Thursday, October 20, 2016

No, most late-term abortions are not medically necessary.

[Editor's note: This post was originally published on July 13, 2016 and has recently been updated.]

When it comes to The Abortion Debate, both sides often try to focus on facets which make the opposition look worst. For example, pro-lifers like to talk about late-term abortions. Pro-choicers like to talk about rape and medically necessary abortions. Both of these are small fractions of all abortions. Nevertheless, they all warrant thoughtful responses.

It's not uncommon for pro-choicers to sincerely believe that most late-term abortions are done for medically necessary reasons. After all, 97% of pro-choicers and 69% of pro-lifers support the legal option of abortion when the woman's life is in danger. Likewise 96% and 68% support it when "the woman's physical health is endangered" (2011 Gallup).

Claiming late-term abortion is usually done out of medical necessity may help counter the public’s overwhelming disapproval of the practice: 64% of all US citizens believe abortion should be illegal in the 2nd trimester, 80% in the third trimester (2013 Gallup). Note that second trimester is week 13 to 26; definitions of "late term" vary, most I've seen include anywhere from 16 to 20 weeks and onward.

Yet, to the best of our knowledge, most late-term abortions are not done for medical reasons.

This 1988 study surveyed 399 women seeking abortion at 16+ weeks. The study found women were obtaining late-term abortions instead of earlier-term abortions (i.e. reasons for delaying) because:

  • 71% Woman didn't recognize she was pregnant or misjudged gestation
  • 48% Woman found it hard to make arrangements for abortion
  • 33% Woman was afraid to tell her partner or parents
  • 24% Woman took time to decide to have an abortion
  • 8% Woman waited for her relationship to change
  • 8% Someone pressured woman not to have abortion
  • 6% Something changed after woman became pregnant
  • 6% Woman didn't know timing is important
  • 5% Woman didn't know she could get an abortion
  • 2% A fetal problem was diagnosed late in pregnancy
  • 11% Other
But, again, these are reasons for delaying abortion, not necessarily reasons for seeking abortion. This is an important distinction because, for example, a woman may have delayed her abortion because it was hard to make arrangements for it, but she may be getting the abortion due to medical necessity. If we want to know why women getting late-term abortions seek abortion in the first place, we need to look elsewhere. Unfortunately, sources discussing this seem to be very hard to come by.
(If you know of any statistics looking only at late-term abortions and women's reasons for obtaining abortion in that time-frame -- NOT reasons for delaying -- please email it to or message us on the Facebook page.)

According a 2004 study by Guttmacher, 1,160 women seeking abortion (not just late-term) gave overall reasons for obtaining an abortion at all stages (may list more than one):
  • 74% Having a baby would dramatically change my life
  • 73% Can't afford a baby now 
  • 48% Don't want to be a single mother or having relationship problems
  • 38% Have completed my childbearing
  • 32% Not ready for a(nother) child
  • 25% Don't want people to know I had sex or got pregnant
  • 22% Don't feel mature enough to raise a(nother) child
  • 14% Husband or partner wants woman to have abortion
  • 13% Possible problems affecting the health of the fetus
  • 12% Physical problem with my health
  • 6% Parents want me to have an abortion
  • 1% Woman was victim of rape 
  • <0.5% Became pregnant as a result of incest
The same Guttmacher study has statistics for later term abortion (13+ weeks gestation, see Table 6). According to Guttmacher, 21% of women who had abortion at or past 13 weeks were doing so for fetal health concerns, and 10% for personal health concerns. This would mean, at most, 31% of these later term abortions were for health reasons. In other words:

At least 69% of 13+ week abortions are not done for fetal or maternal health concerns.

But in fact the percent of elective abortions will be higher than 69% because in some cases the same woman who had personal health concerns also cited fetal health concerns, meaning there is overlap between these two groups. Furthermore the 69% figure relies on a heavily generous interpretation: it assumes health concerns always equal medically necessary abortions. As the study explains:

Women who felt that their fetus’s health had been compromised cited concerns such as a lack of prenatal care, the risk of birth defects due to advanced maternal age, a history of miscarriages, maternal cocaine use and fetal exposure to prescription medications. Concerns about personal health included chronic and life-threatening conditions such as depression, advanced maternal age and toxemia. More commonly, however, women cited feeling too ill during the pregnancy to work or take care of their children.

A risk—not even a certainty--of a birth defect could include something as minor as a cleft lip. A risk of cleft lip gets included in the “medically necessary” category. In other words, many health problems are not serious enough to warrant the phrase "medically necessary abortion" yet are still included here. Pro-choicers often use the phrase “medically necessary” to conjure up images of things like ectopic pregnancies, but the reality is many of the abortions categorized as “medically necessary” are not nearly so impactful, much less fatal. 

Examples of common birth defects

Some people say “late-term” abortion should only include abortions at or after 16 weeks gestation. I’ve only been able to find reasons for abortions at or after 13 weeks data, which is slightly different. One could argue that the proportion of medically necessary abortions after 16 weeks would be higher.

And it probably would be. However there’s no indication it would be so high as to constitute even a majority of late-term abortions, much less “nearly all” late-term abortions. The data available suggests that (a) it’s true women seeking late-term abortions are more likely to be doing it for medical reasons than women seeking earlier term abortions and (b) it’s also true that most late-term abortions are not done for medical reasons.

Remember that at 13+ weeks, at most 31% of women were seeking abortion for medical reasons. Let’s be generous and guess that at 16+ weeks, it’s now 50% of women seeking abortion for medical reasons. According to Guttmacher, about 1,000,000 abortions are done every year, and 4.8% of those are done at 16+ weeks gestation ( = 48,000 abortions). Even if a full half of those are for medical reasons (very unlikely), that means 24,000 late-term abortions done annually for non-medical reasons. So: At least 65 late-term abortions are done every day in the U.S. for non-medical reasons. That is worth our attention, and if as many people are as opposed to late-term abortions as Gallup reveals, then it's worth everyone's attention! 

Follow up: More evidence that most late-term abortions are elective

Editor's note: a previous version of this article incorrectly stated that Guttmacher finds at least 75% of 13+ week abortions are for non-medical reasons. The 75% figure is for all abortions, not only abortions after 13 weeks. We have corrected the figure for 13+ weeks to the 69% minimum based on the Guttmacher report.

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