A significant number of women need access to abortion care after the first trimester, generally identified as up to 12 weeks of gestation.
Finding a clinic or hospital
The quality of care can vary widely among all medical facilities. Since many women do not talk about their abortion experiences, it is often difficult to know what to look for when choosing a clinic or to find reviews by clinic patients. But the Abortion Care Network has published some very helpful guidelines to finding the service that will best fit your needs.
Clinics that provide abortions at 14–24 weeks. For a listing of clinics in your state that provide abortions from 14 to 24 weeks, contact the National Abortion Federation or Planned Parenthood Federation. Please refer to this map for information about the location of later abortion services.
Finding a hospital in your state that provides later abortions. Hospitals provide only 5% of all the abortions performed in the U.S.(1) Many hospitals provide abortions only in cases of fetal anomaly or serious risk to the woman's health, while some will provide later abortions in selected situations based on the judgment of the clinician team. Some teaching hospitals have excellent abortion services integrated into their obstetrics/gynecology department.
If a woman is diagnosed with a problem pregnancy and decides to terminate that pregnancy, she should ask the doctor who gives her this diagnosis for a referral to the closest provider. If the doctor cannot or will not identify a provider, the woman should call the maternal/fetal medicine department of the closest non-Catholic hospital and request an immediate appointment for a pregnancy termination.
If a woman is more than 14 weeks pregnant and has problems finding an appropriate hospital provider, she should immediately call the National Abortion Federation or Planned Parenthood. With each passing week, a pregnancy termination is more expensive and it is harder to find a provider, so women should not delay in finding an appropriate referral as quickly as possible after deciding to end a pregnancy.
Clinics outside the United States that provide abortions at 24 weeks and later. British law allows abortions after 24 weeks on grounds of serious risk to the woman’s health and life and in cases of very serious fetal malformation. There is no existing provision for women from other countries. For services in Great Britain, contact bpas.
Abortions after 22 weeks are also provided in the Netherlands and in Sweden. Most European countries provide later abortions in cases of risk to the health of the woman or serious fetal anomalies. The Fédération Internationale des Associés Professionnels de l’Avortement et de la Contraception (FIAPAC) maintains a list of European clinics.
Taiwan and Singapore provide abortions to 24 weeks.
Federal Medicaid does not cover abortion, and abortion coverage is excluded from the coverage of all Federal employees and dependents, including those in the military and their families, prisoners, and those dependent on Indian Health Services.
33 states ban state Medicaid funds from covering abortion except in cases of life endangerment, rape or incest. 17 states allow state Medicaid funds to cover the costs of abortion. See list of states allowing Medicaid funds to cover the costs of abortion.
A few states prohibit private insurers from covering abortion services, except in cases of life endangerment. 5 states restrict insurance coverage of abortion in private insurance plans; 4 limit coverage to cases when the woman's life is endangered; 1 limits coverage to life endangerment, rape and incest. 12 states restrict abortion coverage in insurance plans for public employees. More information about which states restrict private insurance coverage is provided in “Restricting Insurance Coverage of Abortion,” published by the Guttmacher Institute in January 2010. With health care reform and the passage of new insurance restrictions in many states, check with your insurer about what coverage you may currently have.
If a woman has private health insurance, she can call her company to find out if her abortion will be covered. It is important to let the company know if the pregnancy is being terminated because of a fetal anomaly or threat to the woman's health, as this may impact whether or not the procedure will be covered. It is also important to call the facility providing the abortion, as some clinics do not accept private insurance. If financial help to pay for an abortion is needed, see the following section.
Financial assistance for abortion care
The National Abortion Federation hotline provides referrals and financial assistance to women who need later abortions:
- For clinic referrals only (no funding) 1-877-257-0012
- For referrals and financial assistance 1-800-772-9100
- General listings for abortion clinics
The National Network of Abortion Funds is a network of state-based funds that provide financial assistance. Find the fund in your state online or call 617-524-6040.
The decision to terminate a pregnancy can be difficult for some women, regardless of the woman's reason or the gestational age of the pregnancy. In addition to family and friends, these organizations and websites offer support:
- Backline—Backline offers support to women and their loved ones around all aspects of pregnancy and decision-making about abortion, adoption and parenting. They provide nonjudgmental and confidential options counseling and support before and after abortion. Call their Talk Line at 1-888-493-0092, Mon–Thurs 5 PM–10 PM PST; Fri–Sun 10AM-3PM PST.
- Exhale: an after-abortion counseling talkline—Exhale provides support to women who have abortions, and their partners, friends and family. All calls are confidential, and the cultural, social and religious beliefs of all callers is respected. Call 1-866-4 EXHALE (1-866-439–4253), Mon.–Fri. 5 PM–10 PM PST; Sat.–Sun. 12 noon–10 PM PST.
- Abortion for fetal anomalies—This website was established by families that ended wanted pregnancies due to fetal anomalies.
(1) Jones RK et al., Abortion in the United States: incidence and access to services, 2005, Perspectives on Sexual and Reproductive Health, 2008, 40(1):13.
For a list of information that may be helpful for clinicians to gather prior to making a referral for an abortion see this printable reference card.