“I was 19 weeks pregnant when I found out that my daughter, Miley Rose, was incompatible with life and that staying pregnant posed a significant health risk to my body. Tennessee had a “Life of the Mother” exception in place, but I did not qualify for it because I was not sick enough.” – Allie Phillips, Tennessee Native and TN House of Representatives Candidate.
Philips’ heart-wrenching experience is not unique, and stories like hers are increasingly unfolding across the country. By age 45, about 30% of women have had an abortion, according to the Guttmacher Institute, a research and policy nonprofit organization committed to advancing sexual and reproductive health and rights worldwide. And more than 60% of them are already moms.
Access to abortion care has been significantly more limited since Roe v. Wade was overturned in June 2022. And more often than not, it has come at a cost: Many women have to take days off from work — sacrificing income to seek care out of state, having to cover both travel and child care costs and enduring extensive medical tests — in addition to the physical and psychological hardship that accompanies any abortion.
It’s important to stay informed and know where to go and what to do if you are seeking an abortion. These are the most common questions women have about abortion and access.
[READ: What Is TFMR? Termination of Pregnancy for Medical Reasons.]
What to Know About Abortions
Is abortion available in my state? If not, where is the closest place I can go to get one?
According to the Guttmacher Institute’s Center for Reproductive Rights, 29 states currently allow abortions, with five limiting the ability to have an abortion up to a gestational stage ranging from 22 to 24 weeks. The remainder have either no gestational limit or are legal until viability, which is the gestational age at which there is a reasonable likelihood of the fetus being able to survive outside the womb, with or without artificial support. While that number can vary, it is typically 27 weeks.
In contrast, 13 states — Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, South Dakota, Tennessee, Texas and West Virginia — have complete abortion bans, with no exceptions for rape or incest. And eight states — Arizona, Florida, Georgia, Iowa, Nebraska, North Carolina, South Carolina and Utah — have implemented laws that severely restrict abortion access.
As access and abortions have dramatically decreased in states with bans, other states are seeing significant increases in the number of abortions provided.
The Guttmacher Institute recorded an 11% increase in clinician-provided abortions in 2023 from 2020 in states where there are lenient abortion restrictions.
“More providers that were not typically managing pregnant women desiring pregnancy termination are managing more of these patients,” says Dr. Arianna Sholes-Douglas, a board-certified OB-GYN at Tula Wellness in Tucson, Arizona. “For example, a family medicine doctor or maybe even a gynecologist who didn’t normally have those conversations are offering medical care and educating patients in these situations.”
Laws about abortion continue to change. You can find more information about laws in your state and how to get an abortion at abortionfinder.org. To find a qualified professional, search the National Abortion Federation’s database of members.
What does viability mean? And why is it important?
Viability-based restrictions initially referenced in Roe v. Wade deemed that a fetus is viable after the second trimester, which is roughly 27 weeks. But what does it mean for a fetus to be viable?
According to the American College of Obstetricians and Gynecologists, a fetus is viable when it is likely to survive outside of the womb, which is anywhere from 27 to 40 weeks.
In contrast, a fetus would be deemed nonviable by a practitioner if it was born earlier than 22 weeks or if the fetus has a serious congenital defect that would prevent it from developing properly. Congenital defects are abnormal physical or neural growth changes that may occur during gestation.
Other situations that would deem a pregnancy nonviable include a molar pregnancy, in which a genetically incomplete embryo, that cannot survive implants in the uterus, and an ectopic pregnancy where a fertilized egg attaches outside of the uterus, most often in a fallopian tube.
Simply put, if a pregnancy is nonviable, it means that the fetus will not develop into a baby or can’t survive outside the uterus.
For example, a fetus can be viable with genetic conditions like Down syndrome or a cleft lip. However, other birth defects like certain severe congenital heart defects — where the heart or blood vessels don’t develop normally — would result in a nonviable fetus.
“So, if someone is about eight weeks pregnant, and they see there’s no cardiac activity at the time of an ultrasound, (they’re) typically given the option of … some medication that can help,” says Dr. Tanniesha Barlow, Rex Chair of the Department of Obstetrics and Gynecology at the University of North Carolina at Chapel Hill.
Although evolving medical tools and practices have helped give babies born at nearly 22 weeks a chance of survival by using extreme measures, it is not without consequences. Babies born prematurely or before 37 weeks risk long-term disabilities like cerebral palsy, cognitive impairments, hearing loss, blindness and severe lung problems.
But the distinction is not always so clear-cut, and making the decision involves considering many factors. Even when women feel that the decision is the best one for them, it’s not always easy to make.
“For example, developing preeclampsia (hypertension during pregnancy) at 23 weeks is a potentially life-threatening condition if the pregnancy continues. We potentially have a viable fetus within days,” says Sholes-Douglas. “However, that fetus may not have grown appropriately and is severely premature. As a maternal-fetal medicine specialist, I have to have difficult conversations with the patients discussing the chances of viability and potential of complications due to severe prematurity. Abortion restrictions further complicate these conversations and the management of life-threatening illnesses of the mother.”
Nevertheless, for many states that have capped abortion access well before 27 weeks, women must seek care elsewhere. That is what Phillips had to endure when she was only 19 weeks pregnant.
“I had no choice but to flee my state to obtain the lifesaving healthcare I needed,” says Phillips.
[READ: How to Get the Birth Control That’s Right for You]
What are the different types of abortion?
Women have two common options when pursuing an abortion. The first is a medical abortion, which is available only up to 70 days of gestation, or a surgical abortion, which can be done during the first or second trimester.
Medical Abortion
The least invasive and more accessible option, a medical abortion is a combination of two oral medications taken a couple of days apart. The first pill, mifepristone, causes the embryo to detach from the uterine lining. One to three days later, you take misoprostol, a pill that can be administered orally (either inside the cheek or under the tongue) or vaginally. Misoprostol will cause contractions that allow pregnancy tissue to pass, almost like a very heavy period. A week or two after taking the misoprostol, women return to their doctor to make sure the pregnancy has terminated.
Medical abortions are banned in the same 13 states that have complete abortion bans, with no exceptions for rape or incest.
Surgical Abortion
A surgical abortion during the first trimester is a one-day procedure that can take anywhere from three to six hours, depending on how far along you are. Women less than 12 weeks pregnant will receive oral pain medication, which may take between 45 and 60 minutes to take effect. Women from 12 to 15 weeks receive misoprostol, which softens the cervix and makes dilation easier but takes two to three hours to become effective.
A doctor will have you lie on the exam table as if you were having a regular pap smear or annual gynecological exam. Your doctor will clean and may numb your cervix. Then they’ll use a narrow tube to gently suction the uterine lining, fetus and any other pregnancy tissue.
“The first trimester is safer,” says Barlow in regards to the gestational period at the time of an abortion. “Typically, it’s a pretty low-risk procedure.”
A surgical abortion during the second trimester is performed over two days but does not require someone to stay overnight in the hospital. This procedure is known as dilation and evacuation (D&E). On the first day, the doctor may use small dilating sticks called laminaria or dilapan, which help to soften and dilate the cervix. The doctor will then clean and numb the cervix before inserting the sticks, which will widen as they absorb moisture from your body.
The following day, a woman will receive anesthesia administered through IV. Many women fall asleep and don’t remember the procedure. Afterward, the doctor will remove either the laminaria or dilapan and use suction to empty your uterus.
[READ: When to See a Gynecologist for the First Time and What to Expect]
How can I pay for an abortion? Is it covered by my insurance?
According to Planned Parenthood, abortion costs vary based on the type of abortion you need, how far along your pregnancy is, the state or health center where you plan to receive care and your health insurance plan.
On average, abortion pills can cost around $800. The average cost is around $580 at Planned Parenthood. In-clinic abortions can cost about the same as a medical abortion, but only during the first trimester.
In-clinic abortion or surgical abortion early in the second trimester can average about $715. Late in the second trimester, it can range from $1,500 to $2,000.
These are estimates based on Planned Parenthood prices and don’t account for health insurance coverage and additional out-of-state abortion expenses, such as child care, hotel or travel. But, depending on your plan, your insurance may cover elective abortion medication or procedures.
Under the Pregnancy Discrimination Act of 1978, insurance policies must cover medically necessary pregnancy care and abortion when the patient’s life is endangered. It’s best to check your insurance plan to know whether it covers an elective abortion.
Nevertheless, abortion care can still be quite expensive, but there are numerous nonprofit organizations that help alleviate the financial burden for women who can’t afford it. Organizations like the Women’s Reproductive Right Assistance Program and the National Network of Abortion Funds both provide funds for abortion medication and procedures and also help arrange travel and child care for those who have to travel out of state.
What are the risks of an abortion?
The risk of complications during or after an abortion is relatively low. According to the Guttmacher Institute, less than 1% of women in the United States who get an abortion from trained clinicians in safe conditions have complications from the procedure.
However, “as the fetus gets larger, there are more complications because you are still taking on those risks of just the pregnancy in itself,” says Barlow. “Pregnancy can be extremely dangerous for some women, depending on if they have heart conditions, if they have one kidney or they have a badly functioning kidney.”
The risks associated with a mother who’s been denied a medically necessary abortion can be quite extreme.
“Whatever risk is posed to the mother is considered first and foremost,” says Sholes-Douglas. “So whether that’s infection or cardiovascular risk, the mother’s life takes precedence whether we are dealing with a nonviable or a viable fetus. But it especially takes precedence for a nonviable fetus before 24 weeks.”
Common Abortion Misconceptions
Can I get pregnant after having an abortion?
The short answer is, yes. Having an abortion does not increase the risk of infertility. According to ACOG, some women can get pregnant immediately after an abortion.
Does emergency contraception cause abortion?
No, emergency contraceptives are designed to prevent pregnancy and are most effective in the 72 hours following unprotected sex. They cannot end a pregnancy or be used as an alternative to a medical abortion.
Is having an abortion linked to breast cancer?
No. There is no link between abortions and the risk of breast cancer, according to the American Cancer Society.
How will having an abortion affect my mental health?
Having an abortion is not linked to mental health problems. According to a study conducted by Advancing New Standards in Reproductive Health, seeking an elective abortion does not increase the risk for depression, anxiety or suicidal thoughts. On the other hand, the study does show that women who are denied an abortion or have to seek care out of state are more likely to have worse physical and mental health.
[SEE: 11 Signs of Postpartum Depression.]
How Will Abortion Care Potentially Change Under the Next Administration?
Under the Kamala Harris and Tim Walz Administration
As vice president and a presidential candidate, Kamala Harris’s stance on abortion is not much different from President Joe Biden’s. During the September presidential debate with Trump, Harris said she would do everything in her power to overturn the Dobbs v. Jackson ruling that gave the decision of abortion legalization back to the states.
“One does not have to abandon their faith or deeply held belief to agree that the government and Donald Trump certainly should not be telling a woman what to do with her body,” Harris said during the debate.
The decision to overturn the Dobbs v. Jackson ruling would have to win a majority vote in the House of Congress. During the debate, Trump stated he was confident it would not win the majority vote because the House is evenly split between the two parties.
Nevertheless, the Biden/Harris administration has focused their efforts on the Emergency Medical Treatment and Labor Act, which would help provide clarity to medical providers who risk violating state and federal laws when attending to medical emergencies that would require an abortion.
Under Donald Trump and J.D. Vance Administration
During his presidency, Donald Trump appointed Supreme Court justices who overturned the nearly 50-year-old bill legalizing abortion in the United States. He believes the decision should be left up to the states, which he claimed during the presidential debate is what “everybody wanted.”
Harris has claimed that if Trump was elected into office he would sign into law a federal abortion ban, which Trump has denied. However, it is not far-fetched to speculate since his stance on abortion has fluctuated quite dramatically in recent months.
It was only in August Trump told NBC News he believed the six-week abortion ban in Florida was “too short,” but not even a day later he told Fox News he would be voting “no” in favor of an amendment that would extend the gestation period on the ban.
Since Roe v. Wade’s overturning, numerous states have illegalized abortion completely without any exception for rape or incest. Yet, during the Biden-Trump presidential debate, Trump stated his support for exceptions to the ban for rape and incest.
His campaign website does not mention abortion care, access to abortion care or reproductive rights in any manner.
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What to Know When Seeking Abortion Care: Cost, Access and How It Works originally appeared on usnews.com
