U.S. Saw Highest Abortion Rate in Over a Decade After Dobbs

There were more than 1 million abortions in 2023, fueled in part by an increase in medication abortions, according to the Guttmacher Institute.

The overturn of Roe v. Wade has forced abortion seekers to overcome steep barriers as 14 states have banned the procedure with limited exceptions, and seven states have heavily restricted access. Despite these challenges, the U.S. still saw its highest abortion rate in more than a decade last year.

There were more than 1 million clinician-provided abortions in 2023, according to the Guttmacher Institute’s latest Monthly Provision Study (the last time there were more than a million abortions in the U.S. health-care system was 2012). About 63 percent of those were medication abortions. Researchers found that abortions increased in almost every state without a total ban, and that the largest spikes were in states that border those that have outlawed the procedure. For example, abortions in Illinois increased by 72 percent, with providers seeing an estimated 25,660 patients from out of state, according to the study. Abortions also surged in New Mexico, Virginia, and North Carolina. (The report does not track self-managed abortions taking place outside the formal health-care system, so the figures undercount how many pregnancies were terminated in 2023.)

The authors of the study said that “the drastic loss of access in states with bans has been counterbalanced by monumental efforts on the part of clinics, abortion funds, and logistical-support organizations to help people in ban states access care through financial and practical support.” But this infrastructure is teetering on the brink of collapse. Anti-abortion lawmakers have so far introduced bills that would further restrict care in 20 states. Donations to abortion funds and other practical-support organizations have dried up, even as the total cost of the procedure continues to increase. Many abortion seekers today need to travel longer distances and are getting care later in pregnancy, in part due to an explosion in patient volume that has led to longer clinic wait times in states where the procedure remains legal. While some new clinics are cropping up in states that protect abortion, they have faced financial barriers and opening their doors can take a long time.

The report found medication abortion has become a more common method of terminating a pregnancy, increasing from 53 percent of all abortions in 2020 to 63 percent in 2023. Authors of the study say this is in part due to the expansion of telehealth services. But the legal battle over the FDA’s approval of mifepristone, one of the two pills used in medication abortions, is ongoing. On March 26, the U.S. Supreme Court will hear oral arguments on whether to reinstate restrictions on its use that health experts say are outdated and medically unnecessary. The justices could decide to dramatically curtail access to medication abortion.

“Any return to restrictions on medication abortion provision via telemedicine would be detrimental for people who either prefer or only have access to abortion using telemedicine,” researchers said. “While the current court case only affects use of mifepristone — and a misoprostol-only regimen is also a safe and effective method of medication abortion — everyone seeking an abortion should have access to the full range of safe, effective options.”