Recent legislative efforts in several states aim to restrict or ban abortions later in pregnancy, citing the protection of life. However, based on my 20 years of experience as the first female doctor in the U.S. to openly provide abortions in the third trimester, the reality is quite different. The stories of my patients, marked by trauma, desperation, and resilience, stand in stark contrast to the often-negative political rhetoric surrounding this procedure, which demonizes doctors and shames those seeking care.
While third-trimester abortions constitute a small percentage of all abortions (estimated at around 1%), understanding them is crucial to understanding the broader context of abortion care. Listening to individuals in the most dire situations provides insight into the experiences of all who seek abortion and emphasizes the critical need for safe, legal, and accessible care throughout every trimester.
I began my practice in Wichita, Kansas, mentored by Dr. George Tiller. Following his assassination by an anti-abortion extremist in 2009, I continued this work in Albuquerque, New Mexico, until 2001. During those years, I provided care to patients who had nowhere else to turn, often after they had exhausted all other options.
Some patients received devastating diagnoses late in their pregnancies, revealing conditions that would result in their baby’s early death or significant suffering. These included lethal conditions like Potter’s syndrome, where the baby’s kidneys fail to develop, and non-lethal but severe conditions like lissencephaly, characterized by a short life filled with intractable seizures.
However, fetal abnormalities were not the sole reason patients sought third-trimester abortions. I also treated victims of domestic violence who were unable to seek abortion care until their abuser was incarcerated. I cared for rape survivors who were so traumatized that they couldn’t process their pregnancy. I also performed abortions in cases where birth control, even the most effective methods, failed. Because they were using birth control, these patients often didn’t realize they were pregnant until they were well into the third trimester.
I assisted mothers who initially planned to continue their pregnancies but lost their jobs and could no longer afford to care for their existing children. I also provided care for many teenagers and even younger girls who were too afraid to disclose their pregnancy and concealed it with loose clothing until it became impossible to hide. In recent years, I’ve seen an increase in patients who sought abortions earlier in their pregnancies but were prevented from obtaining them due to various state regulations, such as gestational limits, waiting periods, cost, transportation challenges, and the closure of clinics across the country.
However, these barriers did not deter women from terminating their pregnancies.
These obstacles only delayed care and increased hardship. The Turnaway Study demonstrated that individuals denied abortions experience higher rates of poverty, physical complications, and long-term health problems.
My patients were already aware of these realities. One patient stated that continuing her pregnancy would be fatal, while an abortion would save her life. Many held strong anti-abortion beliefs yet felt that abortion was essential to prevent suffering for themselves and their families. They were also deeply concerned about their future child’s well-being, desiring a good life with adequate resources and opportunities, which they knew their circumstances would prevent.
We are often urged to be “reasonable” about abortion and accept limitations at various gestational points. However, these limits fail to account for the unpredictable nature of pregnancy and the complexities of individual lives. Each accepted restriction brings us closer to a world where abortion is neither safe, legal, nor accessible.
This creates a slippery slope towards total bans, which are becoming increasingly common in many states. Instead, we must fully support those seeking third-trimester abortions, recognizing that they are equally deserving of compassionate and competent care.
A father once told me that continuing his baby’s pregnancy, given the child’s condition, would be immoral. The mother of a young rape victim once said, “You don’t know the story until you are the story.”
When these stories are truly heard, judgment gives way to understanding and compassion.
Adapted from Beyond সংক্ষেপ Limits by Shelley Sella, MD. (Beacon Press, 2025). Reprinted with permission from Beacon Press.
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