Hillary Clinton said that late-term abortions "are because of medical necessity." There is little research on the subject, but existing data do not support her claim.
Former Secretary of State Clinton, who's running for the Democratic nomination for president, appeared on CBS' "Face the Nation," and host John Dickerson asked if she supports a "federal limit on abortion at any stage of pregnancy." She said this is a painful question, and went on to discuss the medical need for late-term abortions.
A spokesman for Clinton's campaign told us that she meant that many late-term abortions — not all or even most — are because of medical reasons. But that's not what she said. Her statement left the impression that the majority, if not all, late-term abortions are medically necessary. The available evidence does not support that assertion.
According to the Guttmacher Institute, which conducts research on sexual and reproductive health and abortion, only 1.2 percent of all the abortions in the United States take place after 20 weeks gestation. ("Late-term" does not have a specific definition, but some states that prohibit later abortions define them as occurring after 20 weeks.) There is no definitive information as to how many of those abortions are due to medical necessity (which usually includes either a severe fetal anomaly or a threat to the life of the mother). Joerg Dreweke, a spokesman for the Guttmacher Institute, told us in an email that "[i]t does not appear that there is much in the way of research on this question."
One study that did examine the question of why late-term abortions are sought was published in 2013 in the Guttmacher Institute's peer-reviewed journal, Perspectives on Sexual and Reproductive Health. That study compared 272 women who had abortions at or after 20 weeks with 169 women who had first-trimester abortions; importantly though, the study specifically excluded any women who sought later-term abortions due to fetal anomaly or maternal life endangerment.
The study's primary finding was that "[i]n many ways, women who had later abortions were similar to those who obtained first-trimester procedures." It found that those who delayed abortions until later in their pregnancies were more likely to be younger women, those with limited financial resources, and those who experienced logistical delays, such as the need for extended travel to an abortion provider.
Though the study did not include medically necessary late-term abortions, it at least illustrates that there are women receiving abortions after 20 weeks who do so for non-medical reasons.
One of the authors of that paper, Diana Greene Foster, a professor at the University of California, San Francisco's Bixby Center for Global Reproductive Health, told us in an email that "[t]here aren't good data on how often later abortions are for medical reasons." She said based on limited research and discussions with researchers in the field that abortions for fetal anomaly "make up a small minority of later abortions," and that those for life endangerment are even harder to characterize. This is because many of the women who fall into that category would be treated under emergent circumstances at hospitals rather than at a dedicated abortion clinic, making numbers harder to obtain, Foster said.
The Guttmacher Institute does have information about the reasons for abortion at all gestational ages, but not separately for late-term abortions. It summarizes the reasons as follows:
According to an older study, published in 1998 in the journal International Family Planning Perspectives, 2.8 percent of a sample of 1,773 U.S. women in 1987-1988 who had had an abortion said "maternal health" was the underlying reason for obtaining an abortion, but this was not specific to late-term abortions. Another 3.3 percent said "fetal health" was the reason.
There is no question that some abortions later in pregnancies are medically necessary.
Some serious fetal defects are only detected later in pregnancies, and some maternal medical issues, such as severe preeclampsia and diabetes, could endanger both the fetus and the mother. According to the Kaiser Family Foundation, 43 states currently prohibit abortion after certain points in a pregnancy; that point is 20 weeks for some states, while others specify 22 or 24 weeks, the point of viability of the fetus, or the third trimester. All those states do have exceptions when the life of the mother is endangered, and some also make exceptions when the mother's health is at stake or when the fetus is deemed nonviable.
There are no hard numbers to back up Clinton's comment that late-term abortions "are because of medical necessity." Though evidence is lacking in general on the issue, some abortions are performed later in pregnancies for other reasons.
– Dave Levitan
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