Packages of abortion pills are prepared for patients in Peabody, Mass., in 2023.SOPHIE PARK/The New York Times News Service
In nearly every state that has banned abortion, the number of women receiving abortions increased between 2020 and the end of 2023, according to the most comprehensive account of all abortions by state since the overturning of Roe v. Wade.
In the 13 states that enacted nearly total abortion bans, the number of women receiving abortions increased in all but three, according to the study. Some women travelled to clinics in states where abortions were legal. Others ordered abortion pills from U.S. doctors online, after doctors in other states started writing prescriptions under shield laws that protect them when they provide mail-order pills to patients in states with bans.
The only states with bans where abortion fell during this period were Texas, where the decrease was small; Idaho, where it was larger; and Oklahoma, where the data showed an unusually large number of abortions in 2020.
Nationwide, the study also found that abortions have continued to rise. There were roughly 587,000 abortions in the first half of this year, an increase of more than 12% from the same period in 2023.
“It’s a surprise to everyone,” said David S. Cohen, co-author of the coming book “After Dobbs: How the Supreme Court Ended Roe but Not Abortion” and a law professor at Drexel University. “I think most people thought there would be creativity and determination that would still get a lot of people abortions once Roe v. Wade was overturned. But I don’t think anyone thought it would stay the same, let alone go up.”
Many state bans went into effect soon after June 2022, when the Supreme Court overturned Roe, which had guaranteed the right to abortion nationwide. Other states began putting in shield laws in the summer of 2023. The new data shows the extent to which these laws have blunted the effects of the bans.
In recent years, many anti-abortion groups have been arguing for a federal ban that would override state laws.
“A serious breakdown in the law takes place when one state attempts to interfere with another state’s efforts to protect their citizens,” said Kristan Hawkins, the president of Students for Life of America, a group that opposes abortion.
The abortion increases could stall or reverse under a different presidential administration or a major court decision. The Food and Drug Administration’s embrace of telehealth abortion began in 2021 under the Biden administration. Vice President Kamala Harris has made protecting abortion rights a central theme of her campaign.
Former President Donald Trump has sent mixed messages about how he would regulate abortion pills but has expressed openness to restricting access to them. A future FDA could ban telehealth abortion or reverse its approval of abortion pills altogether. Federal officials could also impose restrictions on mailing any materials used in abortions. A lawsuit working its way through federal courts seeks similar restrictions.
The new analysis, published Tuesday by WeCount, a group overseen by academic researchers, includes counts of abortions from all known abortion providers in the United States since April 2022. It also uses clinic survey data from the Guttmacher Institute, a reproductive health research group, on the number of women travelling between states for abortion care, and comparison data from 2020. Both organizations support abortion rights.
The numbers of abortions in ban states could be overstated. It was not widely possible to order pills under shield laws until the second half of last year, and the researchers’ data on those orders was for that period. Their data on interstate travel, though, was for the full year, and they divided it by two. As a result, the number of women who travelled in the second half of the year may have been overestimated if fewer women travelled later in the year once they could order pills instead.
“The people doing these studies are scientists doing the best they can with incomplete data,” Cohen said. “It’s a pretty good estimate, but they’ll be the first to tell you there are still a lot of unknowns.”
For the first time, the report breaks out the number of abortions provided under the new shield laws. On average, it found, these laws are enabling 7,700 abortions a month in states with total abortion bans or six-week bans.
In Mississippi, where abortion has been illegal since July 2022, around 3,300 women got abortions in a six-month period last year, an increase of 16% from 2,850 in six months in 2020. Nearly half of women ordered pills under shield laws, and the rest travelled out of state. For women in West Virginia, abortions increased 57%, and in Tennessee, 38%.
Telehealth abortions were a big driver of the increases. Across all states, there were an average of 20,000 abortions per month in the period from April to June this year, up from about 8,000 per month in the same period last year. The number of in-person abortions was mostly stable, decreasing 3% during that time.
The expansion of telehealth abortion has been an important factor even in states where abortion has remained legal, especially in rural areas. In Wyoming, where abortion is legal but many women live far from clinics, telehealth accounted for 55% of abortions in the second quarter of this year, compared with 8% in New York.
Other factors have also contributed to the increase in abortions, researchers said. New clinics have opened, and a nationwide surge of publicity about the issue may have decreased stigma. Abortion rights groups have helped people get access to abortion financially or logistically, enabling many women to travel out of state.
Eighty per cent of the abortions counted by WeCount were reported directly by abortion providers or public health departments. The rest, in places that did not provide complete data, especially California, Florida, New Jersey and New York, were estimated based on other information.
These numbers do not include abortion pills that were ordered from overseas pharmacies, or other abortions that did not involve a licensed U.S. clinician. The research does not measure whether every woman who orders abortion pills ends up taking them.
Comparisons to 2020 are not exact because the earlier data used slightly different methods. Over the last two years, some states have enacted new abortion restrictions, and some have reversed them. Florida’s six-week abortion ban went into effect in May, and Iowa’s six-week ban in July. The legal status of abortion also changed in Indiana, South Carolina and Wisconsin during the study period.
The bans have prevented some women who wanted abortions from getting them. They may not have been able to afford to travel, to find child care or take time off work. Some may have been uncomfortable ordering pills or unaware of the options. Research suggests that these women tend to be teenagers, to be Black and Native American, and to have low incomes. Research on birth and death records from last year shows that the birth rate increased somewhat in states with abortion bans, as has infant mortality.
“The data don’t tell us anything about people wanting abortions and not getting them,” said Dr. Alison Norris, a chair of WeCount and a professor of epidemiology at Ohio State University.
Still, the data suggests that the Dobbs decision and the resulting bans were not effective in decreasing the overall prevalence of abortion in the United States.