The Guttmacher institute has released new data from the Monthly Abortion Provision Study—an initiative launched last month to provide monthly estimates on the number of abortions, both medication and procedural, provided within the formal health care system. The latest estimates cover the period from January through July 2023 and are the first to capture the devastating impact of severe new abortion restrictions that went into effect in North Carolina on July 1.
The new North Carolina law (SB 20) banned abortion after 12 weeks of pregnancy and forced patients to make two trips for their abortion, including a medically unnecessary in-person visit for state-mandated counseling at least 72 hours before their abortion. In July, there was a 31% decrease from the previous month in the number of abortions documented in the state. The new data show 2,920 abortions provided in July, which was 1,310 fewer than the 4,230 documented in June. In September, Guttmacher researchers reported a 55% increase in abortions in North Carolina in the first six months of 2023 compared with 2020 data, likely driven by abortion bans in nearby states that sent more patients there.
“Previous Monthly Abortion Provision data showed an increase in abortions in nearly every state that bordered a ban state, emphasizing that many pregnant people overcame significant obstacles to travel for care,” says Guttmacher data scientist and Monthly Abortion Provision Study project lead, lsaac Maddow-Zimet. “The steep drop we see in North Carolina’s July abortion numbers likely represents both North Carolinians and out-of-state patients who are no longer able to access vital reproductive health care due to arbitrary gestational bans and medically unnecessary barriers.”
Interpreting the Findings
In an accompanying analysis, Guttmacher policy experts explain that while North Carolina’s new 12-week ban is undoubtedly limiting access for some, the new in-person requirement to receive state-mandated counseling at least 72 hours before the procedure, which was previously offered by telephone, may be having an even wider impact. The two-trip requirement imposes onerous burdens that make it harder for patients to obtain care and for providers to offer it. Traveling for abortion care, both within and out of state, was already a hardship for many abortion seekers, and for some, making two visits may be too big of a barrier to overcome. Such restrictions disproportionately impact marginalized populations, who are less likely to have the resources and privilege to overcome obstacles to care.
“In addition to causing direct harm to people seeking abortion, North Carolina’s abortion ban immediately caused mass confusion and devastation among health care providers as we were forced to delay time-sensitive health care and turn away patients we were trained to care for,” says Dr. Katherine Farris, Chief Medical Officer for Planned Parenthood South Atlantic and a North Carolina abortion provider. “The first month that the new law was in effect was particularly burdensome for clinics as they scrambled to comply with an expanded web of medically unnecessary and onerous restrictions that put more strain on an already limited number of providers in the state. Even though we are doing our level best to care for every patient, the bottom line is that abortion bans are bad medicine because they tie the hands of health care providers, interfere with medical best practices and put patients in dangerous situations.”
Regional Impact
The Southeast is home to some of the most restrictive abortion laws in the country and travel to North Carolina has been an important lifeline for abortion seekers in nearby states like Georgia, Tennessee, South Carolina and West Virginia. North Carolina’s new requirement of two in-person visits, at least three days apart, will fall hard on out-of-state patients, many of whom are traveling hundreds of miles to access care. Some patients may be able to order medication abortion from US-based providers who, since June, have relied on the protection of shield laws in their originating state to prescribe abortion pills to patients in states that have banned abortion. Other people will self-manage their abortion or be forced to remain pregnant.
A six-week abortion ban went into effect in South Carolina on August 23, further decimating access to abortion throughout the Southeast. Future data releases from the Monthly Abortion Provision Study will shed additional light on the impact of this policy and its ripple effects in other states.
Abortion Decreases Across the Country
From June to July 2023, there was a 7% national decline in the number of abortions provided in the formal health care system. While abortions declined in most states, the decline in North Carolina was by far the largest.
The policy analysis explains that the large decline in abortions provided in North Carolina—and the smaller national decline—may to some degree reflect seasonal variations in when pregnancies occur. These declines may also foreshadow an overstretched and exhausted support network of abortion funds, practical support groups and dedicated providers struggling to meet a growing demand for care, and the associated financial and logistical needs, to the same extent as they did in the first half of 2023.
About the Study
The Monthly Abortion Provision Study produces monthly estimates of the number of abortions provided within the formal health care system in the United States. These include abortions provided at brick-and-mortar health care facilities (such as clinics or doctor’s offices) as well as medication abortions provided via telehealth and virtual providers located in the United States. This study does not collect data on self-managed abortions, which we define as abortions occurring without in-person or virtual contact with the formal health care system.
The study’s estimates are generated by a statistical model that combines data from samples of providers with historical data on the caseload of every US provider. As more data are collected each month, estimates for past months become more precise. Each estimate is expressed as an uncertainty interval, which quantifies our confidence that the true value falls within a particular range.
The Monthly Abortion Provision Study interactive resource currently shows monthly data for January–July 2023 and is designed to help measure the impacts of abortion policies on state-level abortion incidence and trends. The interactive graphics also show the change in number of abortions provided between 2020 (six-month period) and January–June 2023.
About the Guttmacher Institute
The Guttmacher Institute is a leading research and policy organization committed to advancing sexual and reproductive health and rights worldwide. The Institute has a long history of tracking abortion incidence in the United States and globally. Every three years since 1974, the Guttmacher Institute has conducted the Abortion Provider Census of all known facilities providing abortion in the United States to collect information about service provision, including total number of abortions.
Acknowledgment
The Monthly Abortion Provision Study is supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development, the Office of Research on Women’s Health, and the Office of Behavioral and Social Sciences Research of the National Institutes of Health, under award number R61HD112921. The content is the sole responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.