Open main menu

Late termination of pregnancy (TOP),[2] also known as postviability abortion,[3] is a termination of pregnancy that is performed during a later stage of pregnancy. Given the complex, gradual nature of human fetal development, the definition of "late" in this context is not precise, and different medical publications have discussed the varying gestational age points that can be involved.

Late termination of pregnancy
Other namesPostviability abortion, third trimester abortion, induced termination of pregnancy (ITOP),[1] late-term abortion
SpecialtyObstetrics and gynecology

Late-term abortions usually take place when the mother's health is at serious risk or when fatal abnormalities have been detected.[4] These anomalies may include anencephaly or limb-body wall complex were death generally occurs around the time of birth regardless.[5] Health conditions in the mother that may be reasons include preeclampsia and placenta accreta.[5] The risk of a mother's death following a surgical abortion after 20 weeks is less than that of typical childbirth at term in the United States.[6]

In 2015 in the United States, about 1.3% of abortions took place after the 21st week.[7] Less than 1% occur after 24 weeks.[4] Proportionally, women under 15 years of age more commonly undergo an abortion after the 21st week.[7]

Late termination of pregnancy is more controversial than abortion in general as it results in the death of a fetus that is more developed and sometimes able to survive independently. Most countries in Europe permit abortion in the later part of pregnancy if specific circumstances are present.[8] The American College of Obstetricians and Gynecologists states with respect to abortion that "politicians should never interfere in the patient-physician relationship".[5]



A late termination of pregnancy often refers to an induced ending of pregnancy after the 20th week of gestation, i.e. after a fetal age (time since conception) of about 18 weeks. The exact point when a pregnancy becomes late-term, however, is not clearly defined. Some sources define an abortion after 16 weeks as "late". [9] Three articles published in 1998 in the same issue of the Journal of the American Medical Association (JAMA) 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.[10][11] The third JAMA article chose the third trimester, or 28th week of gestation.[12]

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.


There is no sharp limit of development, age, or weight at which humans automatically become viable.[13] According to studies between 2003 and 2005, 20 to 35 percent of babies born at 23 weeks of gestation survive, while 50 to 70 percent of babies born at 24 to 25 weeks, and more than 90 percent born at 26 to 27 weeks survive.[14] It is rare for a baby weighing less than 500 g (17.6 ounces) to survive.[13] A baby's chances for survival increases 3-4% per day between 23 and 24 weeks of gestation and about 2-3% per day between 24 and 26 weeks of gestation. After 26 weeks the rate of survival increases at a much slower rate because survival is high already.[15]

Stages in prenatal development, showing viability and point of 50% chance of survival (limit of viability) at bottom. Weeks and months numbered by gestation,

Due to the potential of signs of life in a non-viable fetus—and the corresponding legal implications[16][17]—most experts recommend induced fetal demise for abortions after 18 to 20 weeks gestation.[18][19][20] The International Federation of Gynecology and Obstetrics states that abortions "after 22 weeks [gestation] must be preceded by feticide."[21] If medical staff observe signs of life, they may be required to provide care: emergency medical care if the child has a good chance of survival and palliative care if not.[22][23][24]

Mental healthEdit

While a single first-trimester abortion carried no more mental health risk than carrying a pregnancy to term, abortion could not be proven safe in other cases as far as mental health was concerned.[25] Women who terminate a pregnancy because of abnormalities discovered through fetal screenings have a similar risk of negative mental health outcomes as women who miscarry a wanted pregnancy or experience a stillbirth or the death of a newborn.[25] However, "the differing patterns of psychological experiences observed among women who terminate an unplanned pregnancy versus those who terminate a planned and wanted pregnancy highlight the importance of taking pregnancy intendedness and wantedness into account when seeking to understand psychological reactions to abortion."[25]


Histogram of abortions by gestational age in England and Wales during 2004.
Abortion in the United States by gestational age, 2004. (Data source: Centers for Disease Control and Prevention)
  • Australia: As of 2015, South Australia is the only Australian state or territory to keep reliable abortion statistics. During 2012, 92% of abortions were performed before 14 weeks' gestation, 6% between 14–20 weeks, and 2% (n=96) at a later stage. Of the 96 abortions carried out beyond 20 weeks, 53 were due to actual or probable fetal abnormality.[26]
  • Canada: During the year 2009, 29% of induced abortions were performed before 8 weeks, 41% at 9 to 12 weeks, 7% at 13 to 16 weeks and 2% over 21 weeks.[27]
  • England and Wales: In 2015, 8% of abortions occurred after 12 weeks; 0.1% occurred at or over 24 weeks.[28]
  • New Zealand: In 2003, 2.03% of induced abortions were done between weeks 16 and 19, and 0.56% were done over 20 weeks.[29]
  • Norway: In 2005, 2.28% of induced abortions were performed between 13 and 16 weeks, 1.24% of abortions between 17 and 20 weeks, and 0.20% over 21 weeks.[30] Between February 15, 2010 and December 1, 2011, a total number of ten abortions were performed between 22 and 24 weeks. These have been declared illegal by The Norwegian Directorate of Health.[31]
  • Scotland: In 2005, 6.1% of abortions were done between 14 and 17 weeks, while 1.6% were performed over 18 weeks.[32]
  • Sweden: In 2005, 5.6% of abortions were carried out between 12 and 17 weeks, and 0.8% at or greater than 18 weeks.[33]
  • United States: In 2003, from data collected in those areas that sufficiently reported gestational age, it was found that 6.2% of abortions were conducted between 13 and 15 weeks, 4.2% between 16 and 20 weeks, and 1.4% at or after 21 weeks.[34] In 2014, the CDC reported that 1.3% of reported abortions (5,578) were performed at 21 weeks of gestation or later.[35]


United StatesEdit

Late-term abortions usually take place when the mother's health is at serious risk or when fatal abnormalities have been detected.[4]

A study from 2013 found after excluding abortion "on grounds of fetal anomaly or life endangerment", that women seeking late abortions "fit at least one of five profiles: They were raising children alone, were depressed or using illicit substances, were in conflict with a male partner or experiencing domestic violence, had trouble deciding and then had access problems, or were young and nulliparous". They concluded that "bans on abortion after 20 weeks will disproportionately affect young women and women with limited financial resources".[36]

England and WalesEdit

The NHS records the reasons given for abortions at all stages of development. In 2015, 2,877 abortions were performed at 20 weeks or above. Of these, 23 (0.8%) were performed to save the life of the pregnant woman, 1,801 (63%) were performed for mental or physical health reasons, and 1046 (36%) were performed because of foetal abnormalities. [37]

Legal restrictionsEdit

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.[38]

On the other hand, 49 of the 152 most populous countries allowed abortion without restriction as to reason, but 44 of these required specific justification after a particular gestational age:[38]

  • 12 weeks (Albania, Armenia, Azerbaijan, Belarus, Belgium, Bosnia-Herzegovina, Bulgaria, Croatia, Cuba, Czech Republic, Denmark, Estonia, France, Georgia, Greece, Kazakhstan, Kyrgyz Rep., Latvia, Lithuania, Moldova, Mongolia, Norway, Russian Federation, Saudi Arabia, Slovakia, Slovenia, South Africa, Ukraine, Tajikistan, Tunisia, Turkey, Turkmenistan and Uzbekistan)
  • 13 weeks (Italy)
  • 14 weeks (Austria, Cambodia, Germany, Hungary, Romania and Spain)
  • 18 weeks (Sweden)
  • 22 weeks (North Macedonia)
  • 24 weeks (Singapore)
  • viability (Netherlands and to some extent the United States)
  • no limit (Canada, some states in the United States, China, and North Korea)

In these countries, abortions after the general gestational age limit are allowed only under restricted circumstances, which include, depending on country, risk to the woman's life, physical or mental health, fetal malformation, cases where the pregnancy was the result of rape, or poor socio-economic conditions. For instance, in Italy, abortion is allowed on request up until 90 days, after which it is allowed only if the pregnancy or childbirth pose a threat to the woman’s life, a risk to physical health of the woman, a risk to mental health of the woman; if there is a risk of fetal malformation; or if the pregnancy is the result of rape or other sexual crime.[39] Denmark provides a wider range of reasons, including social and economic ones, which can be invoked by a woman who seeks an abortion after 12 weeks.[40] Abortions at such stages must in general be approved by a doctor or a special committee, unlike early abortions which are performed on demand. The ease with which the doctor or the committee allows a late term abortion varies significantly by country, and is often influenced by the social and religious views prevalent in that region.

Some countries, like Canada, China (Mainland only) and Vietnam have no legal limit on when an abortion can be performed.[38]

United StatesEdit

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 December 2014, forty-two states had bans on late-term abortions that were not facially unconstitutional under Roe v. Wade or enjoined by court order.[41] 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",[42] as it had done in banning intact dilation and extraction with the Partial-Birth Abortion Ban Act of 2003.[43]

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.[41] Note that just because a portion of a state's law is found to be unconstitutional does not mean that the entire law will be deemed unconstitutional: "[I]nvalidating the statute entirely is not always necessary or justified, for lower courts may be able to render narrower declaratory and injunctive relief," meaning the court could declare that only those parts of the law that are violative of the Constitution are invalid (declaratory relief), or that the court can prohibit the state from enforcing those portions of the law (injunctive relief).[44]

Eighteen states prohibit abortion after a certain number of weeks' gestation (usually 22 weeks from the last menstrual period).[41] 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.[45] Because this provision is not explicitly written into these state 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".[46]

Ten states (although Florida's enforcement of such laws are under permanent injunction) require a second physician's approval before a late-term abortion can be performed.[41] 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".[47] Pro-choice organizations, such as the Guttmacher Institute, posit that some of these state laws are 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.[41]

Thirteen 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.[41] 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 the case of a living fetus.[48]


There are at least four medical procedures associated with late-term abortions:


  1. ^ Duke, C. Wes (September 2009). "Challenges and Priorities for Surveillance of Stillbirths: A Report on Two Workshops". Public Health Rep. 124 (5): 652–659. doi:10.1177/003335490912400507. PMC 2728657. PMID 19753943.
  2. ^ Graham, RH; Robson, SC; Rankin, JM (January 2008). "Understanding feticide: an analytic review". Social Science & Medicine. 66 (2): 289–300. doi:10.1016/j.socscimed.2007.08.014. PMID 17920742.
  3. ^ Guttmacher Institute. "State Policies in Brief, An Overview of Abortion Laws" (PDF). Guttmacher Institute. Retrieved 28 September 2015.
  4. ^ a b c Belluck, Pam (2019-02-06). "What Is Late-Term Abortion? Trump Got It Wrong". The New York Times. ISSN 0362-4331. Retrieved 2019-05-16. Abortions after 24 weeks comprise less than one percent of all abortions. When they occur, it is usually because the fetus has been found to have a fatal condition that could not be detected earlier, such as a severe malformation of the brain, or because the mother’s life or health is at serious risk.
  5. ^ a b c "Facts are Important: Abortion Care Later in Pregnancy is Important to Women's Health - ACOG". Retrieved 6 June 2019.
  6. ^ Safe abortion: technical and policy guidance for health systems (2 ed.). World Health Organization. 2012. p. 21. ISBN 9789241548434. Retrieved 6 June 2019.
  7. ^ a b Jatlaoui, Tara C.; Boutot, Maegan E.; Mandel, Michele G.; Whiteman, Maura K.; Ti, Angeline; Petersen, Emily; Pazol, Karen (23 November 2018). "Abortion Surveillance — United States, 2015". MMWR. Surveillance Summaries. 67 (13): 1–45. doi:10.15585/mmwr.ss6713a1. |access-date= requires |url= (help)
  8. ^ "Abortion Legislation in Europe". January 2015. Retrieved 6 June 2019.
  9. ^ Weihe, Pál, Steuerwald, Ulrike, Taheri, Sepideh, Færø, Odmar, Veyhe, Anna Sofía, & Nicolajsen, Did. (2003). The Human Health Programme in the Faroe Islands 1985-2001. In AMAP Greenland and the Faroe Islands 1997-2001. Danish Ministry of Environment. Retrieved April 19, 2007.
  10. ^ Sprang, M. L.; Neerhof, M. G. (1998). "Rationale for banning abortions late in pregnancy". Journal of the American Medical Association. 280 (8): 744–747. doi:10.1001/jama.280.8.744.
  11. ^ Grimes, D. A. (1998). "The continuing need for late abortions". Journal of the American Medical Association. 280 (8): 747–750. doi:10.1001/jama.280.8.747.
  12. ^ Gans Epner, J. E.; Jonas, H. S.; Seckinger, D. L. (1998). "Late-term abortion". Journal of the American Medical Association. 280 (8): 724–729. doi:10.1001/jama.280.8.724.
  13. ^ a b Moore, Keith and Persaud, T. The Developing Human: Clinically Oriented Embryology, p. 103 (Saunders 2003).
  14. ^ March of Dimes --> Neonatal Death Retrieved on November 10, 2014. In turn citing:
  15. ^ (). What are the chances that my baby will survive?. [ONLINE] Available at: [Last Accessed 14 November 2012].
  16. ^ Diedrich, J.; Drey, E. (January 2010). "Clinical Guidelines: Induction of fetal demise before abortion" (PDF). Contraception: A Publication of Society of Family Planning. 81 (6): 462–73. doi:10.1016/j.contraception.2010.01.018. PMID 20472112. Retrieved 26 October 2015. Inducing fetal demise before induction termination avoids signs of live birth that may have beneficial emotional, ethical and legal consequences.
  17. ^ Committee on Health Care for Underserved Women (November 2014). "Committee Opinion 613: Increasing Access to Abortion". Obstetrics & Gynecology. 124 (5): 1060–1065. doi:10.1097/01.aog.0000456326.88857.31. PMID 25437742. Retrieved 28 October 2015. “Partial-birth” abortion bans—The federal Partial-Birth Abortion Ban Act of 2003 (upheld by the Supreme Court in 2007) makes it a federal crime to perform procedures that fall within the definition of so-called “partial-birth abortion” contained in the statute, with no exception for procedures necessary to preserve the health of the woman...physicians and lawyers have interpreted the banned procedures as including intact dilation and evacuation unless fetal demise occurs before surgery.
  18. ^ "Practice Bulletin: Second-Trimester Abortion" (PDF). Obstetrics & Gynecology. 121 (6): 1394–1406. June 2013. doi:10.1097/ PMID 23812485. Retrieved 30 October 2015. With medical abortion after 20 weeks of gestation, induced fetal demise may be preferable to the woman or provider in order to avoid transient fetal survival after expulsion.
  19. ^ Society of Family Planning (February 2011). "Clinical Guidelines, Labor induction abortion in the second trimester". Contraception. 84 (1): 4–18. doi:10.1016/j.contraception.2011.02.005. PMID 21664506. Transient survival with misoprostol for labor induction abortion at greater than 18 weeks ranges from 0% to 50% and has been observed in up to 13% of abortions performed with high-dose oxytocin.
  20. ^ Fletcher; Isada; Johnson; Evans (Aug 1992). "Fetal intracardiac potassium chloride injection to avoid the hopeless resuscitation of an abnormal abortus: II. Ethical issues". Obstetrics and Gynecology. 80 (2): 310–313. PMID 1635751. ... following later abortions at greater than 20 weeks, the rare but catastrophic occurrence of live births can lead to fractious controversy over neonatal management.
  21. ^ Milliez, Jacques (2008). "FIGO (International Federation of Gynecology and Obstetrics) Committee Report: Ethical aspects concerning termination of pregnancy following prenatal diagnosis". International Journal of Gynecology and Obstetrics. 102 (102): 97–98. doi:10.1016/j.ijgo.2008.03.002. PMID 18423641. Termination of pregnancy following prenatal diagnosis after 22 weeks must be preceded by a feticide
  22. ^ Nuffield Council on Bioethics (2007). "Critical care decisions in fetal and neonatal medicine: a guide to the report" (PDF). Retrieved 29 October 2015. Under English law, fetuses have no independent legal status. Once born, babies have the same rights to life as other people.
  23. ^ Gerri R. Baer; Robert M. Nelson (2007). "Preterm Birth: Causes, Consequences, and Prevention. C: A Review of Ethical Issues Involved in Premature Birth". Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes;. In 2002, the 107th U.S. Congress passed the Born-Alive Infants Protection Act of 2001. This law established personhood for all infants who are born “at any stage of development” who breathe, have a heartbeat, or “definite movement of voluntary muscles,” regardless of whether the birth was due to labor or induced abortion.
  24. ^ Chabot, Steve (5 August 2002). "H.R. 2175 (107th): Born-Alive Infants Protection Act of 2002". Retrieved 30 October 2015. The term ``born alive is defined as the complete expulsion or extraction from its mother of that member, at any stage of development, who after such expulsion or extraction breathes or has a beating heart, pulsation of the umbilical cord, or definite movement of the voluntary muscles, regardless of whether the umbilical cord has been cut, and regardless of whether the expulsion or extraction occurs as a result of natural or induced labor, cesarean section, or induced abortion.
  25. ^ a b c "Mental Health and Abortion". American Psychological Association. 2008. Retrieved April 18, 2012.
  26. ^ Pregnancy Outcome Unit, SA Health. (2014). [1]. Retrieved July 10th, 2015.
  27. ^ Globe & Mail. (2012). Percentage distribution of induced abortions by gestation period. Retrieved December 7th, 2012.
  28. ^ Government Statistical Service for the Department of Health. (May 17, 2016). Abortion statistics, England and Wales: 2015. Retrieved October 20, 2016.
  29. ^ Statistics New Zealand. (January 31, 2005). Demographic Trends 2004. Retrieved April 19, 2007.
  30. ^ Statistics Norway. (April 26, 2006). Induced abortions, by period of gestation and the woman's age. 2005. Retrieved January 17, 2006.
  31. ^ The Norwegian Directorate of Health. (May 7, 2012). Senaborter etter 22. uke Retrieved May 11, 2012.
  32. ^ ISD Scotland. (May 24, 2006). Percentage of abortions performed in Scotland by estimated gestation. Retrieved May 10, 2007.
  33. ^ Nilsson, E., Ollars, B., & Bennis, M.. The National Board of Health and Welfare. (May 2006). Aborter 2005. Retrieved May 10, 2007.
  34. ^ Strauss, L.T., Gamble, S.B., Parker, W.Y, Cook, D.A., Zane, S.B., & Hamdan, S. (November 24, 2006). Abortion Surveillance - United States, 2003. Morbidity and Mortality Weekly Report, 55 (11), 1-32. Retrieved May 10, 2007.
  35. ^ Jatlaoui, Tara C.; Shah, Jill; Mandel, Michele G.; Krashin, Jamie W.; Suchdev, Danielle B.; Jamieson, Denise J.; Pazol, Karen (2017-11-24). "Abortion Surveillance — United States, 2014". MMWR. Surveillance Summaries. 66 (24): 1–48. doi:10.15585/mmwr.ss6624a1. ISSN 1546-0738. PMID 29166366.
  36. ^ Foster, Diana (December 2013). "Who Seeks Abortions at or After 20 Weeks?". Perspectives on Sexual and Reproductive Health. 45 (4): 210–218. doi:10.1363/4521013. PMID 24188634. Retrieved 9 September 2014.
  37. ^ Department of Health (17 May 2016). Report on abortion statistics in England and Wales for 2015 (PDF) (Report). p. 31 (Table 7b). Retrieved 2016-10-24.
  38. ^ a b c Anika Rahman, Laura Katzive and Stanley K. Henshaw. A Global Review of Laws on Induced Abortion, 1985-1997, International Family Planning Perspectives (Volume 24, Number 2, June 1998).
  39. ^ "Archived copy" (PDF). Archived from the original (PDF) on 2013-03-13. Retrieved 2012-10-07.CS1 maint: Archived copy as title (link)
  40. ^ "DENMARK". Retrieved 13 October 2015.
  41. ^ a b c d e f Guttmacher Institute. (April 1, 2007). State Policies on Later-Term Abortions. State Policies in Brief. Retrieved April 19, 2007.
  42. ^ Annas, George J. (24 May 2007). "The Supreme Court and Abortion Rights". New England Journal of Medicine. 2007 (356): 2201–2207. doi:10.1056/NEJMhle072595. PMID 17476003.
  43. ^ Hern, Warren M. (22 Oct 2003). "Did I violate the Partial-Birth Abortion Ban?". Retrieved 27 October 2017.
  44. ^ Ayotte v. Planned Parenthood, 546 U.S. 320 (2006).
  45. ^ Webster v. Reproductive Health Services, 492 U.S. 490 (1989).
  46. ^ NARAL Pro-Choice America. (2007). "Delaware." Who Decides? The Status of Women's Reproductive Rights in the United States. Retrieved April 19, 2007.
  47. ^ Doe v. Bolton, 410 U.S. 179 (1973).
  48. ^ Planned Parenthood Ass'n v. Ashcroft, 462 U.S. 476, 486-90 (1983).

External linksEdit