Key Facts on Abortion in the United States

Note: This brief was updated on June 21, 2024 to incorporate new data on abortion statistics.

On June 24, 2022, the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization overturned the constitutional right to abortion, as well as the federal standards of abortion access established by prior decisions in the cases Roe v. Wade and Planned Parenthood v. Casey. Prior to the Dobbs ruling, the federal standard was that abortions were permitted up to fetal viability in all states. That federal standard has been eliminated, allowing states to set policies regarding the legality of abortions and establish limits. KFF is tracking and updating the status of abortion access and availability, with some states banning almost all abortions and some states protecting abortion access.

This issue brief answers some key questions about abortion in the United States and presents data collected before and new data that has been published since the overturn of Roe v. Wade.

• What is abortion?
• How safe are abortions?
• How often do abortions occur?
• Who gets abortions?
• At what point in pregnancy do abortions occur?
• Where do people get abortion care?
• How much do abortions cost?
• Does private insurance or Medicaid cover abortions?
• How does the public view abortion?

What is abortion?

Abortion is the medical termination of a pregnancy. It is a common medical service that many women obtain at some point in their life. There are different types of abortion methods, which the National Academy of Sciences, Engineering, and Medicine (NASEM) places in four categories:

• Medication Abortion – Medication abortion, also known as medical abortion or abortion with pills, is a pregnancy termination protocol that involves taking oral medications. There are two widely accepted protocols for medication abortion. In the U.S., the most common protocol involves taking two different drugs, mifepristone and misoprostol. Typically, an individual using medication abortion takes mifepristone first, followed by misoprostol 24-48 hours later. In the U.S., the Food and Drug Administration (FDA) has approved this protocol of medication abortion for use up to the first 70 days (10 weeks) of pregnancy, and its use has been rising for years. Another medication abortion protocol uses misoprostol alone. Patients can take 800 µg (4 pills) of misoprostol sublingually or vaginally every three hours for a total of 12 pills. The regimen is also recommended for up to 70 days (10 weeks) of pregnancy, but it is not currently approved by the FDA and is more commonly used in other countries. Guttmacher Institute estimates that in 2023, medication was used for almost two thirds (63%) of all abortions. Many have confused emergency contraception (EC) pills with medication abortion pills, but EC does not terminate a pregnancy. EC works by delaying or inhibiting ovulation and will not affect an established pregnancy.

• Aspiration, a minimally invasive and commonly used gynecological procedure, is the most common form of procedural abortion. It can be used to conduct abortions up to 14-16 weeks of gestation. Aspiration is also commonly used in cases of early pregnancy loss (miscarriage).
• Dilation and evacuation abortions (D&E) are usually performed after the 14th week of pregnancy. The cervix is dilated, and the pregnancy tissue is evacuated using forceps or suction.
• Induction abortions are rare and conducted later in pregnancy. They involve the use of medications to induce labor and delivery of the fetus.

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How safe are abortions?

Decades of research have shown that abortion is a very safe medical service.

Despite its strong safety profile, abortion is the most highly regulated medical service in the country and is now banned in several states. In addition to bans on abortion altogether and telehealth, many states impose other limitations on abortion that are not medically indicated, including waiting periods, ultrasound requirements, gestational age limits, and parental notification and consent requirements. These restrictions typically delay receipt of services.

• NASEM completed an exhaustive review on the safety and effectiveness of abortion care and concluded that complications from abortion are rare and occur far less frequently than during childbirth.
• NASEM also concluded that safety is enhanced when the abortion is performed earlier in the pregnancy. State level restrictions such as waiting periods, ultrasound requirements, and gestational limits that impede access and delay abortion provision likely make abortions less safe.
• When medication abortion pills, which account for the majority of abortions, are administered at 9 weeks’ gestation or less, the pregnancy is terminated successfully 99.6% of the time, with a 0.4% risk of major complications, and an associated mortality rate of less than 0.001 percent (0.00064%).
• Medication abortion pills can be provided in a clinical setting or via telehealth (without an in-person visit). Research has found that the provision of medication abortion via telehealth is as safe and effective as the provision of the pills at an in person visit.
• Studies on procedural abortions, which include aspiration and D&E, have also found that they are very safe. Research on aspiration abortions, the most common procedural method, have found the rate of major complications of less than 1%.

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How often do abortions occur?

There are three major data sources on abortion incidence and the characteristics of people who obtain abortions in the U.S: the Centers for Disease Control and Prevention (CDC), the Guttmacher Institute, and most recently, the Society of Family Planning’s (SFP) #WeCount project.

The federal CDC Abortion Surveillance System requests data from the central health agencies of the 50 states, D.C., and New York City to document the number and characteristics of women obtaining abortions. Most states collect data from facilities where abortions are provided on the demographic characteristics of patients, gestational weeks, and type of abortion procedure. Reporting these data to the CDC is voluntary and not all states participate in the surveillance system. Notably, California, Maryland, and New Hampshire have not reported data on abortions to the CDC system for years. CDC publishes available data from the surveillance system annually. The most recent data is for the year 2021.

Guttmacher Institute, an independent research and advocacy organization, is another major source of data on abortions in the U.S. Prior to the Dobbs ruling, Guttmacher conducted the Abortion Provider Census (APC) periodically which has provided data on abortion incidence, abortion facilities, and characteristics of abortion patients. Data from the APC are based primarily on questionnaires collected from all known facilities that provide abortion in the country, information obtained from state health departments, and Guttmacher estimates for a small portion of facilities. The most recent APC reports data from 2020.

The CDC and Guttmacher data differ in terms of methods, timeframe, and completeness, but both have shown similar trends in abortion rates over the past decade. One notable difference is that Guttmacher’s study includes continuous reporting from California, D.C., Maryland, and New Hampshire, which explains at least in part the higher abortion volume in their data.

Since the Dobbs ruling, the Guttmacher Institute has established the Monthly Abortion Provision Study to track abortion volume within the formal U.S. health care system. This ongoing effort collects data on and provides national and state-level estimates on procedural and medication abortions while also tracking the changes in abortion volume since 2020. The Monthly Abortion Provision Study was designed to complement Guttmacher’s APC along with other data collection efforts to allow for quick snapshots of the changing abortion landscape in the U.S.

Society of Family Planning’s (SFP) #WeCount is another national reporting effort that measures changes in abortion access following the Dobbs ruling. The project reports on the number of abortions per month by state and includes data on abortions provided through clinics, private practices, hospitals, and virtual-only providers. The report does not include data on self-managed abortions that are performed without clinical supervision. The most recent #WeCount report analyzes data from April 2022 to data from December 2023, marking 18 months of abortion data since Dobbs.

This KFF issue brief uses data from the CDC, Guttmacher, and SFP as well as other research organizations.
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How has the abortion rate changed over time?

For most of the decade prior to the Dobbs ruling, there was a steady decline in abortion rates nationally, but there was a slight increase in the years just before the ruling.

In their most recent national data, Guttmacher Institute reported 930,160 abortions in 2020 and a rate of 14.4 per 1,000 women. CDC reported 622,108 abortions in 2021 and a rate of 11.6 abortions per 1,000 women (excludes CA, DC, MD, NH). Guttmacher’s study showed an upward trend in abortion from 2017 to 2020 whereas CDC’s report showed an increase in abortions from 2017 to 2021 except for a slight decrease in 2020.

While most attribute the long-term decline in abortion rates to increased use of more effective methods of contraception, several states had reduced access to low- or no-cost contraceptive care as a result of reductions in the Title X network under the Trump Administration, which may have contributed to the slight rise in abortions prior to the Dobbs ruling. Other factors that may have contributed to the increase could include greater coverage under Medicaid that subsequently made abortions more affordable in some states and broader financial support from abortion funds to help individuals pay for the costs of abortion care.

Even prior to the Dobbs ruling, abortion rates varied widely between states.

National averages can mask local and more granular differences. Lower state-level abortion rates do not reflect less need. Some of the variation has been due to the wide differences in state policies, with some states historically placing restrictions on abortion that make access and availability to nearly out of reach and, on the other side, some states enshrining protections in state Constitutions and legislation.

• In 2020, the abortion rate (per 1,000 women ages 15-44) ranged from 0.1 in Missouri to 48.9 in the District of Columbia (DC). Trends also varied between states. While the national rate of abortion increased between 2017 and 2019, some states saw declines, with particularly sharp drops in states where heavy restrictions were put into place.

While the number of abortions in the U.S. dropped immediately following the Dobbs decision, new data show that the number of abortions slightly increased overall 18 months following the ruling. However, the small upswing nationally obscures the massive declines in abortion care provided in states with bans.

In 2023, the volume of in-person and virtual-only abortions averaged 84,600 abortions per month, slightly higher than the 2022 monthly average of 81,900 abortions. Nationally, the number of abortions varied month-by-month, with the largest decrease observed in November 2022 (approximately 8,200 fewer abortions than pre-Dobbs period) and the largest increase in March 2023 (approximately 10,000 more abortions than pre-Dobbs period). The states with abortion bans experienced the largest cumulative decreases in the number of abortions, including Texas, Georgia, Tennessee, and Louisiana (data varies by month in each state; data not shown). States with the largest cumulative increases in the total number of abortions include Illinois, Florida, and California (data not shown).

States without abortion bans experienced an increase of abortions following the Dobbs ruling likely due to a combination of reasons: increased interstate travel for abortion access, expanded in-person and virtual/telehealth capacity to see patients, increased measures to protect and cover abortion care for residents and out-of-state patients, and the broader availability of low-cost abortion medication.

However, these aggregated trends mask the sharp decline in abortions provided in states with total bans or severe restrictions as well as the hardships that many pregnant people experience in accessing abortion care. The #WeCount report estimates that approximately 180,000 additional abortions would have occurred in these 18 months had Roe not been overturned (data not shown).
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Who gets abortions?

Most of the information about people who receive abortions comes from CDC data prior to the Dobbs ruling. In 2021, women across a range of age groups, socioeconomic status, and racial and ethnic backgrounds obtained abortions, but the majority were obtained by women who were in their twenties, low-income, and women of color.

• Women in their twenties accounted for more than half (57%) of abortions. Nearly one-third (31%) were among women in their thirties and a small share were among women in their 40s (4%) and teens (8).
• More than half of abortions were among women of color. Black women comprised 42% of abortion recipients, 30% were provided to White women, 22% to Hispanic women, and 7% were among women of other races/ethnicities.
• Many women who sought abortions have children. Approximately six in 10 (61%) abortion patients in 2021 had at least one previous birth.

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At what point in pregnancy do abortions occur?

The vast majority (93%) of abortions occur during the first trimester of pregnancy according to data available from before the Dobbs decision.

Before the 2022 ruling in Dobbs, there was a federal constitutional right to abortion before the pregnancy is considered to be viable, that is, can survive outside of a pregnant person’s uterus. Viability is generally considered around 24 weeks of pregnancy. Most abortions, though, occur well before the point of fetal viability.

• Data from 2021 found that four in ten (40%) abortions occurred by six weeks of gestation, another four in ten (39%) occurred between seven and nine weeks, and 14% at 10-13 weeks. Just 7% of abortions occurred after the first trimester.
• Prior to the decision in the Dobbs case, almost half of states (22) had enacted laws that ban abortion at a certain gestational period. Most of these limits are in the second trimester, but some are in the first trimester, well before fetal viability. Many of these laws had been blocked because they violated the federal standard established by Roe v Wade. Some states have enacted laws banning abortions after fetal cardiac activity can be detected, or around 6 weeks of pregnancy, which is often before a person knows they are pregnant. Since the Dobbs ruling, states can ban abortion or establish pre-viability gestational restrictions because the federal standard that had been in place until then has been overturned.

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Where do people get abortion care?

Just over half of abortions were provided at clinics that specialize in abortion care in 2020. Others were provided at clinics that offer abortion care in addition to other family planning services.

Guttmacher Institute estimated that 96% of abortions were provided at clinics and just 4% were provided in doctors’ offices or hospitals in 2020. Most clinic-based abortions were provided at clinics that specialize in providing abortion care, but many were provided at clinics that offer a wide range of other sexual and reproductive health services like contraception and STI care. Most abortions are provided by physicians. However, in 19 states and D.C., Advanced Practice Clinicians (APCs) such as Nurse Practitioners and midwives may provide medication abortions. Conversely, 31 states prohibit clinicians other than physicians from providing abortion care.

Even prior to the ruling in Dobbs, access to abortion services was very uneven across the country though. The proliferation of restrictions in many states, particularly in the South, had greatly shrunk the availability of services in some areas. In the wake of overturning Roe v. Wade, these geographic disparities have widened. Many clinics stopped offering abortion services shortly after the Dobbs ruling, and a recent report estimates that over 60 independent abortion clinics have shut down altogether in 2022 (42 clinics) and 2023 (23 clinics as of October 2023).

Telehealth

Telehealth has grown as a delivery mechanism for abortion services. While procedural abortions must be provided in a clinical setting, medication abortion can be provided in a clinical setting or via telehealth. Access to medication abortion via telehealth had been limited for many years by a Food and Drug Administration (FDA) restriction that had permitted only certified clinicians to dispense mifepristone in a health care setting. The drug could not be mailed or picked up at a retail pharmacy. However, in December 2021, the FDA permanently revised its policy and no longer requires clinicians to dispense the drug in person. Additionally, in January 2023, the FDA finalized a change that allows retail pharmacies to dispense medication abortion pills to patients with a prescription. These policy changes opened the door to use telehealth for medication abortion.

• In a telehealth abortion, the patient typically completes an online questionnaire to assess (1) confirmation of pregnancy, (2) gestational age and (3) blood type. If determined eligible by a remote clinician, the patient is mailed the medications. This model does not require an ultrasound for pregnancy dating if the patient has regular periods and is sure of the date of their last menstrual period (in line with ACOG’s guidelines for pregnancy dating). If the patient has irregular periods or is unsure how long they have been pregnant, they may need to obtain an ultrasound to confirm the weeks of gestation and rule out an ectopic pregnancy and send in the images for review before receiving their medications. The follow-up visit with a clinician can also happen via a telehealth visit.
• Telehealth can be administered by providers from traditional brick-and-mortar clinics or by virtual-only clinics. Virtual clinics began to proliferate after the FDA revised its in-person dispensing requirement in 2021, rising from no virtual clinics in 2020 to 69 clinics in 2022 (representing 9% of 789 facilities that offer medication abortion).
• However, even in some of the states that have not banned abortion altogether, telehealth may not be available. Many states had established restrictions prior to the Dobbs ruling that limit the use of telehealth abortions by either requiring abortion patients to take the pills at a physical clinic, require ultrasounds for all abortions, set their own policies regarding the dispensing of the medications used for abortion care, or directly ban the use of telehealth for abortion care. As of March 2024, of the 36 states that have not banned abortion, twelve had at least one of these restrictions, effectively prohibiting telehealth for medication abortion.
• Medication abortion has emerged as a major legal and legislative front in the battle over abortion access across the nation. Multiple cases have been filed in federal and state courts regarding aspects of the FDA’s regulation of medication abortion as well as the mailing of medications. One state, Louisiana, has classified mifepristone as a controlled substance. Additionally, a federal 1873 anti-obscenity law, the Comstock Act, prohibits the mailing of any medication used for abortion. While this law has not been enforced for years, it could be invoked by a future more conservative Presidential Administration if it is not repealed by Congress.
• The Data from SFP’s May 2024 #WeCount report show that one in five (19%) abortions were provided via telehealth in December 2023. These telehealth abortions include those provided by virtual clinicians (48%), brick-and-mortar clinics (5%), and providers that prescribe medication abortion in states with shield laws to patients in other states with bans (36%) or telehealth restrictions (12%). States with shield laws aim to protect clinicians and minimize the legal risks associated with providing abortion care to patients in states where abortion or telehealth abortion are banned or restricted. Since July 2023, SFP estimates that more than 40,000 people have accessed medication abortion through these shield laws.

Self-Managed Abortions

Self-managed abortions are provided without a clinician visit (either via telehealth or in person) and typically involve obtaining medication abortion pills from an online pharmacy that will send the pills by mail or by purchasing the pills from a pharmacy in another country. While this can involve asynchronous contact with non-US-based clinicians, it does not typically involve a direct consultation with a clinician either in person or via telehealth.

Tracking the volume of these online orders can help fill in gaps in abortion count estimates but can also be difficult. Some companies may not share data on purchases, and it would also be unclear whether patients actually take the abortion medication after receiving it in the mail.

A recent study estimated that compared to expected pre-Dobbs numbers, at least 26,000 additional self-managed medication abortions took place in the six months following the Supreme Court ruling. More than half of these self-managed medication abortions were provided through volunteers in community networks, while others were performed by telehealth organizations outside the formal U.S. health care system and online vendors.

Interstate Travel

The Guttmacher Institute Monthly Abortion Provision Study is the only data source so far to provide in-depth information on interstate travel pre- and post-Dobbs. Guttmacher estimates that prior to Dobbs, nearly one in ten people obtained an abortion by traveling across state lines in 2020. The latest data show that the interstate travel rate for abortion care more than doubled in 2023, with approximately one in five (~171,000) abortion patients traveling out of state for care in 2023 compared to 74,000 in 2020. Illinois experienced the largest increase in inbound travel for abortion care, with an estimated 37,300 abortion patients traveling into the state in 2023. North Carolina, New Mexico, Florida, and Kansas also experienced a rise in the number of out-of-state abortion patients during this time. However, Florida and North Carolina have implemented earlier gestational restrictions since this time, which will likely lower the 9,600 and 15,800 patients, respectively, traveling to those states for abortions.

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How much do abortions cost?

The costs of abortion services vary depending on the method and often exceeds $500.

Obtaining an abortion can be costly. On average, the costs are higher for abortions in the second trimester than in the first trimester. The state bans and restrictions enacted since Dobbs can also raise the costs, as some people have to travel substantial distances to obtain abortion care. Many people pay for abortion services out of pocket, but some people can obtain assistance from local abortion funds.

• In 2021, the median costs for people paying out of pocket in the first trimester were $568 for a medication abortion and $625 for a procedural abortion. The Federal Reserve estimates that nationally, more than one-third of people do not have $400 on hand for unexpected expenses, with higher shares of Hispanic (57%) and Black (58%) women than saying they could not cover an emergency expense using their current savings compared to 36% of White women. For people with low incomes, who are more likely to need abortion care, these abortion costs are often unaffordable.
• The costs of abortion are higher in the second trimester compared to the first, with median self-pay of $775. In the second trimester, more intensive procedures may be needed, more are likely to be conducted in a hospital setting (although still a minority), and local options are more limited in many communities that have fewer facilities. This results in additional nonmedical costs for transportation, childcare, lodging, and lost wages.
• Abortion funds are independent organizations that help some people pay for the costs of abortion services. Most abortion funds are regional and have connections to clinics in their area. Funds vary, but they typically provide assistance with the costs of medical care, travel, and accommodations if needed. However, they do not reach all people seeking services, and many people are not able to afford the costs of obtaining an abortion because they cannot pay for the abortion itself or cover the costs of travel, lodging or missed work. Since Dobbs, these networks received a reported 39% more requests for abortion support and financially supported more than 100,000 individuals seeking abortion care. While donations to these networks rose immediately following Dobbs, the frequency of donations slowed, and funds have begun to taper, and some organizations recently reported suspending operations altogether.
• People can get abortions through self-managed means online. Websites like Plan C provide information about online resources that sell and mail abortion pills. The costs for these services range from around $28 or more for abortion pills by mail without clinician consultation, to upwards of $150 for abortion by mail with a clinical consultation.

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Does private insurance or Medicaid cover abortions?

Insurance coverage for abortion services is heavily restricted in certain private insurance plans and public programs like Medicaid and Medicare.

Private insurance covers most women of reproductive age, and states have the responsibility to regulate fully insured private plans in their state, whereas the federal government regulates self-funded plans under the Employee Retirement Income Security Act (ERISA). States can choose whether abortion coverage is included or excluded in private plans that are not self-insured.

• Prior to the Dobbs ruling, several states had enacted private plan restrictions and banned abortion coverage from ACA Marketplace plans. Currently, there are 11 states that have policies restricting abortion coverage in private plans and 26 that ban coverage in any Marketplace plans. Since the Dobbs ruling, some of these states have also banned the provision of abortion services altogether.
• A handful of states (9), however, have enacted laws that require private plans to cover abortion.
• The Medicaid program covers approximately one in five women of reproductive age and four in ten who are low-income. For decades, the Hyde Amendment has banned the use of federal funds for abortion in Medicaid and other public programs unless the pregnancy is a result of rape, incest, or it endangers the woman’s life.
• States have the option to use state-only funds to cover abortions under other circumstances for women on Medicaid, which 17 states do currently. However, more than half (56%) of women covered by Medicaid live in Hyde states.
• According to a Guttmacher Institute survey of patients in the year prior to the Dobbs ruling, a quarter (26%) of abortion patients in the study used Medicaid to pay for abortion services, 11% used private insurance, and 60% paid out of pocket. People in states with more restrictive abortion policies were less likely to use Medicaid or private insurance and more likely to pay out of pocket compared to people living in less restrictive states.
• Federal law also restricts abortion funding under the Indian Health Service, Medicare, and the Children’s Health Insurance Program. Over the years, language similar to that in the Hyde Amendment has been incorporated into a range of other federal programs that provide or pay for health services to women including: the military’s TRICARE program, federal prisons, the Peace Corps, and the Federal Employees Health Benefits Program.

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How does the public view abortion?

KFF’s national polls have consistently found that a majority of the public did not want to see Roe v. Wade overturned and that most people feel that abortion is a personal medical decision. The public also strongly opposes the criminalization of abortion both among people who get abortion and the clinicians who provide abortion services. Most adults (74%) and reproductive-age women (79%) say that obtaining an abortion should be a personal choice rather than regulated by law (data not shown). Furthermore, the majority of the public supports access to abortions for patients who are experiencing pregnancy-related emergencies (86%), a patient’s right to travel for abortion care (79%) and protecting doctors who perform abortions from legal penalties (67%). Abortion continues to be a prominent election issue, and KFF polling from May 2024finds that nearly three in four women voters say the 2024 election will have an impact on abortion access in their state.

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Additional KFF resources:

Abortion in the US Dashboard

Access and Coverage of Abortion Services

Policy Tracker: State and Federal Reproductive Rights and Abortion Litigation Tracker

Policy Tracker: Exceptions to State Abortion Bans and Early Gestational Limits

Issue Brief: The Hyde Amendment and Coverage for Abortion Services Under Medicaid in the Post-Roe Era

Issue Brief: What are the Implications of the Dobbs Ruling for Racial Disparities?

Interactive: How State Policies Shape Access to Abortion Coverage

Medication Abortion

Fact Sheet: The Availability and Use of Medication Abortion

Issue Brief: What’s at Stake for Access to Medication Abortion and the FDA in the Supreme Court Case FDA v. the Alliance for Hippocratic Medicine?https://www.kff.org/womens-health-policy/issue-brief/legal-challenges-to-the-fda-approval-of-medication-abortion-pills/

Issue Brief: The Intersection of State and Federal Policies on Access to Medication Abortion Via Telehealth

Public Opinion on Abortion

KFF Health Tracking Poll: KFF Health Tracking Poll March 2024: Abortion in the 2024 Election and Beyond

KFF Health Tracking Poll: Women’s Views of Abortion Access and Policies in the Dobbs Era: Insights From the KFF Health Tracking Poll

Other Resources on Women’s Health

Interactive: State Profiles for Women’s Health

Interactive: State Health Facts on Women’s Health Indicators

Homepage: Women’s Health Policy