Womens Health

Nebraska Ban Hurts Women Who Can't Help Needing Late-Term Abortions

| by

*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