Abortion Law: Understanding The 24-Week Cutoff And Its Legalities

Abortion laws vary across the world. In the US, abortions at or after 21 weeks are uncommon and represent 1% of all abortions. They are expensive and often require travel and lost wages. In Europe, abortions are only permitted after 10-14 weeks if specific circumstances are present, such as a serious danger to the life or health of the woman, or when a serious malformation or anomaly of the fetus is diagnosed. In the UK, abortions are usually carried out before 24 weeks but can be carried out after in very limited circumstances, for example, if the mother's life is at risk or the child would be born with severe disabilities.

Abortion laws in the US

Gestational Limits

The Supreme Court's ruling overturning Roe v. Wade gave states the power to individually regulate abortion, or even ban it completely, before viability, which is generally considered to be between 24 to 28 weeks after a patient's last menstrual period. Despite this, some states implemented bans before the 24-week mark, based on the "unfounded assertion" that a fetus can feel pain at 22 weeks.

Currently, 14 states ban abortions at or near "viability", the point where a fetus can survive outside the womb. Four states ban abortions at 24 weeks, and 18 states prohibit abortion after a certain number of weeks, usually 22 weeks from the last menstrual period.

State Laws

As of 2024, abortion is illegal in 14 states at any stage of pregnancy. Six states and Washington D.C. do not impose any term restrictions.

In Alabama, abortion is illegal with exceptions to preserve the pregnant individual's life or physical health. There are no exceptions for rape, incest, or fatal fetal abnormalities. Performing an abortion in Alabama is a Class A felony with up to 99 years in prison.

In contrast, abortion is legal in California up to the point of fetal viability or after that if necessary to preserve the life or health of the pregnant individual.

Reasons for Late-Term Abortion

Abortions at or after 21 weeks are uncommon and represent 1% of all abortions in the US. Reasons for late-term abortions include medical concerns such as fetal anomalies or maternal life endangerment, as well as barriers to care that cause delays in obtaining an abortion.

Terminology

Discussions on late-term abortions are often fraught with misinformation and inflamed by the terminology used to describe them, including "late-term", "post-viability", "partial birth", "dismemberment", and "born-alive" abortions. It's important to note that "late-term" abortion is not an accepted medical term, and there is no consensus on which gestational ages it refers to.

Political Stance

The topic of abortion, especially third-trimester abortions, has been a divisive issue in US politics. Democrats tend to brush off questions about restricting these abortions, either denying that their policies would allow them or pointing out their rarity. On the other hand, Republicans have alleged that medical providers "execute" live-born babies, which, if true, would be considered homicide under US law.

Public Opinion

Most Americans believe that third-trimester abortions should be restricted. A 2023 Gallup poll found that while two-thirds of Americans support legal abortion in the first trimester, only 22% think it should be legal in the third trimester.

The landscape of abortion laws in the US is complex and constantly evolving. While some states have strict bans on abortion, others allow more flexibility, and a few have no restrictions at all. The debate around abortion, especially late-term abortions, remains a contentious issue in US politics and society.

Abortion laws in Europe

Abortion laws vary significantly across Europe. In most European countries, abortion is generally permitted within a term limit below fetal viability, although there are exceptions that permit abortion later in the pregnancy. The longest term limits are in the United Kingdom and the Netherlands, both at 24 weeks of gestation. In the UK, abortion is allowed if continuing the pregnancy would pose a greater risk of injury to the physical or mental health of the pregnant woman or her existing children than if the pregnancy were terminated.

In 2020, the specific time frame in European countries where abortions are legal varied from 10 to 24 weeks. The most permissive legislation was in the UK, followed by the Netherlands with 22 weeks. By contrast, women in Portugal can have an abortion up to 10 weeks, although this time frame can be exceeded in specific situations such as a risk to the woman's health, rape, or fetal malformation.

In most European countries, the standard practice is to legalise abortion on request or broad social grounds, at least in the first trimester of pregnancy. Additionally, abortion is also legal throughout pregnancy where necessary to protect a pregnant woman's health or life. 41 European countries allow abortion on a woman's request or broad social grounds, while six do not: Andorra, Liechtenstein, Malta, Monaco, Poland, and San Marino. Abortion is subsidised or fully funded in many European countries.

In some European countries, short time limits for access to abortion can have harmful impacts on women, particularly adolescent girls and marginalised communities, who may not always be able to obtain care within the legal timeframe. This may result in women needing to travel to other jurisdictions to access legal abortion or accessing abortion care at home outside of the scope of the law.

Some European countries have enacted reforms to extend the time limits for access to abortion on request or broad social grounds, recognising that although most abortions in Europe take place during the first trimester of pregnancy, short time limits can harm women who seek abortion care after the relevant time limit.

Medical procedures for abortions at 24 weeks

Abortions at 24 weeks are considered late-term abortions. In the UK, abortions can be performed after 24 weeks only in very limited circumstances, such as when there is a risk to life or problems with the baby's development. In the US, abortions after 24 weeks are rare, with less than 1% of abortions taking place after this point.

Abortions at 24 weeks are typically performed in a hospital under the care of qualified doctors. The procedure is usually carried out over two to three days but does not require an overnight stay in the hospital. This procedure is known as dilation and evacuation (D&E).

On the first day, patients meet with a health educator and doctor to prepare for the procedure. This visit typically lasts around two to four hours. During this time, patients may receive oral medications, including pain relievers and anti-anxiety medications.

On the second day, the procedure is performed. Medication is administered intravenously to induce anesthesia and loss of consciousness. The doctor then uses suction and gynecological instruments to empty the uterus, with ultrasound guidance. The procedure typically takes around 15 to 45 minutes, and patients are monitored in a recovery room for about two hours afterward.

In some cases, cervical softening and dilating may be performed using medication and/or small dilating sticks called laminaria or Dilapan. Laminaria are thin sticks made from seaweed that widen as they absorb moisture from the body, while Dilapan are synthetic sticks that work in the same way. These may be placed in the cervix a day or two before the abortion to help prepare the body for the surgical procedure.

After the procedure, patients can expect to experience vaginal bleeding and cramping. These side effects typically last for a few weeks. It is important to follow the instructions provided by the doctor for post-surgical care and to seek medical help if any complications arise.

It is worth noting that abortions at 24 weeks are rare and may not be available in all countries or regions. The availability of abortions after 24 weeks varies depending on local laws and regulations.

Reasons for abortions at 24 weeks

Abortions at 24 weeks are rare and often difficult to obtain. In the US, abortions at or after 21 weeks represent 1% of all abortions.

There are several reasons why individuals seek abortions at 24 weeks. Firstly, medical concerns, such as fetal anomalies or maternal life endangerment, are common reasons for abortions at this stage. For instance, structural fetal anomalies are often detected during a fetal anatomy scan around 20 weeks, and some of these anomalies are lethal, prompting individuals to terminate their pregnancies. Additionally, life-threatening conditions like severe preeclampsia, cancer, or intrauterine infection may develop later in pregnancy, necessitating termination to preserve the pregnant person's health or life.

Secondly, barriers to care and delays in obtaining an abortion earlier in pregnancy can lead to abortions at 24 weeks. These barriers include financial constraints, lack of information or access to abortion services, transportation difficulties, and lack of insurance coverage. For example, abortions can be costly, with third-trimester abortion costs ranging from a few thousand dollars to over $25,000. Moreover, individuals may not suspect they are pregnant until later in pregnancy, or they may face challenges in accessing abortion providers due to limited availability or geographic distance.

In some countries and states, abortions at 24 weeks are only permitted under specific circumstances. For instance, in Europe, abortions later in pregnancy are generally allowed if the pregnancy poses a serious danger to the life or physical or mental health of the woman, or if a severe fetal anomaly is diagnosed. Similarly, in the US, some states ban abortions at 24 weeks unless there are exceptions to preserve the life or health of the pregnant person or in cases of lethal fetal anomalies.

The cost of abortions at 24 weeks

The cost of an abortion at 24 weeks depends on several factors, including the method used, the country or region where the procedure is performed, and whether it is carried out on the NHS or privately.

In the United Kingdom, abortions are mostly carried out free of charge on the NHS. However, private abortions are also available and vary in cost depending on the stage of pregnancy and the method used. According to BPAS, a registered charity that provides abortion services, the price for a surgical abortion between 19 and 24 weeks is higher than the price for a medical abortion between 11 and 24 weeks. The precise charge is discussed during the booking and confirmed at the consultation.

In the United States, abortion laws and access vary by state, and costs can differ significantly. Some states have implemented bans on abortion before the 24-week mark, which can impact the availability and cost of abortions at later stages of pregnancy.

In other countries, such as Canada, China, and Vietnam, there may be no legal limit on when an abortion can be performed, which can affect the cost structure. Additionally, countries like Australia, and to some extent, the United States, have abortion laws that vary by state or territory.

It is important to note that the cost of an abortion at 24 weeks is not just financial. The procedure can be emotionally challenging, and there may be social consequences to consider as well. Seeking support from a trained pregnancy counsellor or a trusted friend or family member can help individuals make informed decisions and cope with the emotional aspects of the procedure.

Frequently asked questions