facility had no appointments for three weeks. They also learned that the clinic could not accept the health insurance that Rachel’s family had. Since Rachel’s procedure would take two days to perform, they would also need to make arrangements to stay in a hotel. Rachel and her mother spent the next three weeks borrowing $2,500 to pay for the travel, hotel, and abortion. On the day that Rachel finally had her abortion, she was 2 days shy of 24 weeks pregnant.

Rachel’s story is more common than many might think. “Pro-choice” or “pro-life,” most people do not realize that although only one percent of abortions occur at 21 weeks or later, this one percent represents about 11,000** women in the United States who get later abortions every year.[1],[2]  Many of these women must raise $2,000 to $4,000 to get the abortion they need. These women are disproportionately young and poor, and many already have a job. Some struggle to cover the cost of birth control pills, in addition to food and the next month’s rent. Pulling together the money for an abortion takes time and sacrifice. 

This is compounded by the fact that the nearest abortion provider is often in another state. In addition to various state regulations that restrict access to abortion care, such as waiting periods and parental consent laws, only a few facilities nationwide provide abortions late in the second trimester. Since these abortions usually require two or more days to complete and are not widely available, women who must travel to these providers have to make extensive arrangements for travel, childcare, and accommodations. These all add to the cost for the woman, and as she scrambles to put all the pieces together, the cost of her abortion continues to rise. At 10 weeks the average abortion costs $450.  Each additional week may add $100 or more.  Studies have found that many women who obtain later abortions tried to have the abortion sooner but could not overcome these financial, geographic, and political barriers. [3],[4]

For Rachel, being unfamiliar with the symptoms of being pregnant, having irregular periods, her ambivalence about abortion coming from growing up in a “pro-life” family, and being in denial about the fact that her boyfriend had raped her all contributed to late recognition of her pregnancy.  Restrictive policies, a delayed referral, and needing to travel to find a provider who could help her pushed her to present much later for the abortion she needed.

Diana* already had special-needs three year-old twins when she found herself pregnant a second time.  She brought up the idea of abortion with her abusive, alcoholic husband who angrily rejected the idea, despite their current financial and emotional strain.  He demanded she deliver a son for him, a “normal one,” not some “freak show” like before, and punched and kicked her when she argued.

During Diana’s 20th week of pregnancy, after weeks of fear and contemplation, she secretly borrowed money for an abortion from her sister.  Before bed that night, she hid clothing and her purse in the bathtub, planning to slip away with the twins in the pre-dawn hours.  When her husband caught her attempting to leave, he beat her ferociously. Three weeks later, her bruises still present, Diana found another opportunity to leave, this time leaving the twins with her sister. She feared for their safety and her own, but was resolute in her decision to terminate her pregnancy.

She took a bus to New York City, now 23 weeks pregnant, but the abortion was more expensive than planned. A friend offered to contribute, and together they spent another few days raising the additional $300. Diana was lucky; in spite of the delays and obstacles, she found help raising the money and was able to get to New York City where there are abortion providers who could take care of her.

Diana’s story, like Rachel’s, is a typical example of “the perfect storm”- the intersection of life situation, funding and regulatory barriers, scrambling to find a provider and needing to travel – all circumstances that may lead a woman to seek an abortion later in her pregnancy. However, most Americans are unaware of how women find themselves in the center of this storm. According to a 2010 Gallup poll, 45 percent of Americans consider themselves to be pro-choice. Nevertheless, only one quarter of Americans support women’s right to end an unwanted pregnancy in the second trimester.[5] Many Americans become uncomfortable with later abortion because they focus on the developmental level of the fetus rather than on the rights of the pregnant woman, overlooking the myriad reasons that women need later abortions. Without the full picture of women like Rachel and Diana, it is easy to assume that women who obtained later abortions had total control over when to come for abortion care and simply chose to delay. These women are often misjudged as careless and immoral and of not taking responsibility for presenting earlier for abortion care.

The reality is that women need later abortions for many of the same reasons women need any other abortion. A woman or girl is not yet ready to start a family; she’s about to start college; she’s just lost her job; she was raped; she needs to look after her existing children.  Later abortions, like earlier abortions, happen because birth control fails, because the choice of when and how to be sexual is not always a woman’s choice, because obtaining health insurance is slow or out of reach, or because the decision to fully commit to the children that she already has is a moral decision that women take seriously. For some women, a diagnosis of fetal anomaly comes late in pregnancy, for some it comes earlier.  For others, partners leave, houses disappear in hurricanes or floods and their new situation means they no longer feel they can parent a new child. Women who seek early and later abortions alike do not make a decision about a pregnancy in isolation; each woman’s decision is impacted by her location, health, socioeconomic status, race, nationality, religious beliefs and family circumstances.

In April 2010, the Nebraska legislature banned abortions after 20 weeks of pregnancy for all reasons except for the life and physical health of the mother. This law will go into effect on October 15.  What little public discussion there has been about this new law has centered on the constitutionality of the ban or the scientific credibility of the reasons for the ban.  Scarce attention is being paid to the women whose abortions will be prohibited if the ban is allowed to go into effect.

The stories of the women who need later abortions must be placed at the center of the debate.  The Rachels and Dianas of Nebraska have lost access to the abortions that they need. While we may not all agree with the decisions these women make, we can develop empathy and understanding for their situations, along with the awareness that these women are struggling to do the best they can with time against them.  Support for women seeking later abortions needs to start with each of us.

*The stories in this article are true summaries of women who presented for services at the ParkMed Physicians clinic in New York during 2009.  Details have been changed to protect the anonymity of the women.

**Estimated from CDC data containing all states but CA, LA, and NH, plus Guttmacher State Profile data for CA, LA, and NH.


[1] Centers for Disease Control and Prevention. Abortion Surveillance–United States, 2006. Surveillance Summaries, 27 November 2009. MMWR 2009;58(No.SS-8).

[2] Guttmacher Institute. State Center. Accessed 30 July 2010. At: http://www.guttmacher.org/statecenter/sfaa.html

[3] 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 Oct;74(4):334-44.

[4] Drey EA, Foster DG, Jackson RA, Lee SJ, Cardenas LH, Darney PD. Risk factors associated with presenting for abortion in the second trimester. Obstet Gynecol. 2006 Jan;107(1):128-35.

[5] Gallup Poll News Service. Abortion. Accessed 21 July 2010. At: http://www.gallup.com/poll/1576/abortion.aspx#1

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  • mechashiva

    Excellent analysis of this issue. I really liked the point you made about focusing on fetal development and constitutionality of term restrictions rather than the situations of the women seeking later abortions. I fall into those traps myself sometimes, and I really shouldn’t since I do know better. The way the debate is framed to focus on the uterus, it is really easy to lose sight of the women.

  • saltyc

    Very important information that needs to be understood.

    “pro-life” policies such as the Hyde ammendment, insurance non-coverage, limiting number of providers and stigma absolutely have the consequence of causing later abortion.

     

    The most heartbreaking thing is talking to a young pregnant woman who doesn’t want to be pregnant is stuck in a “pro-life” family, it is a lot like a young gay person stuck in a homophobic family. The very support structure that was there to nurture, support and guide you now is betraying you. What if they had parental notification laws for homosexuality?

     

    I volunteer for a local grass-roots abortion fund and I have to admit that when talking to a woman who is past 19 weeks, I do feel queasy. I have a weak stomach, that’s why I don’t eat meat except for fish on rare occasion, and I don’t watch violent movies etc. I could not even bring myself to kill a brown recluse spider I found in my linen closet, my partner set it free outside.

    But for all the reasons others have noted here, I absolutely support her right to bodily autonomy and self-determination, and if she can find a provider, I will help her get an abortion.

    I do believe we should limit the time a woman gets an abortion, 24 weeks seems like a reasonable cut-off, not for philosophical reasons but practical ones, mainly in the interest of protecting women and providers.

    And woman will get abortions earlier if abortion is liberalized, as they do in countries with fewer restrictions.

     

    Also I want to say something about the pressure that exists to make women give up their babies for adoption. This is one of the goals, if I’m not mistaken, of the so-called common ground movement, to convince women to change their minds and carry a pregnancy to term then give the baby up for adoption. I spoke to a pregnant woman recently wanted an abortion who said she does not believe in adoption. I can totally relate, and this was a reason I had an abortion too. It would be wrong for me to give up a child to a stranger, for me the responsible, moral thing if I brought a child into the world would be to take care of it.

    Now I am NOT saying that another woman is wrong for giving up a baby for adoption, I would never say that.

    Some people would say that’s moral relativism, but in the real world you need a way to hold apparently contradictory views.

    When people insist on trying to convince a woman to give up a baby for adoption, that’s  just as wrong as not supporting a woman who does want to give a baby up for adoption. In both cases she is following for conscientious, moral principles.

  • hekate

    I do believe we should limit the time a woman gets an abortion, 24 weeks seems like a reasonable cut-off, not for philosophical reasons but practical ones, mainly in the interest of protecting women and providers.

    Why should the restrictions be legislated? Abortion should be treated like every other medical procedure: the patient and her doctor make the decision for what’s appropriate and safe. Shouldn’t we trust physicians to counsel women as to when an abortion is appropriate? We trust physicians to decide when other procedures are safe, so why not this one? 

  • saltyc

    Yeah, what do I mean by “we” in the we should limit

    I agree that assessment should come from physicians who know more about it than I or legislators do.

    Philosophically, ethically, I would say any woman has the right to not be pregnant, at any time. I think it would be very hard to find a practitioner willing to do it after it becomes so much more difficult and the possibility of more complications arising. But standards of practice should be in place to avoid the errant practitioner willing to do very risky procedures.

    But yeah, I’m skating on thin ice here. I really don’t know what I’m talking about.

  • saltyc

    wrong place

  • crowepps

    I don’t agree that you don’t know what you’re talking about because your position sounds consistent with what works in the real world.  The example of Canada, which leaves the decision in the hands of those involved, is pretty clear, and so is the example of Mexico, where the Church has sailed right past banning abortion and birth control and now insists the government has the right to punish women for stillbirth.  They haven’t yet QUITE made it illegal to be female, but they’re certainly trying!

     

    The problem as I see it is that it would be difficult to set up reasonable standards of practice, it would definitely be hard to enforce them (since they are rarely enforced NOW in other matters) and it might be difficult to get a referral to an appropriate doctor if your primary care physician feels he/she has the right to impose his moral values on his patients.

  • arekushieru

    And that’s the point I was trying to conveigh, on another thread.  You said it so much better than I could!  So, agree with crowepps, you are being VERY clear!  :D

  • forced-birth-rape

    ~I do not believe the statistics on women and girls who get abortions because of rape. My mother made me go to a therapist when I was sixteen, I did not tell him anything, he asked over and over again, so did my mother.
    I said no, no, no! It wasn’t until I was nineteen that I realized what had happened clearly. I do not know one woman, who would tell the truth and say, I am getting an abortion because I was raped. Especially right after some one is raped, most can’t say it~

    • bj-survivor

      ~I do not believe the statistics on women and girls who get abortions because of rape. My mother made me go to a therapist when I was sixteen, I did not tell him anything, he asked over and over again, so did my mother.
      I said no, no, no! It wasn’t until I was nineteen that I realized what had happened clearly. I do not know one woman, who would tell the truth and say, I am getting an abortion because I was raped. Especially right after some one is raped, most can’t say it~

      I’ve been raped, twice, in fact. And I still have a hard time talking about it or even bringing it up or responding to others who talk about their rapes. I probably come across as callous when I am noticeably absent from discussions or even expressions of empathy toward others who are open about the crimes committed against them. For that, I am sincerely sorry, but I just get tongue-/keyboard-tied when it becomes too personal. It’s been over two decades and I’m still processing it. Please know that even though I am silent, I am your compatriot in that agony, that rage, that violation that you feel.

      Thank you, FBIR, for your raw passion on the issue of women’s right to control their own bodies, of your no-holds-barred, spot-on indictment of “pro-life” ideology as window-dressing for promotion of rape culture.

  • forced-birth-rape

    ~So many women in my family has been raped, the only way I know about most of the rapes is another female was there and told people. We are forbidden to speak about it to them, they pretend it never happened. I think over half of the rape victims in the world immediately block it out as best they can, and try to pretend it never happened. I have never talked to people on the Internet so hateful and heartless as pro lifers, I was crying tonight about something one said. I have not noticed you being callous, just the opposite. (And thank you sweetie! Try your best to have a sweet gorgeous life, I love you!)~

  • purplemistydez

    Thank you both for your honesty and openness.

  • lina

    This is so important. This part in particular: “Many Americans become uncomfortable with later abortion because they focus on the developmental level of the fetus rather than on the rights of the pregnant woman, overlooking the myriad reasons that women need later abortions.”

    When we look at the way the whole debate over healthcare reform turned into a brawl over abortion, did you ever hear the people who are supposed to be on the side of women’s rights within Congress ever challenge the immorality of the Hyde amendment, or raise the issue of women’s human rights, or even talk about one of these stories of real life women who are suffering as a result of this society’s institutionalized oppression of women? This is why I think that task falls to us non-politicians. We’ve got to mobilize for our right to be human!

  • runningshoe