Reproductive healthcare providers across the United States are reporting a troubling trend: patients are arriving for abortion services “later and sicker” than in previous years. This shift is largely attributed to the rapid expansion of abortion bans and significant legal restrictions now in place across approximately 41 states. As legislative barriers mount, the path to accessing care has become increasingly complex, forcing many individuals to travel long distances or delay procedures until they reach later stages of pregnancy.
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 landscape is creating a “perfect storm.” Financial instability is a primary driver of these delays. Since 2023, more than 20 million people have lost Medicaid coverage, while an additional 3 to 5 million have either lost or dropped their Affordable Care Act exchange plans. “People are getting chucked off of Medicaid. The premiums are all going up,” Horvath explained. “Instead of seeking care early, they’re just not going in. There’s no place to go.”
The financial burden of later-term procedures is substantial. Alisha Dingus, executive director of the DC Abortion Fund (DCAF), highlighted the extreme pressure on patients, noting that they often face a “$22,000 gap with maybe three days to pull together funding.” A recent study published in JAMA confirmed that rising costs and the shrinking number of available providers create significant barriers to accessing care later in pregnancy. Erika Christensen, cofounder of Patient Forward, added that as a pregnancy progresses, the cost of care rises while the availability of providers diminishes, compounding the impact of existing state restrictions.
Despite the growing complexity of the health landscape, some providers are working to fill these gaps. In Maryland, where the state constitution protects reproductive freedom and there is no viability limit, clinics like Partners in Abortion Care and Care Reproductive are serving patients from across the country and the world. Horvath emphasized that the reasons for seeking later abortion care remain consistent with those for earlier procedures, including new medical information regarding the fetus or the patient’s own health, as well as sudden life changes like job loss.
Horvath stressed that pregnancy can be inherently dangerous, and at any stage, an abortion carries lower risks than continuing a pregnancy. Dingus noted that because the procedure is often a multi-day process with high barriers to entry, seeking an abortion at this stage is an intentional decision made with significant thought. While some supporters of abortion rights still harbor stigma regarding later procedures, providers argue that these medical decisions should remain between patients and their doctors, rather than being dictated by politicians.
The operational challenges for clinics are also severe. In 2025, Partners in Abortion Care stopped accepting Medicaid for later abortions because reimbursement rates resulted in thousands of dollars in losses per procedure. Despite this, the clinic has not turned patients away, relying on partnerships with roughly 40 different abortion funds to ensure patients are fully funded. DCAF remains a critical partner, supporting at least 20 people per week who are at 28 weeks’ gestation or later. However, Dingus warned that while donations surged immediately following the Dobbs decision, funding has since slowed to a trickle even as the need for support continues to climb.
The nature of care has evolved significantly over the last decade. Christensen, who required an abortion at 32 weeks ten years ago, recalled that the experience was once limited to “old-timey” clinics run by a small number of older providers. Today, the field is younger, more diverse, and predominantly female, with a strong focus on trauma-informed care. Modern facilities, such as the Partners clinic, prioritize patient autonomy through comfortable, welcoming environments—featuring soft lighting, reclining recovery chairs, and respectful, consent-based medical practices.
Reflecting on the emotional weight of the work, Horvath shared the story of a 12-year-old patient she recently treated. When asked what she looked forward to upon returning home, the child simply said she wanted to be a kid again. “This is life-saving work,” Horvath said. “This little girl gets to go be a little girl again.” 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 the later abortion population is disproportionately young people living below the poverty line in healthcare deserts, Christensen pointed out, adding: “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.”. 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 abortions are OK until this point, except for these things’ – then we get into the business of somebody in an office building in Annapolis deciding what they think is a good abortion and a bad abortion, she continued: “When we say: ‘Well. 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.
