By Melinda Young
The number of publicly advertising abortion facilities that provide procedural abortions dropped by 11% from 2021 to 2023, a new study finds.1 The study captures the time periods before and after the U.S. Supreme Court overturned Roe v. Wade with their decision in Dobbs v. Jackson Women’s Health Organization.
The Advancing New Standards In Reproductive Health (ANSIRH) tracks all publicly advertising facilities that offer abortion, conducting a comprehensive annual review, says Nancy Berglas, DrPH, a public health scientist at ANSIRH, Department of Obstetrics, Gynecology & Reproductive Sciences at the University of California, San Francisco in Oakland, CA. “We do a web search, followed by mystery client phone calls, where people seeking abortions call facilities in our database to find out if they’re still open, still providing abortions,” she explains. “We ask what duration in pregnancy they provide abortions, costs, insurance, and things like that.”
For the 2024 study, Berglas wanted to know what had changed since 2023, in terms of which services were being provided and specifically how far in gestation were facilities doing abortions. “Changes in medication abortion have led to increases since Dobbs, but that is only available through the first trimester of pregnancy,” she says.
“What we found at centers that offer procedural abortions is a decrease in the number of abortions, which is not surprising given the abortion bans,” Berglas says. “We found that 115 facilities had stopped offering services altogether, likely because they were closed or became medication abortion only.” Of the abortion facilities that prioritized procedural abortions from 2021 to 2023, an additional 99 decreased the gestational limit for offering abortion services, she adds.
“We definitely saw a change at abortion facilities in terms of how far in gestation they offer abortion,” she says. The changes vary widely according to where people live. Before Dobbs, 6.5% of abortions occurred after the first trimester, and that had been stable for a decade. After Roe was overturned, states that enforced abortion bans, as well as some that did not, saw a decrease in gestation limits to accessing the procedure. The number of facilities that offered procedural abortion at or after 14 weeks of gestation decreased by 5.5% nationally from 2021 to 2023.1
Rapid changes in the pre-Dobbs and post-Dobbs period are continuing as more states impose abortion bans, such as Florida and its six-week ban, and more states also are increasing abortion access, including those with ballot initiatives, like Ohio.
“The biggest changes were the bans in 14 states throughout the South and parts of the Midwest, where abortion is no longer available at all, and also the gestational limits in South Carolina, North Carolina, Georgia, and Florida,” Berglas explains. “These are places that have abortion available but not as far in gestation as it was before, such as six-week bans.”
When fewer places offer abortions after 14 weeks, it has a ripple effect on people wanting abortion in their own states and those who have to leave their states to obtain an abortion.
“Not being able to get an abortion in your home state pushes people later in their pregnancy as they navigate legality, availability of services, whether they can afford to travel, take time off work, childcare,” she says. “All these things that push people later in pregnancy as they seek abortion.” This affects people who live in protective states because each facility is taking on more patients, and it creates delays in abortion access, she adds.
The strain on the abortion provider system is evident. One example is Planned Parenthood of Greater New York (PPGNY), which paused deep sedation services in Manhattan — lowering its gestational limit — and closed four health centers in August 2024 because of financial challenges. The organization cited systemic failures in the U.S. healthcare system and challenges from growing operating expenses, unreliable insurer reimbursements, ongoing pandemic recovery, and a hostile political environment.2 “The temporary pause to deep sedation services limits PPGNY’s ability to provide abortion at over 20+ weeks gestation at the Manhattan Health Center,” the statement reads.2
In some states with abortion written into laws or constitutions, the gestational limit has increased, and some facilities are able to offer procedural abortion beyond what they had been doing. “Seventy-three facilities increased the gestational limit, and 64 are newly opened or perhaps have newly started advertising services they offer,” Berglas says. “There is push and pull as facilities close and restrict what they can offer people, and others are able to make changes in their practice to extend how far in pregnancy they can offer abortion.”
The study shows that the need for procedural abortion later in pregnancy is important, especially as increasing numbers of women are traveling hundreds of miles to abortion centers to obtain an abortion that they could not get in their home state. Their need to travel pushes them further into pregnancy gestation, which limits the number of abortion facilities that will help them.
“Facilities listen to pregnant people directly as they need services and seek services, and as the political environment and policy environment changes in so many ways, we aim to do our part by documenting that and providing information back to clinicians and advocacy organizations, support organizations, and policy makers,” Berglas says. “This is so they can understand what is happening and figure out the next steps to support people.”
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
- Berglas NF, Schroeder R, Kaller S, et al. Changes in availability of later abortion care before and after Dobbs v. Jackson Women’s Health Organization. Obstet & Gynecol. 2024;Oct. 24. doi: 10.1097/AOG.00000000000005772. [Online ahead of print].
- Planned Parenthood of Greater New York. Citing financial challenges, Planned Parenthood of Greater New York moves to temporarily pause deep sedation services in Manhattan and close four health centers. Aug. 7, 2024. https://www.plannedparenthood.org/planned-parenthood-greater-new-york/about/news/citing-financial-challenges-planned-parenthood-of-greater-new-york-moves-to-temporarily-pause-deep-sedation-services-in-manhattan-and-close-four-health-centers-2
