Abortions are up in the US. It's a complicated picture as women turn to pills, travel

[December 30, 2024]  By GEOFF MULVIHILL and KEVIN S. VINEYS

Abortion has become slightly more common despite bans or deep restrictions in most Republican-controlled states, and the legal and political fights over its future are not over yet.

It's now been two and a half years since the U.S. Supreme Court overturned Roe v. Wade and opened the door for states to implement bans.

The policies and their impact have been in flux ever since the ruling in Dobbs v. Jackson Women's Health Organization.

Here's a look at data on where things stand:

Abortions are slightly more common now than before Dobbs

Overturning Roe and enforcing abortion bans has changed how women obtain abortions in the U.S.

But one thing it hasn't done is put a dent in the number of abortions being obtained.

There have been slightly more monthly abortions across the country recently than there were in the months leading up to the June 2022 ruling, even as the number in states with bans dropped to near zero.

“Abortion bans don’t actually prevent abortions from happening,” said Ushma Upadhyay, a public health social scientist at the University of California San Francisco.

But, she said, they do change care.

For women in some states, there are major obstacles to getting abortions — and advocates say that low-income, minority and immigrant women are least likely to be able to get them when they want.

For those living in states with bans, the ways to access abortion are through travel or abortion pills.

Pills become a bigger part of equation — and the legal questions

As the bans swept in, abortion pills became a bigger part of the equation.

They were involved in about half the abortions before Dobbs. More recently, it’s been closer to two-thirds of them, according to research by the Guttmacher Institute.

The uptick of that kind of abortion, usually involving a combination of two drugs, was underway before the ruling.

But now, it's become more common for pill prescriptions to be made by telehealth. By the summer of 2024, about 1 in 10 abortions was via pills prescribed via telehealth to patients in states where abortion is banned.

As a result, the pills are now at the center of battles over abortion access.

This month, Texas sued a New York doctor for prescribing pills to a Texas woman via telemedicine. There's also an effort by Idaho, Kansas and Missouri to roll back their federal approvals and treat them as “controlled dangerous substances,” and a push for the federal government to start enforcing a 19th-century federal law to ban mailing them.

Travel for abortion has increased

Clinics have closed or halted abortions in states with bans.

But a network of efforts to get women seeking abortions to places where they're legal has strengthened and travel for abortion is now common.

The Guttmacher Institute found that more than twice as many Texas residents obtained abortion in 2023 in New Mexico as New Mexico residents did. And as many Texans received them in Kansas as Kansans.

Abortion funds, which benefitted from “rage giving” in 2022, have helped pay the costs for many abortion-seekers. But some funds have had to cap how much they can give.

The abortion map has been in flux

Since the downfall of Roe, the actions of lawmakers and courts have kept shifting where abortion is legal and under what conditions.

Here's where it stands now:

The ban that took effect in Florida this year has been a game-changer

Florida, the nation’s third most-populous state, began enforcing a ban on abortions after the first six weeks of pregnancy on May 1.

Missouri residents and pro-choice advocates react to a speaker during Missourians for Constitutionals Freedom kick-off petition drive, Feb. 6, 2024, in Kansas City, Mo. (AP Photo/Ed Zurga, File)

That immediately changed the state from one that was a refuge for other Southerners seeking abortion to an exporter of people looking for them.

There were about 30% fewer abortions there in May compared with the average for the first three months of the year. And in June, there were 35% fewer.

While the ban is not unique, the impact is especially large. The average driving time from Florida to a facility in North Carolina where abortion is available for the first 12 weeks of pregnancy is more than nine hours, according to data maintained by Caitlin Myers, a Middlebury College economics professor.

Clinics have opened or expanded in some places

The bans have meant clinics closed or stopped offering abortions in some states.

But some states where abortion remains legal until viability – generally considered to be sometime past 21 weeks of pregnancy, though there’s no fixed time for it – have seen clinics open and expand.

Illinois, Kansas and New Mexico are among the states with new clinics.

There were 799 publicly identifiable abortion providers in the U.S. in May 2022, the month before the Supreme Court reversed Roe v. Wade. And by this November, it was 792, according to a tally by Myers, who is collecting data on abortion providers.

But Myers says some hospitals that always provided some abortions have begun advertising it. So they’re now in the count of clinics – even though they might provide few of them.

Lack of access to abortions during emergencies is threatening some patients' lives

How hospitals handle pregnancy complications, especially those that threaten the lives of the women, has emerged as a major issue since Roe was overturned.

President Joe Biden's administration says hospitals must offer abortions when they're needed to prevent organ loss, hemorrhage or deadly infections, even in states with bans. Texas is challenging the administration’s policy and the U.S. Supreme Court this year declined to take it up after the Biden administration sued Idaho.

More than 100 pregnant women seeking help in emergency rooms and were turned away or left unstable since 2022, The Associated Press found in an analysis of federal hospital investigative records.

Among the complaints were a woman who miscarried in the lobby restroom of Texas emergency room after staff refused to see her and a woman who gave birth in a car after a North Carolina hospital couldn't offer an ultrasound. The baby later died.

“It is increasingly less safe to be pregnant and seeking emergency care in an emergency department,” Dara Kass, an emergency medicine doctor and former U.S. Health and Human Services official told the AP earlier this year.

Abortion rights are popular with voters

Since Roe was overturned, there have been 18 reproductive rights-related statewide ballot questions.

Abortion rights advocates have prevailed on 14 of them and lost on four.

In the 2024 election, they amended the constitutions in five states to add the right to abortion. Such measures failed in three states: In Florida, where it required 60% support; in Nebraska, which had competing abortion ballot measures; and in South Dakota, where most national abortion rights groups did support the measure.

AP VoteCast data found that more than three-fifths of voters in 2024 supported abortion being legal in all or most cases – a slight uptick from 2020. The support came even as voters supported Republicans to control the White House and both houses of Congress.
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Associated Press writers Linley Sanders, Amanda Seitz and Laura Ungar contributed to this article.

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