Abortion providers across the United States are observing a trend of patients arriving later in their pregnancies for reproductive healthcare, a shift driven by the proliferation of state-level bans and significant restrictions. According to Diane Horvath, cofounder of Partners in Abortion Care in Maryland—the only all-trimester clinic in the country owned and operated by women—patients are showing up “later and sicker” as access to care becomes increasingly difficult.
Data indicates that about 41 states have implemented abortion bans or significant restrictions at various stages of pregnancy. Compounding this challenge, the broader healthcare landscape has seen a decline in coverage: more than 20 million people have lost Medicaid access since 2023, while between 3 and 5 million individuals have lost or dropped coverage through Affordable Care Act exchanges in recent months. “People are getting chucked off of Medicaid. The premiums are all going up,” Horvath noted. “Instead of seeking care early in pregnancy, they’re just not going in. There’s no place to go.”
The financial burden of later abortion—generally defined as care past the first trimester—increases as the pregnancy progresses. Alisha Dingus, executive director of the DC Abortion Fund (DCAF), highlighted the severe funding gaps patients face. “Sometimes you’re looking at a $22,000 gap with maybe three days to pull together funding,” she said. Research from a recent Jama study confirms that rising costs and limited provider availability create substantial barriers to care. Erika Christensen, cofounder of the advocacy group Patient Forward, noted that the population seeking later abortion is disproportionately young, living below the poverty line, and residing in healthcare deserts. “They’re sort of in a perfect storm: they have the least amount of time to find the money for the most expensive care,” Christensen said. Yet even among some abortion supporters, she said, there is stigma around later abortion.
Despite these obstacles, specialized clinics are operating in states like Maryland, which has no viability limit and constitutional protections for reproductive freedom. Facilities such as the Care Reproductive Health Clinic and Partners in Abortion Care serve patients from across the country and abroad, alongside the DuPont Clinic in Washington DC. Horvath explained that reasons for later abortions mirror those for earlier procedures, including new health information, loss of employment or housing, or domestic abuse. She emphasized that at any stage, abortion remains lower risk than continuing a pregnancy.
Legal barriers often force patients to travel across multiple states, encountering gestational limits repeatedly until they reach a clinic in a haven state, often well into the third trimester. “Even before Dobbs, there was always a high number of people who traveled to this region for their abortion care because we didn’t have any gestational age bans,” Dingus said. “Probably in the past two years, we’ve seen a pretty significant uptick in people who are needing funding at 30 weeks and later.” Dingus described the decision to seek care at this stage as an intentional, carefully considered medical choice. Horvath added that medical decisions should remain between the patient and their provider, rather than being dictated by politicians. In 2025, Partners in Abortion Care ceased accepting Medicaid for later procedures due to unsustainable reimbursement rules, though they continue to work with roughly 40 abortion funds to ensure patients are fully funded.
While DCAF has supported at least 20 people per week at 28 weeks’ gestation or later, Dingus noted that funding is becoming strained as demand increases. Christensen observed that while the landscape is complex, the new generation of providers is diverse, trauma-informed, and focused on patient autonomy. For Horvath, the work is deeply personal. Then she saw a very young patient, a 12-year-old girl who needed an abortion. Horvath asked her: “What are you looking forward to when you go back home?” She simply said she wanted to be a kid again. “This is sacred work. This is life-saving work,” Horvath said.
