The number of abortions in the U.S. rose sharply in 2023, an unexpected turn of events that occurred as abortion-rights supporters were decrying new restrictions on abortion imposed by states.
More than 1 million abortions were recorded in 2023, a 10% increase from 2020, according to the Guttmacher Institute, a nonprofit research organization that supports abortion access. Isaac Maddow-Zimet, a data scientist at Guttmacher, told NPR, “That’s the highest number in over a decade, (and) the first time there have been over a million abortions provided in the U.S. formal health care system since 2012.”
To some abortion opponents, the numbers seem to contradict rhetoric about “reproductive freedom” being lost after Roe v. Wade was overturned in 2022.
So what’s going on? Is abortion increasing simply because of the widespread availability of abortion drugs and telehealth, as Guttmacher posits? Or is it actually getting easier for some women to get an abortion since they are being offered financial aid and other kinds of support post-Dobbs?
With just one year of data, it’s hard to say anything conclusively, especially because abortion reporting, even over time, is not comprehensive or uniform, and essentially comes down to the reporting agency’s best guess. But here’s what we know about the latest numbers and the speculation about what happened in 2023.
How many abortions were there in 2023?
According to Guttmacher, which was once part of Planned Parenthood, there were 1,026,700 abortions in 2023, compared to 930,160 in 2020. That represents a 10% increase nationwide, although in some states, especially those bordering states with abortion restrictions, the increase in abortion was considerably higher.
Guttmacher’s numbers are widely reported, in part because abortion numbers released by the Centers for Disease Control and Prevention tend to lag two years behind. The CDC’s most recent Abortion Surveillance report, released in November 2023, covers abortions in 2021. As the CDC notes in that report, the agency requests abortion data from the central health agencies of all the states, Washington, D.C., and New York City, but not all the states report. (In 2021, California, Maryland, New Hampshire and New Jersey did not report.)
Guttmacher compiles its data by surveying abortion providers across the country, as it has done since 1973. The institute acknowledged its own limitations in providing accurate numbers, saying “these annual estimates are almost certainly an undercount, as they include only those abortions obtained within the formal US health care system: at brick-and-mortar health facilities, such as clinics or doctor’s offices, and via telehealth and virtual providers.”
But the numbers come on the heels of a previous increase in abortions, in the three years ending in 2020, and they suggest that a decadeslong trend of fewer abortions has been upended by changes in how abortion is provided.
Why are abortions increasing despite state bans?
According to Guttmacher’s report, the availability of abortion drugs and prescribing via telehealth are the primary reasons for the increase in abortions. The report suggests that there has also been an uptick in efforts to help women get abortions even amid bans that came after the Dobbs decision returned abortion law to the states. According to health policy research organization KFF, there are currently bans in 14 states.
“(T)he 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,” according to Guttmacher, which noted significant increases in abortions provided in three states that border states with abortion bans: Illinois saw an increase of 72%; Virginia, 76%; and New Mexico, 257%.
“Not all increases at the state level can be attributed to increased travel across state lines, however,” Guttmacher said. The institute said that some states have expanded protections for abortion providers and women’s access to abortion.
There has also been increased funding offered to women who want an abortion, through groups like the National Network of Abortion Funds. And some employers began offering abortion-related benefits after Dobbs, with some offering to pay for travel and lodging for the person getting the abortion, as well as a companion. The National Network of Abortions Funds says on its website: “Need an abortion? Abortion funds provide the financial and logistical support you need to get the abortion you want.” Another group offers assistance for child care, gas, food and lost wages, in addition to the abortion itself.
Planned Parenthood says its average cost of abortion drugs is $580, although the price can run as high as $800.
“Following the Dobbs decision, we saw the abortion lobby double down its efforts to increase abortion on demand for any reason ... The rise in mail-order abortion drugs, following the FDA’s decision to roll back important safeguards, despite known risks, contributed to this increase. This widespread push has put women’s health and safety last in the name of ‘expanding access,’” Tessa Longbons Cox, senior research associate at Charlotte Lozier Institute, said in an email.
The Charlotte Lozier Institute is a research and education arm of Susan B. Anthony Pro-Life America.
The rise in abortion drugs
The rise in abortions in 2023 occurred alongside a 10 percentage-point increase in the number of drug-induced abortions during the same time period. According to Guttmacher, “there were approximately 642,700 medication abortions in the United States in 2023, accounting for 63% of all abortions in the formal health care system. This is an increase from 2020, when medication abortions accounted for 53% of all abortions.”
In 2001, the year after the Food and Drug Administration approved the drug mifepristone to end pregnancy, the number of medication abortions was 6%. That number has risen every year since then. The drug is at the center of a case pending before the Supreme Court: Alliance for Hippocratic Medicine v. FDA.
Guttmacher says the case against the FDA, brought by physicians who oppose abortion, uses “low quality science” and if the court finds for the Alliance, it “could restrict the ability to mail mifepristone directly to patients and reinstate the requirement for the drug to be provided in person,” a requirement that Guttmacher calls “outdated and medically unnecessary.” Such a decision might slow or reverse the trend of rising medication abortions.
But in an recent op-ed for Deseret, Provo attorney Camille S. Williams argued that the “risk evaluation and mitigation strategies” the FDA put in place to protect patients when it first permitted mifepristone in 2000 are still important, including the in-office visit and the required reporting of adverse events. While the FDA says that complications are exceedingly rare, Williams cited Guttmacher’s statistics to argue that given the total number of abortions in 2023, “This means, according to the prescribing information, that this FDA-approved drug regimen sends tens of thousands of women to the emergency room each year.”
Regardless of how the court rules, abortion drugs will still be available, though perhaps not with the ease with which they are obtained today. The decision is expected by the end of June.
And despite the abortion numbers, abortion opponents still have cause to celebrate. A study released last year suggested that 32,000 births in 2023 might be related to abortion bans. As CNN reported, “fertility rates increased most significantly in states with longer travel times to the nearest abortion providers, the new research found, including a 5.1% increase in Texas and a 4.4% increase in Mississippi.”