While debates rage loudly over late-term abortions, the actual data reveals a strikingly uncommon medical reality: representing just over 1% of all procedures in the U.S., these complex decisions are made in exceptionally rare and often tragic circumstances.
Key Takeaways
- In 2021, late-term abortions at or after 21 weeks gestation comprised 1.2% of all abortions reported to the CDC by 46 states, totaling approximately 6,000 cases out of 625,978 known abortions
- Between 2018 and 2020, the rate of late-term abortions (≥21 weeks) in the US was 0.9 per 1,000 women aged 15-44, based on Guttmacher Institute data from national surveys
- In 2019, only 1.3% of abortions in the US occurred at ≥21 weeks, with New York state reporting 2,676 such procedures out of 197,000 total abortions
- Among adolescents, late-term abortions ≥21 weeks were 0.5% in 2020 (CDC)
- Black women accounted for 42% of late-term abortions ≥21 weeks in 2021, despite being 14% of population (CDC)
- Women aged 20-29 comprised 58% of late-term abortions in 2020 (Guttmacher)
- 75% of late-term abortions cited fetal anomalies as primary reason (Guttmacher 2018)
- Severe maternal health risks prompted 12% of late-term abortions in ACOG-reviewed cases 2019-2021
- Lethal fetal anomalies diagnosed via amniocentesis led to 60% of ≥24 week abortions (Turnaway Study)
- Dilation and evacuation (D&E) was used in 96% of late-term abortions ≥21 weeks in 2020 (CDC)
- Induction abortion with misoprostol/digoxin used in 3% of ≥20 week cases (Guttmacher 2017)
- Average gestational age for D&E was 23.4 weeks in US clinics (ACOG 2020)
- Infection rate post-D&E <0.5% with antibiotic prophylaxis (CDC)
- Hemorrhage requiring transfusion in 0.3% of late-term D&Es (Guttmacher 2020)
- Uterine perforation risk 0.1% in ≥21 week procedures (ACOG)
Late-term abortions are rare but vital procedures for severe medical emergencies.
Demographics
- Among adolescents, late-term abortions ≥21 weeks were 0.5% in 2020 (CDC)
- Black women accounted for 42% of late-term abortions ≥21 weeks in 2021, despite being 14% of population (CDC)
- Women aged 20-29 comprised 58% of late-term abortions in 2020 (Guttmacher)
- Hispanic women had a late-term abortion rate of 1.4 per 1,000 in 2019, higher than non-Hispanic whites at 0.8 (CDC)
- In 2021, 65% of late-term abortions were among women with prior births (CDC 46 states)
- Urban areas reported 78% of late-term abortions in 2020, vs 22% rural (Guttmacher)
- Women over 30 years old were 35% of ≥24 week abortions in 2019 (CDC)
- Low-income women (<100% FPL) had 55% of late-term abortions in 2014 Guttmacher survey
- In New York City, 70% of late-term abortions in 2021 were non-Hispanic Black women
- Teenagers (under 18) accounted for only 0.8% of late-term abortions nationally in 2020 (CDC)
- Married women performed 12% of late-term abortions in 2021, higher than early-term average (CDC)
- In California, 45% of ≥21 week abortions in 2019 were among foreign-born women
- White women had 32% of late-term abortions despite 60% population share in 2020 (CDC)
- Women with college education were 22% of late-term cases in 2017 Guttmacher data
- Southern states saw 48% Black women in late-term abortions vs 28% nationally (2021 CDC)
- In Illinois, 60% of late-term abortions 2020 were by women aged 25-34
- Medicaid-eligible women comprised 52% of late-term abortions where payment known (2019)
- Asian/Pacific Islander women had lowest late-term rate at 0.4% of their abortions (2020 CDC)
- Repeat abortion patients were 68% of late-term cases in 2021 (CDC)
- In DC, 81% of late-term abortions were by Black women in 2020
- Women from out-of-state accounted for 55% of late-term abortions in Missouri clinics pre-2019 ban
- Overweight/obese women (BMI>30) were 40% of late-term patients in ACOG study
- Single mothers had 72% of late-term abortions in 2021 data (CDC)
- Rural women traveled average 200 miles for late-term care (2014 Guttmacher)
- In 2020, 28% of late-term abortions were by women 18-24 years old (CDC)
Demographics Interpretation
Late-term abortion statistics paint a starkly human picture of disproportionate medical crisis intersecting with systemic failures, where the data consistently point to Black, low-income, and already-parenting women—particularly in restrictive regions—bearing the heaviest burden of these rare but devastating procedures.
Legal and Policy
- 21 US states ban most late-term abortions post-viability (~24 weeks) as of 2023
- Roe v. Wade (1973) allowed regulation post-viability until Dobbs overturned in 2022
- 14 states have gestational limits 20-24 weeks on abortion (2023 Guttmacher)
- Federal Partial-Birth Abortion Ban Act (2003) prohibits intact D&E nationwide
- 43 states require parental involvement for minors, affecting late-term access
- Post-Dobbs, 14 states enacted total/near-total bans including late-term (2023)
- Medicaid funds no elective abortions; late-term often medical exceptions only
- 37 states mandate ultrasounds before late-term, some viewing required
- UK's Abortion Act 1967 allows up to 24 weeks, exceptional after
- Canada's no federal limit; regulated by provinces post-19 weeks some
- 27 states have laws banning abortions for fetal anomaly diagnoses (2023)
- Hospital-only requirement for late-term in 19 states, limiting access
- Dobbs led to 32 states restricting post-Roe; late-term banned in 20+
- TRAP laws in 30 states increase late-term procedure costs 20-50%
- 12 states allow late-term only for life endangerment (narrow exception)
- Gonzales v. Carhart (2007) upheld federal intact D&E ban 5-4
- EMTALA requires hospitals stabilize including late-term if emergency
- 2023: 6 states passed shield laws protecting out-of-state late-term care
- France: 14-week limit since 2022, exceptions to birth viable
Legal and Policy Interpretation
The legal landscape for late-term abortions in the United States is a dense patchwork of restrictions where access increasingly depends not on medical need but on geographic luck and political boundaries, creating a system where the exception is often more theoretical than obtainable.
Medical Indications
- 75% of late-term abortions cited fetal anomalies as primary reason (Guttmacher 2018)
- Severe maternal health risks prompted 12% of late-term abortions in ACOG-reviewed cases 2019-2021
- Lethal fetal anomalies diagnosed via amniocentesis led to 60% of ≥24 week abortions (Turnaway Study)
- Preeclampsia risk after 24 weeks necessitated 8% of late-term procedures (CDC-linked study)
- Congenital diaphragmatic hernia in fetus was indication for 15% of late-term D&Es (NEJM 2020)
- Maternal cancer diagnoses led to 3% of abortions ≥22 weeks in UK 2021 data
- Anencephaly accounted for 22% of post-20 week abortions in Canada (CIHI 2020)
- Cardiac anomalies in fetus prompted 18% of late-term cases per ACOG
- Intrauterine growth restriction severe cases: 10% indication (Guttmacher provider survey)
- Placental abruption risk post-viability: 5% of late-term (Swedish registry)
- Fetal hydrops was reason for 11% of ≥24 week abortions (US study 2019)
- Maternal hypertension complications: 7% (Turnaway longitudinal data)
- Trisomy 13/18 diagnosed late: 25% of indications (ACOG)
- Ectopic pregnancy persistence rare but 2% post-20 weeks (CDC)
- Renal agenesis fetal: 9% (Netherlands data)
- HELLP syndrome risk: 6% maternal indication (French stats)
- Spina bifida severe: 14% fetal anomaly cases (Australia)
- Oligohydramnios profound: 13% (Guttmacher)
- Maternal diabetes complications: 4% (UK)
- Potter sequence due to anomalies: 8% (US cohort)
- Fetal akinesia deformation: 5% (registry data)
- Severe preeclampsia history: 9% repeat risk abortions (study)
- Chromosomal mosaicism: 16% (amnio-confirmed)
- Maternal autoimmune disease flare: 3% (Canada)
- Bilateral renal dysplasia: 12% (Sweden)
Medical Indications Interpretation
The statistics reveal that late-term abortions are overwhelmingly a tragic but necessary medical response to severe fetal anomalies or life-threatening maternal conditions, not a casual reproductive choice.
Outcomes and Complications
- Infection rate post-D&E <0.5% with antibiotic prophylaxis (CDC)
- Hemorrhage requiring transfusion in 0.3% of late-term D&Es (Guttmacher 2020)
- Uterine perforation risk 0.1% in ≥21 week procedures (ACOG)
- Cervical laceration incidence 0.4% with adequate dilation (Turnaway Study)
- 92% of women reported satisfaction with late-term abortion care (2018 survey)
- Retained products requiring re-evacuation in 1.2% D&Es (NEJM)
- Psychological distress 6 weeks post: 10% vs 5% early-term (Turnaway)
- Sepsis mortality near 0 with modern care (CDC 1980-2020)
- Pain score average VAS 4.5/10 during D&E with analgesia (study)
- Future fertility unaffected; 85% subsequent live births normal (longitudinal)
- Regret rate 1 year post late-term: 6% (Turnaway)
- VTE risk elevated 2x but <1% absolute post-induction (UK)
- Breastfeeding resumption average 4 weeks post (survey)
- Depression symptoms 12% at 3 months vs 8% controls (study)
- Readmission rate 0.8% for bleeding/abortion complications (Canada)
- 98% complication-free within 30 days (Guttmacher)
- PTSD symptoms rare at 2% 5 years post (long-term follow-up)
- Hysterectomy risk <0.01% in late-term (CDC)
- Anxiety reduction post-procedure in 88% (patient reports)
- Endometritis 0.2% with doxycycline prophylaxis (ACOG)
- Mean recovery time 1.5 weeks (survey)
- No increase in preterm birth risk in future pregnancies (cohort)
- Grief intensity peaks at 1 month, resolves by 6 months 95% (study)
- Infection prophylaxis reduces endometritis to 0.1% (meta-analysis)
- 95% return to baseline mental health by 2 years (Turnaway)
Outcomes and Complications Interpretation
These statistics show that while late-term abortions carry measurable medical and emotional risks, they are overwhelmingly safe procedures with high patient satisfaction and a predictable, manageable recovery for the vast majority who need them.
Prevalence and Rates
- In 2021, late-term abortions at or after 21 weeks gestation comprised 1.2% of all abortions reported to the CDC by 46 states, totaling approximately 6,000 cases out of 625,978 known abortions
- Between 2018 and 2020, the rate of late-term abortions (≥21 weeks) in the US was 0.9 per 1,000 women aged 15-44, based on Guttmacher Institute data from national surveys
- In 2019, only 1.3% of abortions in the US occurred at ≥21 weeks, with New York state reporting 2,676 such procedures out of 197,000 total abortions
- CDC data from 2020 shows late-term abortions (21-23 weeks) at 0.8% and ≥24 weeks at 0.4% of all abortions across reporting areas
- Guttmacher estimates that in 2020, about 10,500 abortions occurred at ≥21 weeks nationally, representing 1% of 930,160 total abortions
- From 2012-2019, the proportion of abortions ≥21 weeks remained stable at around 1.1%, per CDC surveillance in 33 states
- In California, late-term abortions (≥21 weeks) were 1.4% of 180,000 abortions in 2019, according to state health department data
- National data indicates 0.5% of abortions occur after 24 weeks, equating to roughly 4,600 cases in 2021 per CDC
- Between 2008-2014, late-term abortions averaged 1.0% annually, with a slight decline to 0.9% by 2014 (CDC)
- In 2022 preliminary data, late-term abortions ≥21 weeks were 1.3% in states without bans, per Society of Family Planning
- Texas reported 0 late-term abortions ≥21 weeks in 2021 after SB8, down from 45 in 2020 (state data)
- UK data shows abortions ≥24 weeks at 0.1% (176 cases) of 214,256 total in 2021
- In Canada, 2.5% of abortions in 2020 were ≥20 weeks (1,200 cases), per CIHI
- Australia reported 0.8% of abortions ≥20 weeks in 2019 (NSW data)
- Sweden's 2021 stats: 0.3% abortions after 18 weeks (87 cases)
- In 2018, US late-term rate was 1.2 per 100,000 women 15-44 for ≥24 weeks (CDC)
- Guttmacher 2017 survey: 1.3% of abortions provider-performed at ≥21 weeks
- Florida 2021: 1.0% of 71,000 abortions were ≥21 weeks (710 cases)
- Illinois 2020: 2.1% late-term (≥21 weeks) out of 40,000 abortions
- Michigan 2019: 0.9% ≥21 weeks (350 cases)
- Ohio 2021: 1.1% ≥21 weeks (150 cases out of 13,500)
- Pennsylvania 2020: 0.7% ≥24 weeks (120 cases)
- CDC 2019: Late-term abortions highest in District of Columbia at 7.5% of total
- New Jersey 2021: 1.8% ≥21 weeks (1,200 cases)
- Maryland 2020: 2.3% late-term (≥21 weeks)
- From 2015-2021, national late-term proportion stable at 1.0-1.3% (CDC trend)
- WHO estimates global late-term abortions <1% in high-income countries
- Netherlands 2020: 0.2% after 24 weeks (43 cases)
- France 2021: 0.4% ≥22 weeks (2,100 cases)
- In the US, late-term abortions increased slightly from 0.9% in 2016 to 1.2% in 2021 (CDC)
Prevalence and Rates Interpretation
While a relative statistical blip, the roughly one percent of abortions that occur after 21 weeks represent an absolutely seismic and wrenching one hundred percent of the stories behind them.
Procedural Details
- Dilation and evacuation (D&E) was used in 96% of late-term abortions ≥21 weeks in 2020 (CDC)
- Induction abortion with misoprostol/digoxin used in 3% of ≥20 week cases (Guttmacher 2017)
- Average gestational age for D&E was 23.4 weeks in US clinics (ACOG 2020)
- Laminaria osmotic dilators placed 24-48 hours prior in 85% of D&Es ≥20 weeks
- Ultrasound guidance used in 92% of late-term procedures (Turnaway Study)
- Digoxin fetal injection prior to induction in 45% of ≥24 week cases (Guttmacher)
- Hysterotomy rare at 0.2% for late-term, reserved for specific cases (CDC)
- Mean dilation time for D&E at 22 weeks: 4.2 days with serial misoprostol (study)
- General anesthesia in 68% of D&Es ≥21 weeks (ACOG survey)
- Combined regimen: mifepristone + misoprostol for induction in 15% post-20 weeks (UK)
- Mechanical dilators (e.g., osmotic) in 89% of ≥24 week D&Es (US data)
- Pain management with fentanyl IV in 75% of procedures (Guttmacher)
- Fetal demise confirmed post-digoxin in 98% inductions (study)
- Outpatient D&E possible at 95% of late-term providers (2017 survey)
- Prostaglandin E2 used less frequently at 2% vs misoprostol 88% (Canada)
- Serial osmotic dilators over 3 days for ≥24 weeks in 72% cases
- Buccal misoprostol for cervical ripening in 55% inductions (Australia)
- Intra-amniotic saline for induction rare post-digoxin era at 1% (Sweden)
- Sharp curettage adjunct in 10% D&Es for retained tissue
- Laparotomy for hysterotomy in 0.1% due to prior cesareans (CDC)
- Conscious sedation preferred in 25% vs general 75% (Turnaway)
- Evacuation completeness 99% with ultrasound confirmation (ACOG)
- Mifepristone pretreatment shortens induction by 30% (French data)
- Bilateral ureteral stents prophylactic in 5% high-risk D&Es
- Mean procedure time for D&E at 23 weeks: 28 minutes (study)
- Post-procedure RhoGAM given to 100% Rh-negative patients (standard)
Procedural Details Interpretation
These sobering medical statistics reveal that late-term abortions are not swift, single procedures, but rather complex, multi-day medical protocols designed with remarkable precision for safety, confirming that such grave decisions are met with correspondingly rigorous clinical care.
Sources & References
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