By: Gabrielle Winger, Policy and Legal intern

Dr. Leroy Carhart is one of the four later abortion providers in the United States. Not only does he and his wife Mary manage a clinic in their home state of Nebraska, but the couple flies 1,145 miles each way on a weekly basis to serve their second clinic in Bethesda, Maryland.

With the recent Supreme Court nominee Brett Kavanaugh, the fate of Roe v. Wade has become increasingly unclear in an administration that has prided itself on being anti-choice. This has been made apparent in a few different ways, including pushing for a domestic gag rule that would prevent Title X clinics from discussing abortion care. More recently, this involves the Supreme Court case ‘National Institute of Family and Life Advocates v. Becerra’ that ruled that fake health clinics who pose as abortion providers do not have to post notice that they are not a licensed medical center. Of the dozens of various barriers to abortion care that all 50 states have enacted, limiting the time period in which someone can legally access abortion care is among the most common. 43 states currently prohibit abortion after a certain point in pregnancy. 17 of these states prohibit abortion after fetal viability, 2 prohibit abortion in the third trimester, and 24 states impose prohibitions after a certain number of weeks; the majority being 20 weeks post-fertilization. In addition to these time sensitive bans, a little less than half of the states impose further regulations that permit later abortion only to save the life or health of the woman (binary language is often the only language used in state policy when describing abortion), and some states even require a second physician be present during a later abortion to “treat a fetus if it is born alive in all or some circumstances” or to “certify that the abortion is medically necessary in all or some circumstances”.

One thing is abundantly clear: later abortions are heavily regulated in the United States, and accessing this medical procedure is a costly, involved process. Due to these strict state regulations, Dr. Carhart’s Maryland office often see individuals from across the United States that are seeking a later abortion. While talking to a clinic administrator at Dr. Carhart’s office, it was discussed that individuals often fly into Maryland and stay in a nearby hotel to easily access the clinic during the process of the procedure.

Besides the cost of the procedure alone, obtaining a later abortion is a costly endeavor. For individuals who are traveling in to Dr. Carhart’s office from other states, the cost of travel, the previously mentioned hotel stay, food, and other unexpected expenses can all add up extremely quickly. When you factor in the cost of the procedure, which can cost an average of $1,300-$5,000+ depending on how far along the pregnancy is, this entire process can be extremely costly.

If you don’t have insurance or an insurance plan that covers abortion care, monetary support from family, friends, or organizations such as the National Network of Abortion Funds or the National Abortion Federation, obtaining a later abortion can be nearly impossible. This puts low income women and other individuals seeking abortion care at a direct disadvantage in accessing later abortion care. As a result, only those who have the financial means to pay for any costs necessary have the ability to travel to access abortion care and puts many women and other individuals in the United States in a position where they cannot access the procedure if it’s not offered by their closest abortion provider.

Although only about 9% of women obtain an abortion after the first trimester and 1% of women obtain an abortion at 21 weeks or later, those who are intentionally accessing later abortions often do so due to fetal medical conditions or because pregnancy poses a threat to their health. As shown through a 2008 study, women who have had multiple disruptive events such as unemployment or separation from a partner are also more likely to have an abortion at or after 13 weeks. As previously mentioned, due to the cost of the procedure that can potentially cost thousands of dollars, raising money to obtain the procedure can also delay the process of obtaining an abortion. Regardless of the reason for obtaining a later abortion, the personal decision to obtain a later abortion should not need to meet a litmus test for “acceptable” reasons to get the procedure.

As we consider the future of abortion access in the United States, we need to prepare for the various threats that may become a reality. Options such as utilizing telemedicine to obtain an medication abortion or streamlining the process for booking and funding travel to states such as Maryland that allow physicians such as Dr. Carhart and his staff to perform later abortions are all being considered. Regardless of potential anti-choice measures, abortion advocates will continue to demand access to safe, legal abortion and implement ways for individuals of all socio-economic status to access abortion care.

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Gabrielle Winger is a graduate student at George Washington University studying Public Policy with a concentration in Women’s, Gender, and Sexuality Studies. She will be graduating in the spring of 2019. She can be reached at for further inquiries.

The political leader of the pro-choice movement in Maryland.

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