US abortions reach highest level in over a decade, sparked by surge in medication abortion

Abortions are on the rise in the United States, despite bans that have taken effect in more than a dozen states since the US Supreme Court's Dobbs decision that revoked the federal right to abortion in June 2022.

There were more than 1 million abortions in the US in 2023, the highest rate in more than a decade and a 10% jump from 2020, according to a report released Tuesday by the Guttmacher Institute, a research and policy organization focused on sexual and reproductive health that supports abortion rights. The latest trends also suggest that medication abortion is a more common option than ever.

Although abortions all but stopped in the 14 states with total bans, nearly every other state had an increase in the number of abortions provided from 2020 to 2023. As the geography of abortion care shifted amid a fractured policy landscape, the 10% increase in abortions nationwide meant that states without total bans saw a 25% increase in those years.

The "drastic loss of access in states with bans has been counterbalanced by monumental efforts on the part of clinics, abortion funds and logistical support organizations to help people in ban states access care through financial and practical support," the authors of the report wrote.

States bordering those with bans had particularly large increases, but abortions also increased in other states where they remained legal.

"It is very possible that, while access was dramatically curtailed for people living in ban states, access substantially improved for residents of states without bans," the authors wrote.

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In addition to state policies enacted to protect patients and access to care and increased financial support from abortion funds, researchers from the Guttmacher Institute suggest that improved access to telehealth in recent years may have made medication abortion more broadly available.

Medication abortion has become more common than ever post-Roe, according to another new Guttmacher report. Nearly two-thirds of all abortions in the US in 2023 - an estimated 642,700 - were medication abortions, the report says.

Medication abortion, also known as medical abortion, is a method by which someone ends their pregnancy by taking two pills - mifepristone and misoprostol - rather than having a surgical procedure.

This option has become steadily more common over the two decades it's been available, rising from less than 10% of all abortions in the US in 2001 to 53% in 2020 and 63% in 2023.

But mifepristone, the drug that was approved for abortion use by the US Food and Drug Administration in 2000, faces an unprecedented legal challenge. On March 26, the US Supreme Court will hear oral arguments in a case that puts access to the medication at stake - even in states where abortion remains legal - and raises questions about the authority that courts have to overrule determinations by FDA experts about a drug's safety.

Misoprostol can be used on its own for a medication abortion and is a safe alternative, but research suggests that using both pills together is the gold standard.

Research has long found that medication abortion is safe and effective, but another recent study found that to be true even when the patient gets the medicine through a telehealth appointment.

"Any return to restrictions on medication abortion provision via telemedicine would be detrimental for people who either prefer or only have access to abortion using telemedicine," the Guttmacher researchers wrote in the new report. "While the current court case only affects use of mifepristone - and a misoprostol-only regimen is also a safe and effective method of medication abortion - everyone seeking an abortion should have access to the full range of safe, effective options."

The new reports from Guttmacher estimate abortion trends based on responses from a sample of abortion providers in the US. They probably undercount the number of abortions in the US, as the data does not include abortions that happen outside of the formal health care system or medication abortions that were sent to people in states where abortion is banned.

CNN's Jen Christensen and Tierney Sneed contributed to this report.

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