Kate Dineen assumed she would always have access to reproductive healthcare because of where she lived. It came as a shock when she was denied an abortion in 2021 because of gestational limits to the procedure in Massachusetts law.

Dineen was 33 weeks into her pregnancy, the third trimester, when a routine ultrasound detected a problem with the fetus’s brain. An MRI showed that her son, whom she’d named Teddy, had suffered a catastrophic stroke in utero. A pediatric neurologist gave her the news over a Zoom call during the COVID-19 pandemic.

“I said, ‘What’s the best-case scenario? Is there any chance of a normal, healthy outcome?’ And he kind of cast his gaze downward and muttered, ‘No,’” Dineen said. “I had this fear that I was going to go into labor in Massachusetts, and there was going to be nothing I could do aside from watching my son suffer an unknown fate.”

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Dineen’s story is rare among those seeking an abortion, and it’s one of the least-discussed types of abortion. Researchers and doctors say later abortions are complicated, expensive and difficult to access, with very few clinics nationwide that can or will provide them. Later abortions also are heavily criticized by anti-abortion groups and Republican elected officials, who often say states without viability limits allow doctors to kill a baby after birth, which is false.

In the four years since the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, access to all abortion in more than a dozen states has dramatically decreased. During that same time, some clinics have expanded later abortion offerings, and advocates — including Dineen — are pushing for many of the 21 states that have bans after 18 weeks to drop them.

Some project optimism about the support for repealing gestational bans, while others are taking a more incremental approach based on their assessments of political realities and general discomfort about the subject even from abortion-rights advocates. Other abortion-rights advocates continue to focus on expanded access earlier in pregnancy, including ballot initiatives to reverse abortion bans.

Frances Kissling, president of Catholics for Choice from 1982 to 2007, said laws that put some limitations on abortion after fetal viability strike the right balance in providing exceptions for certain circumstances without taking an extreme view.

“I think it works better for everybody if no one takes an absolutist position on this,“ Kissling said. “In a sense, there are no good answers, but it certainly is not good to take the position that no limitations in the third trimester would ever be acceptable.”

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Kissling’s approach is at the heart of a split among abortion-rights advocates that has developed since Dobbs — whether to return to the way laws were made after the U.S. Supreme Court decided Roe v. Wade, which allowed abortion access to be limited after fetal viability, or whether to push for more.

Dineen’s pregnancy was well past Massachusetts’ cutoff of 24 weeks, around the time that the medical community recognizes a fetus can potentially survive, with medical intervention, outside of the womb.

The state law at the time included exceptions past that point for lethal fetal anomalies, but Dineen’s case was refused by the hospital where she sought care because doctors said they couldn’t guarantee the fetus wouldn’t survive after birth. She had to drive 500 miles to Bethesda, Maryland.

“It was something that I was just so floored by; I felt so naïve,” Dineen said.

‘We see all of these’

The most recent data from the federal Centers for Disease Control and Prevention, from 2022, showed about 1.1% of abortions nationwide took place after 21 weeks of pregnancy, although that total reflects voluntary reporting from only 46 states. More than 93% of abortions happen in the first trimester, before 13 weeks. But thousands of people will still need abortion options later in pregnancy every year for a host of reasons.

Nine states have laws protecting abortion access throughout pregnancy, but only four of those — Colorado, Illinois, Maryland and New Mexico — plus Washington, D.C., have clinics that provide abortion past 32 weeks, meaning people experiencing a problem like Dineen’s most often have to travel. Nationwide, about 20 clinics provide abortions past 24 weeks.

Among the states that protect access throughout pregnancy is Alaska. But unlike the other states, doctor availability at any stage is extremely limited, with two Planned Parenthood clinics statewide, neither of which provides abortion after 18 weeks.

One new all-trimester clinic opened in New Mexico since Dobbs, and a new clinic replaced Boulder Abortion Clinic in Colorado after it closed in 2025. The former chief operating officer of the Boulder clinic, Alicia Moreno, is now executive director of RISE Collective and said about two-thirds of the clinic’s patients come from other states or from Canada. Many times, they are patients like Dineen, who received grave news about a wanted pregnancy.

Other patients must seek a later abortion clinic because they were delayed by logistics such as time off work, travel and financial barriers, while still others are delayed because of abortion bans or bureaucratic hurdles, such as a healthcare provider taking weeks to determine whether a patient qualifies for a legal exception.

Or in some cases, she said, people go to an anti-abortion crisis pregnancy center without knowing what those centers are and are “led on for weeks” until they exceed the state’s legal limit.

“We see all of those on a weekly basis,” Moreno said.

Patients also include preteens and teenagers, who are more likely to not know they are pregnant until later.

National anti-abortion group Americans United for Life takes the view that there is never a good reason to terminate a pregnancy after fetal viability and that it should not be permitted.

Public support for legal abortion in all or most cases stood at 64%, according to a July 2025 AP-NORC poll, but it dropped significantly when broken out by trimester. A 2023 Gallup poll showed support for legal abortion in the second and third trimesters at 37% and 22%, respectively.

Support for legal access is lower for a person who just doesn’t want to be pregnant, such as Ayesha Perry-Iqbal, who didn’t discover she was pregnant until 24 weeks in 2021, referred to as a cryptic pregnancy.

The stigma gets compounded the later in pregnancy you are, even in places that are really progressive.– Amy Hagstrom Miller, president and CEO of Whole Woman’s Health clinics

“I was obviously in shock and was not sure what it was that I wanted to do because I felt like since I was past the limit in California, I didn’t really have a choice,” said Perry-Iqbal, who is from Wales but now lives in Los Angeles.

A doctor told Perry-Iqbal she could still go to Colorado. Amid feelings of guilt and frustration, she decided she didn’t want to have a child.

“When I sat down and was like, ‘Actually this is not something I want, this is not the path I deserve, and this is not the story that I want for my child,’ I decided to do what was best for me,” she said. “It didn’t sit well with a lot of people.”

She remembers arriving in a private car at the back of the health clinic to avoid protesters and walking through two different layers of security before making it to the waiting room. It made her feel like she was doing something wrong.

Culture changes

It’s been a decade since Erika Christensen had her own later abortion. At 31 weeks, her fetus was no longer growing and wasn’t swallowing. Doctors said her baby would not be able to breathe outside her body, and was likely to die shortly after birth. Terminating the pregnancy meant Christensen had to travel from her home in New York to Colorado.

Three years later, Christensen and her husband, Garin Marschall, founded Patient Forward and became staunch advocates for removing barriers to later abortion care. She remembers searching for options in 2016 and thinking of it as a desert, whereas now there are more clinics offering services later with more diverse staff and more public discussion of the issue.

“It’s a completely different culture than it was 10 years ago,” Christensen said. “That is progress, even as we have so many more barriers to eliminate.”

Even in states that have made it easier to provide later abortion care since Dobbs, such as in Minnesota, where the legislature repealed laws targeted at abortion providers in 2023, the costs become prohibitive.

Later abortion care requires many more expensive medications, specialized equipment and other services, and healthcare costs keep going up while reimbursement rates remain stagnant or lag behind.

But costs can be more easily addressed than cultural norms. Amy Hagstrom Miller, president and CEO of Whole Woman’s Health, has one abortion clinic in Minneapolis, as well as others in Maryland, New Mexico and Virginia. She said more needs to be done to increase understanding of the complexities around later abortion and why it happens.

“The stigma gets compounded the later in pregnancy you are, even in places that are really progressive,” Hagstrom Miller said. “You hear people say, ‘Why did they wait so long, why didn’t they do something about it sooner?’”

Looking to the future

Patient Forward and other abortion-rights groups have been vocally opposed to ballot initiatives that include language about fetal viability, including in Missouri, where voters narrowly passed an initiative in 2024 to overturn the state abortion ban, and in Idaho, where a question that would overturn its near-total ban will likely be on the ballot later this year.

Initiatives that passed in Arizona and Nevada also allow the government to restrict access after fetal viability.

But some push back on allowing abortions at later stages, including Melanie Folwell, executive director of Idahoans United for Women and Families and lead organizer of the state’s initiative. The ballot language includes a line that says it is not a violation of reproductive freedom and privacy to regulate abortion after fetal viability except in cases of medical emergency, and Folwell said criticisms from national organizations on that subject are unwelcome.

“It’s disappointing that the national political class is painfully out of touch with our reality on the ground. I’d invite them to take a break from firing off press releases and selling tote bags and spend some time knocking doors with our grassroots volunteers in Chubbuck or Coeur d’Alene or Caldwell,” Folwell said. “This is the real work right now and we’re proud to be doing it.”

In Massachusetts, Kate Dineen says she is working to ensure other people aren’t denied care the way she was. In 2022, she successfully lobbied to change the language about legal abortion after 24 weeks to include an additional exception for “grave fetal diagnoses,” which she said has already allowed more patients to access later care.

The next step, she said, is a full repeal of the 24-week limit. Dineen said she’s excited that the bill, titled the Prioritizing Patient Access to Care Act, is moving through the state House and Senate.

“When we start talking about number of weeks and severity of fetal diagnosis or quality-of-life projections, we’ve already lost the conversation. We shouldn’t be talking about any of that,” Dineen said. “It’s about who gets to decide — the government, or the pregnant person.”

Late-trimester abortion access

Which states don’t have limits on abortion access based on fetal viability?

Alaska, Colorado, Maryland, Michigan, Minnesota, New Jersey, New Mexico, Oregon and Vermont

What does viability mean?

Viability is the point at which a fetus can survive outside of the uterus with medical intervention. There is no week of pregnancy when viability begins, because there are many factors that go beyond gestational age. That includes what medical facilities and equipment are available, fetal weight and other factors.

At around 23 weeks, the survival rate for preterm newborns is between 23% and 27%; at 24 weeks; it’s between 42% and 59%; and at 25 weeks, it ranges from 67% to 76%. Some states specify a number of gestational weeks to define viability, such as Massachusetts at 24 weeks, while others do not.

Source: American College of Obstetricians and Gynecologists