Use of medication abortion in the formal US health care system has risen substantially from 53% of all abortions in 2020 to 63% in 2023. In the first full calendar year following the US Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision, approximately 642,700 medication abortions took place within the health care system, according to new data from the Guttmacher Institute’s Monthly Abortion Provision Study.
The findings include national and state-level abortion data for all of 2023, comparisons with 2020 abortion levels, updated data on interstate travel for abortion care and data on the proportion of all abortions that were medication abortions. Two accompanying policy analyses (one on the medication abortion findings, the other on national abortion numbers), also released today, provide additional context.
“Improved access to medication abortion is a positive development, but it is not a panacea,” says Rachel Jones, Guttmacher principal research scientist. “As abortion restrictions proliferate post-Dobbs, medication abortion may be the most viable option—or the only option—for some people, even if they would have preferred in-person procedural care. Thus, it is important to keep in mind that an increase in medication abortion does not necessarily indicate that all people using this method prefer it. Every person deserves access to abortion care on their terms and according to their needs and preferences—whether that care is via telemedicine, an in-person visit or outside the formal health care system.”
The study found that, in 2023, there were an estimated 1,026,690 abortions in the formal US health care system and a rate of 15.7 abortions per 1,000 women of reproductive age. This represents a 10% increase in the number of abortions from 2020 and is the highest number and rate of abortions measured in the United States in more than a decade.
This increase was close to universal—almost every state without a total abortion ban saw an increase over 2020 totals in the number of abortions provided. The 10% increase at the national level in many ways understates the degree to which health systems, providers and support networks have had to scale up care in certain states: States without total bans experienced a 25% increase in abortions in 2023 compared with 2020. The sharpest increases were seen in states bordering ban states, where abortions increased by 37% from 2020 to 2023.
On March 26, the Supreme Court will hear oral arguments in a case that could dramatically affect access to mifepristone, one of the two drugs used in the most common medication abortion regimen. “As our latest data emphasize, more than three out of five abortion patients in the United States use medication abortion. Reinstating outdated and medically unnecessary restrictions on the provision of mifepristone would negatively impact people’s lives and decrease abortion access across the country,” explains Guttmacher director of federal policy, Amy Friedrich-Karnik.
Since the US Food and Drug Administration (FDA) approved the use of mifepristone in 2000, use of medication abortion has been increasing steadily. In 2021, the FDA lifted medically unnecessary in-person dispensing requirements for mifepristone, which expanded access to medication abortion by allowing it to be mailed directly to patients. Because of its relative accessibility, abortion opponents have escalated their attacks on medication abortion.
About the Study
The Monthly Abortion Provision Study produces monthly estimates of the number of abortions provided within the formal health care system in the United States. These include abortions provided at brick-and-mortar health care facilities (such as clinics or doctor’s offices) as well as medication abortions provided via telehealth and virtual providers located in the United States. As of the January 2024 release, counts for all months include telehealth abortions provided under “shield laws” to patients in states where abortion is legal but telehealth provision of abortion is banned. Abortions are counted as having been provided in the state in which a patient had a procedure or where pills were dispensed.
The study’s estimates are generated by a statistical model that combines data from samples of providers with historical data on the caseload of every US provider. As more data are collected each month, estimates for past months become more precise. Each estimate is expressed as an uncertainty interval, which quantifies our confidence that the true value falls within a particular range.
The Monthly Abortion Provision Study interactive resource includes monthly data on the number of abortions by state for January–December 2023 and is designed to help measure the impact of abortion policies on state-level abortion incidence and trends. The interactive graphics also show the estimated number and proportion of out-of-state abortion patients for every state in 2023 and the change in the proportion of abortions provided in each state to patients traveling from out of state between 2020 and 2023.
About the Guttmacher Institute
The Guttmacher Institute is a leading research and policy organization committed to advancing sexual and reproductive health and rights worldwide. The Institute has a long history of tracking abortion incidence in the United States and globally. Every three years since 1974, the Guttmacher Institute has conducted the Abortion Provider Census of all known facilities providing abortion in the United States to collect information about service provision, including total number of abortions.
Acknowledgments
The Monthly Abortion Provision Study is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Office of Research on Women’s Health, and the Office of Behavioral and Social Sciences Research of the National Institutes of Health, under award number R61HD112921. The content is the sole responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.