Limits on early abortion drive more women to get them later

Christina Taylor holds plaster casts of her baby's hands and feet.

By BARBARA ORTUTAY

Associated Press

June 2, 2022 7:16 PM PT

An 18-year-old was undergoing treatment for an eating disorder when she learned she was pregnant, already in the second trimester. A mom of two found out at 20 weeks that her much-wanted baby had no kidneys or bladder. A young woman was raped and couldn’t fathom continuing a pregnancy.

Abortions later in pregnancy are relatively rare, even more so now with the availability of medications to terminate early pregnancies.

Across large parts of the United States, they are also increasingly difficult to obtain.

Now, if the U.S. Supreme Court overturns its 1973 Roe vs. Wade decision that legalized abortion, women will face even more hurdles in some parts of the country and may have to travel to another state to get an abortion.

That means more women could end up having the procedure later than they wish, and the burden falls more heavily on some groups, such as teens, poor, Black, Latino and Native American women and those who live in states where access to any abortion is limited.

“It’s not because people don’t want to have them sooner,” said Dr. Diane Horvath, an OB-GYN in Baltimore who has performed abortions for 16 years. “It’s because barriers and new information cause them to have to push it back to later in pregnancy.”

The Associated Press interviewed three women who had abortions later in their pregnancy. While their backgrounds and reasons for terminating their pregnancies were varied, none expressed doubt about their decision — or said they were traumatized by it — and all said they were grateful that they were able to do it.

Wanted baby, missing organs

Christina Taylor already had two kids when she became pregnant with her third. Everything was going well at the start and she was looking forward to welcoming a new baby into the family.

When she was 20 weeks pregnant, Taylor went for an ultrasound and basic anatomy scan that is normally done at this stage. For most people, this is a time to find out the baby’s sex. For some, it’s also when fetal abnormalities are detected.

“I laid down and the ultrasound tech was doing her thing and she was getting really quiet and was taking a really long time,” she recalled. “She left the room at one point, ‘I need to talk to the doctor.‘”

When the tech returned, Taylor could see from the look on her face that something was wrong. When the doctor arrived, he told the couple that there was no amniotic fluid. There were also no kidneys. The baby would probably not survive the pregnancy, or if by some miracle made it to full term, he would die shortly after birth.

“I told the doctor, look, I’m not sure.… I don’t buy the age of viability thing, but for my own mental health and for the health of my family I want to terminate my pregnancy as soon as possible,” Taylor recalled.

She got a second doctor’s opinion and an MRI, which not only confirmed that there were no kidneys present but also no bladder.

Fortunately, in Colorado, abortion is legal, as it was at the time, with no gestational limits. In the U.S., nearly all abortions take place in the first trimester of pregnancy. Just over 6% of abortions were performed at 14 to 20 weeks’ gestation, the second trimester, in 2019 according to the Centers for Disease Control and Prevention. Fewer than 1% took place at 21 weeks or later, in the third, based on the most recent data available.

Taylor’s story shows what getting an abortion with access to good healthcare, health insurance and no legal obstacles can look like.

“I had the option to wait it out and see when he passed and then, you know, you’d have a stillbirth. But I knew I couldn’t do that. Like, I couldn’t put my kids through that,” Taylor said.

On the way home from the MRI, she called her insurance company and found that it covered both types of abortion procedures: dilation and evacuation, and induction and dilation. She chose the latter, which essentially would mean inducing labor and going through delivery. This way, she could have the procedure in a maternity ward, with a team of midwives.

“There was a small chance that he could have been born still alive and we would have been able to hold him and say goodbye when he passed,” Taylor said.

She labored for a day and a half. Given the circumstances, she recalled it as an overall positive experience, knowing “how much worse it could have been” had they still lived in Texas, where even in 2017 the procedure would not have been legal. The state’s current ban of all abortions after six weeks makes no exceptions — Taylor would have had to travel out of state to receive care, or possibly wait until her baby died in her womb, putting her at increased risk of infections and even death.

Only eight states allow abortions at any time during a pregnancy. Twenty states have no specific time limits but prohibit abortions at the time of “fetal viability,” which is generally considered to be around 23 or 24 weeks but depends on a host of other factors besides gestational age.

“I still grieve to this day for the loss of my son, and my husband does too,” said Taylor, who has been sharing her abortion story to bring attention to experiences such as hers. “But you know, we accept that that’s something that happens sometimes. And especially because of the context of knowing how lucky we were to just not have laws in the way of just doing what felt right.”

‘I would rather die’

“Everyone thinks you present pregnancies the same way. You miss a period, you throw up, you take a test and at five weeks, you know you’re pregnant. And that is just not how life shakes out for a lot of people,” said Erika Christensen, founder of PatientForward, a nonprofit that helps people access later abortions.

Jenn Chalifoux, now 30 and studying law at the University of Colorado in Boulder, became pregnant in 2010 when she was 18 and receiving inpatient care for an eating disorder in New York. Her story touches on popular myths: that women always know they are pregnant and that women in liberal states with laws that ban only rare late abortions can easily get them.

Chalifoux returned home from college in the summer before her sophomore year to receive treatment for restrictive eating. A common symptom of such eating disorders is the loss of one’s period. A common — though by no means fail-safe — sign of being pregnant is also the loss of one’s period.

“I had a medical team of doctors and psychiatrists and stuff that I was working with. And at no point did any of us think that the fact that I hadn’t gotten my period was because of a pregnancy,” Chalifoux said.

As she was starting to recover from the eating disorder, though, her period still hadn’t returned. She was on birth control, but just to rule it out, she took a home pregnancy test, which was positive. After confirming the pregnancy through a blood test, she reached out to Planned Parenthood, where she was told that it was too late for a medical abortion and she would need a surgical procedure.

“I spent probably at least two weeks thinking about the financials, going through the money that I had,” Chalifoux said. “And a week makes a difference.”

The cost of an abortion increases significantly as time goes on, from a few hundred dollars to thousands in the second trimester and even tens of thousands later on. For many women, financial barriers to abortion serve to push the procedure later, because it can take time to come up with money. Medicaid, which provides healthcare coverage to low-income Americans, does not pay for abortions except in the case of rape, incest or when the mother’s life is in danger.

“It’s really hard to get an abortion in this country,” Christensen said. “And the idea that people are able to seek care by a certain date is kind of based on the myths that we get all the information we need by a certain time and that we live in equitable environments with equal access to resources and healthcare. Neither of those are true.”

Horvath, a fellow with Physicians for Reproductive Health, said she’s already seeing patients from other states in her Maryland practice who have found themselves too far into the pregnancy to be able to have abortions in their state.

Realizing that she could not handle it alone, Chalifoux told her parents, who embraced her with support. By this point, weeks had passed since she learned she was pregnant and she started to experience physical symptoms of pregnancy. The experience of not having control over her body as it changed horrified her, and she said she was getting intrusive thoughts of performing an abortion on herself.

“I just remember feeling like I wanted to cut myself open or die. The experience of not having control over my body and feeling my body, feeling it change, noticing the changes and knowing that I was getting more pregnant every day was just … I mean, it was like horror,” she recalled.

After going for an initial appointment at a hospital to prepare for the procedure, another ultrasound revealed that she was further along than first thought. In all, Chalifoux said, it took about a month from the time she learned she was pregnant until she was able to receive an abortion, a few days after she turned 19.

“It was such a long time ago that I’ve healed from a lot of it, but I’m able to recognize that where I used to think that my abortion was traumatic for me, I can realize now that it was the pregnancy that was traumatic. And that the abortion was actually very healing,” she said.

Today, Chalifoux is studying law, hoping to become a public defender or find work fighting against mass incarceration and speaks publicly about her abortion as part of her reproductive rights activism. Looking back, she says, she does not think she would have survived if she were forced to carry the pregnancy to term.

“I can remember having this fear that I would be forced to give birth,” she said. “And I can remember thinking that I would rather die.”

Rape and a doctor’s miscalculation

It was July 2020. The young woman decided to check out her friend’s stand-up comedy show in a downtown Houston comedy club. She wouldn’t know anyone in the audience, but that didn’t matter. Working in the service industry and being a social, responsible person who had lived on her own since she turned 18, she wasn’t worried. She met what seemed like “a group of really cool people.” She had some drinks with them and had a good time, she recalled. Looking back, she doesn’t recall any women being part of the group. But she trusted herself.

“Everything kind of happened really fast,” said the woman, 31, whom the AP is not identifying because she is the victim of sexual assault. “I’m pretty sure, pretty sure someone slipped something in one of my drinks. I ended up waking up the next morning in a rundown motel room somewhere in southwest Houston.”

She had nothing on her except her clothes and shoes. Her phone, wallet and underwear were missing. It was about 10:30 a.m. and the motel’s management was banging on her door. Instead of offering help, she recalled, the motel’s employees yelled at her and kicked her out. The woman, who is Black, thinks they might have thought she was a prostitute. She walked along the side of the highway until she found a gas station where she could call a family member to pick her up.

Time went on, and she didn’t tell anyone what happened except one close friend. She started dating someone.

In late October, early November of that year, she took a home pregnancy test. She was on birth control, but she figured maybe it had failed. She was pregnant.

After an initial appointment with a doctor who gave her an incorrect gestational age, she followed up at a women’s clinic, where she learned that she was actually further along. She did the math and traced back the start of her pregnancy to the time she was raped in July.

“And that was just something that I was not … I would not have been able to live with,” she said.

The woman said it took her more than a week to absorb the shock of learning that she became pregnant from a sexual assault. More time passed as she searched for an abortion provider, encountering crisis pregnancy centers that tried to steer her away from terminating the pregnancy. One of the centers, she said, was calling her daily at one point. The woman said she felt harassed.

There was also the cost. According to medical bills the woman provided to the AP, the cost of her procedure increased by $2,500 between the time she was examined in Austin, Texas, before her abortion and the time she arrived in New Mexico for the procedure. PatientForward helped cover her costs.

She was in her third trimester by the time she got on an airplane, alone, to fly to New Mexico and terminate her pregnancy at 27 weeks of gestation. She hasn’t told her family what happened, or any other friends, still coping with feelings of shame and guilt from both the rape and the abortion. She does not know who raped her.

“I have no idea who did it. No idea,” she said. “I never went back and pursued it.”