10 Points to Consider When Engaging with Policy Debates Around Abortion

Abortion rights and access continue to be at the forefront of US policy conversations at the state and federal levels in 2024. Two years after the US Supreme Court overturned the constitutional right to abortion in Dobbs v. Jackson Women’s Health Organization, that decision’s fallout is still being felt across the nation in myriad ways.

Misinformation about abortion and related reproductive health topics is widespread, which is why it is critical for anyone covering abortion-related issues or otherwise engaging with these debates to have reliable information at their fingertips. Here are 10 key points to consider when engaging with ongoing US abortion policy debates.

1. More than two years after the US Supreme Court overturned Roe v. Wade, the abortion access landscape in the country has shifted dramatically.

• 13 states are enforcing total abortion bans with very limited exceptions.
• 28 additional states have abortion bans based on gestational duration as of October 8—eight states ban abortion at or before 18 weeks’ gestation and 20 states ban abortion at some point after 18 weeks. See Guttmacher’s interactive map for abortion policies currently in effect in each state.
• Despite these bans, Guttmacher’s Monthly Abortion Provision Study estimated that clinicians provided 1,033,000 abortions nationally in 2023.
• As of our May 2024 analysis, this was an 11% increase from 2020 (the latest year of data before Roe was overturned) and the highest number measured in the United States in over a decade.
• From 2020 to March 2024, the number of brick-and-mortar clinics providing abortion care in the United States declined by 5%, meaning that an increased number of patients have been served by a smaller number of clinics over time. Online-only, or virtual, clinics may have alleviated some of this increased demand.
• People who are denied abortion access in their state of residence must either overcome the enormous obstacles related to traveling out of state, navigate a self-managed abortion or continue a pregnancy against their will.

2. One of the major ways that abortion care has shifted in recent years is increased access to and use of medication abortion.

• Medication abortion is a safe and effective option, constituting 63% of clinician-provided abortions in 2023, up from 53% in 2020. The most common regimen used by US providers involves two drugs, mifepristone and misoprostol, and has been available in clinical settings since the US Food and Drug Administration (FDA) approved mifepristone in 2000.
• Outside of clinical settings, people can also safely self-manage an abortion using these pills, typically acquired from online-only providers or community networks. Using misoprostol alone is also a regimen supported by leading professional and medical organizations in the United States and around the world.
• One reason for the increase in medication abortions is broader availability of telehealth provision, which expanded considerably after the FDA fully lifted medically unnecessary in-person dispensing requirements for mifepristone in January 2023.
• While the US Supreme Court dismissed the baseless case that could have limited access to mifepristone (FDA v. Alliance for Hippocratic Medicine) in June 2024, the anti-abortion movement will continue trying to restrict access to this critical drug.

3. The proliferation of state abortion bans means more people are forced to travel out of state for abortion care, which often comes with significant financial and logistical costs.

• Data from Guttmacher’s Monthly Abortion Provision Study show more than 168,000 people crossed state lines in 2023 to get an abortion from a provider in another state.
• The latest data from this study also confirm people are traveling farther distances to obtain an abortion post-Dobbs. For example, in 2023, 3,400 Louisiana residents traveled across multiple state lines to access care in states like Florida, Georgia and Illinois.
• The study also finds the states that share a border with states that have a total abortion ban are taking on the majority of patients forced to travel from their home state. Our online dashboard includes interactive tools to visualize inflows and outflows of abortion patients in every state: Increases in the number of abortions from 2020 to 2023 were particularly sharp in Illinois (72% increase), New Mexico (257% increase) and Virginia (77% increase).
• The average cost of abortion care ranges from $500 to $2,000 or more later in pregnancy, and these are usually out-of-pocket costs for those traveling across state lines. Travel and logistical costs, on top of a host of other reasons, make travel difficult or untenable for many people.
• Abortion funds play a critical role in alleviating some of the financial costs that come with seeking an abortion, although many organizations have raised the alarm about struggling to support the current level of patient demand.

4. Abortion is needed throughout pregnancy, but this care is often difficult to access because of bans and stigma.

• Most abortions occur in the first trimester. Centers for Disease Control and Prevention (CDC) data for 2021 show that 81% of US abortions took place at or before nine weeks’ gestation and an additional 13% were at 10–13 weeks.
• Abortions later in pregnancy (those that happen after 21 weeks since the last menstrual period) are less common than at earlier gestations, but still occur in meaningful numbers. According to CDC data, fewer than 1% of abortions happen at 21 weeks or later, and this proportion gets much smaller at later gestational durations.
• Only nine states and the District of Columbia legally allow abortion throughout pregnancy, although that does not mean abortion care is actually available at later gestations. On top of legal restrictions and limited providers, anyone seeking an abortion later in pregnancy has to contend with the steep financial cost and likely out-of-state travel.
• Research indicates two broad “pathways” for those needing abortion care later in pregnancy: they learned new information (e.g., pregnancy discovered late, fetal anomaly) or experienced obstacles earlier in pregnancy (e.g., high cost, restrictions like total abortion bans or insurance coverage bans).
• Reputable medical groups affirm that the term “late-term abortion” has no medical meaning and should not be used. The AP Stylebook suggests using the term “abortion later in pregnancy” or, even more specifically, “abortion after [number] weeks.” “Post-birth abortion” is an especially ugly false claim and it does not occur or reflect the realities of medical care.
• Patients who obtain abortions later in pregnancy and providers offering this care are often vilified and targeted by anti-abortion activists, making it especially important to use medically accurate language and avoid false narratives and inflammatory rhetoric.

5. Exceptions to abortion bans rarely work in practice and are a thinly veiled attempt to make draconian laws look less cruel.

• Every state enforcing a total abortion ban has an exception if the pregnancy is a threat to the pregnant person’s life; fewer states have exceptions based on health risks.
• However, these exceptions are often meaningless in practice. Testimonies from lawsuits filed by people denied or delayed in receiving abortion care in life-threatening situations in Idaho, Oklahoma, Tennessee and Texas (states with total abortion bans) highlight the harrowing experience of being denied care despite meeting the state’s criteria. Stories from providers, along with the preventable deaths of at least two women in Georgia, also highlight the inhumanity of these bans.
• Rape and incest exceptions are rarer, but when in place, they also do not protect survivors. Patients must jump through additional, often insurmountable, hoops to get care, such as reporting the assault to law enforcement within a limited time period.
• Focusing on exceptions also leads to framing “good” versus “bad” reasons for obtaining an abortion.

6. Abortion is a common life experience shared by people holding a range of gender identities.

• One in four US women of reproductive age will have an abortion by age 45, using the 2020 abortion rate. The overall number of abortions has increased since 2020, and the lifetime incidence proportion also may have increased since that year.
• Not everyone who needs an abortion identifies as a woman; using gender-inclusive language when possible accurately reflects the diversity of people who obtain care.
• Guttmacher data from 2021–2022 show that LGBTQ+ people, including individuals who do not identify as women, make up as many as 16% of US abortion patients.
• This data suggest that LGBTQ+ individuals are able to obtain an abortion, while also facing unique barriers—like discrimination and lack of inclusive health care—that can make it difficult or impossible to access abortion care.

7. Abortion bans and restrictions disproportionately impact those with the fewest resources, who are already struggling to access health care and face overlapping systems of oppression.

• This includes Black people and other people of color, those with low incomes, LGBTQ+ people, young people, those in rural areas and people with disabilities.
• The majority of people who get an abortion are already struggling to make ends meet: 71% of abortion patients have low incomes and the majority are already parents.
• People of color account for most individuals accessing clinical abortion care. Specifically, 30% identify as Latinx (30%), 29% as Black, 4% as Asian and 7% as another non-White racial group or more than one race.
• Guttmacher data from a 2021–2022 survey found that adolescent abortion patients were more likely than adult abortion patients to experience delays in accessing care due to a lack of information and transportation barriers. Specifically, 70% of adolescent respondents wanted to have their abortion sooner than they were able to, and these barriers have only become more significant since Roe was overturned.
• Guttmacher data also show that foreign-born abortion patients in the United States face more financial and information barriers than US-born patients, leading to increased obstacles to obtaining abortion care. Also, fewer foreign-born patients have health insurance than US-born patients.
• States where abortion is more restricted have fewer maternal health care providers and higher rates of both maternal and infant deaths than states where abortion is available. These inequities disproportionately harm Black and Indigenous communities.

8. Policymakers opposed to reproductive freedom never intended to stop after overturning Roe—they are set on complete governmental control over reproductive health and decision-making by a variety of means.

• A national abortion ban remains the anti-abortion movement’s main priority, whether through passing federal legislation, enforcing the Comstock Act or other means, including via incremental steps like a 15-week national ban.
• Restricting people’s freedom to travel and cross state lines is another area anti-abortion policymakers have focused on. In 2024, four states introduced and one (Tennessee) enacted legislation that criminalizes non-parent adults who support a minor’s travel out of state for an abortion. Several counties in Texas passed ordinances to try to limit people’s ability to travel for care.
• Another route of attack on bodily autonomy has been gender-affirming care bans, which surged in 2023. More than half of US states currently ban gender-affirming care, mainly for those younger than 18, but some extend to age 21. Anti-transgender and anti-abortion policies often originate from the same activists, organizations and policymakers. They also tend to use similar strategies, such as targeting youth and creating a hostile legal environment for providers.
• The Alabama Supreme Court ruled in February 2024 that embryos are considered children under the state’s Wrongful Death of a Minor law, briefly halting in vitro fertilization (IVF) treatments in the state. The ruling received widespread attention, as it highlights another goal of the anti-abortion movement to enshrine fetal personhood in laws and policies. This outcome could lead to further bans on abortion, plus IVF and methods of contraception (e.g., emergency contraception and IUDs) that anti-abortion advocates have wrongly asserted are also abortifacients.

9. Emerging evidence shows that abortion bans and restrictions are harming reproductive health in numerous ways.

• An increasing body of evidence is emerging that illustrates the myriad harms caused and exacerbated by the Dobbs decision across a broad range of reproductive health outcomes.
• Data from surveys in four states before and after Dobbs show that women aged 18–44 experienced increased barriers to accessing contraceptives and reported lower quality contraceptive care a year after the Dobbs decision.
• In a national survey of more than 550 obstetrician-gynecologists, 20% of respondents felt constraints on managing miscarriages and pregnancy-related emergencies post-Dobbs. In states with total abortion bans, the proportion was 40%. The majority of all respondents believed their ability to manage pregnancy-related emergencies had worsened and that racial inequities in maternal health increased following Dobbs.
• In states with total abortion bans, medical students must seek out-of-state abortion training. As students consider abortion legality when choosing residency programs, the distribution of new health care professionals around the country could shift, along with the sexual and reproductive health care landscape more broadly.

10. Federal and state policymakers have the tools to put an end to abortion bans and restrictions and support people’s access to the abortion care they need.

• The Abortion Justice Act includes provisions that support the full spectrum of reproductive health care, including abortion services.
• The Equal Access to Abortion Coverage in Health Insurance (EACH) Act would ensure insurance coverage for abortion—no matter how much someone earns, their type of insurance or where they live.
• The Health Equity and Access under the Law (HEAL) for Immigrant Families Act would expand immigrants’ eligibility for health insurance coverage and access to care, including sexual and reproductive health services.
• State-level policymakers must pass legislation that expands and protects access to abortion, including enshrining the right to abortion in a state constitution and implementing policies to expand access to abortion care for all.
• Voters will also weigh in on abortion rights and access in the November 2024 election through state ballot measures in 10 states that would protect and expand abortion rights.