Charting the Chaos

“Policies implemented in one state don’t stay in that state. They have ripple effects across the country,” says Data Scientist Isaac Maddow-Zimet, who works on Guttmacher’s Monthly Abortion Provision Study. The study estimates the number of US abortions provided in clinics and via telehealth, the number of people who must travel for care, as well as other key data that tell a fuller story of what patients experience while seeking abortion care.

Since the Dobbs ruling, the state policy landscape has continued to shift. Guttmacher’s state work is built to track that movement and hand the data to the people who can act on it: advocates, abortion funds and the legislators trying to keep care accessible.

Doing that takes a special kind of teamwork. The effort spans two of Guttmacher’s divisions, research and policy, which work in lockstep. Researchers assemble the evidence, and policy carries it into the rooms where laws are written.

Principal State Policy Advisor Kimya Forouzan and her team follow the full sweep of state policy—minors’ access to care, STI treatment, contraception, even which clinicians are allowed to provide abortion—and turn the information into something advocates can wield.

This work serves two audiences with different needs. The first is the partners working to get people care. “There are many partners in this movement focused day-to-day on making sure people can access the care they need—through an abortion fund, through a legal organization providing judicial bypass,” Forouzan says. “Knowing the impacts of what’s happening in the states really allows them to best serve their clients.”

The second audience is advocates and policymakers weighing legislation that impacts millions of lives. Their questions tend to be practical: What other states have done this? What have been the implementation hurdles? How have things gone? Should our state consider doing the same thing?

Guttmacher gathers those answers in one place. “We cut out that additional work that advocates and policymakers need to do, so they can get right to the priorities within their state,” Forouzan says. By bringing together their knowledge of state policy and reproductive health research, they’re able to streamline decision-making and influence policy change.

In addition to tracking policy movements, abortion-related travel is one of the most important metrics to monitor—how many people have to leave their state of residence for care, and to which states they are traveling can be a measure of how far access has shifted. Few efforts can follow that movement the way Guttmacher’s Provision Study can.

“What we published most recently that was new for us was putting those patient travel numbers together with telehealth numbers,” Maddow-Zimet says. “There’s been a really big increase in shield law provision—telehealth providers in shield law states providing medication abortion to people in states with total bans.” In 2025, roughly 91,000 patients accessed abortion in total-ban states this way.

Set side by side, the two trends move in different directions. “Because people are able to get access via telehealth, that means that some of those people no longer need to travel,” Maddow-Zimet says. “But there’s still an enormous amount of people traveling from places like Texas, from places like Louisiana.” Maddow-Zimet and Forouzan co-write most of those Provision Study reports, so the data and its legal implications land together.

This research also shows that abortion care doesn’t happen in a silo. “That travel can only happen because of navigational, logistical and financial support from a broad infrastructure that sprang up in the wake of Dobbs. Abortion funds are a huge part of that,” Maddow-Zimet says. When the team recently shared a legislative briefing with the National Network of Abortion Funds (NNAF), the advocates from NNAF and member funds spoke to what they were seeing on the ground while Guttmacher supplied the data. “Putting specific numbers on it and talking about the kind of volume that is occurring can help hammer home to people like legislators or policymakers the value that abortion funds bring,” Maddow-Zimet says.

Evidence can also completely change how a state sees itself. In Illinois, the Provision Study documented so much travel flowing into the state that it had become a regional hub for abortion access—a finding the governor, advocates and abortion funds in the state have used to argue for more support. Maddow-Zimet says, “I like to think that we shape the context and provide the raw material that other folks can use to help build the case for protective policies.”

Abortion is only one part of what Guttmacher tracks. Principal Research Scientist Megan Kavanaugh leads the Institute’s domestic contraception portfolio. Her collaboration with Power to Decide—an organization that, among other initiatives, helps people find and access birth control—pairs Guttmacher’s national research on the publicly funded family planning system with the group’s clinic-level data on the family planning methods available in states. The project draws on Power to Decide’s large clinic-locator database, which allows anyone to look up exactly what contraceptive methods are available near them. “The two organizations really put our brains together to say: how can we leverage the data both of us have to create something greater than its parts?” Kavanaugh says.

What they built is a new way to see contraceptive access—and its gaps—at the county level. The maps compare what women in a given county may need to what nearby clinics offer. “The floor is that there should be alignment between how many people need this care and what is available in their county,” Kavanaugh says. “There’s not a lot of alignment across the country at the county level.”

The more ambitious move is what comes next: using the same data to proactively model threats to contraceptive access before they arrive. “What happens if you take Planned Parenthood out of this entire publicly funded family planning system?” Kavanaugh says. “What would that do to those contraceptive access estimates that we’re calculating?” Her team is running that analysis now, including a simulation of what would happen if Planned Parenthood clinics become ineligible to receive federal funds to support care delivery, and the possible consequences when upcoming changes to Medicaid take effect.

The rigorous scientific data Guttmacher is amassing compete with a rising tide of falsehoods. “We’ve seen such exponential growth of misinformation in state legislatures,” Forouzan says. “It’s really vital for Guttmacher’s research to work hand in hand with state advocates to combat that.”

Guttmacher treats reproductive care as one connected story instead of separate issues. When contraception, fertility and abortion get pulled apart, it distorts the picture. “Abortion is towards one end of a long continuum of reproductive care,” Kavanaugh says. “When you try to silo one aspect of this care from the others, that’s not how people live their lives, and it doesn’t represent reality.”

Ask this team what success looks like in three years, and there’s no simple answer. “A lot of the reason for building state-level research infrastructure is that we don’t know what’s going to happen,” Maddow-Zimet says. “There’s been a lot of rapid change, and there probably will continue to be.”

Guttmacher wants the evidence ready no matter what the future holds. “Part of the benefits of building a strong research infrastructure is that we’re already set up to evaluate, document and predict the impacts of changes as they are occurring,” he says. “Research can be incredibly slow, so unless you have it already set up, it’s not possible.”

Anti-abortion activists keep pushing to expand bans. Contraceptive care is disappearing in the counties most dependent on federal funding. Misinformation is moving from social media into statutes. In this fight, data is not neutral bookkeeping. It helps determine whether false claims backing regressive policies go unchallenged or are countered with scientific evidence.