Medication Abortion Is Still the Most Common Type
An abortion rights activist holds a box of mifepristone during a rally in front of the U.S. Supreme Court on March 26, 2024, in Washington, D.C. Credit - Drew Angerer—AFP/Getty Image
New data reveal that the majority of abortions that were provided in most states in 2023 were medication abortions—a pattern that reproductive health experts say underscores the need to protect access to abortion pills.
The Guttmacher Institute, which researches and supports sexual and reproductive health and rights, released on Feb. 27 an analysis of state-level data on medication abortion in 2023. Guttmacher researchers had previously found that medication abortions accounted for 63% of all abortions provided by clinicians in 2023 in states without the most restrictive policies—most states, in other words—and the data released on Thursday expanded on that finding by breaking that number down by state. A full 95% of abortions performed in Wyoming were medication abortions, and 84% of abortions in Montana were. Lowest were Washington, D.C., at 44%, and Ohio, at 46%, according to the report.
Researchers also looked at how women were receiving medication abortion: whether through prescriptions from in-person clinics or via telemedicine. In states without near-total abortion bans or bans on telemedicine provision, about 10% of abortions in 2023 were provided by online-only clinics, ranging from 7% in states like New York and California to as high as 60% in Wyoming.
'What these data are telling us is that medication abortion is a critical option for folks in most states without total abortion bans, and we're also seeing that in some states, telemedicine is playing a pretty major role,' says Isabel DoCampo, senior research associate at the Guttmacher Institute and one of the lead authors of the analysis. 'What this communicates is that lawmakers shouldn't support efforts to curtail medication abortion or telemedicine access for medication abortion, and that these options need to be expanded. Medication abortion is an option with high demand, with high need in most states without total abortion bans, and access to medication abortion via any means shouldn't be restricted.'
The two-drug regimen of mifepristone and misoprostol is the most common medication abortion method that U.S. providers offer. The U.S. Food and Drug Administration approved mifepristone to be used for abortions more than 20 years ago, and years of research have found the drug to be both safe and effective. But recently, mifepristone has faced attacks from anti-abortion activists and some politicians, including through court challenges.
Read More: How the Biden Administration Protected Abortion Pill Access—and What Trump Could Do Next
The analysis published on Thursday is part of the Guttmacher Institute's Monthly Abortion Provision Study, an ongoing project that shares monthly estimates of abortions provided by clinicians in states without near-total bans. Researchers survey providers and use a statistical model to estimate data. The project started when the Guttmacher Institute saw a 'need for more frequent data collection and more frequent reporting' in an era of quickly changing policies on abortion, after the U.S. Supreme Court overturned Roe v. Wade, DoCampo says.
The research team focused on abortions provided at both brick-and-mortar facilities and online-only providers in states that didn't have near-total abortion bans in 2023. DoCampo says one of the reasons the team decided not to include states with near-total bans was to protect providers' confidentiality. Some abortion shield laws offer protections for providers prescribing abortion pills via telemedicine and sending them to patients in states with bans or restrictions, but New York's law is currently being tested through two legal challenges in Louisiana and Texas.
Read More: What Are Abortion Shield Laws?
Because the team didn't include data from states with near-total bans or include self-managed abortions, DoCampo says, 'If we're thinking about all abortions occurring in the U.S., our numbers reflecting medication abortion provision are likely an undercount, and medication abortion likely plays an even greater role in the U.S. abortion access landscape.'
The data also show that even states that have many different characteristics have similar proportions of medication abortion provision. For instance, Wyoming is a rural state with low population density and, at the time, it had a near-total ban on abortion and a first-of-its-kind ban on medication abortion. (Wyoming's abortion bans were later blocked.) Delaware, meanwhile, has a higher population density and protective abortion policies. But in both states, medication abortion accounts for a high proportion of abortions. 'It's likely that there's a constellation of factors at the state level' influencing the proportion of medication abortion, DoCampo says, such as abortion policies, insurance reimbursement rates for medication vs. procedural abortion, and the number of clinics operating in the state.
Ushma Upadhyay—a professor in the department of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco and a member of the university's Advancing New Standards in Reproductive Health program—was not affiliated with the Guttmacher Institute's research and says she was 'delighted' to see this data breakdown by state. With so much variation in factors like abortion policy and insurance coverage, which all impact abortion access and preferences, this type of data is 'incredibly valuable,' she says.
'These rates show that restrictions are ineffective; when it comes to abortion, people are going to do what they need to to access abortion care,' Upadhyay says. 'I think that this is exactly why anti-abortion activists are coming after medication abortion—they can see that people are able to access it, there's more and more research that it is safe and effective, [and] patients enjoy the level of autonomy that it provides them.'
Upadhyay says she thought the team's methodology was 'very strong.' But she wishes the report discussed in greater detail the role that insurance plays in this area, and agrees that the data were likely undercounting the prevalence of medication abortion because states with near-total abortion bans weren't included in the analysis.
Some of the states the Guttmacher team looked at have abortion restrictions, such as Georgia, Florida, and Iowa, which all ban abortion after about six weeks of pregnancy. Upadhyay notes that some of those states had high proportions of medication abortion, including Georgia at 83%. 'That is a perfect illustration of the power that medication abortion has; it's across the country,' she says. 'People are accessing it more and more, and they're able to use it despite the increasing number of restrictions in states.'
Contact us at letters@time.com.
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