Reproductive healthcare providers across the United States are reporting a troubling trend: patients are arriving for abortion care both later in their pregnancies and in more compromised health. This shift coincides with a wave of restrictive legislation that has left approximately 41 states with significant bans or limits on abortion access, forcing many individuals to navigate a fragmented and increasingly difficult landscape.
Diane Horvath, cofounder of Partners in Abortion Care in Maryland—the only all-trimester clinic in the country owned and operated by women—notes that the current environment is creating a “perfect storm.” She explains that patients are often “later and sicker” by the time they reach a facility. This is exacerbated by a broader crisis in healthcare coverage; since 2023, over 20 million people have lost Medicaid access, and between 3 and 5 million have dropped or lost Affordable Care Act exchange coverage. “People are getting chucked off of Medicaid. The premiums are all going up,” Horvath said, adding that many patients simply stop seeking care early because, “They’re just not going in. There’s no place to go.”
The financial burden of obtaining an abortion increases significantly as a pregnancy progresses. Alisha Dingus, executive director of the DC Abortion Fund (DCAF), highlights the extreme pressure this places on families. “Sometimes you’re looking at a $22,000 gap with maybe three days to pull together funding,” Dingus noted. For those living in healthcare deserts, the situation is dire. Erika Christensen, cofounder of Patient Forward, points out that the population seeking later-term care is disproportionately young and living below the poverty line. “Further into pregnancy, the cost of care goes up, the number of providers goes down, and more and more restrictions go into effect,” Christensen explained.
Despite these obstacles, some providers are stepping into the gaps. In Maryland, where the state constitution protects reproductive freedom and there is no viability limit, clinics like Care Reproductive are serving patients from across the globe. Horvath emphasizes that the reasons for seeking later abortions remain consistent with those for earlier procedures, including new medical information regarding the fetus or the patient’s own health. She stresses that pregnancy “can be really dangerous,” and that at any stage, an abortion is statistically lower risk than continuing a pregnancy.
The process for obtaining care late in pregnancy is often a multi-day, intentional medical procedure. Dingus describes the high barriers as a testament to the gravity of the decision, noting that it is made with significant thought and care. While some abortion supporters still harbor stigma regarding later procedures, Horvath argues that medical decisions should remain between patients and their providers, rather than being dictated by “somebody in an office building in Annapolis.”
Financial sustainability remains a constant challenge. In 2025, the Partners clinic stopped accepting Medicaid for later abortions because reimbursement rates resulted in thousands of dollars in losses per procedure. However, the clinic continues to operate by collaborating with roughly 40 different abortion funds. DCAF remains a critical partner, often funding at least 20 people per week who are at 28 weeks’ gestation or later. While donations surged immediately following the Dobbs decision, Dingus reports that funding has since slowed to a trickle, even as the demand for support continues to climb.
The landscape of care has evolved significantly over the last decade. Christensen, who sought an abortion at 32 weeks ten years ago, recalls a time when only a few “old-timey” clinics were available. Today, the field is more diverse, with younger providers offering trauma-informed care. Modern facilities, such as the Partners clinic, prioritize patient autonomy through comfortable, respectful environments—using soft lighting, reclining chairs, and ensuring that no procedure occurs without explicit permission.
Reflecting on the human impact of this work, Horvath shared the story of a 12-year-old patient. When asked what she looked forward to upon returning home, the child simply said, “I think I just really want to be a kid again.” For Horvath, the ability to provide that outcome is what defines the work as life-saving. “This little girl gets to go be a little girl again,” she said. The report also notes that the time during which the vast majority of abortions occur – tends to rise the later it happens in a pregnancy, the cost of later abortion – which is loosely defined as anything past the first trimester. The report also notes that a recent Jama study found, rising costs and decreasing availability “may create substantial barriers to accessing later abortion care”. The report also notes that for some, particularly children, the pregnancy itself may not be diagnosed until very late. The report also notes that hitting up against gestational limits at each point, they might go to several different states seeking care. The report also notes that but the place that I have to land is: I have to trust this pregnant person to make that decision, and I realize that not having a set rule is a really uncomfortable thing for people to hold. The report also notes that “I do not pretend that I know better about someone’s life than they do,” Horvath added.