An Abortion Provider Debunks Trump’s Debate Talking Points

One of Donald Trump’s biggest weaknesses this presidential election is his anti-abortion stance, particularly the role he played (and routinely brags about) in the overturning of Roe v. Wade. During Tuesday’s presidential debate, he attempted to neutralize that weakness by painting Democrats as the extreme party when it comes to abortion rights, repeating falsehoods about patients seeking the procedure “in the ninth month” of pregnancy and having “post-birth abortions.”

This inflammatory rhetoric hinges on voters’ unfamiliarity with abortion care later in pregnancy. Despite what 67 percent of Americans think, only a small percentage of abortions occur after 21 weeks of gestation and they become even rarer further into pregnancy. Providers say these later terminations tend to be medically complex cases that are logistically and financially challenging for many patients.

On Wednesday morning, I caught up with Dr. Matthew Reeves, an abortion provider with two decades of experience and the founder of DuPont Clinic in Washington, D.C., one of a handful of clinics across the country that offer abortions later in pregnancy, about the misinformation Trump spread in the debate and what the public gets wrong about second- and third-trimester abortions. “Trump went off the deep end,” Reeves tells me. “He just can’t pull back from going to illogical extremes.”

Donald Trump said last night that women in this country have abortions in the ninth month of pregnancy. Practically, does any state allow that?

Abortion does not extend to after birth. As the moderator said, there are laws about that already. It’s worth starting with the numbers. As of a few years ago, there were roughly 6 million births and a million abortions a year in the U.S. The number of abortions in the third trimester is in the 1,000 range, maybe less. So you’re talking about a fraction of a percent of all pregnancies, and they all have very valid reasons.

No one approaches this lightly. Trump would like to paint a picture of people just walking into labor and delivery at nine months and saying, “I want an abortion!” That doesn’t happen. It’s not something you can just decide, walk somewhere, and get right away. It’s more specialized. Someone has to refer you; it’s an involved process. It’s not simple, and it’s not available everywhere.

Can you describe what kinds of cases you have seen in which patients have abortions later in pregnancy? What are the circumstances?

It can range from fetal anomalies to maternal health conditions. There’s a whole range of uncommon situations that do occur that would necessitate an abortion. Then there are cases with preteens and teenagers who are pregnant, often by rape or incest. We’ve even seen patients who had IVF coming in for abortions. These are families that are desperate to have a child, and they’ve done everything they could to have one but there’s something wrong with the pregnancy. It’s a good marker of how seriously families take this. There’s a whole host of reasons folks seek an abortion in the third trimester, and none of them are casual decisions.

Are abortions later in pregnancy widely available in the country? Were they before Dobbs?

Before Dobbs, it was very hard to get an abortion in the third trimester and it was really only available in a handful of locations in the country. But since Dobbs, the need has actually increased. Patients are being pushed later in pregnancy because there is no access in their own states and it’s so hard to get an abortion earlier.

What are some of the barriers to accessing this care? Can you talk about the logistical challenges, the financial cost?

Later abortions take longer. Abortion in the first trimester is basically a procedure that lasts five minutes. It is most comparable to something like an IUD insertion. Once you get into the second trimester, it’s typically two days, and in the third trimester, it’s often three days. It’s naturally more expensive to provide that care. Prices vary depending on the gestational age, but typically, once you get into the third trimester, you’re looking at something like $10,000. And because it’s not available everywhere, patients have to travel, often large distances. Consequently, you need a hotel or some place to stay. Many patients have children, so they need to deal with child care. It all adds up.

Back in 2019, former Virginia governor Ralph Northam, a neurosurgeon, said, “There may be a fetus that’s nonviable. So in this particular example, if a mother is in labor, I can tell you exactly what would happen. The infant would be delivered. The infant would be kept comfortable. The infant would be resuscitated if that’s what the mother and the family desired. And then a discussion would ensue between the physicians and the mother.” Trump repeatedly refers to these comments to argue that “post-birth abortions” occur in this country (and last night, he incorrectly attributed them to the “West Virginia governor”). What do you make of his interpretation? 

I was totally baffled. That’s just not a thing. First, infanticide is illegal. And when we say “abortion” in common discourse in the U.S., what it often means is an induced abortion. But abortion in itself is a generic medical term that means “ending a pregnancy without a live birth.” A miscarriage is a spontaneous abortion. There’s no such thing as an abortion after a pregnancy ends because the abortion is the end of pregnancy. It’s like saying you’re going out the door after you’re out the door. It’s dumb.

How does misinformation like this about abortions later in pregnancy affect your work? How does it impact patients?

The stigma of “abortion is wrong, particularly later abortion,” just makes a hard situation even harder for patients. In the clinic, it certainly makes us worry because this sort of vitriol leads to more violence and more crazy acts by domestic terrorists. We have to just do a lot more for security than any other medical practice has to do. It wears on the staff to constantly be on our guard.

Additionally, after Dobbs, the lack of access and the fear created by the laws make it harder for patients to find abortion clinics. A lot of these laws are designed to stifle free speech and free communication between patients and their doctors. Doctors are afraid to talk about abortion, and that’s particularly detrimental. A lot of these laws put obstetrician-gynecologists in the horrible position of having to choose between malpractice and breaking a law. That’s just a horrible place for the government to put medical providers in.

For example, if there’s a miscarriage in progress at 18 weeks, where the patient is bleeding and has an infection but there’s still a fetal heart rate, it would be an abortion according to some state law. The right medical answer is pretty clear: You need to evacuate the uterus, which means performing an abortion. But often, because of these laws, providers feel that their hands are tied and that they can’t do the right thing.

Trump did mention last night that he supports exceptions for rape, incest, and the life of the pregnant person. What do you make of that?

This life exception is fraudulent; it’s just totally misleading. You can’t wait until someone is on the verge of death to act. That is what happened in Ireland with Savita Halappanavar, right? She had a ruptured membrane and got an infection, but the fetus’s heart didn’t stop. They acted when she was on the verge of death, and she died. You need to act sooner. By the time you can see that someone is going to die, it is too late.

These cases make it clear that lawmakers cannot account for all pregnancy scenarios when they try to restrict abortion care.

If anyone could distill obstetrics down to a couple pages of a law, all of us obstetrician-gynecologists would be out of work. The reason we have a job is that it is complex and there aren’t simple answers. Trying to legislate care just creates bad medicine. There’s no other field where that has been politicized so much.

This interview has been edited and condensed for length and clarity.

The Cut offers an online tool you can use to search by Zip Code for professional providers, including clinics, hospitals, and independent OB/GYNs, as well as for abortion funds, transportation options, and information for remote resources like receiving the abortion pill by mail. For legal guidance, contact Repro Legal Helpline at 844-868-2812 or the Abortion Defense Network.