The number of women in Texas who died while pregnant, during labor or soon after childbirth skyrocketed following the state’s 2021 ban on abortion care — far outpacing a slower rise in maternal mortality across the nation, a new investigation of federal public health data finds.

From 2019 to 2022, the rate of maternal mortality cases in Texas rose by 56%, compared with just 11% nationwide during the same time period, according to an analysis by the Gender Equity Policy Institute. The nonprofit research group scoured publicly available reports from the Centers for Disease Control and Prevention and shared the analysis exclusively with NBC News.

“There’s only one explanation for this staggering difference in maternal mortality,” said Nancy L. Cohen, president of the GEPI. “All the research points to Texas’ abortion ban as the primary driver of this alarming increase.”

“Texas, I fear, is a harbinger of what’s to come in other states,” she said.

The SB 8 effect

The Texas Legislature banned abortion care as early as five weeks into pregnancy in September 2021, nearly a year before the U.S. Supreme Court overturned Roe v. Wade — the case that protected a federal right to abortion — in June 2022.

At the time, Texas Gov. Greg Abbott, a Republican, lauded the bill as a measure that “ensures the life of every unborn child.”

Texas law now prohibits all abortion except to save the life of the mother.

The passage of Texas’ Senate Bill 8 gave GEPI researchers the opportunity to take an early look at how near-total bans on abortion — including cases in which the mother’s life was in danger — affected the health and safety of pregnant women.

The SB 8 effect, Cohen’s team found, was swift and stark. Within a year, maternal mortality rose in all racial groups studied.

Among Hispanic women, the rate of women dying while pregnant, during childbirth or soon after increased from 14.5 maternal deaths per 100,000 live births in 2019 to 18.9 in 2022. Rates among white women nearly doubled — from 20 per 100,000 to 39.1. And Black women, who historically have higher chances of dying while pregnant, during childbirth or soon after, saw their rates go from 31.6 to 43.6 per 100,000 live births.While maternal mortality spiked overall during the pandemic, women dying while pregnant or during childbirth rose consistently in Texas following the state’s ban on abortion, according to the Gender Equity Policy Institute.

“If you deny women abortions, more women are going to be pregnant, and more women are going to be forced to carry a pregnancy to term,” Cohen said.

Beyond the immediate dangers of pregnancy and childbirth, there is growing evidence that women living in states with strict abortion laws, such as Texas, are far more likely to go without prenatal care and much less likely to find an appointment with an OB-GYN.

Doctors say the feeling among would-be moms is fear.

“Fear is something I’d never seen in practice prior to Senate Bill 8,” said Dr. Leah Tatum, an OB-GYN in private practice in Austin, Texas. Tatum, who was not involved with the GEPI study, said that requests for sterilization procedures among her patients doubled after the state’s abortion ban.

That is, women prefer to lose their ability to ever have children over the chance that they might become pregnant following SB 8.

“Patients feel like they’re backed into a corner,” Tatum said. “If they already knew that they didn’t want to pursue pregnancy, now they’re terrified.”

Tatum said she’s seeing many women in their late 30s and 40s who, even though they’d like to have a child, worry they wouldn’t have an option to end the pregnancy if it turned out that the baby wouldn’t be born healthy. “‘What happens if I end up with a genetically abnormal fetus?’” Tatum said her patients have asked her. They worry their options are limited, she said. ‘Treated like a criminal’

That unthinkable tragedy happened to Kaitlyn Kash, 37, of Austin, Texas.

Kash had a textbook pregnancy with her first child, a healthy little boy, born in 2018.

“It’d been so easy the first time,” she said. “Never in my wildest dreams did I think we would go down the journey that we went down.”

When she became pregnant again, it wasn’t until Kash’s second trimester, at 13 weeks, that she and her husband, Cory, discovered that their fetus had severe skeletal dysplasia, a rare genetic disorder affecting bone and cartilage growth. It was highly unlikely the baby would survive.

Kaitlyn Kash and her husband, Cory, at home with their two children. NBC News

“We were told that his bones would break in utero and he would suffocate at birth,” Kash said. “We were expecting our doctor to tell us how we were going to care for our baby, how we were going to end his pain.”It was October 2021, just a month after Texas passed the SB 8 abortion law.

“We were told that we should get a second opinion, but make sure that it was outside of Texas,” she said.

At 15 weeks, Kash had to travel to Kansas to terminate her doomed pregnancy. Outside the medical clinic, protesters harassed the grief-stricken mom.

“I was being treated like a criminal,” she said. “I didn’t get the dignity that I deserved to say goodbye to my child.”

“It’s just another example of how it’s heartbreaking to practice in the state of Texas,” Tatum said. “These patients are asking for help. The state of Texas has failed women.”

CORRECTION (Sept. 21, 2024, 8:17 a.m. ET): A previous version of this article misstated the maternal mortality rates by demographic. The figures represent the number per 100,000 live births, not percentages.

By denying and restricting access to abortion to millions of people since the overturning of Roe v. Wade in 2022 with the Dobbs decision, the United States is failing to comply with its international human rights obligations and standards to ensure pregnant people have access to abortion, according to a new report published by Amnesty International today.

The report, Abortion in the USA: The Human Rights Crisis in the Aftermath of Dobbs, shares stories from individuals across the country who have been harmed by restrictive laws and practices in their states, putting a human face on the multitude of the ways in which people are harmed when denied the human right to abortion.

In addition to abortion bans and restrictions in 21 states, barriers for emergency medical care and efforts to criminalize abortions that threaten pregnant people and healthcare workers alike have all led to the current human rights crisis. The spread of false information and stigmatization of abortion in addition to provision of unqualified care by so-called crisis pregnancy centers – often run by activists who oppose abortion – is also contributing to the crisis, according to the report.

“These barriers and bans to abortion create a scenario where an individual’s access to abortion care depends on where they live and what resources they have,” said Jasmeet Sidhu, senior researcher with Amnesty International USA.

“Access to reproductive care, including abortions, must not depend on the state in which somebody lives, or the ability an individual does or does not have to travel to another state. The current landscape leads to some people not being able to access abortion care, which is not how human rights are supposed to work.”

In the days and months after the Supreme Court rendered a 2022 decision gutting the U.S. constitutional protection for abortion, advocates predicted many negative impacts to come for women and their families. At least one such prediction has come true: there has been an increase in intimate partner violence in places with a near-total ban on abortion. Intimate partner violence, which occurs between two people in a romantic relationship, increased by about 7-10% in U.S. counties where people had to travel further for abortion care in 2023 than in 2017, according to a new study published in the National Bureau of Economic Research.

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This led to an estimated 9,000 additional incidents of intimate partner violence in states that limit abortion rights, according to the study, which is one of the first to examine data on how restrictions to abortion access are linked to violence. That adds up to $1.24 billion in additional social costs, the study finds. There are a few reasons why restrictions to abortion could lead to increased intimate partner violence, the study’s authors say. Restrictions often cause more financial strain because women have to take time off from work and travel farther away to seek abortion care. (The average person seeking care in such a state had to travel 241 miles farther for abortion care than women in states without these laws.) Restrictions limit people’s options, which could worsen the mental and physical health of women and men, leading to abuse. And pregnancy is already known to increase intimate partner violence; one study found pregnant women were 16% more likely to die by homicide than were non-pregnant women.

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Read More: What Are Abortion Shield Laws? Restrictions on abortion can also bind women to violent partners. The Turnaway study, which looked at what happened to women denied an abortion because they were over the clinic’s gestational limit, found that these women sustained more intimate partner violence compared to those who were able to obtain an abortion. They were also at higher risk for suicidal ideation. Abortion restrictions can worsen intimate partner violence even if women end up getting an abortion, says Dhaval Dave, an economics professor at Bentley University in Massachusetts and one of the study’s authors. “Delays, financial strains, stress, and prolonged engagement with violent partners can all affect relationship quality and increase the risk of interpersonal violence, even if an abortion is ultimately obtained,” he says. The study also found a larger increase in intimate partner violence in areas with lower educational attainment and income, suggesting the restrictions are more harmful to vulnerable populations, he says.

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The new data do not surprise experts in the field of intimate partner violence, who say that the increase in incidents was fairly predictable. Restrictions to abortion enable reproductive coercion, in which one intimate partner uses controlling tactics to influence the other person’s reproductive choices without their consent, says Sara L. Ainsworth, chief legal and policy director at If/When/How, a nonprofit that runs the Repro Legal Hotline for people needing legal advice about pregnancy and abortion. Read More: Abortions Keep Increasing in the U.S., Data Show The current legal climate has also made it easier for abusers to threaten victims around reproductive health decisions, she says. That’s because some states, including Idaho and Texas, have criminalized the act of helping people seeking abortion care. That can further isolate victims from people who could otherwise help them navigate an abusive relationship.

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Ainsworth says the Repro Legal Hotline has seen an increase in people calling who are in relationships that have become violent and in those in which the abuser is threatening to involve the police around reproductive health decisions. Even though doing so is not legal in many states, the threat of police involvement is enough to scare many women, she says. “The abuser is using this landscape that we’re in to terrorize the person that is their intimate partner,” she says. Across the country, hotlines have seen a 10% increase in calls from victims who are facing an unsafe pregnancy, which is one in which they are subject to abuse, says Pamela Jacobs, CEO of the National Resource Center on Domestic Violence. Even before abortion restrictions, some abusers would sabotage women’s birth control to try and make them become pregnant, she says, and these restrictions make it even easier for women to be forced into pregnancy.

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Shoring up access to legal help and medical care—especially abortion care—could counter this increase in intimate partner violence, experts say. So could helping women have the economic security to leave abusive partners. Economic insecurity is the No. 1 reason victims aren’t able to leave a relationship, says Jacobs.

But in the current political climate, any major improvements in access to care are unlikely. Looming cuts to SNAP and Medicaid would take away economic independence from women in abusive relationships, rather than restore it, says Jacobs.

In addition, many sexual-assault help centers and hotlines are federally funded and have been affected by federal funding cuts. That means that as intimate partner violence increases, the resources for women affected by it are shrinking.

Note: This brief was updated on February 27, 2025 to incorporate new data on abortion statistics.

The Supreme Court’s 2022 ruling in Dobbs v. Jackson Women’s Health Organization overturned the constitutional right to abortion that had been in place for nearly 50 years under Roe v. Wade. Prior to the Dobbs ruling, abortions were permitted up to fetal viability in all states. That federal standard was eliminated under Dobbs, allowing states to ban or restrict abortion before viability. 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 since the Dobbs ruling.

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, terminates a pregnancy by oral medications. There are two widely accepted protocols for medication abortion. In the U.S., the most common protocol involves the drugs mifepristone and misoprostol. Typically, an individual takes mifepristone first, followed by misoprostol 24-48 hours later. The U.S. Food and Drug Administration (FDA) has approved this abortion protocol up to the first 70 days (10 weeks) of pregnancy. Another medication abortion protocol uses misoprostol alone, which 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.The 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 is a contraceptive that prevents pregnancy 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).

, 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.

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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What does research show about the safety of 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. Additionally, many states impose other limitations on abortion that are not medically indicated, including waiting periods and parental notification and consent requirements that 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 are administered at or before 9 weeks gestation, 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.

Studies on procedural abortions, which include aspiration and D&E, have also found that they are very safe, with the rate of major complications less than for aspiration abortions. Abortion medications and procedures are also often used for people experiencing miscarriages and stillbirths, and can improve safety by preventing delays when a loss is inevitable.

Most OBGYN physicians say that the Dobbs decision has had a negative impact on maternal health and patient safety. In a national KFF survey of OBGYNs, more than six in ten say that racial and ethnic inequities in maternal health (70%), management of pregnancy-related medical emergencies (68%), and pregnancy-related mortality have all worsened (64%) since the Dobbs decision.

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What is the status of abortion policy in the United States today?

Since the 2022 Dobbs ruling, abortion has been banned in 13 states, and another 6 states have implemented early gestational limits between 6 and 12 weeks. Most other states allow abortion to the point of fetal viability, which is generally considered around 24 weeks gestation.

All states that ban abortion have exceptions if an abortion is needed to prevent the death of the pregnant person. Additionally, some state bans make exceptions when the pregnancy is threatening the pregnant person’s health, when the pregnancy is the result of rape or incest, and when there is a lethal fetal anomaly. However, in practice, these exceptions have proven to be unworkable except in the most extreme circumstances. Furthermore, eight states that ban abortion do not make exceptions for cases of rape or incest and six do not have exceptions to protect the health of pregnant people.

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How often do abortions occur?

The most recent data estimates that more than one million abortions (1,056,150) occurred in the U.S. in 2023.

Three different organizations currently track abortion volume at the state and the federal levels: the federal Centers for Disease Control and Prevention (CDC), the Guttmacher Institute, and the Society for Family Planning (SFP). The CDC has been collecting abortion data for decades, but several states do not provide data to the federal government (reporting to the CDC is voluntary) and there is a two-to-three-year time lag until the data become publicly available.

Since the Dobbs ruling, the Guttmacher Institute’s Monthly Abortion Provision Study and the SFP’s #WeCount have been tracking state level changes in abortion volume based on data provided by abortion clinics and providers. Both studies provide national and state-level estimates on procedural and medication abortions but differ in some methodologic details. The Guttmacher study compares current abortion rates to 2020, while #WeCount compares rates to the months immediately before Dobbs in 2022. Neither source includes data on self-managed abortions, which are abortions that a pregnant person can do on their own by taking medication abortion pills without clinical supervision. For more details about data sources, see KFF’s issue brief on abortion trends.

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. Immediately following the Dobbs ruling, the number of abortions in the U.S. dropped as more states enforced bans and restrictions.

Paradoxically, the most recent data show that the abortion volume in the U.S. slightly increased overall in the two years following the Dobbs ruling. However, the small upswing nationally obscures the massive declines in abortion care provided in states with bans.

In the first six months of 2024, the national abortion volume averaged 98,000 abortions per month, higher than the monthly averages before the Dobbs decision. There are month-to-month variations in all states, and changes in policy can cause larger shifts. For example, in May 2024 Florida implemented a ban on abortions after six weeks gestation (previously permitted up to 15 weeks), and subsequently there was a noticeable decline in abortions in the state and nationally.

States without abortion bans experienced an increase of abortions in the two and a half years since 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, the aggregate increase nationally masks 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. In states with bans, abortions are near zero.

Who gets abortions?

Most of the information about people who receive abortions comes from CDC data. In 2022, 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 (9%).

Information on the race and ethnicity of people who obtain abortions is particularly limited, but based on available data, more than half of abortions were among women of color in 2022. Black women comprised 40% of abortion recipients, 32% were provided to White women, 21% to Hispanic women, and 7% were among women of other races/ethnicities. Additionally, White, Black, and American Indian and Alaska Native women are disproportionately represented among women ages 18-49 in states that have banned abortion compared to states that provide broader access to abortion. Many women who sought abortions have children. Approximately six in 10 (59%) abortion patients in 2022 had at least one previous birth.

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. When people have abortions later in pregnancy, it is often because the fetus is not viable and the pregnancy may endanger the pregnant person’s life.

Data from 2022 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.

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.

The Guttmacher Institute estimates 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.

Many clinics stopped offering abortion services shortly after the Dobbs ruling, but contrary to expectations, the number of abortions conducted by abortion-providing facilities increased overall since the ruling. However, the distribution of these facilities varies widely by state and geographic region, and the increase is largely driven by the expansion of virtual abortion clinics. While virtual clinics can remove geographic barriers for those seeking abortion care, their services are limited to medication abortion. Brick-and-mortar clinics can offer medication abortion, procedural abortions, and services for abortions later in pregnancy. However, the overall number of brick-and-mortar independent clinics has decreased over the years, with over 75 independent abortion clinics shutting down between 2022 and 2024.

Even prior to the ruling in Dobbs, access to abortion services was very uneven across the country. 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 only widened.

Telehealth

Telehealth has grown as a delivery mechanism for abortion services. While procedural abortions must be provided in person in a clinical setting, medication abortion can be provided in a clinical setting or via telehealth without an in person visit. Access to medication abortion via telehealth had been limited for many years by an FDA restriction that permitted only certified clinicians to dispense mifepristone within a health care setting. In December 2021, however, the FDA permanently revised this policy and no longer requires clinicians to dispense the drug in person. Additionally, in January 2023, the FDA finalized a policy change that allows retail pharmacies to dispense medication abortion pills to patients with a prescription. These policy changes opened the door to using telehealth for medication abortion.

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, from no virtual clinics in 2020 to 226 clinics in 2023 (representing 24% of facilities that offer 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 medications. The follow-up visit with a clinician can also happen via a telehealth visit.

Research has found that the provision of medication abortion via telehealth is as safe and effective as provision of the pills at an in person visit. Yet, in some states that have not banned abortion, telehealth may not be available because of state-level restrictions enacted prior to the Dobbs ruling that require patients to take the pills at a physical clinic, require ultrasounds for all abortions, or directly ban telehealth for abortion care. Of the 36 states that have not banned abortion, 12 had at least one of these restrictions as of March 2024.

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.

Some states have passed shield laws, designed to reduce the legal risks for clinicians who provide abortion care to patients who live in states where abortion is banned or restricted. The shield laws bar the clinicians’ resident state from extraditing them if a restrictive state attempts to prosecute the clinician for performing an abortion that is otherwise legal in their home state. As of September 2024, 9 states have shield laws in place that explicitly protect providers regardless of patient location.

Data from SFP’s latest #WeCount report show that one in five (20%) abortions were provided via telehealth in June 2024. These telehealth abortions include those provided by brick-and-mortar clinics, virtual clinicians, and clinicians in states with shield laws who prescribe medication abortion to patients in states with bans or telehealth restrictions.

Self-Managed Abortions

Self-managed abortions 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, usually without the involvement of a physician or advanced practice clinician. 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.

It is difficult to track the volume of self-managed abortions since they are outside of the formal health care system, and it is unknown if all people who receive medication pills take them. One study estimated that at least 26,000 additional self-managed medication abortions took place in the six months following the Dobbs ruling. More than half of self-managed medication abortions pills were distributed through volunteers in community networks, while others were provided 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. Even before Roe v Wade was overturned, abortion was highly restricted in many states. The latest data from 2023 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 37,000 abortion patients traveling into the state in 2023. North Carolina, New Mexico, and Kansas also experienced a rise in the number of out-of-state abortion patients during this time.

How much do abortions cost?

The costs of abortion services vary depending on the method and can exceed $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 result in additional nonmedical expenses for transportation, childcare, lodging, and lost wages. Many people pay for abortion services out of pocket, but some people can obtain assistance from local abortion funds, or coverage through their insurance plan or with state funds in some states.

In 2023, the median costs for people paying out of pocket in the first trimester were $563 for a medication abortion and $650 for a procedural abortion. For people with low incomes, who are more likely to seek abortion care, these costs are often unaffordable. The costs of abortion are higher in the second trimester compared to the first, with median self-pay reaching $1000. In the second trimester, more intensive procedures may be needed and local options are more limited in many communities that have fewer facilities.

Abortion funds are independent organizations that help pay for some of the costs of abortion services, typically medical care, travel, and accommodations if needed. Most abortion funds are regional and have connections to clinics in their area, but they do not reach all people seeking services. Since Dobbs, these networks received a reported 39% more requests for support, and while donations to these networks rose immediately following Dobbs, the frequency of donations slowed, and funds have begun to taper.

The costs for abortion services through virtual clinics, such as AidAccess and Abuzz, as well as self-managed sites, are typically lower than in person services. In 2023, the median cost of medication abortion from virtual clinics was $150. Costs at online pharmacies listed on Plan C range from a low of $25 for abortion pills by mail without clinician consultation, to upwards of $150 for abortion by mail with a clinical consultation.

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.

Among women of reproductive age, approximately one in three are covered by private insurance, one in five are covered by Medicaid, and one in ten are uninsured. States regulate fully-insured private plans in their state, whereas the federal government regulates self-funded plans. States can choose whether abortion coverage is included or excluded in private plans that are not self-funded.

Prior to the Dobbs ruling, several states had enacted private plan restrictions and banned abortion coverage from ACA Marketplace plans. Currently, there are 10 states that have policies restricting abortion coverage in private plans and 25 that ban coverage in any Marketplace plans. Since the Dobbs ruling, some of these states have also banned the provision of abortion services altogether. Conversely, 12 states require private plans to cover abortion.

For decades, the Hyde Amendment has banned the use of federal funds for abortion in Medicaid, Medicare and other public programs unless the pregnancy is a result of rape, incest, or if it endangers the pregnant persons’ life. States have the option to use state-only funds to cover abortions under other circumstances for those on Medicaid, which 20 states do currently.

Data from 2021, prior to Dobbs, estimated that a quarter (26%) of abortion patients 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 more likely to pay out of pocket compared to people living in less restrictive states.

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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. Similarly, findings from the 2024 KFF Women’s Health Survey show 70% of women of reproductive age—the age group that is most directly impacted by state abortion policies—support a nationwide right to abortion.

Furthermore, much of the public supports access to abortions for patients who are experiencing pregnancy-related emergencies (88%), a patient’s right to travel for abortion care (79%), and protecting doctors who perform abortions from legal penalties (67%).

The number of abortions provided in most of the U.S. increased slightly in 2024 from the year before, according to new data released on April 15. The research was conducted by the Guttmacher Institute, which studies and supports sexual and reproductive health and rights. The organization uses both a statistical model and survey responses from providers to estimate the number of abortions provided by clinicians in states without near-total bans for its Monthly Abortion Provision Study. The data released on April 15 show that nearly 1,038,100 abortions were provided in 2024 across all states without near-total bans—a less than 1% increase from 2023 to 2024.

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While that number is relatively steady compared to the year before, researchers noted that the finding “masked substantial variability across individual states,” with some states experiencing significant decreases and others seeing notable increases. For instance, there were roughly 12,100 fewer abortions provided in Florida in 2024 than in 2023, which researchers attributed to the state implementing a ban on abortion after six weeks of pregnancy, a policy that went into effect in May 2024. Similarly, South Carolina provided about 3,500 fewer abortions in 2024 than in 2023. Researchers attributed this to the state’s six-week ban, which was upheld by the state Supreme Court in August 2023. At the same time, researchers found that the number of abortions provided in Wisconsin increased from about 1,300 in 2023 to about 6,100 in 2024—an increase of 388%. Abortion access in the state became largely unavailable after the U.S. Supreme Court overturned Roe v. Wade in 2022 until late 2023, when a Wisconsin judge ruled that an 1849 law that had been interpreted as a ban didn’t make abortion illegal. Arizona, California, Kansas, Ohio, and Virginia also saw significant increases in the number of abortions provided in 2024 compared to the year before.

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“What happens in one state affects what happens in other states,” says Isaac Maddow-Zimet, data scientist at the Guttmacher Institute and the project lead for the Monthly Abortion Provision Study. He notes that while Florida saw a sharp decline in the number of abortions provided between 2023 and 2024, Virginia, which allows abortions until about 26 weeks of pregnancy, saw a significant increase. In part, he says, that’s because people in Florida “were traveling to Virginia to access care.” The data also reveal that about 155,100 people traveled across state lines for an abortion in 2024, accounting for about 15% of all abortions provided in states without near-total bans. That’s a slight decrease from 2023, when roughly 169,700 people crossed state lines, representing about 16% of abortions in states without near-total bans. Still, the number of people who traveled across state lines for an abortion in 2024 is nearly double the number who did so in 2020, before the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, according to Maddow-Zimet.

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“[Travel is] still a major way that people are accessing care, despite the many barriers that accompany it, and it’s still extremely elevated compared to historical patterns,” he says. It’s not yet clear why travel for abortion declined slightly from 2023 to 2024, but he speculates that more patients in states with near-total abortion bans may be receiving abortion pills in the mail via telehealth rather than having to travel across state lines. Another explanation, he says, could be dwindling resources to support travel. Read More: What Are Abortion Shield Laws? “Abortion funds saw big increases in donations immediately post-Dobbs, and then really saw that drop off, and they’ve only had to deal with an increasing amount of need,” Maddow-Zimet says. Ushma Upadhyay, a public health scientist at the University of California, San Francisco who was not involved in the new research, says that the slight increase in abortions in 2024 is consistent with data from other sources (including WeCount, an abortion tracking effort that she co-chairs.) While a limitation of the Guttmacher Institute’s research is that it doesn’t include data from states with near-total abortion bans, she says, it illustrates trends in out-of-state travel for abortion care.

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“That’s a huge contribution to our understanding of what’s happening with abortion access right now,” Upadhyay says. Familiar states were at the top when it came to the number of abortions provided to out-of-state residents: Illinois, North Carolina, Kansas, and New Mexico. Illinois, which allows abortion until fetal viability, provided the highest number of abortions to out-of-state residents in 2024, at about 35,000 abortions, which accounted for 39% of all abortions provided in the state. Meanwhile, Kansas, which allows abortion until about 22 weeks of pregnancy, provided roughly 16,100 abortions to out-of-state residents, but that accounted for the majority of abortions provided in the state—71%. That’s in part due to their geographical proximity to states that have near-total bans, as well as efforts among abortion providers and some state governments to make abortion more accessible, according to Maddow-Zimet. Illinois, for instance, is “the closest point of access” for many people living in Southern states that have near-total abortion bans and are surrounded by states with restrictive policies, he says.

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Similarly, Maddow-Zimet says that New Mexico (which doesn’t have a gestational limit on abortion) and Kansas see many patients from Texas, which has banned abortion in nearly all situations. North Carolina is also the closest state for many people living in states with restrictive abortion laws, such as Florida. North Carolina has banned abortion after 12 weeks of pregnancy and has a 72-hour waiting period to get an abortion. “That means that you have to stay multiple days or might have to travel twice, and so it’s really remarkable that people are still traveling to North Carolina to access care,” Maddow-Zimet says. “It speaks to the amount of need there is.” The number of abortions in states without near-total bans that were provided by online-only clinics increased from 10% in 2023 to 14% in 2024, though the researchers note that the national number is likely even higher. Upadhyay says she thinks this is a trend that will likely continue as people learn more about medication abortion, which can be prescribed via telehealth. Previous research from the Guttmacher Institute has found that medication abortion is the most common method of abortion in the U.S.

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Maddow-Zimet says 2024 was a year that saw significant changes in state abortion laws—both to expand and restrict access to care. “There’s really a bifurcated policy landscape where we have a lot of efforts on one side to increase access to care,” he says, and, on the other, “an enormous amount of effort to make care more and more difficult to access.”

“We absolutely see those trends continuing,” he says.