Abortions Increased After Dobbs, But Researchers Warn People Are Still Being Denied Care

“My biggest fear is people will take away from these new numbers that everything’s fine,” Dr. Ushma Upadhyay, who helped collect and analyze abortion data from January through March, told Jezebel.

By Kylie Cheung  |  August 8, 2024 | 5:32pm
Photo: AbortionPolitics
Abortions Increased After Dobbs, But Researchers Warn People Are Still Being Denied Care

June marked the second anniversary of Dobbs v. Jackson Women’s Health, which has led to almost half of all states imposing total or near-total abortion bans. But on the national level, the number of monthly abortions increased since Dobbs, according to the latest #WeCount report from the Society for Family Planning released on Wednesday. Researchers found that, from January through March this year, the abortion rate increased slightly compared to the same period last year. There were an average of 98,990 abortions per month during the first quarter of 2024, which is 14% higher than the monthly average from the first quarter of 2023. 

The #WeCount report attributes this largely to the availability of medication abortion through telemedicine—including in states that have banned abortion—and so-called shield laws in six states, which protect abortion providers from prosecution for remotely prescribing abortion pills to people where abortion is banned. Since July 2023, six states have enacted shield laws, which #WeCount’s report links to a surge in self-managed medication abortions via telemedicine: In March, doctors in states with shield laws remotely prescribed medication abortion to almost 10,000 patients in states with bans, accounting for a tenth of all abortions in the nation.

Dr. Ushma Upadhyay, a University of California, San Francisco School of Medicine professor who co-leads #WeCount, told Jezebel telemedicine expands access to abortion on multiple fronts, on top of removing travel barriers. “Even before Dobbs, cost has always been the greatest barrier. Telehealth is available at a much lower cost, and some providers offer it free to people in states that have banned abortion,” Upadhyay said. Telemedicine also opens up greater availability in “surge states,” or states where abortion is legal that has absorbed an influx of out-of-state patients since Dobbs. If people can access abortion remotely, that opens up “greater availability for in-person appointments,” she explained.

Still, Upadhyay stressed that these numbers present an incomplete picture. “My biggest fear is people will take away from these new numbers that everything’s fine, everyone can get abortion, and they don’t have to pay attention,” she said. There are still “many reasons people can’t get abortions in states with bans—it can be too difficult or costly to travel, they can’t get child care, they don’t know about options for telehealth or abortion pills.” Many people living under bans may be too afraid of violating those laws, Upadhyay added. Many are adolescents, who “face the greatest barriers.”

A survey published by the National Domestic Violence Hotline in June showed that 7% of respondents said their abusive partners prevented them from having medication abortions. These respondents said their partners did so by threatening to commit suicide, lighting the pills on fire, physically locking them up, or threatening to harm them and their families if they took the pills. Self-managed abortion from one’s home has become a lifeline post-Dobbs—but it’s not an option for everyone.

Banning abortion will neither end the need for abortion, nor stop it from happening. But bans create massive, sometimes insurmountable barriers that will inevitably stop some people—often those with the least resources—from having abortions. Dr. Alison Norris, another #WeCount researcher, told Jezebel their data is a “testament to the fact that the need for and use of abortion” hasn’t changed after Dobbs. But “it’s unfair that by virtue of their geography, some people have to overcome extremely burdensome barriers—and thousands may not be able to.”

For people who can’t access abortion under these narrow exceptions, many will travel out of state for care. In 2023 alone, over 170,00 people traveled out-of-state for abortion, per a Guttmacher report published in June. States that protect abortion rights and which border states with bans saw the greatest increase in in-clinic abortions. Illinois saw the highest average monthly increase in abortions—2,623—in the first quarter of 2024, compared with the period before Dobbs.

#WeCount researchers obtained data from four states where abortion was banned during the first months of this year—Missouri, South Dakota, Montana, and Nebraska—all of which reported a small number of abortions, which were provided under the narrow, ambiguous exceptions in their bans. Upadhyay says that these numbers “are much, much smaller than we’d expect them to be under such exceptions,” including for rape and medical emergencies, “if they were actually being invoked.” But we know that exceptions are rarely if ever invoked because doctors in most states that ban abortion are threatened with prison time, leading them to take a highly conservative approach. Upadhyay also doesn’t believe the Supreme Court’s ruling in Moyle v. U.S. in July—which states that doctors in Idaho have to perform emergency abortions, for now—will help, since the court only “punted” the decision to a lower court instead of issuing a definitive ruling.

#WeCount doesn’t collect data about gestation, but Upadhyay says she’s seen some showing a “higher proportion of abortions further along in pregnancy after Dobbs.” As a result of being further along, they’ll need an in-clinic abortion, requiring out-of-state travel that can further delay the procedure. All of this makes it more expensive. Even before Dobbs, Upadhyay explained, “in many cases, it would take time for someone to collect the money for an abortion, and by the time they’ve collected it, they’re at a later gestation and need even more money because the price is now higher.”

It’s outcomes like this, Norris says, that remind us we can only glean so much from the monthly number of abortions. “I often hear from clinicians that our numbers make sense, but also, there are so many stories numbers can’t possibly tell,” she said. Their data doesn’t show, for example, the “health care deserts” inflicted by bans, as they drive OBGYNs out-of-state en masse, or the “uncertainty and anxiety” that people and families with wanted pregnancies in these states feel, knowing they could face a medical emergency and be unable to access care. “[The data] doesn’t tell the stories of patients who have to travel a long, long way, maybe arriving later in pregnancy with more health problems,” she said. “Patients experiencing severe distress and trauma from the need to travel, who need extra attention and care as a result. Our data can’t show that.”

 
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