"Reckless" and "unsafe": The misinformation around "late-term abortion" is harmful, experts say

Despite not being a real thing, the phrase “late-term abortion” has made its way into public discourse once again. Not only did the presidential debate between President Joe Biden and former President Donald Trump include a very misinformed discussion about “late-term abortions” before Roe v. Wade was overturned. But more recently, the Republican Party adopted a “Make America Great Again” policy platform ahead of its national convention that stated in a 16-page document the party will oppose "late-term abortion, while supporting mothers and policies that advance prenatal care, access to birth control, and IVF (fertility treatments).”

This isn’t the first time anti-abortion advocates have made it seem as if abortions were happening well into the third trimester of pregnancy or after an infant has been born. But the fact remains that “late-term abortion” is nothing more than a made-up phrase that has no basis in medicine. And when politicians perpetuate this term and the made-up idea it only further harms pregnant people in America who choose to terminate their pregnancies at later gestational ages.

“First and foremost, just the term ‘late-term’ abortion is not a medically sound term, there's no consensus about what that means,” Dr. Michael Belmonte, an OBGYN in Washington D.C. and Darney-Landy Fellow with The American College of Obstetricians and Gynecologists (ACOG) told Salon. “A lot of people misleadingly define that as anything at or around 13 weeks of pregnancy or later, when we use the term ‘late-term’ in a medically sound way that refers to a pregnancy at around 41 weeks.”

Indeed, as explained by the American College of Obstetricians and Gynecologists (ACOG) the word “term” in pregnancy refers to the two to three-week period before and after a due date. To be even more clinically accurate, ACOG refers to “early term” 37 weeks through 38 weeks and six days of gestation, “full term” 39 weeks through 40 weeks and six days of gestation, and late-term 41 weeks through 41 weeks and six days of gestation.

“Abortion does not happen during this period,” ACOG emphasizes.

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When anti-abortion advocates say “late-term abortion,” an intentionally vague term, they are typically talking about abortions that occur in the second trimester — at or after 13 weeks of gestation. But according to the Centers for Disease Control and Prevention (CDC), in 2021 about 81 percent of abortions in the U.S. occurred at nine weeks of pregnancy or earlier; 94 percent happened in the first 13 weeks, 3 percent occurred between 16 and 20 weeks of gestation and less than 1 percent occurred after 21 weeks of gestation. Unlike what many anti-abortion advocates try to portray, claims of abortions occurring “moments before birth” or even “after birth” are completely false.

Reasons pregnant people might seek abortion care after 21 weeks of gestation are usually to terminate for medical reasons — such as the fetus having a fatal anomaly — or maternal life endangerment. In fact, as noted by the health policy organization KFF, abortions occurring at or after 21 weeks of gestation have historically been hard to obtain and prohibitive. The post-Dobbs landscape has only worsened this situation. As Salon previously reported, the stories of two women who had to leave Idaho to terminate their nonviable pregnancies in their second trimesters were full of trauma and barriers.

The landmark Supreme Court ruling on abortion access known as Roe v. Wade, which was overturned in June 2022, had two key parts. One was that at the time, in 1973, the Supreme Court ruled that before viability it is a pregnant person’s decision whether to continue a pregnancy — not the government’s decision. Viability is usually defined by gestational age, but many doctors disagree with this. In fact, many physicians would prefer that abortion laws don’t include gestational-age limits.

“Viability is an amorphous concept,” David Hackney, a Cleveland-based maternal-fetal medicine specialist, told Salon. “If you were to go with Roe, [it] had a viability limit, a lot of the ballot initiatives that have been passed have viability as a limit. It's not generally preferred that viability be listed as an exact week because it depends on context — if a fetus has a life-limiting birth defect, then it may never be viable, even at a later gestational age.”

The better definition of viability is the potential to survive outside the uterus, Hackney said.

“Even with high-tech pediatric intervention,” he said. “And that's a medical judgment usually made between the obstetrician, pediatrics, and the patient, and that's the preferred definition.”

Hackney said not restricting “viability” to a specific age is also important because as medicine progresses, viability may change.

“Viability was very different in the 1970s than it is now,” he said. “Viability was very different when I started training than it is now. And viability will change as we project further down the road.”

Dr Stacy Seyb, an Idaho-based maternal-fetal medicine specialist, told Salon over the last few years “viability” is roughly to be accepted after 24 weeks of pregnancy.

“Most places in the United States are going to promote resuscitation and full support of a baby,”  Seyb said, referring to an infant being born after 24 weeks. “But there are conditions, some lethal anomalies or very severe birth defects, that are very extreme, with potentially very poor outcomes, like holoprosencephaly, which has a horrible neurological outcome.”

In these cases, the question becomes how much does someone want to put an infant through with such a potential outcome and for what purposes.

In these cases where life is unlikely to be sustained, Seyb said, doctors will provide “comfort care,” including keeping the patient warm, allowing them to be with their parents, and keeping them comfortable. The idea that infants are being born in the third trimester of pregnancy and being aborted after birth, which Trump promoted during the presidential campaign, is not true.

“I think it's primarily a scare tactic,” Seyb said. “And I think I think it’s an insult to the medical profession.”

Hackney said to talk about “abortion after birth” doesn’t make sense.

“You define abortion as prior to birth. I think an analogy would be if you were talking about a stillbirth — a stillbirth is defined as a fetal loss prior to birth,” Hackney said. “If someone delivered, and the baby was born alive with a heartbeat, and the baby lived for 24 hours and then passed away, that would be tragic, but that wouldn't be a stillbirth.”

Hackney emphasized that some people conflate neonatal hospice and pediatric comfort care with abortion.

“It's important that those are two separate things,” he said. “We will sometimes induce labor without the intent for either the fetus to pass away during the labor process, but not intervening in a life-prolonging way, and allowing the neonate, after being born, to pass away in the context of comfort care.”

But such language circling around “late-term abortions” is “reckless” and “unsafe.”

“You don't know who's going to believe this,” he said. “You don't know who's going to want to take justice into their own hands.”