The landscape for access to abortion is shifting quickly, as state after state passes restrictive laws. Particularly affected by these new laws are women who need abortions later in their pregnancies.

In April 2010, Nebraska became the first state in the country to pass a restriction on abortion after 20 weeks, based on an unscientific claim that fetuses feel pain after 20 weeks gestation. The Nebraska law banned abortions after 20 weeks for any reason except if the pregnant woman’s life is in danger. Prior to the passage of this law in Nebraska, there were 21 states (plus the District of Columbia) where abortion was available after 20 weeks. Although in most of these states these services were dependent on one site and one physician, nonetheless the services existed. Since April 2010, legislation limiting abortions to 20 weeks has been signed into law in Alabama, Georgia, Idaho, Indiana, Kansas, Oklahoma and North Carolina. Bills making access to later abortion more difficult were passed in Missouri and Ohio.

Arizona’s lawmakers have gone even further. Although the Roe v. Wade Supreme Court decision legalized abortion through the second trimester, generally understood as 24 to 26 weeks, Arizona has redefined biology and the right to abortion. Last week Arizona signed into law new restrictions on abortion after 18 weeks. By any calculation, 18 weeks is the middle of the second trimester, and mid-pregnancy. The trimester construction of Roe is becoming irrelevant in many states.

In Arizona, Kansas, Nebraska, North Carolina and Georgia, these new laws eliminated (or will eliminate when enacted) existing services that provide abortion care for women who needed to end a pregnancy after 20 weeks. As a result, today there are today only 16 states that provide abortion care after 20 weeks. 

Women need later abortions for a range of reasons. Studies show that many women who present at clinics after 20 weeks wanted an earlier abortion but faced financial hurdles and legal barriers, barriers which have increased as states pass law after law to restrict access early in pregnancy. Missouri, for example, is right now considering restrictions on medication abortions (which occur by or before nine weeks gestation) that would make it virtually impossible for women to obtain these, with the obvious result that women will seek later abortions, which they then will not be able to get. Other women face a diagnosis of fetal anomaly later in pregnancy, while for some women, circumstances shift and a wanted pregnancy becomes untenable when a woman’s partner leaves, her young child develops a serious illness and needs her full attention, or someone in the family loses their job and/or health insurance. For all of these women, the option to exercise their right to choose abortion is shrinking.

While it is important for all of us to champion the right to later abortion, we must be clear that it is the right to abortion at any gestational age that is under attack. When women who need abortions after 20 weeks lose access, Arizona, with its ban after 18 weeks, is a warning of what is coming next. While the majority of abortions (over 90 percent) in the U.S. are provided to women who are 12 weeks pregnant or less, our right to abortion through the second trimester is being taken away, state by state and week by week. We must come together to find new strategies to protect existing services, help women who need later abortion care get to those states where the services are still provided, and champion the right to abortion for every woman to access the abortion that she needs.