Doctors seek to educate people on later abortions in post-Roe era

By: - July 20, 2022 7:11 am

Doctors and abortion experts say it’s more important than ever to dispel stereotypes surrounding later abortions. (Dana DiFilippo | New Jersey Monitor)

The first parenting decision Erica Goldblatt Hyatt made was to get an abortion.

She didn’t want the procedure — she and her husband were excited to have their first baby — but an ultrasound around 17 weeks revealed a rare anomaly where the fetus’ trachea wasn’t forming and fluid was building up inside his lungs. Several doctors told her there was no chance the fetus would survive the pregnancy or outside the womb.

About three weeks after this diagnosis, she received an abortion at a specialized clinic in Pennsylvania, where she lived.

“It’s agony because there’s the love and wanting and bonding you’ve experienced in this pregnancy and then knowing you have to say goodbye,” she told the New Jersey Monitor. “I had access to compassionate care, but there are many stories of people who have to call multiple clinics, repeat their story over, have to travel — all while every kick of their fetus is a reminder this baby is not going to survive.”

Goldblatt Hyatt’s abortion is considered a later abortion — a procedure terminating a pregnancy in the second trimester. Abortion rights advocates have said for decades that later abortions have been weaponized in the fight to restrict access to abortions or ban them entirely.

But in a post-Roe v. Wade America, where women now face life-threatening ectopic pregnancies or nearly bleed out from incomplete miscarriages in states where abortions are banned, physicians and abortion experts say it’s more important than ever to dispel stereotypes surrounding later abortions, which polls show have much less support than abortion overall.

Lisa Perriera, a doctor at the Cherry Hill Women’s Clinic, has been performing abortions since 2003.

Later abortion, explained

Later abortions have no legal or medical definition — which is why some doctors and advocates have moved away from the phrase “late-term abortion” — but they typically refer to abortions around 20 weeks of pregnancy.

More than 90% of abortions are performed before 13 weeks, and about 7% are done between 14 to 20 weeks, according to the Centers for Disease Control and Prevention. Pro-choice research group the Guttmacher Institute says slightly more than 1% of abortions are performed at 21 weeks or later.

Abortions in the second trimester are nearly always performed in a specialized medical facility.

The earlier an abortion is performed, the safer it is. Abortions at or before 10 weeks can usually be terminated with a pill. Some form of surgery is typically performed between 10 and 12 weeks. For abortions after 27 weeks, the procedure is similar to an induction of labor.

One in four women will have an abortion in their lifetime, according to the Guttmacher Institute.

While there’s a wide variety of reasons someone chooses to terminate a pregnancy, doctors say common reasons include when there are fetal anomalies or when the mother’s life is in danger.

At around 18 to 20 weeks, doctors perform an ultrasound to look for normal anatomy, but sometimes find malformations or other issues. If no surgery can be performed to help the fetus or the baby won’t survive with what the family decides is “a high quality of life,” they often opt for an abortion, said Perriera.

“It’s whether you decide to grieve before you’ve given birth or after you’ve given birth, and it’s a really hard place for many patients to be in,” she said.

She said parents don’t choose to terminate in the third trimester because they’ve suddenly changed their minds about being parents. By then, the family has chosen a name, bought baby clothes, or is eagerly awaiting their child’s arrival, she said, and only a major complication would lead to an abortion or premature delivery, depending on the problem.

Goldblatt Hyatt, who now researches the effects of ending wanted pregnancies and later

abortions on families and teaches at the Rutgers School of Social Work and Robert Wood Johnson Medical Center, said there are socio-economic implications. She said some people don’t discover their pregnancy until later in the term and don’t have access to prenatal care, some families don’t have the resources to provide for a child with medical needs, and parents who are at or below the poverty line sometimes decide they cannot afford another child.

“Intended or unintended pregnancy, if they feel like they can’t take care of another baby or it’s not the right time, whatever reason is a valid reason,” she said.

Polls find most people believe abortions should be legal under any circumstances. Gallup puts that figure at 50%, with 35% saying it should be legal only under certain circumstances and 13% saying the procedure should always be illegal. Pew Research Center polling puts the “legal in all or most cases” figure at 61%.

But support drops the further along the pregnancy is. Gallup polls say 67% of respondents say abortion should be legal in the first three months of pregnancy, but support during the second three months drops to 36%, and it drops again to 20% in the last three months.

Eva Goldfarb, a public health professor at Montclair State University, said anti-abortion activists have worked hard to politicize later abortions and make them seem common, when the reality is they’re very rare.

Goldfarb noted how anti-abortion activists use the phrase “partial-birth abortion” to “freak people out” or spread “outlandish” claims like women getting abortions at nine months because they no longer want to be a mother.

“Those folks have done a successful job in using that rhetoric in the same way, to scare people. They make it sound so reasonable — once a fetus is a full-grown baby, shouldn’t they be protected? It’s about how they frame it and the language that takes away from, this is a rare medical procedure used to save the life of the mother or if the fetus has a severe abnormality where it’s not going to survive,” Goldfarb said.

She stressed that legislators and parents should educate themselves on what a later abortion entails and what it means as New Jersey becomes a safe haven for those seeking abortions.

In January, the Legislature passed and Gov. Phil Murphy signed the Freedom of Reproductive Choice Act, which codified abortion rights into state statute.

Later abortions — which are not banned in New Jersey — appeared to be a problem for some New Jersey Democrats who describe themselves as pro-choice but did not vote for the Freedom of Reproductive Choice Act. These Democrats voiced concerns over how far along someone can abort their pregnancy.

“I don’t know how you can say in a piece of legislation that a woman who is eight months, three weeks, and six days pregnant can have an abortion. I don’t understand how that can happen in any kind of civilized society,” Sen. Gary Schaer (D-Passaic) said during a legislative hearing in January.

Fears as laws evolve in post-Roe America 

Now that the U.S. Supreme Court has overturned Roe v. Wade, there are two tiers of American citizens, Perriera said: those who live in states like New Jersey without abortion bans and those who live in states where reproductive choices are being stripped away.

Fifteen states where there are new abortion restrictions (or plans to introduce them) use the second or third trimesters as the starting point for their bans. Eight states have barred abortion at any time.

Perriera and Goldblatt Hyatt pointed to the University of California’s Turnaway Study, which found 95% of people who chose to have an abortion reported that five years later it was the right decision for them. There were no major impacts on their mental health, and they were more likely to have a wanted child later.

But those unable to have abortions suffered mental and physical challenges, were three times more likely to be unemployed, and were four times more likely to be below the poverty line, according to the study. They were also more likely to suffer from life-threatening complications such as pre-eclampsia.

“It’s not rocket science. Whenever a person is denied choice in their life for whatever reason, they’re going to suffer and feel disempowered, hopeless, helpless, and desperate,” said Goldblatt Hyatt. “I cannot imagine a situation where a person is turned away and has a happy reaction.”

She said she fears some people may induce their own abortions as a result of new abortion bans or restrictions, or that others will be forced to bear babies they don’t want.

Later abortions are already difficult to access even in states where the procedures are protected, said Perriera. She expects more people to travel to states like New Jersey, New York, and California to seek abortions, but pointed again to socio-economic barriers that make it hard for someone to take off work, travel, and pay out-of-pocket for the procedure.

She said she also doesn’t face the same hesitancy some other doctors say they now face when they perform the procedure, whether it’s to terminate an ectopic pregnancy or when they have a patient who is bleeding out and the fetus still has a heartbeat. Doctors in some states could face criminal charges performing abortions in these cases.

“I feel super thankful that our lawmakers are very reasonable and allow doctors to practice with our conscience to provide health care we know provides patient autonomy,” she said. “Do I have concerns that if I care for a person from Texas in New Jersey and I step foot in Texas that I’ll be criminally charged? Yes, I do. I won’t be traveling to Texas any time soon.”

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Sophie Nieto-Munoz
Sophie Nieto-Munoz

Sophie Nieto-Muñoz, a New Jersey native and former Trenton statehouse reporter for NJ.com, shined a spotlight on the state’s crumbling unemployment system and won several awards for investigative reporting from the New Jersey Press Association. She was a finalist for the Livingston Award for Young Journalists for her report on PetSmart's grooming practices, which was also recognized by the New York Press Club. Sophie speaks Spanish and is proud to connect to the Latinx community through her reporting.

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