What you need to know
- About 40% of abortions are performed in the first six weeks of pregnancy, and about 90% in the first trimester. Less than 1% of abortions occur after 20 weeks.
- In recent years, the overall number of abortions appears to be on the rise, mostly through the use of medication. Abortion rates show a similar pattern.
- An increasing percentage of women are opting for self-managed abortions, a procedure that bypasses new state restrictions on abortion access.
The debate over the legality and morality of abortion has been further shaped by the Supreme Court’s June 24th, 2022, Dobbs v. Jackson Women's Health Organization decision overturning Roe v. Wade. States now set their own policies protecting, limiting, or outright banning abortion access without any federal standard for access to abortion. This policy change has created a new focus on medication abortion. In many cases, the current debate does not consider real-world facts about the number, method, and timing of abortions in contemporary America. This brief addresses the following questions: First, how many abortions take place? Is abortion becoming more or less common? Second, at what point in pregnancies are abortions occurring? Third, how are new methods changing the way abortions are performed?
How many abortions occur in America?
Data on the number of abortions performed each year are collected by the federal Centers for Disease Control and the private Guttmacher Institute from local hospitals, doctors, and medical providers (including telemedicine). We use the Guttmacher data because it is available for a wider time.
The two figures below show the trend in the number of abortions over time, both raw numbers and the rate of abortions per 1000 birth-age (15-45) women. The gaps in the lines reflect missing data for 2018 and 2021-2022.
The first chart shows that the annual number of abortions has declined from about 1.6 million in the 1980s to about a million in recent years. The second chart, which controls for population changes, shows that the abortion rate (number of abortions per 1000 birth-age women) has dropped in half, from 30 in the 1980s to less than 15 in recent years.
In general, this data reflects that abortions have become less common over time. During this same time, the birth rate has remained relatively stable.
At what point in pregnancies are abortions occurring?
The Centers for Disease Control collects data on abortion timing – the point during a pregnancy when the procedure is performed. The chart below shows 2020 data (the most recent available).
The chart shows that the vast majority of abortions are performed early in pregnancy—over 40 percent before six weeks and 80 percent before nine weeks. Very few - less than a percent – occur after 20 weeks of gestation. While there is no systematic data available, anecdotal evidence indicates that most abortions performed beyond 20 weeks are because of fetal abnormalities or maternal health issues, although some cases are due to difficulty deciding whether to have an abortion, costs, or clinic access.
How are available methods changing the way abortions are performed?
More and more abortions are being performed using medication (“Plan C”). For reference, the ‘morning after pill’ is typically referred to as “Plan B.”. Plan C, also commonly referred to as the “abortion pill,” is two different medications (pills) taken several days apart, mifepristone and misoprostol, which ends early pregnancies 95-99% of the time. Generally, it is used up to 70 days, or ten weeks, after the first day of a menstrual period is missed. Mifepristone works by blocking the hormone progesterone. Without progesterone, the lining of the uterus breaks down, and the pregnancy cannot continue. Misoprostol, the second medication, is taken either right away or up to 48 hours later and causes the uterus to empty.
The Guttmacher Institute estimates that almost 60 percent of abortions in 2023 were medication abortions. Some states require that one or both pills be taken in a medical facility, but many states allow the pills to be dispensed by mail after a telemedicine appointment. Guttmacher data shows that about 8 percent of abortions in 2023 utilized telemedicine. A more recent study by the Society of Family Planning found that as of mid-2024, the rate of telemedicine abortions has increased to nearly 20 percent.
A separate study by scholars at the University of Texas estimated that in 2022-23, up to 4500 abortions per month were self-managed, where patients obtain Plan C medication from non-U.S. sources and carry out the procedure without medical supervision.
The Take-Away
Although the data does not address the moral/ethical aspects of legalized abortion, it does show that overall abortion rates have been declining for the past generation, with a slight increase in recent years.
Given that approximately 90% of all abortions are performed during the first trimester (weeks 1-14), state laws that restrict abortions during the second trimester (weeks 15-28) will have a relatively small impact on overall abortion rates.
The fact that women can obtain Plan C medication by mail without medical supervision has the potential to sidestep state-level limits on access to abortion. Many providers of these medications are outside the U.S., so they are not subject to U.S. regulation or prosecution. At present, only a small fraction of abortions are self-managed, but this percentage will likely increase due to greater access to medications by mail. The data also suggests that domestic telemedicine abortion providers are sending Plan C medication to residents of states with limited abortion access.
Further reading
Friedrish-Karnik, A., Stoskopf-Ehrich, E., and R. Jones. 2024. Medication Abortion Within and Outside the Formal US Health Care System: What You Need to Know. Guttmacher Institute, https://tinyurl.com/a3zcdt45, accessed 8/5/24.
Diamant, J., Mohamed, B., and R. Leppert. 2024. What the Data Says About Abortion in America, Pew Research Center, https://tinyurl.com/mrx57uur, accessed 8/3/24.
Sources
How many abortions occur in America?
Giuttmacher Institute 2024. Monthly Abortion Provision Study, https://tinyurl.com/38r3duvs, accessed 8/5/24.
At what point in pregnancies are abortions occurring?
Kortsmit, K. 2022. Abortion surveillance—United States, 2020. Surveillance Summaries 71(10): 1–2, https://tinyurl.com/5yj9x69v, accessed 8/5/24. (Chart Data).
Hern, W. M. 2014. Fetal diagnostic indications for second and third-trimester outpatient pregnancy termination. Prenatal diagnosis, 34(5), 438-444.
Foster, D. G., & Kimport, K. 2013. Who seeks abortions at or after 20 weeks?. Perspectives on sexual and reproductive health, 45(4), 210-218.
Kimport, K. 2022. Is third‐trimester abortion exceptional? Two pathways to abortion after 24 weeks of pregnancy in the United States. Perspectives on sexual and reproductive health, 54(2), 38-45.
How are new technologies changing the way abortions are performed?
Society of Family Planning 2024 #WeCount Report. https://tinyurl.com/ytwz6xh7, accessed 8/8/24.
Friedrish-Karnik, A., Stoskopf-Ehrich, E., and R. Jones. 2024. Medication Abortion Within and Outside the Formal US Health Care System: What You Need to Know. Guttmacher Institute, https://tinyurl.com/a3zcdt45, accessed 8/5/24.
Aiken, A. R., Wells, E. S., Gomperts, R., & Scott, J. G. (2024). Provision of medications for self-managed abortion before and after the Dobbs v Jackson Women’s Health Organization decision. JAMA, 331(18), 1558-1564.
Ralph, L., Foster, D. G., Raifman, S., Biggs, M. A., Samari, G., Upadhyay, U., & Grossman, D. 2020. Prevalence of self-managed abortion among women of reproductive age in the United States. JAMA network open, 3(12), e2029245-e2029245
Contributors
Olivia DiPietro (Intern) is a rising junior at Fordham University pursuing a double major in French and journalism.
Allison Cooper (Intern) is a Political Science and Philosophy (Law and Policy) student at Washington University in St. Louis. She will graduate in May 2027 and plans to attend law school post-graduation.
Dr. William Bianco (Research Director) received his PhD in Political Science from the University of Rochester. He is Professor of Political Science and Director of the Indiana Political Analytics Workshop at Indiana University. His current research is on representation, political identities, and the politics of scientific research.
