Guttmacher Institute Releases 2020 Abortion Provider Census with Important Data on US Abortion Landscape Before the Fall of Roe

Findings Show Long-Term Decline in Abortions Has Reversed and Medication Abortion Accounted for More than Half of All US Abortions in 2020

The Guttmacher Institute’s 19th Abortion Provider Census (APC)—the most comprehensive data collection effort on abortion provision in the United States—has just been published in the journal Perspectives on Sexual and Reproductive Health, and key data are available on the Guttmacher website. The report is based on data collected from 1,603 facilities providing abortions in 2019 and 2020 and offers a critical perspective and new data on the state of abortion provision in the United States just before the US Supreme Court overturned Roe v. Wade in June 2022. 

The 2019–2020 APC includes state- and national-level data on abortion incidence, the number of clinics offering abortion care, the impact of COVID on abortion protocols, the prevalence of medication abortion, and the proportion of pregnancies that end in abortion. 

Initial findings from this report were released earlier in 2022. Preliminary data released in February showed that medication abortion accounted for more than half of all US abortions for the first time in 2020, while in June, we reported that the long-term decline in the US abortion rate had reversed and the need for abortion was increasing just as the Supreme Court was poised to overturn Roe v. Wade.  

“Tracking the incidence and rate of abortions and other foundational data is critical to understanding the larger reproductive health landscape in the United States,” says Guttmacher Institute Principal Research Scientist Rachel Jones. “In this new post-Roe reality, the context of abortion care is ever evolving and has changed dramatically since these data were collected. However, this report will continue to serve as a baseline for abortion incidence and other key indicators prior to the implementation of post-Dobbs abortion bans in numerous states.” 

Key findings from the latest report include: 

  • In 2020, 930,160 abortions were provided in clinical settings, an 8% increase from 2017.; 
  • The 2020 abortion rate of 14.4 abortions per 1,000 women aged 15–44 represented a 7% increase from 2017.; 
  • Slightly more than one in five pregnancies, 20.6%, ended in abortion in 2020, up from 18.4% in 2017. 

“An increase in the rate of abortions is a positive development if it means that people are exercising their right to bodily autonomy by deciding when and if they become parents,” says Rachel Jones. “However, while our study demonstrates that more people in the United States are seeking abortion care, the Supreme Court’s radical decision to overturn Roe v. Wade just as we are seeing this historic increase means that fewer people will be able to access it.” 

Between 2017 and 2020, Guttmacher’s research shows that the number of clinics providing abortion care was virtually unchanged, from 808 in 2017 to 807 in 2020. However, there was substantial variation across states: 

  • The number of clinics increased 11% in the Midwest, with 10 more clinics in 2020 than 2017, and 6% in the West, with 18 more clinics in 2020 than 2017. 
  • The number of clinics decreased by 9% in the Northeast, with 22 fewer clinics in 2020 than 2017, and 3% in the South, with six fewer clinics in 2020 than 2017. 

The share of medication abortions increased for all facility types and caseloads in 2020: 

  • Medication abortion accounted for 53% of all abortions, compared with 39% in 2017. 

  • More than 98% of medication abortions reported in the census were provided with mifepristone and misoprostol.  

The report also highlights how access to abortion was already precarious in many states in 2020: 

  • In 2020, six states had only one clinic: Mississippi, Missouri, North Dakota, Rhode Island, South Dakota, and West Virginia.  
    • Additional Guttmacher data have shown that 100 days post-Roe, 13 states had zero clinics providing abortion care: Alabama, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, West Virginia, and Wisconsin. 
  • In 2020, 89% of US counties did not have a clinic facility that provided abortion care, and 38% of women aged 15–44 lived in these counties.  

    • 100 days post-Roe, Guttmacher data showed that 90% of counties did not have a clinic facility that provided abortion, and 48% of women aged 15–44 lived in these counties. 

Guttmacher’s new APC data also highlights the impact that the COVID-19 pandemic had on clinic abortion protocols and procedures: 

  • In 2020, at least 42% of responding clinics adopted remote postabortion visits. Prior to COVID-19, only 8% offered remote post-abortion visits. 

  • Fifteen percent reported service disruptions during COVID. 

    • Disruptions were most common in the South where 25% of responding clinics indicated a disruption in abortion services, followed by the Midwest with 22%. 

    • Sixteen percent of responding clinics in the Northeast reported disruptions, while only 7% of clinics in the West reported disruptions. 

The full report, including interpretation of data, abortion incidence by region and methodology, is available here.