Late-term abortion

Late-term abortions are abortions which are performed during a later stage of pregnancy. Late-term abortion is more controversial than abortion in general because the fetus is more developed and may even be viable.

Definition of "late-term"
A late-term abortion often refers to an induced abortion procedure that occurs after the 20th week of gestation. However, the exact point when a pregnancy becomes late-term is not clearly defined. Some sources define an abortion after 12 completed weeks' gestation as "late". Some sources define an abortion after 16 weeks as "late". Three articles published in 1998 in the same issue of the Journal of the American Medical Association could not agree on the definition. Two of the JAMA articles chose the 20th week of gestation to be the point where an abortion procedure would be considered late-term. The third JAMA article chose the third trimester, or 27th week of gestation.

The point at which an abortion becomes late-term is often related to the "viability" (ability to survive outside the uterus) of the fetus. Sometimes late-term abortions are referred to as post-viability abortions. However, viability varies greatly between pregnancies. Nearly all pregnancies are viable after the 27th week, and almost no pregnancies are viable before the 20th week. Everything in between is a "grey area".

Incidence of later abortion



 * Canada: During the year 2003, 6.5% of induced abortions were performed between 13 to 16 weeks, 2.2% between 17 to 20 weeks, and 0.8% over 20 weeks. This sample included only those procedures carried out in hospitals.


 * England and Wales: In 2005, 9% of abortions occurred between 13 to 19 weeks, while 1% occurred at or over 20 weeks.


 * New Zealand: In 2003, 2.03% of induced abortions were done between weeks 16 to 19, and 0.56% were done over 20 weeks.


 * Norway: In 2005, 2.28% of induced abortions were performed between 13 to 16 weeks, 1.24% of abortions between 17 and 20 weeks, and 0.20% over 21 weeks.


 * Scotland: In 2005, 6.1% of abortions were done between 14 to 17 weeks, while 1.6% were performed over 18 weeks.


 * Sweden: In 2005, 5.6% of abortions were carried out between 12 and 17 weeks, and 0.8% at or greater than 18 weeks.


 * United States: In 2003, from data collected in those areas that sufficiently reported gestational age, it was found that 6.2% of abortions were conducted from 13 to 15 weeks, 4.2% from 16 to 20 weeks, and 1.4% at or after 21 weeks.  Because the Centers for Disease Control and Prevention's annual study on abortion statistics does not calculate the exact gestational age for abortions performed past the 20th week, there is no exact data for the number of abortions performed after viability. In 1997, the Guttmacher Institute estimated the number of abortions in the U.S. past 24 weeks to be 0.08%, or approximately 1,032 per year.

United States

 * ''See also: Reasons for abortions.

In 1987, the Alan Guttmacher Institute collected questionnaires from 1,900 women in the United States who came to clinics to have abortions. Of the 1,900, 420 had been pregnant for 16 or more weeks. These 420 women were asked to choose among a list of reasons why they had not obtained the abortions earlier in their pregnancies. The results were as follows:


 * 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

Legal restrictions on later abortion
As of 1998, among the 152 most populous countries, 54 either banned abortion entirely or permitted it only to save the life of the pregnant woman. In contrast, another 44 of the 152 most populous countries generally banned late-term abortions after a particular gestational age: 12 weeks (Albania, Armenia, Azerbaijan, Belarus, Bosnia-Herzegovina, Bulgaria, Croatia, Cuba, Czech Rep., Denmark, Estonia, France, Georgia, Greece, Kazakstan, Kyrgyz Rep., Latvia, Lithuania, Macedonia, Moldova, Mongolia, Norway, Russian Fed., Slovak Rep., Slovenia, South Africa, Ukraine, Tajikistan, Tunisia, Turkey, Turkmenistan, Uzbekistan, and Yugoslavia), 13 weeks (Italy), 14 weeks (Austria, Belgium, Cambodia, Germany, Hungary, and Romania), 18 weeks (Sweden), viability (Netherlands and to some extent the United States), and 24 weeks (Singapore).

United States
The United States Supreme Court decisions on abortion, including Roe v. Wade, allow states to impose more restrictions on post-viability abortions than during the earlier stages of pregnancy.

As of April 2007, 36 states had bans on late-term abortions that were not facially unconstitutional (i.e. banning all abortions) or enjoined by court order. In addition, the Supreme Court in the case of Gonzales v. Carhart ruled that Congress may ban certain late-term abortion techniques, "both previability and postviability".

Some of the 36 state bans are believed by pro-choice organizations to be unconstituational. The Supreme Court has held that bans must include exceptions for threats to the woman's life, physical health, and mental health, but four states allow late-term abortions only when the woman's life is at risk; four allow them when the woman's life or physical health is at risk, but use a definition of health that pro-choice organizations believe is impermissibly narrow. Assuming that one of these state bans is constitutionally flawed, then that does not necessarily mean that the entire ban would be struck down: "invalidating the statute entirely is not always necessary or justified, for lower courts may be able to render narrower declaratory and injunctive relief."

Also, 13 states prohibit abortion after a certain number of weeks' gestation (usually 24 weeks). The U.S. Supreme Court held in Webster v. Reproductive Health Services that a statute may create "a presumption of viability" after a certain number of weeks, in which case the physician must be given an opportunity to rebut the presumption by performing tests. Therefore, those 13 states must provide that opportunity. Because this provision is not explicitly written into these 13 laws, as it was in the Missouri law examined in Webster, pro-choice organizations believe that such a state law is unconstitutional, but only "to the extent that it prohibits pre-viability abortions".

Ten states require a second physician to approve. The U.S. Supreme Court struck down a requirement of "confirmation by two other physicians" (rather than one other physician) because "acquiescence by co-practitioners has no rational connection with a patient's needs and unduly infringes on the physician's right to practice". Pro-choice organizations such as the Guttmacher Institute therefore interpret some of these state laws to be unconstitutional, based on these and other Supreme Court rulings, at least to the extent that these state laws require approval of a second or third physician.

Nine states have laws that require a second physician to be present during late-term abortion procedures in order to treat a fetus if born alive. The Court has held that a doctor's right to practice is not infringed by requiring a second physician to be present at abortions performed after viability in order to assist in saving the life of the fetus.

Procedures used in later term
There are at least three medical procedures associated with late-term abortions:
 * Dilation and evacuation (D&E)
 * Early induction of labor
 * Intact dilation and extraction (IDX or D&X), sometimes referred to as "partial-birth abortion"

Abortions done for fetal abnormality are usually performed with induction of labor or with IDX; these procedures result in an intact body that the parents can hold and take pictures of as part of their mourning process. Elective late-term abortions are usually performed with D&E.