The Number of Brick-and-Mortar Abortion Clinics Drops, as US Abortion Rate Rises: New Data Underscore the Need for Policies that Support Providers

Since the Dobbs v. Jackson Women’s Health Organization decision eliminated the federal right to abortion in June 2022, the act of getting an abortion has changed radically for pregnant people in many parts of the United States—most crucially for people in states that have banned or severely restricted abortion. People are increasingly obtaining care from online-only clinics, self-managing their abortion and seeking care across state lines. Despite so many changes, brick-and-mortar facilities still account for more than 80% of clinician-provided abortions. New Guttmacher data reveal shifts in the number and distribution of brick-and-mortar clinics in recent years, shedding light on an important indicator of abortion access in the United States.

The number of brick-and-mortar clinics providing abortion care in the United States declined by 5%—a net loss of 42 clinics—between 2020 and March 2024. During this period, much of the decrease in clinic numbers was due to the cessation of abortion care in the 14 states with total abortion bans. By contrast, the number of abortion clinics increased by an average of 3% where abortion is not completely banned. During a similar period (2020–2023), clinician-provided abortions jumped 11% to the highest rate measured in the United States in more than a decade, revealing widespread increases in the need for care.

This analysis describes these changes in the number and distribution of brick-and-mortar abortion clinics while pointing to ways the state policy landscape impact provision. It draws on the Guttmacher Institute’s database of US facilities known to provide abortion care (see Methodology Note below for more information) to present the most up-to-date counts of clinics operating nationally, in states grouped by whether they neighbor states with total abortion bans, as well as in individual states. These data highlight the importance of the protective policies that have been enacted in many states and emphasize the need for state lawmakers to continue to actively support providers and protect abortion access.

Changes in Numbers of Clinics

The nationwide 5% decline in brick-and-mortar abortion clinics took the number of such facilities from 807 in 2020 to 765 in March 2024 (Table 1). This net loss of 42 clinics reflects the total absence of abortion providers in the 14 states that have completely banned abortion, as well as additional changes (both increases and decreases) in facility numbers in the remaining states and the District of Columbia.

TABLE 1. Number of clinics providing abortions, by state abortion ban status, as of March 2024

States with total abortion bans had 63 abortion clinics, collectively, before the Dobbs decision, and all of these were forced to stop providing abortions. Some of these clinics relocated to states where some abortions remain legal, while others closed or limited care to services other than abortion. Because these states had highly restrictive abortion policies that limited clinic numbers even prior to Dobbs, the closures did not represent a substantial change in the total number of US abortion clinics: In 2020, the 63 clinics in states that now ban abortion accounted for only 8% of all abortion clinics nationwide.

In the remaining 36 states and DC, where abortion was not completely banned, there were 21 more clinics operating in March 2024 than in 2020, a 3% increase. Of these 37 jurisdictions, 14 experienced a net gain in the number of clinics, 12 states and DC experienced a net decrease, and 10 experienced no net change.

States’ Capacity to Meet Patient Needs

The changes in clinic numbers occurred during a period when clinician-provided abortions were on the rise, according to data from Guttmacher’s Monthly Abortion Provision Study. Between 2020 and 2023—the two most recent time periods for which there are full-year data on abortion incidence—abortions increased by 11% to a national total of 1,037,000. In 2023, 17% of these abortions were to people traveling out of state for care, compared with only 9% in 2020. Because many people forced to cross state lines for care go to the nearest state where services are available, increases in patients tended to be highest for clinics in states that share a border with states that have total bans or early gestational bans. These trends have placed new strains on abortion providers in many parts of the country.

Abortions in States that Border Ban States

All states that do not completely ban abortion but that share a border with those that do saw increases in abortion caseloads between 2020 and 2023, and on average, these states had greater increases in out-of-state patients than other states without total bans. Some states that share a border with one or more ban states absorbed the additional patients with little or no increase in the numbers of brick-and-mortar clinics between 2020 and March 2024. For example:

• In Colorado, the number of clinics was the same in both years—23—while the number of abortions rose by 88%, an increase of 11,790 abortions (Table 2).

• In South Carolina, there were three clinics in both years and abortions rose by 69%, an increase of 3,640. Almost all of this increase was concentrated in the first half of the year before severe restrictions on abortion, including a six-week ban, took effect in September 2023.

By contrast, other states sharing borders with ban states saw increased numbers of clinics during this period—which allowed them to accommodate very large increases in patients. For example:

• In New Mexico, the number of clinics more than doubled (from six to 13, a 117% increase) and the number of abortions rose by 256% (an increase of 15,000 abortions).

• In Kansas, clinic numbers increased by 50% (from four to six) between 2020 and 2023, and the number of abortions rose by 152% (an increase of 12,440).

Notably, residents in many states sharing a border with ban states were able to access medication abortion via online-only clinics, and this may have alleviated some of the burden on brick-and-mortar facilities.

Abortions in States that Do Not Border Ban States

Some states that do not border those with total bans also saw increases in the number of clinics (between 2020 and March 2024) and the number of abortions (between 2020 and 2023).

• Most notably, in Massachusetts, the number of clinics increased 35%, from 17 to 23, and the number of abortions rose by 26%, or 4,510 abortions.

• New York had three more clinics than in 2020 (a 3% increase), and abortions rose by 21%, or 23,250 abortions.

In such cases, health care providers in legal environments supportive of abortion rights may have scaled up their abortion services in anticipation of serving an influx of out-of-state patients. However, between 2020 and 2023, out-of-state patients accounted for only 9% of the increase in abortions in Massachusetts and 4% of the increase in New York; the rest was due to increases in abortions among residents. Geographic distance from regions with total bans likely meant that the logistic and financial barriers to reaching these new clinics were prohibitive for residents of ban states—but the increased capacity ended up serving the needs of in-state patients.

Abortions in Southern States

Some states that neighbor states with total abortion bans experienced decreases in the number of clinics and sizeable increases in the number of abortions. This was especially consequential in the South, where only Virginia allows abortion beyond 12 weeks of pregnancy.^*

• In Florida, there were four fewer clinics and 7,250 more abortions (a 9% increase).

• In North Carolina, there was one fewer clinic and 13,890 more abortions (a 44% increase).

In 2023, Florida continued to be a point of access to abortion for people in the region. That year, approximately 5,300 more people traveled to Florida for abortions than in 2020, and the share of all abortions provided in Florida that were to nonresidents more than doubled, from 5% in 2020 to 11% in 2023. However, Florida enacted a six-week ban in May 2024, which will have negative consequences for providers and people seeking abortions throughout the region. Wait times for abortion appointments are likely to increase for many patients in the region, and the closest states for those needing care after six weeks’ gestation will be North Carolina (which has a 12-week ban) and Virginia.

Policies that Support Abortion Provision

For many states, the COVID-19 pandemic and the Dobbs decision exacerbated an existing health care provider shortage. Increases in the number of abortion patients, as well as the decreases and net-zero changes in the number of clinics seen in some states, may be placing mounting strain on providers’ capacity to offer care to both the residents of the areas they usually serve, as well as patients traveling due to state bans.

In 2023, 22 states and DC enacted 129 measures protecting abortion access, the highest number of protections ever enacted in one year. Many are intended to support providers to open more brick-and-mortar clinics and to increase clinic capacity to provide care to more patients. Recent policy actions to support providers include the following:

• In 2022, the governor of New Mexico issued an executive order that allocated $10 million dollars for the construction of a clinic near Texas.

• In 2022, Maryland policymakers passed legislation to create an abortion care training program for providers.

• In 2023, 12 state measures were enacted that included grants and other financial support for the health care workforce.

• A number of states, including Maryland, have addressed workforce shortages by allowing advance practice clinicians—nurse practitioners, physician assistants and other medical professionals—to provide abortion care. (Studies show that care provided by advance practice clinicians is both safe and effective.)

These policies offer a roadmap for other states to follow to ensure that there are enough clinics operating in the United States to provide abortion access to all who need it, regardless of where they live. Additional creative policy solutions at every level of government are needed. State policymakers must continue to develop and pass robust, innovative laws that support people’s ability to access abortion care with dignity and respect, while federal policies such as the Abortion Justice Act, the EACH Act and the Women’s Health Protection Act should be enacted.

Conclusion

Brick-and-mortar clinics, which have long been targeted by state policies seeking to force their closure, continue to play a critical role in the US abortion provision landscape. Even with the increasing availability of medication abortion via online-only clinics, these clinics remain vital sources of abortion services—especially for people who are not eligible for medication abortion (for example, because they are 12 or more weeks pregnant) and for those who prefer to have a procedural abortion.

Protective policies in some states have bolstered the provision of abortion care and supported access for people seeking abortion services—both state residents and those traveling from other states. More needs to be done to ensure that people seeking an abortion can obtain care close to where they live and that clinicians can provide high-quality care for their patients without political interference.

Methodology Note

Data on clinic numbers in this report come from the Guttmacher Institute’s database of facilities known to provide abortion care in the United States and reflect updates through March 2024. This analysis focuses on brick-and-mortar clinics, physical facilities that specialize in abortion or in sexual and reproductive health care more broadly. For this analysis, we also consider hospital-affiliated outpatient facilities (which typically have higher abortion caseloads than hospitals) and physicians’ offices that provide more than 400 abortions per year to be brick-and-mortar clinics. The universe of clinics for this analysis does not include hospitals (sites that typically have operating rooms, emergency departments, and labor and delivery departments), physicians' offices offering fewer than 400 abortions per year or online-only clinics that offer medication abortion services without a physical location.

Descriptions of changes in the number of clinics offering abortion services in this analysis refer to net changes. Lack of net change in the number of clinics does not necessarily mean that no clinics opened or closed over the period, only that any closures were offset by new clinics opening or existing clinics beginning to offer abortion.

All estimates of abortion numbers, including proportions of abortions occurring out of state, are from Guttmacher’s Monthly Abortion Provision Study.

TABLE 2. Number of clinics providing abortions and changes over time in clinic and abortion numbers, by state
States with total abortion bans as of March 2024 are highlighted in gray.

*Indiana’s abortion ban took effect on August 1, 2023.