National Background and Context
Each year, a broad cross section of people in the United States obtain abortions. In 2017, 862,320 abortions were provided in clinical settings in the United States.
The U.S. Supreme Court recognized the constitutional right to abortion in the 1973 Roe v. Wade decision and has reaffirmed that right in subsequent decisions.
However, since 2010, the U.S. abortion landscape has grown increasingly restrictive as more states adopt laws hostile to abortion rights. Between January 1, 2011 and July 1, 2019, states enacted 483 new abortion restrictions, and these account for nearly 40% of all abortion restrictions enacted by states in the decades since Roe v. Wade. Some of the most common state-level abortion restrictions are parental notification or consent requirements for minors, limitations on public funding, mandated counseling designed to dissuade individuals from obtaining an abortion, mandated waiting periods before an abortion, and unnecessary and overly burdensome regulations on abortion facilities.
•Approximately 862,320 abortions occurred in the United States in 2017. The resulting abortion rate of 13.5 abortions per 1,000 women of reproductive age (15–44) represents an 8% decrease from the 2014 rate of 14.6.
•In 2017, 55,440 abortions were provided in Texas, though not all abortions that occurred in Texas were provided to state residents: Some patients may have traveled from other states, and some Texas residents may have traveled to another state for an abortion. There was a a 3% decline in the abortion rate in Texas between 2014 and 2017, from 9.8 to 9.4 abortions per 1,000 women of reproductive age. Abortions in Texas represent 6.4% of all abortions in the United States.
Where Patients Obtain Abortions
•In 2017, there were 1,587 facilities providing abortion in the United States, representing a 5% decrease from the 1,671 facilities in 2014. Sixteen percent of facilities in 2017 were abortion clinics (i.e., clinics where more than half of all patient visits were for abortion), 35% were nonspecialized clinics, 33% were hospitals and 16% were private physicians' offices. Sixty percent of all abortions were provided at abortion clinics, 35% at nonspecialized clinics, 3% at hospitals and 1% at physicians' offices.
•There were 35 facilities providing abortion in Texas in 2017, and 21 of those were clinics. These numbers represent a 25% decline in clinics from 2014, when there were 44 abortion-providing facilities overall, of which 28 were clinics.
•In 2017, 89% of U.S. counties had no clinics providing abortions. Some 38% of reproductive-age women lived in those counties and would have had to travel elsewhere to obtain an abortion. Of patients who had an abortion in 2014, one-third had to travel more than 25 miles one way to reach a facility.
•In 2017, some 96% of Texas counties had no clinics that provided abortions, and 43% of Texas women lived in those counties.
Restrictions on Abortion
In Texas, the following restrictions on abortion were in effect as of March 1, 2020:
- Most patients must receive state-directed counseling that includes information designed to discourage them from having an abortion, and then wait 24 hours before the procedure is provided.Counseling must be provided in person for women within 100 miles of the provider and must take place before the waiting period begins, thereby necessitating two trips to the facility.
- Private insurance policies cover abortion only in cases of life endangerment or if the woman's health is severely compromised.
- Health plans offered in the state’s health exchange under the Affordable Care Act can only cover abortion in cases of life endangerment or severely compromised physical health.
- Abortion is covered in insurance policies for public employees only in cases of life endangerment or severely compromised physical health.
- Medication abortion must be provided using the FDA protocol. The use of telemedicine to administer medication abortion is prohibited.
- The parent of a minor must consent and be notified before an abortion is provided.
- Public funding is available for abortion only in cases of life endangerment, rape or incest.
- A patient must undergo an ultrasound at least 24 hours before obtaining an abortion; the provider must show and describe the image to the patient.
- An abortion may be performed at 20 or more weeks postfertilization (22 weeks after the last menstrual period) only cases of life endangerment, severely compromised physical health or lethal fetal anomaly. This law is based on the assertion, which is inconsistent with scientific evidence and has been rejected by the medical community, that a fetus can feel pain at that point in pregnancy.
- The state requires abortion clinics to meet unnecessary and burdensome standards related to their physical plant, equipment and staffing.
1. Jones RK, Witwer E and Jerman J, Abortion Incidence and Service Availability in the United States, 2017, New York: Guttmacher Institute, 2019.
2. Fuentes L and Jerman J, Distance traveled to obtain clinical abortion care in the United States and reasons for clinic choice, Journal of Women’s Health, 2019, https://doi.org/10.1089/jwh.2018.7496.