Since the U.S. Supreme Court overturned Roe v. Wade nearly two years ago, eliminating the constitutional right to access abortion, 14 states have nearly totally banned abortions. The implications have varied from forcing women to carry unwanted or unviable pregnancies to term to women being forced to spend thousands of dollars to travel out of state to influencing where medical students attend their residency programs.
But one thing the restrictive landscape hasn’t done? Reduce the number of abortions happening nationwide.
According to a new report released this week by the Society of Family Planning's WeCount project, the number of abortions in the U.S. has continued to rise slightly since Roe was overturned. In 2023, there were on average 86,000 abortions per month compared to 2022 when there were about 82,000 abortions per month.
While the researchers don’t have their own data from pre-Dobbs, a previous study estimated that in 2020 slightly more than 930,000 abortions occurred in the United States in 2020, averaging about 77,500 per month. The same study estimated that abortion numbers had increased between 2017 and 2020 after decades of the annual number of abortions declining.
WeCount collected their data thanks to their database of all clinics, private medical offices, hospitals and virtual clinic-abortion providers in the United States. Leveraging this database, providers submit the monthly number of abortions. WeCount synthesizes the data and creates imputations for the clinics that don't send their data.
“We're finding that there were a slightly higher number of abortions in 2023 compared to the data we collected in 2022,” Ushma Upadhyay, a professor and public health scientist at the University of California, San Francisco who co-led the research, told Salon in a phone interview. “We’re also able to look at the loss in states with either total abortion bans or six-week bans, and we found that there are about 180,000 fewer abortions in the 18 months since the Dobbs decision in those states.”
These cumulative declines were most notable in Texas, Georgia, Tennessee, Louisiana and Alabama. Notably, the data found that accessing abortion care via telehealth has been a “game changer,” Upadhyay emphasized.
In a telehealth medication abortion, a patient typically talks to a provider over video or a secured chat platform. If the patient is less than 10 weeks pregnant and found to be eligible, the provider can prescribe the patient mifepristone, which blocks pregnancy hormones, and then misoprostol, which causes uterine contractions. The medicines can be delivered via a mail-order pharmacy even to those in states where abortions are nearly completely banned.
According to the report, more than 40,000 people in states with abortion bans and telehealth restrictions received medication abortion through providers in states protected by shield laws between July and December 2023.
“Telehealth has really opened up access for people living in ban states who previously didn't have many other options,” Upadhyay said. “This is an option that their state may not see as legal, but the states providing the care see these as a fully legal option.”
Telehealth can help patients from having to travel many hours to access care, take time off or find childcare — and it’s also less expensive than in-person care.
“This care often does not even require an appointment. Some providers offer it in an asynchronous way, meaning that when the patient comes to the website, completes their medical history information and then any questions, a provider will review it,” Upadhyay said. “Patients that are able to do the entire process from the comfort of their home or even at their work. They don't actually have to take time off of work to communicate with their providers.”
Elisa Wells, co-founder and co-director of Plan C, a non-profit abortion access group, told Salon in a phone interview that she wasn’t surprised to see the increase in abortion numbers in the #WeCount report.
“Abortion is a common health need and as there is more information about abortion and abortion access available through the press — and in part because of these bans — I think people are considering how abortion fits into their lives and utilizing the service that they know is right for them," Wells told Salon. “So we're not at all surprised, and we also know that the WeCount numbers are an undercount because they do not account for the self-managed abortion option.”
At the same time, this is happening as anti-abortion legislators are targeting medication abortion and trying to restrict access. In Louisiana, a bill proposed by a Republican state senator would classify mifepristone and misoprostol as Schedule IV "controlled dangerous substances," essentially lumping it in the same category as sedatives like Xanax and Ambien. Meanwhile, the country is still waiting for the U.S. Supreme Court to make a decision on a case that would restrict access to mifepristone nationwide, and eliminate access to mifepristone by telehealth and by mail.
In other words — and in spite of the fact that self-managed abortions are safer than ever — the future of abortion access is not guaranteed. Even if telehealth access is not eroded, Upadhyay emphasized this data shouldn’t be interpreted as “all of the demand in states with abortion bans” is being met.
“Our biggest concern is that it will be overlooked that there are many, thousands of people living in states with bans who are unable to access abortion that are being forced to carry their unwanted pregnancies to term,” she said. “It's so important that people have healthcare in the communities where they live.”
