Understanding Abortion Care

An Overview of Abortion Care

Data regarding abortion rates and trends come from organizations like the CDC and surveillance reports from the Guttmacher Institute that compile voluntary figures from hospitals, clinics, and central state health agencies to create comprehensive reports. The CDC has been conducting abortion surveillance since 1969 and regularly publishes Abortion Surveillance Reports.

 

Abortion, whether medication or procedural, is a very safe procedure. The 2018 NASEM (spell out) report (link and name) states that ***. This report also supports APCs as abortion providers “use quote here” and states that the barriers to provision of abortion care by APCs is “use politically motivated quote here”. The newest data comparing the risk of continuing a pregnancy  versus having an abortion places the mortality risk (in the U.S. in 2020 ) at an estimated 35-39 times higher for continuing the pregnancy  (Stevenson, Raymond, & Grossman, 2023)" Stevenson, A. J., Raymond, E., & Grossman, D. (2023). Comparing mortality risk of induced abortion with mortality risk of staying pregnant. Contraception, 127(110150), 110150. https://doi.org/10.1016/j.contraception.2023.110150

 

The most recent yearly national total of abortions provided in the United States was in 2020, during which the Guttmacher Institute reported 930,160 abortions in all 50 states and the District of Columbia combined. The reported abortion rate was 14.4 abortions per 1000 women ages 15 to 44 nationwide. Generally, abortion rates nationwide have been declining since 1981. The World Health Organization (WHO) reports 6 in 10 unintended pregnancies end in abortion worldwide each year.

 

In 2020, women in their 20s accounted for the highest percentage of abortions (57.2%). Adolescents under 15 accounted for the lowest percentage of abortions (0.2%). Additionally, the vast majority of reported abortions in the CDC report from 2020 were performed at or before 13 weeks’ gestation (93.1%).

 

Although narrowing, disparities across population groups persist. In 2020, women 20 to 29 years of age, patients who were cohabiting, with low income, and non-Hispanic white and non-Hispanic Black women had higher abortion rates. 

Barriers to Accessing Abortion Care

The Supreme Court decision in Dobbs v. Jackson Women’s Health Organization overturned the federal constitutional right to abortion that had been in place for nearly 50 years. As a result of this ruling, abortion regulation is determined by individual states.  Some states have enacted total or near-total bans on abortion. As of May 1, 2024, 41 states actively have abortion bans with few exceptions. 14 states have total bans, with imposed fines or jail time for both the patient and provider. 27 states have bans based on gestational duration or “fetal viability.” These varying levels of restrictions make it difficult or impossible for patients to exercise their rights without the burden of traveling for care or risking criminalization. 

As of 2023, 1 in 5 pregnant people in the U.S. have to travel out of state to access abortion care. In 2023, 171,300 patients traveled out of state seeking abortion care. This places a burden on providers in states where abortion care is less restricted and places a more direct burden on the patient to avoid criminalization and be in a position financially to cover travel costs.  

Despite state abortion bans since the Dobbs decision, the most recent Monthly Abortion Provision Study from 2023 shows that 1,037,000 occurred in the U.S. formal healthcare system, representing a new rate of 15.9 abortions per 1000 live births, an increase from 2020 abortion rates of 14.4 abortions per 1000 women. 

The post-Dobbs landscape is a patchwork of state laws varying in severity and clarity. Barriers to abortion care have become more institutionalized and formidable. Additional legal, geographical, and financial obstacles also hinder access to abortion care like: 

  • Laws require medically inaccurate counseling of abortion patients for the patient’s consent to be “informed.”
  • Laws requiring abortion providers to narrate an ultrasound image, even against the patient’s wishes
  • Laws mandating that a patient delay their procedure for a minimum period of time (typically 24, 48, or 72 hours) after receiving state-mandated information, which is often medically inaccurate and stigmatizing
  • “TRAP” laws (Targeted Regulation of Abortion Providers) single out abortion providers for medically unnecessary, politically motivated regulations—often forcing clinics to shut down. In the first 100 days after the Dobbs decision, at least 66 clinics closed. As of 100 days after the Dobbs was handed down, 90% of counties in the U.S. lack an abortion provider.
  • Laws requiring parental notice for minors seeking abortion care and in more restrictive states, requiring both parents’ consent

Locations where advanced practice clinicians can provide different types of abortions

  • Procedural and Medication
  • Neither
  • Medication Only