The increasingly hostile political and legal climate for abortion rights and access in the United States requires reconsideration of longstanding systems of state-mandated abortion reporting. Data on abortion incidence and trends are critical for understanding changes in the abortion access landscape and, in turn, can be vital in shaping public policies to improve reproductive health access and outcomes. However, the current climate has escalated the risk of mandated data collection being used to stigmatize, harass, or even prosecute abortion patients and providers—including in situations where abortion care is provided and obtained legally.
The Trump administration has made clear its determination to implement the hard-right agenda laid out in Project 2025, which calls for a federal mandate requiring all states to collect extensive and intrusive information on every abortion provided. New threats also loom at the state level, where several anti-abortion state governments have taken unprecedented actions to weaponize state-mandated abortion reporting. This has included efforts in Indiana to make reports on individual abortions part of the public record—a move that serves no public health purpose and that could directly imperil patients and providers.
Such developments suggest that the benefits of state-mandated abortion reporting no longer outweigh the risks, a shift that is likely to accelerate as anti-abortion policymakers double down on punitive approaches to data collection while using the resulting data to further restrict abortion rights and access.
This shift in the risk–benefit ratio means that state-mandated abortion reporting is no longer an approach that best serves the interests of public health. States should therefore change their laws and regulations to end the mandated collection of such data and instead consider alternative models of data collection, such as voluntary surveys of providers, that can mitigate risks to patients and clinicians. (See the Acknowledgments section below for more details on how Guttmacher arrived at this recommendation.)
Current Policy Landscape
Mandated abortion reporting refers to regulatory regimes in which abortion providers are required by federal, state or local law or regulation to submit specific forms or reports for every abortion they provide. Currently, 46 states and the District of Columbia have some form of mandated abortion reporting. In most of these states, individual-level data (not including patient names) are reported; in a few states (currently, Massachusetts and Illinois), providers report statistics in aggregate. Most of these states publish annual reports using the data they collect from abortion providers; in addition, the federal Centers for Disease Control and Prevention (CDC) has, for decades, partnered with states to compile aggregate state-level statistics on abortions in the United States. While the CDC does not require states to submit abortion data, most states do so, based on the information they have collected through their own reporting requirements. The information collected in these reports varies by state but typically includes the names of the medical facility and the clinician providing abortion care, the patient’s demographic characteristics (e.g., age, race, ethnicity, marital status and number of previous live births), the patient’s residence details (e.g., state or locality), the gestational duration of the pregnancy and the type of abortion provided.
State data on abortion can serve an important purpose as a public source of data on a common reproductive health outcome. There are longstanding concerns, however, about the completeness of the data resulting from state-mandated abortion reporting. In 2020, the last year for which comprehensive data are available from both the CDC and the Guttmacher Institute, state reports compiled by the CDC captured only about two-thirds of the abortions that were counted in a national census conducted by Guttmacher; at the state level, there is also substantial variation over time and between states in the completeness and scope of the abortion data collected.
Recent Trends in Abortion Reporting Policies
In many states, anti-abortion policymakers have seized on abortion reporting as an additional tool for restricting access. This strategy of co-opting abortion reporting to advance a political agenda has generated multiple requirements that serve no public health purpose—mandating that providers report on the reasons their patients sought abortion care, that providers reaffirm their compliance with state-mandated counseling and parental notifications, and in some cases, that they submit ultrasound images to accompany their reports.
More recently, some states have introduced even harsher reporting requirements. For example, the Attorney General of Indiana has pushed for public disclosure of individual terminated pregnancy reports, arguing that this violation of confidentiality is necessary for law enforcement. This chilling move has raised alarms about patient privacy and safety, especially in smaller communities where an individual’s identity could potentially be deduced. Other states have followed similar paths. Oklahoma's laws mandate the collection of extensive personal information from patients, which can compromise their privacy and safety. Louisiana requires providers to report detailed information about the abortion procedures they offer, which can be used to target and harass them.
In a countervailing trend, several states have relaxed their reporting requirements to be less burdensome or have stopped requiring abortion reporting altogether. In February 2024, Michigan abolished its mandatory abortion reporting system, which had been in place since 1979. This move was part of a broader effort to protect reproductive rights following the approval of a 2022 ballot measure that amended the state constitution to guarantee the right to reproductive freedom. In 2023, Minnesota repealed several abortion reporting requirements, including those that mandated reporting on the patient’s reason for seeking an abortion, method of payment, and other extraneous data. Meanwhile, Illinois has reformed its abortion data collection methods to better protect patient privacy, including collecting only aggregate data from providers and limiting the amount of information collected.
Weighing the Risks
The deteriorating abortion access landscape and the specter of more punitive and intrusive state and federal abortion regulations should factor into any assessment of state-mandated abortion reporting. In the current political and legal environment, the potential benefits of reporting requirements are often outweighed by serious risks. These include:
Abortion exceptionalism
It is exceptionally rare for medical procedures to be subject to mandated reporting in state or federal systems. Births and deaths are tracked by vital statistics systems for specific demographic and governance purposes (and to meet federal requirements for the issuance of birth and death certificates); infectious diseases are in some cases subject to mandatory reporting to aid in contact tracing and to avert epidemics. The provision of abortion care does not fit into either of these categories. Notably, miscarriage and the treatment of miscarriage (which typically involves medical interventions identical to those used in abortion care) is not commonly subject to state reporting requirements outside of those needed to register a fetal death certificate at certain points in pregnancy. The premise that abortion care specifically and uniquely requires state surveillance both increases abortion stigma and perpetuates the idea that abortion should stand apart from other health care. It also contributes to longstanding patterns of exceptionalizing abortion in state and federal law, including medically unnecessary regulations that mandate waiting periods and biased counseling prior to abortion provision.
Criminalization of patients and providers
Mandated reporting can increase the risk of pregnancy criminalization—in which the criminal legal system is used to punish or penalize pregnant people deemed insufficiently protective of their pregnancies or suspected of seeking an abortion. In such an environment, abortion reporting requirements can contribute to a culture of surveillance that puts patients and providers at risk of being harmed by the legal system, even when no laws are being broken. For instance, hospital staff may misinterpret reporting requirements as obligating them to notify authorities about a suspected abortion when someone presents for care following a pregnancy loss. Likewise, the threat of criminalization can act as a deterrent to patients when determining whether to seek medically necessary care.
Undermining the patient–provider relationship
Mandated reporting frequently requires providers to question abortion patients on topics that don’t serve a broader public health purpose, are not relevant to providing high-quality care and may stigmatize abortion. For example, requirements that providers question patients about their reasons for terminating a pregnancy inject the government into the patient–provider relationship and imply that patients need to justify accessing a standard form of reproductive care. Asking for a patient’s zip code, county or state may raise the specter of criminalization, especially for patients traveling from states with bans. Forcing providers to ask for information that is potentially invasive or stigmatizing does not serve the best interests of the patient, runs counter to the principles of person-centered care, and can undermine trust between patient and provider.
Threats to patient privacy
Abortion reporting requirements force providers to collect and store sensitive personal information, which may include zip code, age, race, and other data that may allow bad actors to deduce the identities of specific patients even when records have been anonymized and aggregated. Demographic details, combined with a zip code, may make it possible to identify individuals, particularly in small or rural communities or if combined with cell phone geolocation or tracking data. Medically unnecessary data collection is also inappropriate given the increasing risks of information becoming public through inadvertent disclosures, data breaches or cyberattacks by third parties.
Provider burdens
In the post-Dobbs era, many abortion providers are navigating increased caseloads, more complex patient needs and an uncertain legal environment. State-mandated reporting often represents a substantial burden on top of these existing pressures. In many states, providers are required to submit reports within five days of the abortion, and state reporting systems are rarely compatible with internal hospital or electronic health record (EHR) systems. (Recording abortion care within EHR systems can raise additional privacy concerns due to the risk of disclosing a patient’s reproductive health choices to other providers and, in some systems, across state lines.) In some states, the clinician who actually provided the abortion must personally fill out each form; even when this is not the case, facilities have to devote substantial staffing and administrative time to meet these reporting requirements, which can divert resources from patient care.
Repeal or Reform of State-Mandated Abortion Reporting
The enactment of abortion reporting requirements for purely political reasons and their increasing weaponization against patients and providers are clear indications that the harms of this mandatory data collection now outweigh its benefits. To prevent further harms, policymakers at all levels of government should work to remove existing reporting requirements and vigorously oppose new ones, along with any attempt to tie federal funding to abortion reporting.
Likewise, the federal government should not mandate abortion reporting, nor should it require states to report abortion data to the CDC. Efforts to make federal funding for programs such as Medicaid contingent on abortion reporting—as proposed in Project 2025—illustrate that such proposals are not intended to advance medical integrity or public health. Instead, their proponents are willing to jeopardize health care for tens of millions of Americans in pursuit of further restrictions on abortion rights and access.
Developing a New Approach to Abortion Reporting
The end of government-mandated abortion reporting need not impede the collection of rigorous and accurate public health data on abortion care. There are a number of alternative approaches to abortion reporting that collect critical data while prioritizing the safety of abortion patients and providers. Ultimately, state advocates, abortion providers, practical support organizations and others directly involved in the struggle to protect abortion rights and access are best positioned to assess their own state’s context and needs. The following recommendations, however, can serve as a guide for state-level policy discussions about how to reform or repeal systems of government-mandated abortion reporting.
Consider alternative ways to collect data
Health departments and other stakeholders can employ a range of alternative strategies to collect abortion data using less intrusive means. Research efforts such as Guttmacher’s Abortion Provider Census and Monthly Abortion Provision Study as well as the Society of Family Planning’s #WeCount initiative have shown that it is possible to collect high-quality data through voluntary surveys, coupled with extensive provider outreach and consultation. These research efforts are often able to obtain more complete counts than parallel state-mandated collection systems, and use imputation methods to produce estimates for non-responding providers. Other researchers have worked closely with abortion-providing facilities to generate facility-level, state or even national data on demographic characteristics of patients, working in consultation with facility staff to address concerns around sustainability and data privacy. Following these precedents, state health departments could field periodic voluntary surveys of abortion providers to gather key data points, alone or in partnership with local social science researchers.
Assess the goals and utility of data collection
State policymakers and advocates should make an honest assessment of how data that have been collected under existing reporting requirements have been utilized. This should include querying whether the data overall, and which data points specifically, have influenced laws or regulations to improve public health and better meet the needs of abortion patients and providers. If stakeholders can find no evidence that abortion reporting has positively affected public health policy or medical practice, it is a strong indication that some or all of this data collection serves no useful purpose and should be eliminated.
Audit required questions
Advocates and lawmakers should thoroughly review existing reporting requirements through the lens of patient and provider safety. Any questions that could potentially be weaponized by anti-abortion activists or policymakers should be removed. For instance, reporting requirements should not ask invasive questions, such as the patient’s marital status or reason for seeking abortion care, that don’t serve a clear public health purpose. Likewise, required reporting should not include questions that could substantially increase the risk of deducing a patient's identity (such as zip code, race or age), alone or in combination with other data.
Center those most directly impacted
It is critical that any examination of abortion reporting requirements include at all stages of the process the perspectives and experiences of abortion providers and, where feasible, those of patients. Doing so will help ensure that the process centers the needs of those most directly affected by abortion reporting and honors the principles of person-centered care—such as respect for the individual’s right to make decisions about their own health and body without needing to justify themselves.
Account for new modes of care provision
As more abortion provision moves to self-managed care or community access models, an increasing number of abortions will not be captured in facility-level care records and reports to state agencies. This affects not only the tracking of abortion incidence (and assessments of the impact of restrictive laws), but also the representativeness of demographic data on populations accessing abortion care. To inform policy efforts aimed at expanding access, it is critical that researchers and public health professionals work in concert to develop new methods for measuring abortion incidence, underlying demand for services, and barriers to care.
Make reporting less burdensome
States should update and modernize their reporting systems to ensure that any requirements they may decide to retain do not constitute a significant administrative burden. Such systems should be fully reflective of modern abortion provision and should be based on substantive consultations with abortion providers themselves to gauge how they can best comply with such requirements. Under no circumstance should any abortion provider be penalized for nonparticipation.
The Right Policy Now and in the Future
Ending state-mandated abortion reporting—or at a minimum significantly overhauling current requirements to ensure patient and provider safety—is a concrete way to adapt policies to meet the needs of the current moment. Abortion rights and access face unprecedented threats from an anti-abortion trifecta in Washington, DC and from anti-abortion state governments and activists who seek to restrict reproductive autonomy even in states where abortion is broadly legal.
However, the abolition of government-mandated abortion reporting is not just the right policy when abortion access faces imminent threats; it is also the best approach in contexts where abortion rights appear to be more secure. As outlined in this analysis, state-mandated abortion reporting systems are harmful in themselves—for reasons ranging from abortion exceptionalism to the administrative burdens they generate—and that is reason enough to repeal these policies.