Patients are showing up ‘later and sicker’ for abortion care as more US states adopt bans and significant restrictions
Providers are seeing more patients in need of abortions later in pregnancy as abortion bans and restrictions proliferate in US states, all while access to insurance falls.
Those bans and restrictions have also meant that later abortion care access has grown over the past decade in a handful of haven states and cities.
Patients are showing up “later and sicker” in need of reproductive healthcare, said Diane Horvath, cofounder of Partners in Abortion Care in Maryland, the only all-trimester clinic in the US that is owned and operated by women.
About 41 states have abortion bans or significant restrictions at some point in pregnancy. More than 20 million people have lost Medicaid coverage since 2023, while between 3 and 5 million people have lost or dropped their coverage through Affordable Care Act exchanges in recent months.
“People are getting chucked off of Medicaid. The premiums are all going up,” Horvath said. Instead of seeking care early in pregnancy, she said: “They’re just not going in. There’s no place to go.”
The cost of later abortion – which is loosely defined as anything past the first trimester, the time during which the vast majority of abortions occur – tends to rise the later it happens in a pregnancy.
“Sometimes you’re looking at a $22,000 gap with maybe three days to pull together funding,” said Alisha Dingus, executive director of the DC Abortion Fund (DCAF), one of the largest abortion funds in the country. Rising costs and decreasing availability “may create substantial barriers to accessing later abortion care”, a recent Jama study found.
“Further into pregnancy, the cost of care goes up, the number of providers goes down, and more and more restrictions go into effect,” said Erika Christensen, cofounder of Patient Forward, a group focused on all-trimester abortion access.
The later abortion population is disproportionately young people living below the poverty line in healthcare deserts, Christensen pointed out, adding: “They’re sort of in a perfect storm: they have the least amount of time to find the money for the most expensive care … we’re talking about someone’s abortion costing potentially more than they make in an entire year.”
The challenges to accessing abortion also increase as the weeks progress. Only clinics in four states and Washington DC, offer all-trimester care to all patients.
But even as the health landscape grows more complex, more providers are moving into the gaps.
In Maryland, where there is no viability limit on pregnancy and the state constitution now protects reproductive freedom, two all-trimester clinics serve patients from around the country and the world – Care Reproductive Health Clinic and Partners in Abortion Care. There is also the DuPont Clinic in neighboring Washington DC.
Abortions in later pregnancy happen for all the reasons people seek abortion earlier in pregnancy, Horvath said. Patients learn new information about the health of the fetus or about their own health; they lose their jobs or their homes; their partners become abusive or disappear. For some, particularly children, the pregnancy itself may not be diagnosed until very late.
Pregnancy “can be really dangerous”, Horvath said. “At any point in the pregnancy, abortion is going to be lower risk than continuing the pregnancy.”
