About one percent of all abortions in the United States occur at or after 21 weeks of pregnancy, according to CDC surveillance data. That translates to roughly 4,100 procedures per year out of hundreds of thousands performed nationally. The overwhelming majority happen much earlier, and the phrase “late-term” itself is not a standard medical term, which makes the public conversation around this topic muddier than the data warrant.
Why “Late-Term” Is a Contested Phrase
Doctors do not use “late-term” to describe abortions. In obstetrics, “late term” refers to a pregnancy between 41 and 42 weeks of gestation, meaning one that has gone past its due date. When politicians, journalists, or advocacy groups say “late-term abortion,” they are usually referring to abortions performed somewhere in the second or third trimester, but there is no agreed-upon gestational cutoff for the label. Some use it to mean anything after 20 weeks. Others apply it at viability, which itself shifts depending on available neonatal care. The lack of a fixed definition matters because it lets the phrase function more as a rhetorical device than as a clinical category. The CDC tracks abortions by specific gestational-age bands rather than using any umbrella label like “late-term.”
The Full Gestational Breakdown
The most recent CDC Abortion Surveillance report, covering 2022, found that nearly 93% of abortions were performed at or before 13 weeks of pregnancy. About 79% happened at nine weeks or earlier, the period when medication abortion is most commonly used.1Morbidity and Mortality Weekly Report. Abortion Surveillance — United States, 2022 The remaining abortions distributed across later gestational windows, with the numbers shrinking as the weeks increase.
Looking at the 2021 CDC data, the picture is even more granular: 96% of abortions occurred at or before 15 weeks, about 3% took place between 16 and 20 weeks, and just 1% happened at 21 weeks or later.2KFF. Abortions Later in Pregnancy in a Post-Dobbs Era Those proportions have been remarkably stable over time. In 2014, the CDC reported that about 92% of abortions took place in the first 14 weeks, roughly 4% between 16 and 20 weeks, and 1.3% at or after 21 weeks.3ANSIRH. Why do women need later abortion care?
So the one-percent figure for abortions at 21 weeks or later has held steady for years. The small shifts between reporting periods reflect minor changes in data collection and reporting states, not dramatic trends in when people seek care. The consistent pattern is that the vast majority of people who obtain abortions do so early in pregnancy, and each additional week of gestation sees fewer and fewer procedures.
Who Seeks Abortions Later and Why
The reasons behind abortions after the first trimester are rarely simple and almost never the caricature presented in political debates. Research consistently identifies two broad categories: logistical barriers that push people past the gestational age they would have preferred, and medical diagnoses that are not possible to make until later in pregnancy.
On the logistical side, studies have found that people who end up having second-trimester abortions experienced significantly more delaying factors than those who had first-trimester procedures. One study found that these patients encountered an average of three delaying factors, compared to two for earlier patients. The most common obstacles were difficulty locating a provider, delays in obtaining state insurance coverage, being referred away from their initial clinic, and uncertainty about how far along the pregnancy was.4Obstetrics & Gynecology. Risk Factors Associated With Presenting for Abortion in the Second Trimester Another study found that about 58% of abortion patients said they would have preferred to have the procedure earlier. The most common reasons for delay were the time needed to make arrangements, time spent deciding, and time figuring out they were pregnant in the first place. People with lower incomes were roughly twice as likely to report that difficulty making arrangements caused their delay.5PubMed. Timing of steps and reasons for delays in obtaining abortions in the United States
Research specifically focused on people obtaining abortions at or after 20 weeks confirmed this pattern. Later abortion recipients experienced compounding logistical delays, including difficulty finding a provider willing and able to perform the procedure and the challenge of raising money for both the procedure and travel costs.6PubMed. Who seeks abortions at or after 20 weeks? These barriers tend to pile on one another: a person who cannot quickly find a local provider has to look farther away, which increases travel costs, which requires more time to save money, which pushes the gestational age even higher, which further narrows the pool of available providers. The cycle feeds itself.
Cost is one of the most stubborn barriers. People who discover a pregnancy in the first trimester but cannot afford the procedure sometimes have to delay into the second trimester while raising funds. The price of the procedure itself climbs with gestational age, so the delay created by needing more money leads to a procedure that costs even more.7KFF Health News. Barriers to later abortion access
When Fetal Anomalies Drive the Timeline
A meaningful share of abortions later in the second trimester are connected to fetal diagnoses that simply cannot be made earlier. The standard fetal anatomy ultrasound in the United States is typically performed around 18 to 20 weeks of pregnancy. Some structural abnormalities, particularly those involving the central nervous system or the skeletal system, are not detectable before this scan. A study examining the timing of diagnosis found that chromosomal disorders tended to be identified earlier in pregnancy, while conditions like brain abnormalities or skeletal dysplasia were diagnosed later, often pushing terminations into the later second trimester or beyond.8PubMed Central. Fetal diagnostic indications for second and third trimester outpatient pregnancy termination
The timing squeeze created by gestational-age-based abortion restrictions makes this especially fraught. Research has shown that the anatomy ultrasound for people who ultimately had abortions for structural abnormalities at 22 weeks or later occurred at a median of about 20 weeks. For those whose abortions happened between 15 and 22 weeks, the scan occurred roughly a week earlier.9PubMed. Abortion for fetal indications: Timing of prenatal diagnosis and abortion for structural and genetic abnormalities In other words, the gap between the moment a devastating diagnosis is confirmed and a legal gestational limit can be vanishingly small. Genetic abnormalities detected through amniocentesis or chorionic villus sampling tend to be identified earlier, but some results take weeks to return, and a positive result often triggers additional testing before a family reaches a decision.
Dilation and evacuation, or D&E, is the most common procedure for second-trimester terminations in the United States and has been confirmed as reliable for cases involving fetal abnormalities, since it allows pathological confirmation of prenatal diagnoses.10PubMed. Dilation and evacuation for second-trimester genetic pregnancy termination
How the Dobbs Decision Changed the Landscape
The Supreme Court’s 2022 Dobbs decision, which overturned the federal right to abortion, did not directly change how many abortions happen later in pregnancy at a national level. But it reshaped the geography of abortion care in ways that are pushing some patients to later gestational ages. A study of clinics in Washington State found that the average gestational age at the time of procedural abortion increased by about a week after Dobbs, rising from roughly 9 weeks and 4 days to about 10 weeks and 4 days. The number of out-of-state patients also increased.11JAMA Network Open. Abortion Provision and Delays to Care in a Clinic Network in Washington State After Dobbs
That one-week average shift may sound modest, but it reflects something important: people in states with bans now travel farther, wait longer for appointments, and arrive at clinics in states where abortion remains legal at later gestational ages than they otherwise would have. The increase was concentrated in procedural abortions rather than medication abortions, consistent with the idea that people traveling from ban states tend to be further along by the time they reach a provider.
The infrastructure for later abortion care has also contracted. A national analysis found that the number of facilities providing procedural abortions at 14 weeks or later dropped from 327 before Dobbs to 309 afterward, and the number providing care at 24 weeks or later fell from 60 to 50. The biggest losses were in the South.12PubMed Central. Changes in Availability of Later Abortion Care Before and After Dobbs v. Jackson Women’s Health Organization Fewer facilities means longer travel, which means more delay, which means later gestational ages for those who can still access care at all.
Where Later Abortion Care Actually Exists
Even before Dobbs, later abortion care was geographically concentrated. As of August 2024, abortion at 23 weeks was broadly legal in 28 states and Washington, D.C., but only 130 facilities across 19 of those states and D.C. actually advertised services at that gestational age. At 25 weeks, the number plummeted to just 31 facilities in 9 states and D.C.13JAMA Network Open. Later Abortion Care Availability, Quoted Self-Pay Prices, and State Medicaid Acceptance Two states without gestational-age limits had no facilities advertising care at 23 weeks at all, meaning legal access and practical access are very different things.
States that allow Medicaid coverage for abortion accounted for a disproportionate share of available facilities. About 71% of states with Medicaid abortion coverage had at least one facility advertising care at 23 weeks, and those states housed roughly 81% of all the study facilities.13JAMA Network Open. Later Abortion Care Availability, Quoted Self-Pay Prices, and State Medicaid Acceptance This concentration means that a person’s ability to access later care depends enormously on where they live and whether their state funds it.
Safety of Second-Trimester Procedures
Abortion at any gestational age in the United States is quite safe, and the risk of complications rises with gestational age but remains low even later in pregnancy. An audit of over 2,100 D&E procedures at an Australian tertiary hospital found a total complication rate of about 2.2%, with major complications occurring in roughly half a percent of cases. Complication rates were lower before 20 weeks (about 1.7%) than after 20 weeks (about 4.2%), though the difference was driven by minor complications; major complication rates did not differ significantly between the two groups.14PubMed. Second-Trimester Surgical Abortion Is Safe: Audit of Complication Rates at an Australian Tertiary Hospital
For medical (non-surgical) second-trimester abortions using a combination of mifepristone and misoprostol, the most common complication was retained placental tissue requiring removal in an operating room, which occurred in about 19% of cases. Serious events like significant hemorrhage occurred in roughly 4% of cases, blood transfusion in about 2%, and uterine rupture in under half a percent.15PubMed. Maternal complications associated with second trimester medical abortion using mifepristone priming and subsequent misoprostol Similarly, a study of terminations for fetal anomalies at or beyond 20 weeks found that the most common issues were retained placental tissue and postpartum hemorrhage, with severe complications in about 1.3% of cases.16PubMed. Medical termination of pregnancy for fetal anomaly at or beyond 20 weeks’ gestation-What are the maternal risks?
Cervical preparation before D&E procedures has been well studied. A Cochrane review found that osmotic dilators were superior to prostaglandins alone in achieving adequate cervical dilation and reducing procedure time in the early second trimester.17Cochrane Database of Systematic Reviews. Preparation of the uterine cervix before evacuation of second-trimester pregnancy The point is that second-trimester procedures, while more complex than first-trimester ones, are well-established in clinical practice and carry manageable risk profiles when performed by trained providers.
How the U.S. Compares to Other Countries
The pattern of most abortions happening early in pregnancy is not unique to the United States. Across high-income countries, the overwhelming majority of abortions occur before 13 weeks. A multinational analysis found that in most countries studied, over 90% of abortions were completed before 13 weeks. Germany had the highest rate of early completion at 97%. In all countries examined, more than two-thirds of abortions happened before 9 weeks, with Sweden reaching 84%.18BMJ Sexual & Reproductive Health. Trends in the method and gestational age of abortion in high-income countries
The Netherlands stood out as having the highest proportion of abortions after 13 weeks, at about 18%. This is partly because the Netherlands serves as a destination for people from neighboring countries with more restrictive laws, similar to how certain U.S. states now absorb patients from states with bans. The comparison reinforces a consistent pattern: the share of abortions that happen later in pregnancy is small everywhere, but restrictive legal environments in neighboring jurisdictions can concentrate later procedures in places where they remain accessible.
The Fetal Pain Debate
Much of the political urgency around later abortions connects to questions about fetal pain, particularly around 20 weeks, which is the threshold several states used for pre-Dobbs bans. The scientific evidence on this question is genuinely contested. A major systematic review published in JAMA concluded that fetal perception of pain is unlikely before the third trimester. The review noted that the neural connections between the thalamus and the cortex, which are thought to be necessary for conscious pain perception, begin appearing between 23 and 30 weeks, and that brain activity patterns suggesting functional pain processing probably do not develop before 29 or 30 weeks.19JAMA. Fetal Pain: A Systematic Multidisciplinary Review of the Evidence
A more recent paper has challenged this timeline, arguing that subcortical brain structures present as early as the first trimester could mediate some form of pain response without involving the cortex. This view holds that the thalamus and brainstem, which begin developing much earlier, might be sufficient for a rudimentary form of pain experience.20PubMed Central. Fetal Pain in the First Trimester The disagreement hinges on a fundamental question in neuroscience: whether the cortex is required for conscious experience or whether lower brain structures can produce something that qualifies as pain. This is not a question that has been settled, and the debate involves assumptions about consciousness that go beyond what current imaging or measurement can resolve. What is clear is that the one percent of abortions occurring after 21 weeks are not happening at a time when the science cleanly says “no pain” or “definitely pain.”
What Americans Get Wrong About the Numbers
Public discourse about later abortions tends to be wildly disconnected from the actual data. A national survey of over 1,300 Americans in 2023 found that only 25% correctly answered both of the study’s fact-based questions about pregnancy. The researchers concluded that a meaningful share of support for abortion restrictions is linked to misunderstandings about the biological realities of pregnancy rather than to informed moral reasoning.21American Politics Research. Pregnancy Knowledge and Abortion Attitudes
One common misperception is that later abortions are sought casually or for reasons of convenience. The evidence points in the opposite direction: people who have abortions later in pregnancy are disproportionately facing serious fetal diagnoses, extreme logistical barriers, or both. Another misperception is that later abortions are far more common than they actually are. When a topic receives outsized political and media attention relative to its frequency, people naturally overestimate how often it happens. The consistent one-percent figure for abortions at 21 weeks or later does not carry the emotional weight that the debate’s intensity might suggest, but it represents real people making difficult decisions under constrained circumstances.