US Abortion Rate Holds Steady Despite State Bans, Report Finds
A physician prepares boxes of abortion pills to be sent to patients from a Massachusetts clinic on 1 April 2025. Photograph: Sophie Park
The abortion rate in the United States is holding steady despite total and partial bans in numerous states, largely because of travel across state lines and a significant increase in telehealth appointments, according to a new report from the Guttmacher Institute.
Shift Towards Telehealth and Mail-Order Pills
The number of abortions in the US increased slightly last year, from 1.124 million to 1.126 million. There is a notable shift away from traveling to states with legal abortion in favor of telehealth services, where providers can prescribe mail-order pills remotely.
One major change highlighted in the report is the provision of telehealth for patients in states with total bans. Clinicians in states such as New York or Massachusetts, which have shield laws to protect providers, are seeing and prescribing remotely to patients living in states like Texas or Alabama.
Shield laws have been extremely important for protecting providers and increasing access, said Joanne Rosen, a professor at the Johns Hopkins School of Public Health and co-director of its Center for Law and the Public's Health. Essentially, these laws allow people to circumvent the effects of their own state's abortion bans, making medication abortion more affordable and accessible while offering legal coverage to providers.
Decline in Interstate Travel for Abortions
Nationally, 142,000 people traveled across state lines for abortion care in 2025 – a decline from 154,000 in 2024 and 170,000 in 2023. Nearly half of those traveling for abortions were residents of states with total bans.
The drop is almost entirely among residents of states with total bans, where 12,000 fewer people traveled for abortion last year compared to 2024. However, the total number of people who traveled for abortions from states with bans in 2025, at 62,000, was still more than double the number before the Dobbs decision. An additional 47,000 people traveled from states with six- or twelve-week bans.
These estimates for 2025 come from clinician data and do not include fully self-managed abortions, meaning the true number is likely higher.
Rise in Telehealth Visits Amid Legal Challenges
Telehealth visits are seeing major increases in states with bans. This makes sense because people who access telehealth no longer need to travel for care, said Isaac Maddow-Zimet, a data scientist at the Guttmacher Institute and co-author of the report. He noted that this is the first time specific numbers have been released showing this shift almost in real time.
Two trends are emerging simultaneously: it has become more difficult and expensive to travel due to costs like driving, flying, and childcare, and with bans enacted across the country, patients often must travel longer distances. At the same time, telehealth is becoming more broadly available and often much cheaper.
Some patients are also using telehealth in states where abortion isn't banned but which have in-person dispensing requirements, simply because they prefer remote appointments, Rosen added. Abortion medication, approved by the FDA up to 10 weeks of pregnancy, can be effective off-label up to and after 12 weeks.
Legal and Regulatory Uncertainties
While shield laws have provided legal protection to providers, they are now being tested in court; Texas has brought civil actions against doctors in New York and California. We don't yet know what the courts will find, Rosen said.
The FDA is considering imposing restrictions on telehealth prescriptions of mifepristone, despite its high effectiveness and safety profile. Several states have filed lawsuits against the federal government to challenge these rules, arguing concerns over safety and state sovereignty.
Even before the Dobbs decision and subsequent bans, people often lacked a clear understanding of their state's abortion laws until they needed care. Now, with a patchwork of laws across the country, it is even more complicated, requiring navigational support for patients to access reproductive healthcare.
We're in a policy environment where abortion access is incredibly restricted in many states, and because of that, it's really critical that people have multiple routes of access, whether that's telehealth or travel, because people's individual situations are so specific, Maddow-Zimet concluded.
