New restrictions continue to shift US abortion landscape, report shows

By Deidre McPhillips, CNN

(CNN) — The abortion policy landscape continues to shift in the United States, with key changes in how and where women accessed care last year. Although some states with new laws saw dramatic shifts, the number of abortions provided nationwide held steady, with significant shares of women turning to virtual clinics and traveling across state lines for care.

In 2024, there were more than 1 million abortions in the US for the second year in a row, according to new data from the Guttmacher Institute, a research and policy organization focused on sexual and reproductive health that supports abortion rights. When abortions surpassed 1 million in 2023, it marked the highest US abortion rate in more than a decade and a 10% jump from 2020, Guttmacher says.

Since the US Supreme Court’s Dobbs decision revoked the federal right to abortion in June 2022, more than a dozen states have enacted bans, and others have severely restricted access. Amid this patchwork of laws, trends in abortions have varied widely by state.

Between 2023 and 2024, the number of abortions increased or stayed the same in 25 states but decreased in 11 states, Guttmacher data shows. Fourteen states with abortion bans in 2024 were not included in the analysis.

After Dobbs, Florida had become a key abortion access point for people in the South amid widespread restrictions in the region. In 2023, 1 of every 3 abortions in the South – and about 1 in every 12 nationwide – happened in Florida. But a six-week ban took effect in the state in May, driving abortions down 14%. There were about 12,000 fewer abortions in Florida in 2024 than there were in 2023, according to Guttmacher estimates.

The effects of a six-week ban enacted in South Carolina in September 2023 also continue to ripple, with 3,500 fewer abortions provided in the state in 2024 than in 2023.

Abortions provided in Virginia, meanwhile, increased about 5,500 between 2024 and 2023 – the vast majority of which were provided to people who traveled in from a different state.

“The latest abortion travel data are a clear reminder that the impact of a state’s abortion policies extends far beyond its borders,” Kimya Forouzan, principal state policy adviser at the Guttmacher Institute, said in a statement. “For instance, the substantial increase in out-of-state abortion patients in Virginia can likely be attributed to Florida’s six-week ban that went into effect in May 2024. Despite being hundreds of miles away, Virginia is the second-closest state for Florida residents to seek an abortion after six weeks’ gestation and the closest without a mandatory waiting period. This patchwork approach to abortion legality has only exacerbated inequity in abortion access across the country.”

Overall in 2024, about 155,100 people crossed state lines for an abortion, representing about 15% – or more than 1 out of every 7 – of abortions provided in states without total bans, according to Guttmacher data. About as many people traveled across state borders for an abortion in 2023, which is nearly double the number who did so in 2020, before the Dobbs decision.

Illinois has been a key access point, with about 35,000 abortions provided to out-of-state patients in 2024, representing nearly 40% of abortions provided in the state overall, Guttmacher data shows, and North Carolina, Kansas and New Mexico each provided care to more than 10,000 people seeking an abortion in 2024.

“While these data cannot capture the obstacles that many abortion seekers faced or those who were unable to access care, the findings do underscore the determination and dedication of abortion patients, providers, advocates and support organizations,” Isaac Maddow-Zimet, data scientist for the Guttmacher Institute, said in a statement.

In Illinois, the state government, abortion providers and advocates have helped build a “robust infrastructure to expand care and connect traveling patients with funding and navigational support,” the new Guttmacher report notes. “Obtaining abortion care out of state is often only possible because of the intensive efforts of providers, abortion funds, practical support organizations and patients themselves.”

Expanded access to clinics that provide medication abortion through telehealth has also contributed to the rise in abortions in the US, according to the Guttmacher report. About 14% of abortions in 2024 were provided by online-only clinics, up from 10% in 2023 – or an increase of about 40,000 abortions.

This figure does not include abortions that were provided to people under shield laws that allow providers in certain states where abortion remains legal to prescribe medication abortion drugs via telehealth to people living in states with bans or restrictions. Other research suggests that more than 40,000 people accessed telehealth abortions under shield laws in the second half of 2023.

Telehealth is “not an available or preferred option for everyone seeking an abortion,” Guttmacher says, and the majority of abortions in 2024 were still provided via brick-and-mortar facilities. But medication abortion is the most common option in the US, representing nearly two-thirds of all abortions nationwide.

In March, US Food and Drug Administration Commissioner Dr. Marty Makary told senators during his confirmation hearing that he plans to build an “expert coalition” to review data on mifepristone, one of the two drugs used in a medication abortion.

“I have no preconceived plans on mifepristone policy except to take a solid, hard look at the data and to meet with the professional career scientists who have reviewed the data at the FDA, and to build an expert coalition to review the ongoing data, which is required to be collected as a part of the REMS program, the Risk Evaluation and Mitigation Strategy,” Makary said in the hearing. “If we’re going to collect data, I believe we should look at it.”

Mifepristone was approved by the FDA decades ago and has been shown to be safe and effective, but it has been the focus of abortion restrictions in some states since the overturning of Roe v. Wade in 2022.

CNN’s Jacqueline Howard contributed to this report.

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