COLUMBUS, Ohio (WCMH) – For opponents of a proposed constitutional amendment to enshrine the right to abortion, fewer things are more threatening than the proliferation of “painful, late-term abortions” in Ohio.

The phrase, and others like it, is a frequent talking point among anti-abortion advocates. Under the amendment, which protects multiple aspects of reproductive health care, abortions could be restricted after fetal viability unless the health and safety of the pregnant person is at risk. Should the amendment pass, opponents claim, abortions “up until birth” will spread like an epidemic across the state.

“The greedy, racist abortion industry’s ballot amendment means no limits on abortion – even brutal, late-term abortions when the baby can feel pain,” a narrator says in a digital ad launched last Tuesday by Protect Women Ohio.

“Late-term abortions” do not exist in the medical field, according to the American College of Obstetricians and Gynecologists. Medical providers describe a pregnancy as “late term” when a person enters the 40th week of gestation, followed by “postterm” pregnancies at 42 weeks gestation – but those terms are independent from the types of abortion performed at various stages of pregnancy.

Rather, the term is a rallying cry for opponents of Issue 1, who have framed the proposed constitutional amendment as too radical for Ohio. The amendment, which would nullify a six-week ban on the books and pose a legal threat to other state laws aimed at restricting abortion, would usher in the greatest protections for abortion access in the state in decades.

“We don’t believe in late-term abortions where viable babies can feel pain,” Lt. Gov. Jon Husted told a Statehouse lawn overflowing with anti-abortion protesters at the Ohio March for Life rally on Friday.

The reasons that people undergo abortions later in pregnancy – particularly closer to term – are complex, said Katrina Kimport, a medical sociologist and professor at the University of California, San Francisco. And many people who get abortions later in pregnancy wanted the procedure earlier, she said, but social, legal and economic barriers prevented them from accessing it.

“Once they decide they want an abortion, they want the shortest period of time between that decision and when they can actually implement it,” Kimport said. “What I saw in the people that face barriers was a huge extension of that period of time, like really substantial delays. And most often, they were the result of policies.”

Abortions later in pregnancy are the exception, not the norm

According to data from the Centers for Disease Control and Prevention, more than 80% of abortions performed in 2020 occurred in the first nine weeks of gestation, and more than 83% occurred at or under 13 weeks. Abortions performed after the first trimester through 20 weeks gestation account for 5.8% of total abortions. 

Less than 1% of all abortions in the U.S. occur at 21 weeks and beyond – the earliest a fetus may be considered viable, and the latest a person can obtain an abortion in Ohio.

The numbers are similarly distributed in the state. According to data released in September by the Ohio Department of Health, nearly 90% of abortions in 2022 occurred in the first trimester of pregnancy, or under 13 weeks. There were 107 abortions performed at 21 weeks or later, accounting for 0.6% of all abortions in the state.

Data on the reasons people get abortions later in pregnancy is scant, but Kimport has studied it. Her qualitative assessment of 28 women’s experiences undergoing abortions after 24 weeks found two “pathways” to an abortion later in pregnancy: Barriers prevented women from accessing abortions earlier, and new information, particularly about the health of the fetus, led them to terminate the pregnancy.

Certain information about the health of a fetus cannot be known until later in pregnancy, Kimport said. For most of the women she interviewed who terminated their pregnancy due to a severe fetal abnormality, regular scans and tests showed no issues until after 20 weeks gestation, with some not showing serious health issues until 24 weeks or later.

A crucial amount of brain development occurs in the final weeks of pregnancy, as does the development of other organs. Several developmental disorders are not detectable until later in pregnancy. There are also things that can happen to a pregnant person that impact fetal health, including becoming infected with the Zika virus or other diseases and undergoing cancer treatment.

For many of the women Kimport spoke to, doctors could not explain exactly what the severe fetal abnormalities were, not what could have caused them.

“There’s a heartbreakingly large number of ways pregnancy can go wrong. And it’s not all pregnancies, and it’s not even most pregnancies. But for the people it goes wrong for, it’s devastating,” Kimport said. And those are the people who are being denied care, or who are having to go through an excessive number of hoops in order to get the care that they want.”

Those “hoops” can include laws – like one in Ohio – preventing state money from funding most abortions, leaving those on Medicaid to pay out of pocket. Gestational limits force pregnant people to travel for abortions, which can significantly increase costs and delay the procedure, or prevent it altogether.

Kimport has also studied women who considered having abortions but ultimately carried a pregnancy to term. And for many of those women, the barriers in place, particularly poverty, were insurmountable. 

One woman she spoke to wanted the procedure and was in a state where Medicaid covered it. But she could not afford the bus fare, Kimport said.

Policies can also produce a secondary barrier, Kimport said, by building a “social belief that something is wrong.” Abortion stigma can delay or prevent a person from obtaining the procedure, but it can also impact providers’ ability – or willingness – to perform it.

Not including exceptions to state abortion law, only three of Ohio’s nine abortion clinics offer the procedure up until the legal limit, according to services listed on their websites. The rest vary, with most performing the procedure until week 17 or week 19. 

Even in states where the procedure is less restricted, most clinics do not perform later abortions. Data Kimport obtained from UCSF’s Advancing New Standards in Reproductive Health database showed that just four clinics in the U.S. publicly advertised abortions after 24 weeks gestation.

What happens during an abortion later in pregnancy?

One such clinic was founded in 1973 by Dr. Warren Hern in Boulder, Colorado. Hern, a pioneer and major architect of procedures for abortions later in pregnancy, did not respond to a request for an interview. But the Boulder Abortion Clinic steps prospective patients through what they can expect when seeking an abortion at any stage of pregnancy at the clinic.

For pregnancies at the cusp of viability and beyond, the clinic performs a three- or four-day outpatient procedure. After preoperative care, including an ultrasound and counseling about options, the cervix is dilated and amniotic fluid is drained overnight using a laminaria – sterilized, dry seaweed, according to the University of Michigan’s Von Voigtlander Women’s Hospital.

It is also on the first day that an injection is done, through the pregnant person’s abdomen, to stop the fetus’ heart. Some states, including Ohio, require such an injection before performing an abortion after viability.

Dilation and evacuation abortions – which are called “partial birth” abortions in the Ohio Revised Code – use a combination of suction and forceps or other medical instruments to remove fetal tissue, amniotic fluid and the placenta. It’s performed under anesthesia, takes about 10-15 minutes and can cause “strong cramping,” according to the National Abortion Federation. Sometimes, physicians will induce contractions and fully dilate the cervix using medication.