The reality of later-in-pregnancy abortion is more complex than MN debate lets on

A crowd inside the Capitol rotunda
Hundreds crowded the Capitol rotunda on Tuesday to oppose bills lifting restrictions on abortion in Minnesota.
Dana Ferguson | MPR News

When a patient goes to see Dr. Rachel Pilliod, the situation is often a complicated one.

As a maternal fetal medicine specialist, Pilliod often sees pregnant patients referred to her after they get an anatomy scan from their primary physician, at around 20 weeks gestation.

If something looks off with how the baby is developing, Pilliod and her colleagues take a closer look. They do follow-up imaging and tests to determine the scope of the situation, through MRIs and genetic testing.

“We also think about not just chromosomes that are added or deleted, but are little segments of information duplicated or deleted? Or is there a single kind of ‘spell check error’ within all of this genetic material?” she said.

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Each test is different, and can take a lot of time. And if the condition is incompatible with life, patients may be running up against the clock to have the full scope of options.

“Generally what we're talking about, with what falls under the umbrella of a ‘later abortion,’ is actually ending a wanted, or very desired pregnancy,” Pilliod said.

Over the past few months, the issue of later-in-pregnancy abortions has come up frequently in debates on proposed abortion laws in the Minnesota Legislature.

Pro-life and pro-choice advocates gather at the Capitol
An anti-abortion advocate holds up a crucifix at the Minnesota State Capitol on Jan. 27.
Nicole Neri for MPR News

During the marathon floor debate on the PRO Act last month, Republican state Sen. Zach Duckworth of Lakeville called the bill a “free for all,” and said Minnesotans expect their legislators to create limits “especially [for abortions] so late in a pregnancy, to try and safeguard and protect life.”

Later-in-pregnancy abortions, which are loosely defined but generally understood to be around 24 weeks of gestation, are fairly uncommon. According to data shared by abortion providers to the state Legislature and compiled by MPR News, about 1 percent of all reported abortions from 2008-2021 took place after approximately 20 weeks gestation. After 24 weeks, the number drops even further.

In Minnesota, most clinics don’t provide abortions after 20 weeks, according to their posted guidelines, and hospitals and health care providers may have their own internal policies limiting what can be done. Add in state laws limiting when abortions may be performed, and things can get more difficult.

That’s in part what Minnesota Democrats say they’re attempting to address in a bill set to come up for House and Senate floor votes in the coming weeks. The Reproductive Freedom Codification Act would repeal and remove laws on abortion, some of which were ruled unconstitutional by a Ramsey County district judge over the summer.

Pro-life and pro-choice advocates gather at the Capitol
Abortion rights advocates gather at the Minnesota State Capitol building to demonstrate during the Senate debate on the PRO Act on Jan. 27.
Nicole Neri for MPR News

Among them is a law that prohibits abortions after fetal viability, except under certain circumstances. While some legal experts say this law hasn’t been enforceable for decades, it’s not entirely clear cut. If this new law passes, it would be repealed and removed entirely.

“When providers are providing medical care, we want them to be able to provide the care that is appropriate and needed for patients and not have to check with lawyers before doing so,” said Sen. Erin Maye Quade, an Apple Valley DFLer and co-sponsor of the proposal.

“And by leaving unconstitutional laws on our books, it creates confusion. And it really has the chilling effect of preventing people from providing pregnancy care to pregnant people, including abortion care,” she continued.

Many Republican legislators and anti-abortion groups have argued that most Minnesotans support laws that limit abortions after viability, with exceptions for cases where the pregnant person’s life or health could be at risk.

“So certainly, conversations can be had about where exactly these [restrictions] should fall. But there are very few Minnesotans who believe that it makes sense to have unrestricted access to abortion for any reason, at any point in pregnancy,” Rep. Anne Neu Brindley, R-North Branch, said.

An MPR News/Star Tribune/KARE 11 poll from September found that more than half, or 55 percent of likely voters think abortion should be legal in most cases, with 30 percent saying it should be legal “in all cases.” Forty-one percent said it should be illegal in most cases.

Providers across the U.S. have said that even when there are exceptions, gestational limits can create barriers, putting providers in the position to determine what lifesaving conditions mean and how imminent the danger has to be.

“They either have to wait for a later gestational age to be delivered, or they have to wait for the mom to get really sick, or they have to wait for their baby to pass away inside,” Pilliod said.

“A lot of the really high-risk conditions, the lethal conditions, also confer a high risk of stillbirth. And so for some families, it's really tricky to navigate the timing of when and how they can meet their baby — if that's their goal.”

The maternal and fetal health specialist adds families may feel a stillbirth is a “worst-case scenario.”

Pilliod said it would be nearly impossible to create laws that can account for every single circumstance.

“You just cannot imagine all scenarios,” she said. “And I think that's the real tricky part of trying to identify each and every single scenario and to legislate it.”