US abortion rate holds steady largely due to travel and telehealth availability – report

The abortion rate is holding steady in the US despite total and partial bans in some states – largely because of travel across state lines and a significant increase in telehealth appointments, a new report says.US regulatory officials are weighing changes to the ways mifepristone, an abortion medication, may be dispensed, but they have reportedly pushed their review until after the midterm elections, given the widespread support for abortion across the US.The number of abortions in the US increased slightly last year, from 1.124m to 1.126m, according to a Guttmacher Institute report. There’s also a shift away from traveling and toward telehealth, in which providers may prescribe mail-order pills.One major change in this report is the provision of telehealth for patients in states with total bans – with clinicians in states such as New York or Massachusetts, which have shield laws to protect providers, seeing and prescribing remotely to patients living in states such as 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 shield laws allow people to get around the effect of their own state’s abortion ban,” Rosen said. It makes medication abortion more affordable and accessible while giving providers legal coverage.Nationally, 142,000 people traveled across state lines for abortion care in 2025 – a decline from 154,000 in 2024 and from 170,000 in 2023. Nearly half of the people 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 with 2024.But the total number of people who traveled for abortions from states with bans last year, 62,000, was still more than double the number of people who traveled from those states before the Dobbs decision. Another 47,000 people in 2025 traveled from states with six- or 12-week bans.The estimates for 2025 come from clinician data, and do not include fully self-managed abortions, which means the true number is likely higher.Telehealth visits are also seeing major increases in states with bans. That 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. “So it’s not surprising, but it is the first time that we’ve been able to put out specific numbers showing this shift almost in real time.”There are two trends emerging at once, Maddow-Zimet said. It has become more difficult to travel – more expensive to drive or fly and to procure childcare; and with partial or total bans enacted across swaths of the country, patients frequently have to travel longer distances to access care.“People, of course, are traveling much farther than they have ever in the past,” Maddow-Zimet said. “They need to travel hundreds of miles and across many state lines.”At the same time, telehealth is becoming more broadly available, and it’s often much cheaper.“As long as abortion is banned or restricted in many states, there are always going to be people who need or prefer to travel for in-person care – for example, people later in pregnancy, or those who need or prefer procedural care,” Maddow-Zimet said. “But for those who can access or prefer telehealth care, it can relieve a huge burden, and can really be a critical mode of access.”Some patients are also using telehealth in states where abortion isn’t banned but which have in-person dispensing requirements, because they prefer remote appointments, Rosen said. Abortion medication has been approved by the US Food and Drug Administration (FDA) up to 10 weeks of pregnancy, though evidence shows it can be effective when used off-label up to and after 12 weeks.While shield laws have given 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, even though the medication is highly effective and safer than Tylenol. Several states have filed lawsuits against the federal government to challenge these rules.“They’re arguing many things – in part that it’s not safe and in part that it undermines state sovereignty,” Rosen said.Even before the Dobbs decision and subsequent bans, people often didn’t have a good sense of their state’s abortion laws until they needed the care, Maddow-Zimet said. Now “it is even more complicated” with the patchwork of laws across the country, which means patients also need “navigational support” to understand how to access reproductive healthcare, he said.“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 said.