A shifting landscape of abortion policies means the way women access care is changing

By Deidre McPhillips, CNN

(CNN) — The number of abortions in the United States is on the rise two years after the Supreme Court overturned Roe v Wade, but shifting policies are changing the way women access them.

In the spring of 2024, from April to June, there were an average of about 97,500 abortion each month in the US, according to a new report from the Society of Family Planning. The nonprofit organization tracks abortion volume reported by clinics, private medical offices, hospitals and virtual clinic providers that are collected into quarterly #WeCount reports.

As in previous years, the vast majority of abortions in the spring of 2024 – nearly 80% – were provided in-person. But there was a slight downtick compared with last year, with an average of about 2,000 fewer in-person abortions each month.

Meanwhile, telehealth abortions – with medications dispensed through the mail after a remote consultation with a clinician – are increasing, especially medication abortion provided under shield laws to women living in states with bans or restrictions.

Shield laws offer some legal protections for providers who practice in some states where abortion remains legal to prescribe medication abortion drugs via telehealth to people living in states with bans or restrictions. The Society of Family Planning has been including data on abortions provided under shield laws in their trends for a year, and numbers have been steadily increasing.

In the summer of 2023, from July to September, an average of about 5,700 abortions were provided under shield laws each month. By the spring of 2024, that number was up to more than 9,700 abortions each month.

Abortions provided under shield laws jumped from about 1 in every 16 abortions in the summer of 2023 to 1 in every 10 in the spring of 2024, according to data from the new report.

“In this heavily restricted abortion care environment, medication abortion provided via telehealth under shield laws is making a significant contribution to abortion access,” Dr. Ushma Upadhyay, co-chair of #WeCount Co-Chair and professor at the University of California, San Francisco’s Advancing New Standards in Reproductive Health, said in a statement.

In many states with abortion bans, the combination of shield laws and out-of-state travel have helped residents access abortions at similar – and sometimes higher – rates than before the Supreme Court Dobbs decision revoked the federal right to an abortion and paved the way for states to make it illegal.

In West Virginia, for example, there were 835 abortions among state residents in half of 2020 – with a near even split between those provided in-state and those obtained through travel out of state, according to data from #WeCount and the Guttmacher Institute. In the second half of 2023, there were nearly twice as many abortions among West Virginia residents, with more than 1,000 provided out-of-state and more than 200 accessed through under shield laws.

Similarly, in Tennessee, there were about 2,000 more abortions provided to state residents in the second half of 2023 than there were in half of 2020. More than 5,000 residents traveled out-of-state for an abortion in half of 2023, compared with about 1,100 in half of 2020, and more than 1,800 accessed medication abortion under shield laws.

But the story isn’t consistent across all states with bans or restrictions.

In Texas, where travel time to an abortion facility increased from about 15 minutes to an average of eight hours post-Dobbs, more than 17,000 women still made the trek in the second half of 2023. And about 12,400 women access abortions through shield laws – more than any other state. But there was still a gap: About a thousand fewer abortions were provided to Texas residents in the last six months of 2023 than in six months of 2020, the new report shows.

State policies continue to shift years after the Dobbs decision. Voters in at least 10 states will determine the future of abortion access in their state at the polls next month. But abortion access doesn’t always keep pace with changing policies, the new report suggests.

Florida’s 6-week ban went into effect in May 2024. Between March and May, there were 2,500 fewer in-person abortions in the state, but an increase of only about 400 abortions provided under shield laws, #WeCount data shows.

“As abortion bans strip away access, the need for abortion care continues,” Dr. Alison Norris, co-chair of the #WeCount project and professor at The Ohio State University’s College of Public Health, said in a statement. “There is still an immense unmet need for abortion care across the country. Abortion bans have a lasting, harmful impact, especially on the people who are forced to travel long distances to access abortion care, to postpone their care, or to continue their pregnancy against their will.”

Since March 2023, #WeCount has found a small but consistent increase in the average number of US abortions each month. But the researchers note that tracking the number of abortions that do occur does not capture the underlying need. The trends do not include many self-managed abortions, such as those provided through online stores or volunteer networks, and many women are unable to access care at all.

In fact, other recent research has shown that birth rates and infant mortality have increased following the Dobbs decision.

“We are unable to estimate the number of people who were unable to access abortion care and had to carry their unwanted pregnancy to term,” the #WeCount researchers wrote. “The inability to access abortion was a reality for many people before total abortion bans came into place and remains a reality for many, even in states that permit abortion.”

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