Is third‐trimester abortion exceptional? Two pathways to abortion after 24 weeks of pregnancy in the United States

Abstract

Context: In the United States, third-trimester abortions are substantially more expensive, difficult to obtain, and stigmatized than first-trimester abortions. However, the circumstances that lead to someone needing a third-trimester abortion may have overlaps with the pathways to abortion at other gestations.Methods: I interviewed 28 cisgender women who obtained an abortion after the 24th week of pregnancy using a modified timeline interview method. I coded the interviews thematically, focusing on characterizing the experience of deciding to obtain a third-trimester abortion.Results: I find two pathways to needing a third-trimester abortion: new information, wherein the respondent learned new information about the pregnancy-such as of an observed serious fetal health issue or that she was pregnant-that made the pregnancy not (or no longer) one she wanted to continue; and barriers to abortion, wherein the respondent was in the third trimester by the time she was able to surmount the obstacles to abortion she faced, including cost, finding a provider, and stigmatization. These two pathways were not wholly distinct and sometimes overlapped. Conclusions:The inherent limits of medical knowledge and the infeasibility of ensuring early pregnancy recognition in all cases illustrate the impossibility of eliminating the need for third-trimester abortion. The similarities between respondents' experiences and that of people seeking abortion at other gestations, particularly regarding the impact of barriers to abortion, point to the value of a social conceptualization of need for abortion that eschews a trimester or gestation-based framework and instead conceptualizes abortion as an option throughout pregnancy.

Abortion as a sociological case

“…Ultrasound imaging, prenatal testing, and other screenings may yield results demonstrating a serious fetal health issue that makes a pregnancy no longer desired, thereby being central to abortion decision making, and sometimes affording social legitimacy to an abortion decision. 140,141 In other instances, ultrasound can become the barrier to abortion when gestational duration is assessed as beyond a legal limit. Even before the Dobbs decision, all but seven states banned abortion after a specified point in pregnancy, most commonly "viability," asserted as the point in pregnancy after which the fetus can survive outside the uterus.…”

“…Ultrasound and other technologies are also implicated in both compelling a desire to end a pregnancy and the institutional denial of abortion. Ultrasound imaging, prenatal testing, and other screenings may yield results demonstrating a serious fetal health issue that makes a pregnancy no longer desired, thereby being central to abortion decision making, and sometimes affording social legitimacy to an abortion decision 140,141 . In other instances, ultrasound can become the barrier to abortion when gestational duration is assessed as beyond a legal limit.…”