Late termination of pregnancy (TOP)[1] or late-term abortions are abortions which are performed during a later stage of pregnancy. Late-term abortions are more controversial than abortion in general because the fetus is more developed and sometimes viable.
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A late-term abortion often refers to an induced abortion procedure that occurs after the 20th week of gestation. However, the exact point when a pregnancy becomes late-term is not clearly defined. Some sources define an abortion after 16 weeks as "late".[2][3] Three articles published in 1998 in the same issue of the Journal of the American Medical Association could not agree on the definition. Two of the JAMA articles chose the 20th week of gestation to be the point where an abortion procedure would be considered late-term.[4] The third JAMA article chose the third trimester, or 27th week of gestation.[5]
The point at which an abortion becomes late-term is often related to the "viability" (ability to survive outside the uterus) of the fetus. Sometimes late-term abortions are referred to as post-viability abortions. However, viability varies greatly among pregnancies. Nearly all pregnancies are viable after the 27th week, and no pregnancies are viable before the 21st week. Everything in between is a "grey area".[5]
In 1987, the Alan Guttmacher Institute collected questionnaires from 1,900 women in the United States who came to clinics to have abortions. Of the 1,900 questioned, 420 had been pregnant for 16 or more weeks. These 420 women were asked to choose among a list of reasons they had not obtained the abortions earlier in their pregnancies. The results were as follows:[2]
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71% Woman didn't recognize she was pregnant or misjudged gestation |
As of 1998, among the 152 most populous countries, 54 either banned abortion entirely or permitted it only to save the life of the pregnant woman.[14] In addition, another 44 of the 152 most populous countries generally banned late-term abortions after a particular gestational age: 12 weeks (Albania, Armenia, Azerbaijan, Belarus, Bosnia-Herzegovina, Bulgaria, Croatia, Cuba, Czech Republic, Denmark, Estonia, France, Georgia, Greece, Kazakhstan, Kyrgyz Rep., Latvia, Lithuania, Macedonia, Moldova, Mongolia, Norway, Russian Federation, Slovakia, Slovenia, South Africa, Ukraine, Tajikistan, Tunisia, Turkey, Turkmenistan, Uzbekistan, and Yugoslavia), 13 weeks (Italy), 14 weeks (Austria, Belgium, Cambodia, Germany, Hungary, and Romania), 18 weeks (Sweden), viability (Netherlands and to some extent the United States), and 24 weeks (Singapore and Britain)[14] Some countries, like Canada, China (Mainland only) and Vietnam have no legal limit on when an abortion can be performed.[14]
The United States Supreme Court decisions on abortion, including Roe v. Wade, allow states to impose more restrictions on post-viability abortions than during the earlier stages of pregnancy.
As of April 2007, 36 states had bans on late-term abortions that were not facially unconstitutional (i.e. banning all abortions) or enjoined by court order.[15] In addition, the Supreme Court in the case of Gonzales v. Carhart ruled that Congress may ban certain late-term abortion techniques, "both previability and postviability".
All[16] of the 36 state bans are believed by pro-choice organizations to be unconstitutional.[17][18] The Supreme Court has held that bans must include exceptions for threats to the woman's life, physical health, and mental health, but four states allow late-term abortions only when the woman's life is at risk; four allow them when the woman's life or physical health is at risk, but use a definition of health that pro-choice organizations believe is impermissibly narrow.[15] Assuming that one of these state bans is constitutionally flawed, then that does not necessarily mean that the entire ban would be struck down: "invalidating the statute entirely is not always necessary or justified, for lower courts may be able to render narrower declaratory and injunctive relief."[19]
Also, 13 states prohibit abortion after a certain number of weeks' gestation (usually 24 weeks).[15] The U.S. Supreme Court held in Webster v. Reproductive Health Services that a statute may create "a presumption of viability" after a certain number of weeks, in which case the physician must be given an opportunity to rebut the presumption by performing tests.[20] Therefore, those 13 states must provide that opportunity. Because this provision is not explicitly written into these 13 laws, as it was in the Missouri law examined in Webster, pro-choice organizations believe that such a state law is unconstitutional, but only "to the extent that it prohibits pre-viability abortions".[17]
Ten states require a second physician to approve.[15] The U.S. Supreme Court struck down a requirement of "confirmation by two other physicians" (rather than one other physician) because "acquiescence by co-practitioners has no rational connection with a patient's needs and unduly infringes on the physician's right to practice".[21] Pro-choice organizations such as the Guttmacher Institute therefore interpret some of these state laws to be unconstitutional, based on these and other Supreme Court rulings, at least to the extent that these state laws require approval of a second or third physician.[15]
Nine states have laws that require a second physician to be present during late-term abortion procedures in order to treat a fetus if born alive.[15] The Court has held that a doctor's right to practice is not infringed by requiring a second physician to be present at abortions performed after viability in order to assist in saving the life of the fetus.[22]
There are at least three medical procedures associated with late-term abortions:
Abortions done for fetal abnormality are usually performed with induction of labor or with IDX; Elective late-term abortions are usually performed with D&E.