Medication abortions rose in year after Dobbs decision, report finds

Medication abortions rose in the year after the Supreme Court overturned Roe v. Wade, according to a report published Tuesday by the Guttmacher Institute, a research group that supports access to abortion.

In 2023, the first full calendar year since the 2022 Dobbs v. Jackson ruling, there were about 642,700 medication abortions, accounting for about 63% of all abortions in the country, up from 492,210 medication abortions, or 53%, in 2020, according to the report.

“This increase is indicative of the fact that people are overcoming barriers to get the care they need,” said Amy Friedrich-Karnik, the director of federal policy at the Guttmacher Institute. "Abortion is health care."

Following the Dobbs decision, 14 states completely ban abortion, which includes medication abortion. Another handful of states require patients to see doctors in person before they can get prescriptions for the drugs needed for medication abortion or ban shipping the medication by mail.

Medication abortion became available in the U.S. in 2000 when the Food and Drug Administration approved mifepristone, one the drugs used in the regime, for use in early abortions. A second drug, misoprostol, is taken one to two days later.

Since 2020, medication abortion has been the most common method for ending early pregnancies in the U.S., according to the Guttmacher report.

It’s also once again on the judicial chopping block.

Next week, the Supreme Court will hear oral arguments in a case that could decide whether mifepristone will remain easily accessible.

The numbers in the Guttmacher report account only for people who got medication abortions through the U.S. health care system, such as through in-person visits with health care providers. People can also get the pills outside the health care system, such as through community networks or in the mail via online pharmacies.

Dr. Michael Belmonte, a fellow at the American College of Obstetricians and Gynecologists, said many of his patients prefer medication abortion because it provides them with a level of privacy.

“I’m not surprised to see that medication abortion continues to play a growing role,” he said.

Even with the Supreme Court case imminent, the drugs appear to be more available. Earlier this month, CVS and Walgreens announced that they would start dispensing mifepristone.

The report also looked at abortions overall and found that there were an estimated 1,026,690 last year — either through medication or surgery — a 10% increase from 2020 and the first time since 2012 that the number of abortions surpassed 1 million.

States without complete bans on abortions recorded a 25% increase in abortions last year compared with 2020.

The sharpest increases, however, were in states that border those with complete bans, such as New Mexico, which borders Texas and Oklahoma; and Illinois, which borders Missouri and Kentucky.

Other states, like South Carolina, had huge increases in out-of-state abortions because of their proximity to states with complete abortion bans, including many states in the South. (For much of 2023, South Carolina allowed abortions up to 20 weeks. A law banning abortion after six weeks went into effect in May but was blocked just days later; it was reinstated in August.)

Friedrich-Karnik said almost 1 in 5 people are traveling to other states to get abortion care. “All of that impacts the type of care that they’ll be able to receive,” she said.

Arthur Caplan, the head of the Division of Medical Ethics at NYU Langone Medical Center in New York City, said he expected the number of medication abortions would have increased last year, even without the challenge to the FDA’s approval of mifepristone. Medication abortions have been on a steady upswing since it was approved in 2000, according to the Guttmacher report.

“Nothing surprises me about this shift,” Caplan said of the Guttmacher findings. “It’s less burdensome to use a pharmaceutical agent than surgery, and it’s cheaper.”

A Supreme Court decision to restrict access to mifepristone would have huge ramifications for women, he said.

It would be “absolute utter nonsense,” he said. “Were the court to buy into it, it would clearly bring abortion by pill to an end around the country, which would lead immediately to an enormous black market.”

Dr. Kristyn Brandi, an OB-GYN in New Jersey and the former board chair for Physicians of Reproductive Health, an advocacy group for reproductive rights, said medication abortion is often the only option for marginalized communities, including people with disabilities who can’t travel. The medications will become even more common, she said, unless the Supreme Court makes them less accessible.

“That will affect the vast majority of people seeking abortion,” she said.

Belmonte said he is worried about his patients.

“Every patient should be able to choose which abortion option is right for them, without bans, restrictions or burdens,” he said.