As abortion bans spread and delays mount, women seeking care later in pregnancy face growing barriers and persistent misconceptions about why they need it.
Later abortion is one of the most stigmatized and least understood aspects of reproductive health—yet some of the voices perpetuating that stigma come from inside the reproductive rights movement itself. Meanwhile, while most abortions happen in the first trimester, later abortions are increasing as restrictions and bans are delaying care and creating the very conditions that make them necessary.
To address these misconceptions, Erika Christensen and Garin Marschall created Patient Forward after Christensen experienced a later abortion in 2016. The organization is dedicated to eliminating later abortion stigma and barriers.
In 2021, Patient Forward created a website, Who Not When, that provides information to help educate and destigmatize abortions later in pregnancy.
Centering the voices of people who have sought later abortion care, and drawing on research from two leading reproductive health research centers—Advancing New Standards in Reproductive Health (ANSIRH) at University of California San Francisco and Guttmacher Institute—the guide explains who gets later abortions, plus why and how legal restrictions have harmful and punitive effects that fall mainly on young women, low-income women and women of color.
The myths around later abortion are everywhere, even among allies.
“We have a lot of folks in the media, including repro[ductive rights] advocates, saying, ‘Nobody wants to do this,’ or, ‘It’s not even available,’ or, ‘Nobody’s getting abortions that late.’ Yes, they are. They’re getting them in safe, modern, incredibly compassionate abortion clinics,” said Christensen. “We do a lot of destigmatizing work.”
Only nine states offer abortion without gestational limits: Alaska, Colorado, Maryland, Michigan, Minnesota, New Jersey, New Mexico, Oregon and Vermont, plus the District of Columbia.
For the remaining 41 states, bans kick in at every stage of pregnancy: 13 have total bans, four have six-week bans, two have 12-week bans, one has an 18-week ban, and 21 states ban abortion at some point after 21 weeks.
“Most often patients learn new information later in their pregnancy and then are delayed even further by barriers outside their control,” said Christensen.
She’s right: According to research, people get later abortions for two main reasons, often in combination:
- They learn new information later in their pregnancy, such as finding out they are pregnant after the first trimester, learning about a fetal or maternal health issue, or experiencing a disruptive life event like loss of a job or partner.
- They experience barriers delaying access to abortion care, including: gestational bans or burdensome regulations, interactions with religious crisis pregnancy centers, difficulty finding providers offering later abortion care, conflicts with family members or partners, logistical obstacles like travel, child care or time off from work or school, immigration status or probation restrictions limiting travel out of state, and/or difficulty raising money for a procedure that insurance often won’t cover.
… What our exceptions are saying is that we need exceptions to keep the ‘wrong people’ from misusing abortion services. Who is that? Who are those people?
Erika Christensen
Discovering a pregnancy in the second trimester, or even later, happens more often than commonly believed: One in 13.5 pregnancies are discovered after 12 weeks, and one in 475 pregnancies after 20 weeks. Common reasons for not recognizing pregnancy include no symptoms or symptoms not attributed to pregnancy, contraceptive use, absent or irregular periods, being very young, experiencing different symptoms from previous births, and outside stressors.
“We have found that young people are much later to recognize they’re pregnant because their periods are irregular anyway, because they may not be familiar with all the symptoms of pregnancy,” said Dr. Diana Foster Greene of University of California San Francisco. “People with chronic health conditions are also later to discover they’re pregnant because often chronic health conditions have the same symptoms of pregnancy.”
In episode six of a six-part podcast series on later abortion produced by Patient Forward and rePROs Fight Back, patient and advocate Jenn Chalifoux-Gene tells her story of obtaining a later abortion when she was 18. She was in treatment for an eating disorder. The team of doctors treating her were not concerned about her lack of menstruation because amenorrhea is a common symptom of eating disorders. Chalifoux-Gene had been on birth control for over a year.
At one point, she casually mentioned her period had not come back to her mother, who asked if there was any chance she could be pregnant. Chalifoux-Gene took a pregnancy test and it was positive.
Looking back, Chalifoux-Gene realized her pregnancy symptoms had been masked by her eating disorder—even her physicians hadn’t caught it. Then, because she was already about 20 weeks pregnant, she faced multiple barriers to obtaining an abortion, even though she lived in New York state, which had less restrictive laws than many other states. She had to find a clinic that offered later abortions, attend multiple appointments and pay thousands of dollars. It took over four weeks to get the abortion—so long that she almost missed the 24-week cutoff in New York.
For years, Chalifoux-Gene experienced feelings of stigma, some of it coming from the very movement meant to protect her. “The only time I heard people mention later abortion was either to just flat out demonize it or to say, ‘No, we need later abortion because people find out about fetal indications and we need a path for them to be able to make decisions about their pregnancy and their fetus.’
“I was not hearing, ‘We need later abortion because some people just need an abortion and it’s late.’ That just drives stigma. I felt very, very stigmatized.”
Chalifoux-Gene criticized the idea “there are ‘good abortions’ and ‘bad abortions,’ versus just your experience and the healthcare you need access to.”
Chalifoux-Gene got her abortion, then spent years making sense of the shame that came with it. She now works with Patient Forward to educate the public—and abortion rights advocates—about later abortion.
“I hear pro-choice organizations supporting restrictions on later abortion, and I take it personally because it feels like saying if you need an abortion for any of the reasons that our movement has accepted … that’s great, but if you need it after a certain date, we don’t care about your bodily autonomy anymore.
“But why? Why doesn’t my body and my decision and my future and what I want for myself matter as much as people who didn’t have an eating disorder so they found out earlier, or people who weren’t on birth control so they found out earlier, or people who just found out earlier period? It’s deeply stigmatizing, and that stigma can do serious damage.”
Christensen agreed stigma for later abortion is often perpetuated by people in the abortion rights movement who go along with gestational limits or fail to stand up for the right to abortion later in pregnancy.
“Now is the time to ask ourselves and to really be accountable to people like Jenn, and so many thousands of other people, who have been made to feel this shame and stigma by the people paid to protect abortion. It truly blows my mind,” said Christensen.
“Whenever I’m privileged enough to hear Jenn or any later abortion patients tell their stories, it just really kills me. These are not the antis, but it is antiabortion stigma perpetuated by supposedly pro-abortion people. Because what our exceptions are saying is that we need exceptions to keep the ‘wrong people’ from misusing abortion services. Who is that? Who are those people? Not Jenn, right?”
We have the most diverse, youngest group of really capable [later abortion] providers we’ve ever had in history.
Christensen
Chalifoux-Gene’s story is one of many that Patient Forward shares to build understanding about the need for later abortion care, each offering a glimpse into the profound consequences of being denied abortion care. Across these accounts, they reveal how abortion denial can lead to worsening financial instability, poorer health outcomes and strain on family relationships.
According to the Turnaway Study, the consequences of being denied an abortion are sweeping.
- People forced to carry an unwanted pregnancy to term because of a gestational ban have four times greater odds of living in poverty than people who obtain abortions.
- They are more likely to have bankruptcies and evictions, are significantly less likely to have a prime credit score in the two years following the birth and are more likely to struggle to cover basic living expenses like food, housing, and transportation for themselves and their children.
- They are also less likely to have aspirational life plans or have a full-time job.
- They are more likely to experience serious health complications and stay tethered to abusive partners.
- Their children are more likely to live in poverty and have more difficulty meeting developmental milestones.
The full scope of later abortion is undercounted. The CDC reports that only 1 percent of abortions are done after 20 weeks, but Christensen notes this statistic is misleading because it is based on limited data, excluding abortions from many states without gestational bans. According to Patient Forward, “while later abortions are uncommon compared to earlier abortions, there are thousands of people who obtain this care every year, and likely thousands more for whom it is out of reach.” And abortion restrictions and bans are pushing those seeking abortion care later into pregnancy, creating more need for later abortion care at a point when it is more expensive and harder to access.
Christensen emphasized, however, that later abortion care is available across the country—and it’s increasingly trauma-informed and provided by people who reflect the communities they serve. “We have the most diverse, youngest group of really capable providers we’ve ever had in history. We want people to know they’re available, we want people to go to their clinics, we want people to get good, safe clinical care.”
Patient Forward has just released a new guide to obtaining later abortion care: Get Later Care. Available in English and Spanish, the guide is a “free, step-by-step resource designed to help people understand their options, book an appointment, and navigate the (mis)information found online.” Christensen said the guide “helps normalize and destigmatize later abortion care, ensuring people feel informed, supported, and less alone.”
Patient Forward emphasizes that most people who obtain a later abortion would have preferred to access an abortion earlier. “Contrary to popular rhetoric, patients do not wait. Rather, they are delayed.”
Like Jenn Chalifoux-Gene, the people most likely to need later abortion care are the same people who have always faced the greatest barriers to sex education, contraception, and abortion: young, low-income, and racially marginalized people feel the effects of bans and barriers more heavily. Social, economic, and environmental conditions often determine who gets access to healthcare. According to Patient Forward, “opposition to later abortion often comes down to judgment of a hypothetical individual absent consideration of their circumstances or the systemic factors at play.”
The judgment, it turns out, is the barrier—and until that changes, people like Chalifoux-Gene will keep paying the price.
Patient Forward offers a guide to later abortion care, Get Later Care, and a resource hub for opposing viability limits in abortion policy.
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A note from Ms. editors: We want to hear from you for The Majority, a new campaign collecting stories about how reproductive freedom has enabled readers to build the lives they want and need. Poll after poll shows a majority of Americans support reproductive healthcare access. Yet public debate overlooks the lives shaped by abortion access, contraception, IVF, miscarriage care, maternal healthcare or comprehensive sex education—countless women who chose to pursue an education, have children, not have children, protect their health and chart their own future. Add your voice and complete the sentence: “Access to reproductive choices gave me the freedom to….” Together, these stories will help show not only why reproductive freedom remains a majority value, but also what it makes possible.
Look to these trusted groups if you or a loved one needs to know more about reliable abortion care:
- A one-stop-shop for abortion seekers: I Need An A
- Safe websites to buy abortion medication: Aid Access, Plan C Pills, Abortion Finder
- If you need help affording abortion care, contact an abortion fund near you.
- To protect your digital privacy when planning your abortion, click here.
- For free legal help as a patient or doctor, call If/When/How’s Repro Helpline: 844-868-2812
- For medical advice, contact the Miscarriage & Abortion Hotline: 833-246-2632
- If you need to know the abortion law in your state, look to the Center for Reproductive Rights.
