At a clinic in Maryland, desperate patients arrive from all over the country to terminate their pregnancies.

For several years, Morgan Nuzzo, a nurse-midwife, and her friend and colleague Diane Horvath, an ob-gyn, talked about opening a clinic that would provide abortions in all trimesters of pregnancy. In May, 2022, the draft opinion of the Supreme Court ruling that overturned Roe v. Wade was leaked, infusing their plan with fresh urgency. The women had launched a GoFundMe campaign earlier that spring, noting that stand-alone clinics made up the majority of providers offering abortion after fifteen weeks, and that many of these had closed in recent years. Within weeks, Nuzzo and Horvath had raised more than a hundred thousand dollars; that summer, they started training employees for the new clinic, Partners in Abortion Care, in College Park, Maryland. They saw their first patient that October, and by the end of 2023 they had treated nearly five hundred. The youngest was eleven years old, the oldest fifty-three.

For nearly a year, the photographer Maggie Shannon visited the clinic regularly with her Canon R5 camera. The clinic’s staff allowed Shannon in because they wanted to help lift some of the secrecy that surrounds later abortions. “Even within our own community” of reproductive-medicine practitioners, Nuzzo said, “later abortion is still kind of stigmatized.” (Exact numbers are hard to come by, but only about a dozen clinics in the country provide abortions after twenty-four weeks; Partners in Abortion Care offers them up to thirty-four weeks.) In the end, Nuzzo and Horvath were astonished by how often patients agreed to be photographed, albeit with their faces concealed. Many of them wanted others to understand how the obstacles placed in the way of abortion care had pushed their procedures later and later.

Charlotte Moore, a patient-care technician, and Benedict Landgren, an ob-gyn, perform a uterine aspiration, in which suction is used to remove the fetus, placenta, or other membrane tissue. Landgren, who lives in Colorado, travels to Maryland every month or two to work at Partners in Abortion Care. “There are more clinicians than people think who are willing and able to do late-abortion care,” Landgren says. “The big barrier is that there aren’t enough clinics.”

Abortions in the second or third trimester are rare—the vast majority of abortions in the United States are performed in the first thirteen weeks of pregnancy—and when they occur the circumstances tend to be desperate. Horvath told me, “We know that when people decide they need an abortion they want to have it as soon as possible. Nobody is hanging out until they get to twenty or thirty weeks, saying, ‘Oh, I think maybe I’ll have my abortion now.’ ” A common scenario, she said, went like this: “You’re in, say, Texas—you’re pregnant and you need an abortion. You found out you were pregnant at eight weeks, which is a very usual time to find out. You arrange for child care—sixty per cent of people who have abortions are already parents—you get the money together, you’re going to have to travel out of state. You go to the next state that you can go to, and you find out you’re too far along for them. So now it’s going to be three times as much money. The cost goes up because the complexity of care goes up. If you travel four or five states over, how many days off is that, how many days of child care?”

On the second day, thin sticks of laminaria—sterilized, dried seaweed—are grabbed with forceps and placed in the cervix to aid in dilation.

Some people pursue late abortions with wanted pregnancies, having just found out their fetuses have grave anomalies. Such was the case for Kate Cox, a Texas woman whose fetus was discovered to have a lethal genetic condition, and whose plan to have an abortion in state was recently thwarted by the Texas Supreme Court. Some patients have just been given their own diagnoses—of cancer, for instance. “They want to receive chemotherapy, and they’re, like, ‘I can’t do this. I want to save my own life,’ ” Horvath explained. Other women, she added, have had to assimilate devastating new facts—“like the fact that the person who got you pregnant turns out to be an abuser who beats the shit out of you.” There are also patients who are either too young to have a regular menstrual cycle or old enough to be approaching menopause, and did not realize until very late that they are pregnant.

A staffer places a sheet between a patient and a clinician who is using a long needle to administer an injection that stops the fetal heartbeat.

Top left: Mifepristone, which is administered on the first day of the late-abortion process. The Supreme Court will soon decide whether to uphold a lower-court ruling making the medication less accessible. Nuzzo says that if the drug were unavailable it would likely “add another day to the whole process, extending the wait times for patients and limiting the clinic’s capacity.” Top right: A clinician prepares for a procedure. Bottom left: A patient on her third day of treatment. Bottom right: A speculum, which is used to examine the cervix.

One woman Shannon photographed, a thirty-six-year-old whom I’ll call Amanda, was seven months along when she came to the clinic. Several years earlier, Amanda had been given a diagnosis of polycystic ovary syndrome, and doctors had told her that the condition made it very unlikely that she could conceive without in-vitro fertilization. Because of the aftereffects of recent weight-loss surgery—nausea when she felt too full—she didn’t even consider that she might be pregnant until almost thirty weeks. When a home test came back positive, Amanda was floored. She told me that she’d never wanted kids. She’d been sexually abused as a child, struggled with depression, and was living from paycheck to paycheck; the man with whom she’d gotten pregnant had no interest in a baby. “I was very much not in control of my own life,” she said.

It took two weeks to find a place that could do the necessary ultrasound to determine precisely how far along Amanda was; to enlist a friend to accompany her from Maine, where she lived, to Maryland; and to get the time off from her job, which is in retail. A later abortion can resemble going into labor, and take up to three days. First, you must wait for the cervix to dilate. Amanda and her friend stayed at a nearby hotel and returned to the clinic each day. The clinic’s staff had spent hours connecting Amanda with organizations that help fund trips to other states for legal abortions. Such assistance is provided to nearly every patient. “Getting this procedure—it’s a huge fight for women right now,” Amanda told me.

—Margaret Talbot