Late abortions are rare. The US just lost a clinic that offered the procedure for over 50 years

To fellow travelers, Hannah Brehm likely looked like she was taking a belated babymoon well into her third trimester.

But she and her husband had received a crushing diagnosis: Their baby’s brain was not developing properly, upending their wanted pregnancy. Medical experts warned moving forward would likely mean her son would know only pain and suffering. The Minnesota couple wasn’t going to take that chance.

Instead, they went to Colorado, where for decades the Boulder Abortion Clinic served as a resource for women who looked to terminate their pregnancies in the second or third trimester because of medical reasons, like Brehm, or other circumstances.

After more than 50 years, that clinic quietly closed last month, leaving the U.S. with just a handful that offer abortions after 28 weeks into pregnancy - many on a case-by-case basis.

The 87-year-old clinic founder, Dr. Warren Hern, says he is deeply upset: "It became impossible to continue, but closing is one of the most painful decisions of my life."

Anti-abortion advocates have celebrated the closure, calling it a step forward in protecting mothers and unborn children. While the overwhelming majority of abortions take place in the first trimester, former patients and reproductive rights advocates worry about the impact of losing an already narrow resource.

"Chances are it's not gonna happen to you. And I hope it doesn't happen to someone else that you love, but it is happening," Brehm said, reflecting on her experience in 2022.

Federal data shows just 1% of abortions come after 21 weeks of pregnancy, but experts believe that number is higher because some states, including California, don’t give the feds their abortion statistics.

The reasons for late abortions vary. Some diagnoses like anatomy abnormalities or genetic disorders can’t happen until after 20 weeks or later into pregnancy. Other women may not find out they’re pregnant until after the first trimester. Millions of women live in a state with a strict abortion ban.

Sarah Watkins traveled from Georgia to the Boulder clinic in 2019 just before 25 weeks into her pregnancy after learning her baby had a condition called trisomy 18, an extra chromosome that made it likely the baby would die in utero or shortly after birth. A genetic blood screening at 10 weeks previously dismissed chances of the condition, but a detailed ultrasound in the second trimester proved otherwise.

"You can do everything right, by the book, but you still can't find out certain things until that ultrasound at 20 weeks and sometimes even later," she said. "And as a mom, I did not want her to feel a single moment of hurt or suffering or pain or discomfort. That's why I made the decision.”

Watkins described the medical care she received at the Hern’s clinic attentive and caring. Nevertheless, she said traveling to a place with multiple layers of bulletproof glass and a throng of protesters was a traumatic experience.

For years, Hern was the only provider in the U.S. to offer later abortions, starting in 1973 and developing specialized techniques and even innovating certain tools to ensure better health outcomes. But offering abortions late in pregnancy came with risks.

He and his medical team received constant death threats. Someone shot through the windows of the clinic five times in 1988. Five of Hern’s colleagues who offered similar services were assassinated throughout his career, including the 2009 slaying of Dr. George Tiller in Kansas.

When Hern announced the clinic’s closure in late April, the anti-abortion group Susan B. Anthony Pro-Life America declared the news as a "VICTORY" in a social media post.

Hern said the work was always worth it. He recalled one of his first patients who couldn’t believe cleanliness of his operating room; she previously had an illegal abortion that left her humiliated and frightened.

"She looked up at me and said ‘Please, don’t ever stop doing this,'” Hern said. "So I didn’t. Until now."

In the end, financial issues made it almost impossible to operate the clinic. Hern said patients increasingly were having trouble paying for the procedure, which hovers around $10,000 and is often not covered by insurance. Longtime personal donors were also dwindling.

Hern worked with physicians over the decades, hopeful that one day they would take over his clinic, but that never worked out.

"I had to make a decision really, you know, sort of on the basis of the situation at the moment that we couldn't continue,” he said. “It was very, very painful. I see this as my personal failure."

According to the Later Abortion Initiative by Ibis Reproductive Health, fewer than 20 clinics provide abortions after 24 weeks into pregnancy in the U.S. - though that number isn’t considered comprehensive and excludes hospitals and a handful of other clinics for security reasons.

Currently, the group lists three clinics - in New Mexico, Maryland and Washington, D.C. - that provide services after 28 weeks. Five others - in Maryland, New Jersey, New York, Oregon and Washington state - will consider patients depending on physician recommendations or fetal and maternal conditions.

"I think Dr. Hern has been the torchbearer for abortion leaders in pregnancy," said Jane Armstrong, a licensed therapist in Texas who now helps support families who have terminated pregnancies for medical reasons. She ended her own pregnancy around 21 weeks in 2021.

"Who will pick up the mantle? We really do need a new torchbearer right now."

A dozen states have bans on abortion at all stages of pregnancy and four more have bans that kick in after about six weeks. Abortion fund organizations, which help people arrange and pay abortions, say the bans mean a higher demand for later abortions. When people travel, it often takes more time to make appointments, gather the money needed and to catch a flight or take a drive hundreds of miles away.

"Every time a clinic closes, it does impact everybody and what kinds of care they give," said Anna Rupani, executive director of Fund Texas Choice.

Shortly after the nation’s highest court overturned Roe v. Wade in 2022, an all-trimester abortion clinic opened in Maryland - a partnership between certified nurse-midwife Morgan Nuzzo and Dr. Diane Horvath, an OB-GYN who specializes in complex family planning.

They said they’re worried about many things when it comes to reproductive rights, including the Trump administration's move to curtail prosecutions against people accused of blocking access to abortion clinics and reproductive health centers. But they’re also buoyed by the consistent overwhelming number of applications from providers whenever they post a position, and said that the number of clinics that offer later abortions has gone up since Roe was overturned.

"This type of care is still available,” Horvath said. "It's more rare than it was a couple weeks ago, but we want to say loud and proud that our doors are still open and there are other places still open."