Obtaining an abortion after 12 weeks of pregnancy is complex, depending almost entirely on location and individual circumstances. Twelve weeks marks the typical end of the first trimester, after which accessibility to care changes significantly. While most abortions occur before this time, medical procedures remain available in many places for those who need them later in pregnancy. Access is fundamentally shaped by the legal environment of the state and specific medical or logistical factors.
State-Level Legal Restrictions and Timelines
The legal landscape for abortion access in the United States is a patchwork, with rules varying dramatically from state to state. After the first trimester, states impose various restrictions, sometimes prohibiting procedures entirely after a specific gestational age. These limits can range from six weeks to twenty-two weeks, making the geography of the pregnant person a determining factor for access.
Many states protect abortion rights up to the point of “viability,” a common legal benchmark. Viability is defined as the point when a fetus has a reasonable probability of sustained survival outside the uterus. Medically, this point is generally considered to be around 23 to 24 weeks of gestation, though it can vary.
In states that restrict abortion after a specific gestational limit, narrow exceptions are often provided under the law. These exceptions generally include situations where the abortion is necessary to preserve the life or physical health of the pregnant person. Some restrictive laws may also include exceptions for severe fetal anomaly diagnoses or pregnancies resulting from rape or incest, though these exceptions often have their own time limits and are difficult to navigate.
The complexity of these laws means an abortion accessible at 15 weeks in one state may be completely prohibited in a neighboring state. This disparity forces many individuals to travel across state lines to find a facility that legally provides the necessary procedure. The need to travel adds significant financial and logistical burdens to obtaining care.
Medical Procedures Used in the Second Trimester
After 12 weeks of pregnancy, the methods used to perform an abortion change because medication abortion, or the “abortion pill,” is typically less effective and not recommended as the sole method. The two primary procedures used in the second trimester are Dilation and Evacuation (D&E) and Induction Abortion. These procedures require specialized training and are generally performed in a clinic or hospital setting.
Dilation and Evacuation (D&E)
The most common method for second-trimester abortion is the D&E procedure, often performed between 14 and 24 weeks of gestation. This surgical procedure begins with cervical preparation, which involves using medications or small absorbent rods called laminaria to gradually widen the cervix over one or two days. Cervical dilation is necessary to allow the passage of surgical instruments into the uterus. On the day of the procedure, a physician removes the dilating rods, and the uterine contents are gently evacuated using a combination of suction and surgical instruments. The procedure itself usually takes less than 30 minutes, though the patient remains in the clinic for a few hours for recovery.
Induction Abortion
The alternative method is an Induction Abortion, which uses medications to start labor and cause the uterus to contract and expel the pregnancy. This method is often used later in the second trimester or in hospital settings, particularly when a D&E is not medically appropriate or available. The combination of the medications mifepristone and misoprostol is the most effective regimen for this procedure, often resulting in completion within 24 hours.
Factors Leading to Later Abortion Access
Later-term abortions are rarely the result of a casual decision or procrastination; rather, they are often sought due to systemic and logistical delays that prevent earlier access to care. One of the most significant barriers is the financial strain of the procedure, which requires time to raise the necessary funds before an appointment can be secured. The cost of a second-trimester abortion is substantially higher than a first-trimester one, compounding the financial challenge.
Logistical hurdles, such as long travel distances to the nearest clinic, securing transportation, and needing time off work, also contribute to delays. Many states require mandatory waiting periods, sometimes 24 to 72 hours, which necessitate multiple trips or extended stays away from home. These logistical burdens disproportionately affect low-income individuals and those in rural areas.
Another reason for seeking care after 12 weeks involves the timing of medical diagnoses. Severe fetal anomalies, for example, are often detected during the routine anatomy scan, which is typically scheduled around 18 to 20 weeks of gestation. This medical reality means that a person may not even be aware of a serious health concern until well into the second trimester, forcing a difficult decision at a later stage.
Finally, a person may not realize they are pregnant until they are past the first trimester, especially if they have irregular menstrual cycles or mistake early pregnancy bleeding for a period. Navigating a confusing or rapidly changing legal landscape, along with the time it takes to find a provider who performs later-term procedures, can also push the timeline for care past the initial 12-week mark.