Did Overturning Roe v. Wade Really Reduce the Number of Abortions?

It’s been 18 months since the Supreme Court issued its ruling in the case of Dobbs v. Jackson Women’s Health Organization. The case asked the Supreme Court to decide whether states should be allowed to institute their own abortion bans, in spite of the legal precedent set by Roe v. Wade, the landmark case from 1973 that established people’s right to get an abortion anywhere in the country. In a major blow to human rights, the conservative-leaning Supreme Courts decided in favor of state abortion bans, effectively overturning Roe v. Wade and eliminating the federal protections for abortion.

The decision had immediate and devastating impacts. On social media, doctors recounted harrowing stories of having to wait until a patient with a life threatening ectopic pregnancy was in mortal danger to terminate the pregnancy because the procedure was considered a form of abortion. Other doctors shared heartbreaking stories about patients who were forced to carry stillborn babies to term because they couldn’t get the necessary dilation and curettage (D&C) procedure, one of the procedures used to perform abortions. Still others recounted stories of having to put patient’s lives at risk because they couldn’t perform abortions, even when carrying the nonviable pregnancy to term could lead to horrible medical issues for the pregnant person.

And, of course, people who wanted to get abortions for non-medical reasons, which are just as valid as medical reasons, couldn’t get abortions. Diana Greene Foster, a researcher who studies nationwide abortion rates and trends in the number of abortions, told The Atlantic she feared that hundreds of thousands of people wouldn’t be able to get abortion care. Her previous research showed that when people have to travel out of state to get an abortion, they’re far less likely to follow through. And after the Dobbs decision, people in more than a dozen states couldn’t access legal abortions in their home states.

Luckily, Greene’s predictions didn’t come true. Though access to abortion is more difficult than it was before the Dobbs decision, in a demonstration of staggering resourcefulness and resilience, people are still accessing abortions.

The Numbers Don’t Lie

Things looked grim for abortion access in the first six months after Roe was overturned. During that time period, there were 32,260 fewer abortions performed nationwide than in the months before the landmark decision. However, the first six months of 2023 brought a dramatic turnaround. A report by the Society for Family Planning released in October 2023 showed that in the year since the Dobbs decision, the number of abortions nationwide actually increased. Though the number of abortions performed in states with abortion bans decreased dramatically, the number of abortions performed in states without abortion bans increased even more dramatically.

Perhaps the most telling insight from the data gathered by the Society for Family Planning is that the states that saw the biggest increases in abortions were all states that bordered states with abortion bans. This suggests that people who live in states with abortion bans are traveling to neighboring states to access abortion care.

The data also shows that more people than ever are accessing abortion care through telehealth services. Since the Dobbs decision, the number of people using telehealth services to access medication abortion increased by 72%! Medication abortions provided by virtual-only clinics now account for more than 8% of all abortions in the U.S.

Even without federal protections for the right to an abortion and in spite of the state-to-state abortion bans, people are still accessing abortions, and the number of abortions per year continues to rise, as it has since 2017.

Medication Abortion Is Protecting Abortion Access

According to a nationwide survey of abortion providers conducted by the Guttmacher Institute, more than 50% of abortions in 2020 were done via medication rather than a dilation and curettage (D&C) procedure. People who opt for a medication abortion take two drugs, mifepristone and misoprostol. Both of these medications can be taken at home, allowing the pregnant person to manage their abortion on their own, in comfortable and familiar surroundings. Currently, anyone less than 10 weeks pregnant can access medication abortion in states without strict abortion bans.

Alyssa Wagner, a board certified Nurse Practitioner specializing in reproductive and sexual health care and provider for the telehealth organization Hey Jane, told Kinkly that medication abortions are very safe and complications are rare. Only 0.16% of Hey Jane’s patients have experienced “serious adverse events,” which is lower than the national average. Wagner added that the most common complications are the uterus not emptying completely and excessive bleeding, but these are still rare and can usually be managed without a trip to the emergency room.

To give us a better idea of what medication abortion involves, Wagner walked us through the whole process. First, the pregnant person takes a dose of mifepristone, a progesterone blocker. Since pregnancies need progesterone to develop properly, mifepristone ensures that the pregnancy doesn’t have the progesterone it needs to progress. A day or two later, the pregnant person takes a dose of misoprostol, a drug that causes the uterus to contract. Those contractions expel the contents of the uterus, ending the pregnancy. The entire process takes a few days, and though it’s definitely not comfortable, it’s a safe and effective way to terminate a pregnancy

She added that because the medications used for medication abortions can be sent via mail, medication abortion is often far more accessible than an in-clinic procedure.

“It’s not like people are sitting at a clinic for two days while the medications do their thing,” Wagner said. “So, why not get the medications mailed to your house instead of traveling to a clinic?”

She added that even in states that don’t have abortion bans, abortion clinics are few and far between. For many, especially in the giant states of the Midwest, the nearest clinic is literally hours away. Driving there for a medication abortion means taking time off work, spending money on transportation, and maybe even staying locally overnight, depending on the timing of the appointment. Even if people can get an abortion in their state, the logistics make it nearly impossible for some.

Telehealth practices like Hey Jane take all those logistics out of the equation, making abortion far more accessible. Pregnant people seeking an abortion just go to Hey Jane’s website, fill out a comprehensive medical questionnaire, and wait for a licensed, expert provider to contact them. Wagner explained that each questionnaire is reviewed by a team of doctors, nurse practitioners, and registered nurses, all of whom specialize in sexual health. Often the questionnaire provides all the information they need to write a prescription, but sometimes they’ll schedule a quick virtual appointment, which can be done via phone or video conference. Patients can also opt to speak with a provider before receiving their prescription.

In addition to being incredibly convenient, accessing medication abortion via telehealth services allows patients to maintain their privacy and removes the anxiety that’s often associated with going to a clinic. Unfortunately, abortion still carries a ton of stigma in the U.S., which can make seeing a provider in person an unbearably difficult experience.

Wagner, who had an abortion herself during the pandemic, shared her own heartbreaking experience of encountering protesters as she entered the clinic she worked at to get an abortion.

“I worked there, so these protesters know me. And I was used to it, but my husband wasn’t. He went with me, and he was really rattled.”

She emphasized that the option to access medication abortion through telehealth services means that people don’t have to endure harassment while going through the emotional rollercoaster of having an abortion.

Hey Jane can currently mail the medications used for medication abortion to addresses in twenty states, many of which border states where abortions are banned or restrictions on abortion care make access unnecessarily difficult. And, as Wagner explained, the nature of telehealth services means that people living in states with bans or strict restrictions can still access abortion care without going to a clinic if they’re willing to travel.

“The great thing about telehealth is that we’re providing service based on the state you’re in at the time you access our services,” Wagner explained.

So, as long as someone is in a state where Hey Jane provides services at the time that they fill out the questionnaire and provide a mailing address in that state, they can get a medication abortion. Though this still requires travel, which is difficult for many to manage, it removes the logistics associated with accessing abortion care in person: calling to make an appointment, having to accept any available appointment regardless of the obstacles due to limited appointment options, getting the time off work, traveling to the appointment, and perhaps staying locally for a few days to get follow up care. With telehealth, the travel required to access an abortion can be planned according to what works best for the pregnant person. In that way, organizations like Hey Jane are preserving abortion access nationwide, even for people who live in states where abortion is banned.

As Wagner said, “People have always gotten abortions, and they always will.”

The Fight for Abortion Care Is Far From Over

Though abortion is still accessible throughout the country, especially because of medication abortion, that doesn’t mean that everyone who wants or needs an abortion can actually get the care they need. As The Society of Family Planning points out in their October report, about 75% of the people seeking abortion care are low-income and nearly half of them live under the Federal Poverty Level. When people can’t get abortions in their own states and can’t afford to travel to another state to get an abortion, they likely won’t get the care they need. The data gathered for that report confirms this: “The greatest declines in the numbers of abortion occurred in the same states with the greatest structural and social inequities in terms of maternal morbidity and mortality and poverty.”

Because of the demographics of the states where abortions have been banned or heavily restricted, marginalized people have been disproportionately impacted as well. A study published in the Journal of the American Medical Association in 2022 found that “American Indian or Alaska Native, Black, and Hispanic populations experienced large absolute increases in travel time to abortion facilities. These groups have historically worse pregnancy-related mortality outcomes than nonminority populations.” Marginalized people are also more likely to be low-income or live in poverty because of structural racism and pay inequity, which is its own barrier to abortion care.

The bottom line is that the Dobbs decision has made abortion a privilege of those who can afford it, and the people who already suffer the most from racism and inequity are the ones who have the most barriers to getting abortion care.

Even in states where abortion is still legal but heavily restricted, the things people have to endure to get abortion care are devastating. Wagner lived in Ohio when she needed to get an abortion. Due to the state’s “heartbeat bill,” Wagner had to continue to carry a fetus she knew wouldn’t survive to term because it still had a heartbeat. She had to wait until the heartbeat was no longer detectable to terminate the pregnancy, which meant that she couldn’t have a medication abortion.

The irony of an abortion provider who prescribes medication abortions every day not being able to access the exact services she specializes in is cruel, to say the least. But people all over the country are navigating similar obstacles.

“In some states,” Wagner said, “you have to go to a clinic to get the abortion medications in person and literally take the medication in front of a doctor. What other medication do they make you take in front of a doctor?”

And things could get even harder. In early December, the Supreme Court announced that it will hear a case about the Food and Drug Administration’s regulations for the use of Mifepristone, the medication that blocks progesterone to stop a pregnancy from progressing. The case is an appeal of a previous decision made by the 5th Circuit Court of Appeals. In that ruling, the Appeals Court determined that Mifepristone should only be available in person, which would eliminate the possibility of using telehealth services to access the medication, and that the drug should only be used by people who are less than seven weeks pregnant. Since many people don’t know they’re pregnant until their second missed menstrual cycle – around eight weeks of pregnancy – this would severely limit access medication abortions.

When the decision to hear the case was announced, Hey Jane's CEO and Co-Founder, Kiki Freedman, released an unequivocal statement on behalf of the company, “Mifepristone is safe, mifepristone is effective, and mifepristone is still FDA-approved. Hey Jane will continue to deliver evidence-based, compassionate medication abortion care to our patients.”

In our conversation, Wagner stressed that there are other ways to provide medication abortion via telehealth, even if the Supreme Court rules that Mifepristone can only be obtained in person and can only be used up to seven weeks of pregnancy.

She also left us with some empowering words that abortion providers all over the country have uttered for decades: “We will always find a way to provide abortions, in compliance with the letter of the law, no matter what.”