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Fact check: How has the US abortion rate changed since the 2022 Supreme Court decision?
Executive Summary
Since the Supreme Court’s Dobbs decision in June 2022, the national picture shows abortion volume in the United States has rebounded and in some measures increased, driven by shifts in where and how abortions occur rather than uniform declines; recent national estimates place abortions at or above one million in 2024, with an abortion rate of roughly 15.4 per 1,000 women aged 15–44 [1] [2]. At the same time, state-by-state access has fractured, with bans reducing local provision but out‑of‑state care, self-managed abortions, and medication abortion filling gaps [3] [4].
1. Why the national totals climbed despite state bans — A shifting geography of care
After Dobbs, many states enacted bans that sharply reduced in‑state provision, yet national monthly abortion counts and yearly totals did not decline overall; instead, care shifted to non‑banned states and non‑clinical settings, producing a net increase in national volume by 2024 compared with 2020 and 2023 in several datasets [1] [2] [3]. Research through mid‑2023 documented increased mean monthly abortions nationally despite large drops in banned states, suggesting that cross‑state travel, expanded services in permissive states, and more medication or self‑managed abortions offset losses where bans took effect [3]. The Guttmacher and KFF reports for 2024 both estimate roughly one million abortions nationally, indicating a resilience in aggregate demand despite policy fragmentation [1] [2].
2. Numbers and rates: what different datasets report and why they vary
Different groups use different methods: clinic counts, surveys, hospital reporting, and modeling of self‑managed care. The Guttmacher Institute reports an abortion rate of 15.4 per 1,000 women (15–44) in 2024 and a 7% increase since 2020, while KFF reports monthly averages and a national volume exceeding one million in 2024 [1] [2]. Peer‑reviewed journals note smaller monthly increases earlier (April 2022–June 2023) but emphasize data lags and undercounting of self‑managed abortions, which can cause variance between sources [3]. Methodological differences and reporting delays explain most discrepancies, not necessarily contradictions about directionality.
3. Who was most affected — disparities and demographic patterns
Available analyses indicate the majority of abortions continue to be obtained by women in their twenties, by low‑income people, and disproportionately by women of color, demographics that overlap with populations most affected by travel burdens and facility closures [2]. Studies linking abortion bans to downstream outcomes found disproportionate increases in live births and infant mortality concentrated among non‑Hispanic Black infants in restricted states, signaling unequal health impacts that extend beyond abortion statistics [5] [6] [7]. These patterns show that changes in incidence and access are not evenly distributed geographically or demographically.
4. Clinics, later care, and the shrinking landscape in restricted regions
Research documents substantial decreases in clinics offering procedural abortion, notably for later abortions, with the biggest facility closures in the South where many state bans ended in‑state provision entirely, creating “procedural deserts” for later care [4]. The loss of local services has reduced the geographic distribution of care even as national totals rose, forcing patients to travel farther and straining remaining providers in permissive states [4]. These supply shocks also appear to influence medical training and workforce distribution, with OB‑GYN residents altering career plans away from restrictive states, potentially worsening long‑term maternal care access [8].
5. Health outcomes beyond counts: births, infant mortality, and maternal care
Studies published in 2025 document measurable public‑health consequences of bans: estimates attribute tens of thousands of additional live births and several hundred additional infant deaths to restrictions in certain states, with infant mortality rates rising more than expected where bans were enacted [7] [6]. These analyses show that policy effects ripple beyond abortion statistics into infant and maternal health, complicating interpretation of “fewer abortions” as a standalone policy success. The data indicate tradeoffs between restricting abortion access and broader population health outcomes in affected regions.
6. Open questions and data gaps that matter for interpretation
Key unknowns remain: accurate counts of self‑managed medication abortions, long‑term effects on contraceptive behavior, and the full time‑series impacts as state laws evolve. Several authors call for a comprehensive research agenda because available datasets lag and undercount non‑clinic care, which can conceal true incidence and mode shifts [3] [9]. Policymakers and researchers must prioritize improved surveillance, cross‑state data sharing, and inclusion of non‑clinical sources to resolve current uncertainties.
7. Bottom line for readers: what the evidence converges on
Multiple independent analyses through mid‑2025 converge on a central finding: national abortion volume and rates have not collapsed post‑Dobbs and in many measures have increased, but access is sharply uneven, with bans producing local declines, clinic closures, workforce shifts, and measurable adverse health outcomes in restricted states [1] [2] [4] [7]. The debate now hinges less on whether abortions occurred and more on where, how, and with what health consequences they take place, underscoring the importance of continued, methodologically diverse monitoring.