This analysis contains data through June 2023; to find the most current abortion data, visit our Monthly Abortion Provision Study page.
In a post-Roe landscape, each state’s abortion policy reaches far beyond that state’s borders—in significant part because many people seeking abortion are proving highly motivated to travel to get the care they need in the face of abortion bans. Since June 2022, even as many states have banned abortion, many others have enacted measures to protect and expand abortion access. These measures have included repealing burdensome restrictions, dedicating funding for clinic and support infrastructure, enacting shield laws and enshrining abortion rights in their constitutions. Such policies are vitally important, given the increased demand for abortion in these states.
Estimates of the number of abortions provided within the formal US health care system from Guttmacher’s new Monthly Abortion Provision Study validate these efforts to shore up access in states that support abortion rights and highlight the need for more such protections. The study has documented substantial increases in abortions in many states bordering those where abortion has been banned, indicating that significant numbers of residents of states with abortion bans are traveling to neighboring states for abortion care. These findings indicate that all aspects of the abortion infrastructure—including facilities, funds and support networks—require sustained support to serve increased patient caseloads.
Background on the Estimates
The Monthly Abortion Provision Study provides estimates of the number of abortions provided within the formal US health care system, as of January 2023. The estimates are generated by a statistical model that combines data collected from monthly samples of providers with historical data on the caseload of every provider in the United States. Our estimates are accompanied by uncertainty intervals, which reflect the precision with which we can estimate change; estimates with wider uncertainty intervals should be interpreted with caution. While these new data illuminate critical state-level trends, they do not yet offer a comprehensive narrative of national abortion trends in 2023; in addition, they reflect seasonal fluctuations in abortion numbers that can occur even in the absence of significant policy changes.
We compare data from the Monthly Abortion Provider Study with 2020 data from the most recent Guttmacher Abortion Provider Census, which gathers comprehensive data on US national and state-level abortion incidence and care. To do so, we assume that abortion caseloads for January–June 2020 were equivalent to 50% of the abortion caseload for each state in that year. These comparisons do not speak directly to the effects of the Dobbs decision and the policy changes it precipitated, as the number of abortions had started to increase in many states in 2019 and 2020, and these trends may have continued; in addition, starting in the latter half of 2021, Texas Senate Bill 8 had substantial impacts on abortion access in that state and on travel to surrounding states.
Together, these sets of estimates help to increase our understanding of the overall picture of where abortion is being provided and how state-level provision has changed in recent years. The findings complement work by other research teams, including the #WeCount effort by the Society of Family Planning.
No Providers Offering Care in States That Ban Abortion
During January–June 2023, 13 states (Alabama, Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas and West Virginia) had total bans in effect, and legal uncertainty had forced providers to stop offering care in Wisconsin. In these 14 states, abortions in the formal health care system were all but impossible to obtain by 2023. In comparison, in 2020, more than 113,000 abortions (about 12% of all US abortions that year) were provided in these same states—a data point that quantifies the magnitude of the disruption and harm being inflicted by bans.
Since abortion became unavailable in these states, many people were only able to get care traveling out of state for an abortion (which often entails significant financial, logistical and emotional hardship) or by self-managing their abortion outside the formal health care system (for instance by ordering abortion pills online). A small number of people in ban states may have been able to access abortion care under the limited exceptions; for example, there were 14 abortions reported in Texas the first three months of 2023, compared with an average of more than 4,800 per month in 2020. Such exceptions leave most pregnant people unable to get the abortion they need, and some people have been forced to carry their pregnancy to term.
Big Increases in Many States Where Providers Can Offer Care
Prior to Dobbs, abortion had been on the rise nationally, increasing 8% between 2017 and 2020, and some data suggest that this increase continued into 2022. The Monthly Abortion Provision Study shows that many states that are in close proximity to states that banned abortion saw much sharper increases in monthly abortion numbers than would likely be explained by a continuation of earlier trends. Much of the increase is likely attributable to out-of-state patients who were forced to travel for abortion care, reflecting the reality that states that ban abortion are neglecting the health care needs of their residents.
Along similar lines, a number of states that enacted measures post-Roe to protect and expand abortion access saw increases in abortion. Such increases may reflect a combination of factors, including residents benefiting from improved access and people traveling from other states for care, potentially because of bans or other restrictions in their home state.
The following changes are examples of major increases in abortion between 2020 and 2023 in states bordering ban states, many of which also enacted measures to protect abortion access since Roe was overturned:
- In Colorado (a state that has enacted several measures protecting abortion), abortions increased by 89% (90% uncertainty interval of 80–98%), or 5,990 abortions, compared with estimates in a comparable period in 2020. By contrast, abortions increased 8% in the previous three-year period between 2017 and 2020.
- In Illinois (a state that has enacted several protective measures), the number of abortions increased 69% (90% UI 65–74%), an increase of 18,300 abortions from the comparable period in 2020. By comparison, the increase observed between 2017 and 2020 was 25%.
- In New Mexico (a state that has enacted several protective measures), abortion numbers increased by 220% (90% UI 210–229%), an increase of 6,480 abortions from 2020. A 27% increase was observed between 2017 and 2020.
- In South Carolina (which borders Georgia, where an early gestational abortion ban is in effect), abortion incidence increased by 124% (90% UI 124–124%), an increase of 3,270 abortions from 2020. A 4% increase was observed between 2017 and 2020. However, abortion care in South Carolina will now be severely limited by a six-week abortion ban that went into effect on August 23, 2023.
- In Washington (a state that has enacted several protective measures), abortion increased by 36% (90% UI 31–41%), an increase of 3,230 abortions from 2020. Abortions increased 1% between 2017 and 2020.
Implications for the US Abortion Debate
Initial findings from the Monthly Abortion Provision Study paint a vivid picture of how supportive and restrictive abortion policies have contributed to access in each state between 2020 and 2023—and they indicate that large numbers of abortion patients are seeking care in other states. Although no one should have to travel out of state to get necessary health care in the first place, the fact that pregnant people are able to circumvent unjust restrictions on this scale is a testament to the resiliency of those who need abortion care. It reflects their ability to exercise bodily autonomy and self-determination, despite attempts by their state governments to coerce them into continuing an unwanted pregnancy.
However, not everyone who needs an abortion is able to take on interstate travel, nor is it simple, even for those who can. In addition to paying for care, people traveling for abortion services have to contend with travel logistics like transportation, lodging and meals, and may also have to make childcare arrangements or deal with lost wages. Such challenges are likely to increase as anti-abortion states escalate their attempts to interfere with out-of-state travel for abortion and as more states ban or severely restrict abortion, creating larger regional clusters of states with bans and thus increasing the likelihood that patients will have to cross multiple state lines to get care. Such regional clustering likely amplifies the impact of abortion bans; a 12-week ban in North Carolina, for example, will affect the ability of people throughout the Southeast to access early abortion care.
The harms inflicted by this web of bans and restrictions do not affect everyone equally: Research has long shown that abortion bans and restrictions have especially harsh impacts on those with the fewest resources who are already marginalized by the health care system, including people living with low incomes, Black and Brown communities and other people of color, young people, LGBTQ people and those in rural communities.
Even if protective states are unable to fully replace the service provision eliminated by ban states, their role is vital—and yet it’s fragile. The ability to provide abortion care to people who are unable to obtain it in their home state is highly dependent on abortion funds, individual providers and clinic staff, practical support networks and others—and these groups’ efforts are likely not sustainable unless they receive more resources. These nongovernmental solutions should not be a substitute for sound public policy that makes timely and affordable abortion care available to people in their own communities.
Finally, while current efforts by Guttmacher and others in the field are providing important data on the impact of abortion bans, they do not currently include estimates of self-managed abortion, which are obtained outside of the formal health care system. While people have been self-managing their abortions with pills for years in the United States, it has become an increasingly important option post-Dobbs. Some pregnant people prefer to self-manage their abortion, while others self-manage because they are unable to access clinician-provided care. Regardless of the reason, self-managed abortion is an important facet of abortion care deserving of study and support. Guttmacher research efforts are currently underway to estimate the scope of self-managed abortions in the United States.
Conclusion
Americans have made it clear that policymakers' positions on abortion rights are front of mind. As evidence of the damage done by the Supreme Court’s decision to overturn Roe v. Wade mounts, the public pressure on leaders to act in service of our rights and health care needs will likely continue to grow. Everyone deserves to realize their rights and access the resources they need to achieve sexual and reproductive health, no matter their state.
From state policy solutions, executive actions and Congressional support for the Women’s Health Protection Act and the EACH Act, strong public policies are one critical step on our path forward.