Rising demand for later abortions
Across the United States, an increasing number of patients are arriving at abortion providers’ doors later in pregnancy and in more compromised health. As of 2026, roughly 41 states enforce bans or significant restrictions at some point during gestation, leaving a patchwork of legal obstacles that push seekers toward a handful of “haven” states. The erosion of insurance coverage has compounded the problem: more than 20 million people have lost Medicaid since 2023, while between three and five million have dropped or been removed from Affordable Care Act exchanges in recent months. “People are getting chucked off of Medicaid. The premiums are all going up,” says Diane Horvath, co‑founder of Partners in Abortion Care in Maryland, the nation’s only all‑trimester clinic wholly owned and operated by women. “Instead of seeking care early in pregnancy, they’re just not going in. There’s no place to go.”
The shift is not merely geographic. Patients who once might have accessed early‑stage procedures now travel multiple states, often hitting gestational limits at each border. By the time they reach clinics that still provide later care, many are beyond the second trimester. “It is a multiday procedure, and the barriers to access it are so high that to get an abortion at that stage of pregnancy is an intentional decision made with a lot of thought and care,” notes Alisha Dingus, executive director of the DC Abortion Fund (DCAF).
Financial barriers and insurance gaps
The cost of a later abortion – loosely defined as any procedure past the first trimester – escalates sharply as pregnancy progresses. Dingus illustrates the pressure: “Sometimes you’re looking at a $22 000 gap with maybe three days to pull together funding.” A recent JAMA study warned that rising expenses and dwindling provider numbers “may create substantial barriers to accessing later abortion care.”
Insurance losses deepen the crisis. In 2025, Partners in Abortion Care ceased accepting Medicaid for later abortions after discovering that reimbursement rules left the clinic losing thousands of dollars per procedure. “We need a significant amount of monthly funding support in order to stay open if we’re going to accept Medicaid for two‑ and three‑day [procedure] folks, which is crappy. It hurts access, and it’s awful,” Horvath explains. Despite the policy shift, the clinic has not turned away patients; it works with roughly 40 different abortion funds to secure financing.
DCAF’s weekly disbursements reflect the scale of need. On average, the fund helps at least 20 people obtain care at 28 weeks’ gestation or later. “Even before Dobbs, there was always a high number of people who travelled to this region for their abortion care because we didn’t have any gestational age bans,” Dingus observes. “Probably in the past two years, we’ve seen a pretty significant uptick in people who are needing funding at 30 weeks and later.”
While donations surged immediately after the Dobbs decision, the flow has now slowed to a trickle even as demand continues to climb. “We are seeing much larger gaps than we’ve ever seen,” Dingus says, describing the strain on organisations that once thought they could meet the need.
The clinics that remain open
Only four states and Washington, D.C., currently offer all‑trimester care to all patients. Maryland, where the state constitution protects reproductive freedom and no viability limit exists, hosts two such clinics: Care Reproductive Health Clinic and Partners in Abortion Care. The DuPont Clinic in neighbouring Washington, D.C., also serves a regional patient base.
These facilities have evolved beyond the “old‑timey” settings that Erika Christensen, co‑founder of Patient Forward, recalls from a decade ago. Then, only two geriatric white men offered later care in clinics that felt “like walking through a portal back in time.” Today, providers are younger, more diverse, and predominantly women. Their spaces are designed for comfort and autonomy: Partners’ clinic features motifs of flying birds, soft lighting, extra phone chargers, reclining recovery chairs, and blanket warmers. Gowns of all sizes are available, and patients can change into donated clothing or use on‑site laundry machines—a necessity for those who arrive with nothing but the clothes on their backs after a long journey.
Autonomy is central. “Nothing happens without your permission. You can stop us at any time; you can ask questions at any time,” Horvath emphasises. This philosophy extends to the broader conversation about reproductive rights. “If the best we can do, as the mainstream feminist and abortion movement, is ‘ask state daddy for permission for when and under what circumstances we can end our own pregnancies,’ I think it’s not the conversation that is required for us to be equal free people,” Christensen adds.
The personal stakes are stark. Horvath, whose father is a physician, was once uncertain about dedicating her career to later‑abortion care. A turning point came with a 12‑year‑old patient who needed an abortion. When Horvath asked what the girl looked forward to upon returning home, the child replied, “I think I just really want to be a kid again.” That moment cemented Horvath’s resolve. “This is sacred work. This is life‑saving work,” she says. “This little girl gets to go be a little girl again.”
Humanising the care
Later abortions are sought for the same reasons earlier procedures are chosen: new information about fetal or maternal health, job loss, housing instability, abusive partners, or even delayed diagnosis—especially among children. “Pregnancy can be really dangerous,” Horvath notes. “At any point in the pregnancy, abortion is going to be lower risk than continuing the pregnancy.”
The journey to care is rarely straightforward. Patients often navigate a maze of legal restrictions, gestational limits, and financial hurdles. “They’re sort of in a perfect storm: they have the least amount of time to find the money for the most expensive care … we’re talking about someone’s abortion costing potentially more than they make in an entire year,” Christensen points out. The result is a population disproportionately composed of young people living below the poverty line in healthcare deserts.
Despite these challenges, the providers who remain open are committed to creating spaces where patients feel respected and heard. The emphasis on comfort is not merely aesthetic; it is a deliberate effort to affirm patient agency. “We’ve tried really hard to set our clinic up in a way that people know their autonomy is being respected,” Horvath explains.
Recent years have sharpened the national conversation about reproductive rights. “It could always move faster, but progress is progress, and it is changing,” Christensen reflects. While legal battles continue, the clinics that have stayed open are striving to fill the gaps left by restrictive legislation and dwindling financial support.
Why it Matters
The surge in later abortions across the United States is a stark indicator of how legislative and insurance policies directly impact the most vulnerable populations. As bans spread and coverage evaporates, patients are forced into costly, high‑stress journeys that jeopardize both their health and financial stability. The dwindling number of clinics that still provide all‑trimester care underscores a growing crisis in reproductive health equity, highlighting the urgent need for comprehensive insurance reform, increased funding for abortion funds, and policies that protect patient autonomy. The stakes are not abstract; they are measured in the lives of young mothers, children, and anyone caught in the crossfire of political debate. Ignoring this trend risks entrenching a two‑tier system where only those with resources can access timely, safe care, while the rest are left to navigate a perilous landscape of legal and financial barriers.