New figures shed light on US abortion travel as Trump cuts tracking research
For the second year in a row, abortion providers performed more than 1m abortions in the United States in 2024. About 155,000 people crossed state lines for abortions – roughly double the number of patients who did so in 2020, before the US supreme court overturned Roe v Wade and paved the way for more than a dozen state-level abortion bans to take effect.
These numbers, released earlier this week by the abortion rights-supporting Guttmacher Institute, have not changed much since 2023, when the US also performed more than 1m abortions and 169,000 people traveled for the procedure.
This lack of change masks a deep geographical divide in the US, as a handful of states have now become major hubs for people seeking abortions.
In 2024, Illinois provided roughly 35,000 abortions to out-of-state patients, while North Carolina provided 16,700. Kansas and New Mexico, which neighbor anti-abortion Texas, provided 16,100 and 12,800 abortions – the vast majority of which were to out-of-state patients.
'Travel is so incredibly costly, both for patients and for the broader support network of funds, practical support organizations and providers,' said Isaac Maddow-Zimet, a Guttmacher data scientist. The sheer magnitude of the travel, he said, is 'testament to the great efforts that a lot of people are taking in order to make sure that people could access care that really they should be able to access within their own community – without necessarily expending this enormous financial and logistical cost'.
As the Guttmacher report focuses on abortions provided through the formal healthcare system, it does not count self-managed abortions, which appear to be on the rise post-Roe. (Medical experts widely agree that individuals can safely end their own first-trimester pregnancies using abortion pills.) The report also does not track abortions provided to people living in states with total abortion bans, even though providers living in blue states sometimes mail abortion pills across state lines – a practice that, in recent months, has sparked heated litigation.
This does not mean, researchers warned, that everybody who wants a post-Roe abortion is still able to get one. Caitlin Myers, a Middlebury College economics professor who has researched the impact of abortion bans, estimated that about 20-25% of people who want abortions are blocked from getting them by bans.
The Guttmacher report arrived days after the Trump administration effectively demolished the CDC team responsible for government reports on abortion provision in the United States, which are known as 'abortion surveillance' reports. These cuts have alarmed researchers.
'If we can't measure outcomes, we can't do science,' Myers said. 'My concern is that this work fundamentally relies on the ability to track public health outcomes, and if we aren't tracking them, we don't know what's happening to people. We don't know what's happening in their lives. We don't know the effect of policies and interventions.'
In addition to the CDC and Guttmacher, just one other group – #WeCount, a research project by the Society of Family Planning – regularly collects nationwide data on abortion incidence. The groups use different methods to collect data, so the CDC's annual report on the topic has long been less comprehensive than the post-Roe reports issued by Guttmacher and #WeCount.
A number of states – including California, a haven for abortion rights – do not provide information to the federal government about the abortions performed within their borders. The CDC report also lags behind the Guttmacher and #WeCount reports; its most recent report, issued in November, counted abortions performed in 2022.
The CDC report does include information about abortion patients' demographic backgrounds and the gestational age of their pregnancies, which can serve as a critical fact-check in heated debates around abortion. Anti-abortion activists, for example, often condemn abortions that take place later on in pregnancy, but the 2022 CDC report found that only about 1.1% of all abortions take place at or after 21 weeks' gestation.
'Abortion surveillance can be used to asses changes in clinical practice patterns over time,' a former employee from the CDC's Division of Reproductive Health said in a text. 'Without this report, we are losing the ability to track these changes.'
Notably, the move to ax the researchers behind the CDC report appears to run counter to Project 2025, a famous playbook of conservative policies. Project 2025 urged the federal government to dramatically expand the CDC's 'abortion surveillance' by cutting funds to states that did not provide the CDC with information about 'exactly how many abortions take place within its borders, at what gestational age of the child, for what reason, the mother's state of residence, and by what method'. It also suggested that the CDC collect statistics on miscarriages, stillbirths and 'treatments that incidentally result in the death of a child (such as chemotherapy)'.
These proposals alarmed researchers and raised concerns about patients' data privacy, especially given the fact that abortion remains a deeply controversial procedure. But given the turbulence of the Trump administration, experts are not sure whether another agency will ultimately take up Project 2025's recommendations.
Maddow-Zimet said he doesn't 'think that we're necessarily any less concerned than we were before about the possibility of these kind of data mandates going into effect and/or using the data in appropriate ways to either make providers ask patients questions they wouldn't have otherwise asked, that are very stigmatizing, or potentially put providers at risk'.
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Reuters
4 days ago
- Reuters
Four Democratic-led US states urge FDA to remove abortion pill restrictions
NEW YORK, June 5 (Reuters) - The attorneys general of New York, California, Massachusetts and New Jersey asked the Food and Drug Administration to expand access to the abortion pill mifepristone, and remove what they view as outdated and medically unnecessary restrictions. Thursday's petition by the Democratic-led states seeks to force the FDA to acknowledge what the states view as "extensive" evidence that mifepristone is safe, notwithstanding the Trump administration's general opposition to abortion. It came after Health and Human Services Secretary Robert F. Kennedy Jr told Congress last month he ordered FDA Commissioner Marty Makary to review the pill, and unspecified "alarming" new data suggested the government should at least change the label. Mifepristone is the first pill, followed by the drug misoprostol, for medication abortion in the first 10 weeks of pregnancy, and won FDA approval in 2000. Medication abortions account for more than half of U.S. abortions, though 28 states restrict access, according to the nonprofit Guttmacher Institute, which focuses on reproductive health. The petition challenges FDA requirements that mifepristone prescribers be included in national and local abortion provider lists, patients attest in writing that they intend to end their pregnancies, and pharmacies perform a variety of recordkeeping. Citing the drug's safety record, it said those rules, part of the FDA's Risk Evaluation and Mitigation Strategy program, are "no longer justified by science or law," especially in states where abortion is legal and comprehensively regulated. New York Attorney General Letitia James said the rules keep mifepristone out of reach of most primary care settings. She called that problem particularly acute in rural and other areas where getting abortions often requires lengthy travel. "There is simply no scientific or medical reason to subject it to such extraordinary restrictions," James said, referring to mifepristone. "The FDA must follow the science." A spokeswoman for the Department of Health and Human Services said FDA Commissioner Makary "will ensure gold standard science is used while incorporating practical, common-sense considerations to its regulatory processes." Many states, primarily Republican-led or leaning, have restricted or substantially eliminated abortions in the three years since the U.S. Supreme Court overturned Roe v. Wade, the 1973 decision that legalized the procedure nationwide. Last June, the Supreme Court preserved broad access to mifepristone, unanimously ruling that a group of anti-abortion organizations and doctors lacked legal standing to challenge the FDA's approval of the pill. Despite largely siding with abortion opponents, Republican President Donald Trump said during his 2024 campaign he did not plan to limit access to mifepristone. Last month, the administration asked a federal judge to dismiss, on procedural grounds, a lawsuit by three generally Republican states seeking to narrow such access. That lawsuit began during the administration of Democratic President Joe Biden, who generally supported abortion access. Seventeen other Democratic-led or -leaning states plus Washington, D.C., are separately suing the FDA in Spokane, Washington, to loosen restrictions on mifepristone. They said doctors and pharmacies should be able to dispense the pill, as with most drugs, without special certifications. On May 30, the Trump administration urged a dismissal, saying the states didn't show the FDA's policy was flawed or the agency ignored important evidence. The states filed Thursday's petition after a short delay, with the filing having been expected earlier in the morning.
The Independent
27-05-2025
- The Independent
Critics warn anti-abortion groups are using ‘bogus' science to get Trump and RFK to ban widely used drugs
A dubious report from anti-abortion activists that casts doubt on the safety of a widely used abortion drug is now in the hands of top health officials in President Donald Trump 's administration. Abortion rights advocates and public health researchers have roundly condemned the report as an unscientific and politically motivated attempt to undermine the drug approval process for mifepristone, commonly used in medication abortions, which make up a vast majority of all abortions in the United States. Anti-abortion activists and influential right-wing legal groups have spent years suing the federal government in an attempt to cut off Americans' access to mifepristone, which was approved by the Food and Drug Administration more than 20 years ago. Now, those groups appear to have launched a backdoor effort to replace the FDA's data altogether. 'This is one paper based on shoddy research methods to replace decades of safety and efficacy research,' according to Amy Friedrich-Karnik, director of federal policy for reproductive health research group the Guttmacher Institute. 'It's absolutely not legitimate for that one paper to displace decades of medical research,' she told The Independent. 'Can the FDA do it? I mean, an FDA that followed science and rigor absolutely would not do that. I think the question here is, how politicized will the FDA get?' Last month, Trump's FDA Commissioner Marty Makary said he had no plans to change the government's position on mifepristone unless new data discovered a safety concern. Days later, the Ethics and Public Policy Center, a right-wing think tank, released a report claiming serious complications from mifepristone use were 22 times higher than previously reported. It called on the FDA to 'further investigate the harm mifepristone causes to women' and 'reconsider its approval altogether.' Missouri Republican Sen. Josh Hawley – whose wife, Erin Hawley, is a senior counsel with the right-wing legal advocacy group Alliance Defending Freedom, which is suing the government over mifepristone — then called on Makary to 'follow this new data.' Hawley also recently introduced legislation to 'reinstate safety regulations on the chemical abortion drug mifepristone.' Under questions from Hawley in a Senate committee hearing this month, Health and Human Services Secretary Robert F. Kennedy Jr called the report's alleged findings 'alarming.' 'Clearly, it indicates that, at the very least, the label should be changed,' Kennedy said. He asked Makary 'to do a complete review and to report back.' During a Senate hearing on May 22, Democratic Sen. Patty Murray told Makary that the administration is 'laying the groundwork to rip away access to medication abortion across the country.' This 'has not gotten enough attention, and I know you'd prefer to keep it that way,' she said. Makary said he still has not read the center's study, which was not peer-reviewed nor published in a medical journal. Dozens of peer-reviewed studies over the last two decades have shown that fewer than 0.5 percent of patients who take mifepristone have serious adverse reactions. The center's report claims that number is more like 11 percent. The study, first disseminated by conservative and religious media outlets last month, was authored by a group that aims to push back against the 'extreme progressive agenda while building a consensus for conservatives.' The center was on the advisory board of Project 2025, which provided a blueprint for the Trump administration. Its authors include the center's Director of Data Analysis Jamie Bryan Hall and President Ryan Anderson. Hall was a research fellow at The Heritage Foundation: the think tank that organized Project 2025. Anderson is the co-author of five books, including Tearing US Apart: How Abortion Harms Everything and Solves Nothing. The pair cited the work of a 'team of data scientists, analysts, and engineers' who were assisted by their own 'clinical team of board-certified obstetricians and gynecologists.' Members have a 'history of academic research and peer-reviewed publication,' Hall and Anderson wrote. They claimed to have reviewed 865,727 insurance claims from women who were prescribed the drug, but the report does not disclose which database was used. According to The Washington Post, the center said the reason was tied to a confidentiality agreement with the vendor. Public health researchers speaking to The Independent noted that the report's definition of a 'serious adverse event' could include minor side effects, including routine bleeding, unrelated sexually transmitted infections, and routine follow-up visits. The report also lists ectopic pregnancies, which do not result from mifepristone use, as serious adverse events. Citing insurance data, they said their analysis had found 10.93 percent of women experience sepsis, infection, hemorrhaging or another 'serious adverse event' within a period of 45 days following a mifepristone abortion. 'This study is the statistical equivalent of a category 5 hurricane hitting the prevailing narrative of the abortion industry,' Anderson said in a statement. 'Calling it a study would be too generous,' said Dr. Ushma Upadhyay, a professor in the University of California-San Francisco's Department of Obstetrics, Gynecology, and Reproductive Sciences. 'The fact that it's not peer-reviewed means that a lot of the methodological flaws were not corrected or were not addressed in the paper,' she told The Independent. In a statement to The Independent, Anderson with the Ethics and Public Policy Center said they are 'very pleased that government officials at the highest level are taking our invitation to replicate our study seriously.' 'As for the critics, most all of their criticisms are based on explicit misreadings of our paper,' he said. 'As for peer-review, what matters is not academic gate-keepers but replicability. We have made our study fully replicable for anyone who wants to analyze the insurance claims data.' Anderson said: 'We stand behind our analysis of healthcare claims data which is why we are asking the FDA to conduct its own review of this data. Real world data in which money changed hands based on the treatment of patients and coding by doctors brings a higher level of confidence. The dataset is available for purchase and our methodology is public. This study is fully replicable, and we encourage others to replicate it. We are glad that it appears that the FDA will be doing so.' There were 36 reports of deaths associated with mifepristone since the product was approved in September 2000, according to the FDA. Those include two cases of pregnancy outside of the womb and several cases of sepsis. 'The adverse events cannot with certainty be causally attributed to mifepristone because of concurrent use of other drugs, other medical or surgical treatments, co-existing medical conditions and information gaps about patient health status and clinical management of the patient,' the agency noted. A spokesperson for GenBioPro, the manufacturer of mifepristone, said the report is 'clearly flawed.' 'If this study isn't recognized widely for what it is – just another attempt by the anti-abortion movement to spread misinformation about the safety of the abortion pill using a bogus and biased study – Americans will be left with misleading information when they need to make critical health care and life decisions,' Emma Thomas told The Independent in an email. 'This is a report with no peer review, no transparency of methods. It comes out, and within days is cited at our highest levels of government to the person who makes decisions around regulation of medications,' said Heidi Moseson, a senior research scientist at Ibis Reproductive Health. 'And that suggests a very different pipeline of the way information is traveling with sort of egregious political motivation,' she told The Independent. A medication abortion typically involves a two-part protocol: mifepristone, which blocks the hormone progesterone to stop a pregnancy from growing, followed by misoprostol, which helps the uterus contract. The medication is also frequently used for miscarriage treatment. Mifepristone was first approved for use by the FDA in most cases in 2000, and the drug is approved for use up to 10 weeks of pregnancy. A vast majority of all abortions occur within the first nine weeks of pregnancy. Roughly 63 percent of all abortions in the United States are medication abortions, the Guttmacher Institute says. From 2019 through 2020, nearly 93 percent of all abortions were performed before the 13th week, according to the Centers for Disease Control and Prevention. In 2021, the FDA under President Joe Biden permanently lifted the in-person requirement for medication abortion prescriptions, allowing patients to access the drugs via telehealth appointments and online pharmacies so patients can take the drugs at home. In the years that followed, anti-abortion state legislators filed more than 100 bills to restrict access to abortion drugs, or sought to ban them altogether. After the Supreme Court overturned Roe v Wad e in 2022, more than a dozen states effectively outlawed all abortions in most circumstances. Months after that ruling, Alliance Defending Freedom filed a federal lawsuit targeting mifepristone with a court in Amarillo, Texas, on behalf of a group of anti-abortion physicians, claiming the FDA wrongfully approved mifepristone and then improperly eliminated requirements that the drug should only be dispensed in person. Trump-appointed District Judge Matthew Kacsmaryk, who had formerly worked as a chief counsel with right-wing Christian legal activist group First Liberty Institute, later issued a ruling to suspend the FDA's approval of the drug, but the Supreme Court unanimously rejected his decision. Whether the FDA under the Trump administration can now simply swap underlying data with another is 'the million dollar question,' according to Upadhyay. 'As a scientist, it's really concerning and devastating to see what is meant to be a system to keep people safe and understand true health risks weaponized in this moment to further restrict people's access to really essential healthcare,' Moseson said.
The Independent
24-05-2025
- The Independent
Millions of women use abortion drugs safely. Experts warn anti-abortion groups are pushing ‘bogus' science to get them banned
A dubious report from anti-abortion activists that casts doubt on the safety of a widely used abortion drug is now in the hands of top health officials in President Donald Trump 's administration. Abortion rights advocates and public health researchers have roundly condemned the report as an unscientific and politically motivated attempt to undermine the drug approval process for mifepristone, commonly used in medication abortions, which make up a vast majority of all abortions in the United States. Anti-abortion activists and influential right-wing legal groups have spent years suing the federal government in an attempt to cut off Americans' access to mifepristone, which was approved by the Food and Drug Administration more than 20 years ago. Now, those groups appear to have launched a backdoor effort to replace the FDA's data altogether. 'This is one paper based on shoddy research methods to replace decades of safety and efficacy research,' according to Amy Friedrich-Karnik, director of federal policy for reproductive health research group the Guttmacher Institute. 'It's absolutely not legitimate for that one paper to displace decades of medical research,' she told The Independent. 'Can the FDA do it? I mean, an FDA that followed science and rigor absolutely would not do that. I think the question here is, how politicized will the FDA get?' Last month, Trump's FDA Commissioner Marty Makary said he had no plans to change the government's position on mifepristone unless new data discovered a safety concern. Days later, the Ethics and Public Policy Center, a right-wing think tank, released a report claiming serious complications from mifepristone use were 22 times higher than previously reported. It called on the FDA to 'further investigate the harm mifepristone causes to women' and 'reconsider its approval altogether.' Missouri Republican Sen. Josh Hawley – whose wife, Erin Hawley, is a senior counsel with the right-wing legal advocacy group Alliance Defending Freedom, which is suing the government over mifepristone — then called on Makary to 'follow this new data.' Hawley also recently introduced legislation to 'reinstate safety regulations on the chemical abortion drug mifepristone.' Under questions from Hawley in a Senate committee hearing this month, Health and Human Services Secretary Robert F. Kennedy Jr called the report's alleged findings 'alarming.' 'Clearly, it indicates that, at the very least, the label should be changed,' Kennedy said. He asked Makary 'to do a complete review and to report back.' During a Senate hearing on May 22, Democratic Sen. Patty Murray told Makary that the administration is 'laying the groundwork to rip away access to medication abortion across the country.' This 'has not gotten enough attention, and I know you'd prefer to keep it that way,' she said. Makary said he still has not read the center's study, which was not peer-reviewed nor published in a medical journal. Dozens of peer-reviewed studies over the last two decades have shown that fewer than 0.5 percent of patients who take mifepristone have serious adverse reactions. The center's report claims that number is more like 11 percent. The study, first disseminated by conservative and religious media outlets last month, was authored by a group that aims to push back against the 'extreme progressive agenda while building a consensus for conservatives.' The center was on the advisory board of Project 2025, which provided a blueprint for the Trump administration. Its authors include the center's Director of Data Analysis Jamie Bryan Hall and President Ryan Anderson. Hall was a research fellow at The Heritage Foundation: the think tank that organized Project 2025. Anderson is the co-author of five books, including Tearing US Apart: How Abortion Harms Everything and Solves Nothing. The pair cited the work of a 'team of data scientists, analysts, and engineers' who were assisted by their own 'clinical team of board-certified obstetricians and gynecologists.' Members have a 'history of academic research and peer-reviewed publication,' Hall and Anderson wrote. They claimed to have reviewed 865,727 insurance claims from women who were prescribed the drug, but the report does not disclose which database was used. According to The Washington Post, the center said the reason was tied to a confidentiality agreement with the vendor. Public health researchers speaking to The Independent noted that the report's definition of a 'serious adverse event' could include minor side effects, including routine bleeding, unrelated sexually transmitted infections, and routine follow-up visits. The report also lists ectopic pregnancies, which do not result from mifepristone use, as serious adverse events. Citing insurance data, they said their analysis had found 10.93 percent of women experience sepsis, infection, hemorrhaging or another 'serious adverse event' within a period of 45 days following a mifepristone abortion. 'This study is the statistical equivalent of a category 5 hurricane hitting the prevailing narrative of the abortion industry,' Anderson said in a statement. 'Calling it a study would be too generous,' said Dr. Ushma Upadhyay, a professor in the University of California-San Francisco's Department of Obstetrics, Gynecology, and Reproductive Sciences. 'The fact that it's not peer-reviewed means that a lot of the methodological flaws were not corrected or were not addressed in the paper,' she told The Independent. The Independent has requested comment from the center. There were 36 reports of deaths associated with mifepristone since the product was approved in September 2000, according to the FDA. Those include two cases of pregnancy outside of the womb and several cases of sepsis. 'The adverse events cannot with certainty be causally attributed to mifepristone because of concurrent use of other drugs, other medical or surgical treatments, co-existing medical conditions and information gaps about patient health status and clinical management of the patient,' the agency noted. A spokesperson for GenBioPro, the manufacturer of mifepristone, said the report is 'clearly flawed.' 'If this study isn't recognized widely for what it is – just another attempt by the anti-abortion movement to spread misinformation about the safety of the abortion pill using a bogus and biased study – Americans will be left with misleading information when they need to make critical health care and life decisions,' Emma Thomas told The Independent in an email. 'This is a report with no peer review, no transparency of methods. It comes out, and within days is cited at our highest levels of government to the person who makes decisions around regulation of medications,' said Heidi Moseson, a senior research scientist at Ibis Reproductive Health. 'And that suggests a very different pipeline of the way information is traveling with sort of egregious political motivation,' she told The Independent. A medication abortion typically involves a two-part protocol: mifepristone, which blocks the hormone progesterone to stop a pregnancy from growing, followed by misoprostol, which helps the uterus contract. The medication is also frequently used for miscarriage treatment. Mifepristone was first approved for use by the FDA in most cases in 2000, and the drug is approved for use up to 10 weeks of pregnancy. A vast majority of all abortions occur within the first nine weeks of pregnancy. Roughly 63 percent of all abortions in the United States are medication abortions, the Guttmacher Institute says. From 2019 through 2020, nearly 93 percent of all abortions were performed before the 13th week, according to the Centers for Disease Control and Prevention. In 2021, the FDA under President Joe Biden permanently lifted the in-person requirement for medication abortion prescriptions, allowing patients to access the drugs via telehealth appointments and online pharmacies so patients can take the drugs at home. In the years that followed, anti-abortion state legislators filed more than 100 bills to restrict access to abortion drugs, or sought to ban them altogether. After the Supreme Court overturned Roe v Wad e in 2022, more than a dozen states effectively outlawed all abortions in most circumstances. Months after that ruling, Alliance Defending Freedom filed a federal lawsuit targeting mifepristone with a court in Amarillo, Texas, on behalf of a group of anti-abortion physicians, claiming the FDA wrongfully approved mifepristone and then improperly eliminated requirements that the drug should only be dispensed in person. Trump-appointed District Judge Matthew Kacsmaryk, who had formerly worked as a chief counsel with right-wing Christian legal activist group First Liberty Institute, later issued a ruling to suspend the FDA's approval of the drug, but the Supreme Court unanimously rejected his decision. Whether the FDA under the Trump administration can now simply swap underlying data with another is 'the million dollar question,' according to Upadhyay. 'As a scientist, it's really concerning and devastating to see what is meant to be a system to keep people safe and understand true health risks weaponized in this moment to further restrict people's access to really essential healthcare,' Moseson said.
