Conservative States Banned Abortion. US Abortion Rates Increased.

What explains the rise?

Since the Supreme Court issued its ruling in Dobbs v. Jackson Women’s Health and ended the era of legal abortion in the United States, fourteen American states have banned the procedure, and seven more have imposed tight new restrictions. Abortion rates in these states have predictably dropped off. But they have, perhaps surprisingly, ticked up in others. Why?

One would expect that, with abortion criminalized in more than a quarter of the country, national abortion rates would drop. We know that there are women who need abortions for medical reasons who are being refused them. We know there are many, many women who seek abortions but can’t get them, and also can’t afford to travel out of state, or don’t know how to get abortion pills to self-manage their own abortions. We know that many women in abortion-hostile states are carrying pregnancies to term against their will.

Part of what explains why rates didn’t drop is that the abortion rights movement has made an enormous effort to help women access abortion care. Part of that effort has been to get abortion pills to women, regardless of whether abortion is legal not. Part of that effort has been to get women to abortion clinics in states where the procedure remains legal (that effort is extremely expensive, so do help out if you can). And part of it has been international, as American women, particularly those in border states, travel to Mexico for pills.

But that would explain a continuation of pre-Dobbs rates, not a rise.

One reason abortion rates may have gone up is because abortion bans pushed feminist groups to radically expand their work on self-managed abortion. Before Dobbs, some groups were pushing to make self-managed abortion a more accessible option; others were trying to soften telemedicine abortion restrictions. The Covid pandemic helped on that second bit. But self-managed abortion was relatively controversial, even within the pro-choice movement. Some activists argued that women should be able to choose for themselves how to end their pregnancies, and should have the ability to do so entirely outside of the medical system. Others argued that abortion is healthcare, and should be mainstreamed and treated as such — and should be done under the care of a medical professional.

Dobbs largely ended that dispute. For women who live in places where abortion is outlawed, self-managed abortion — that is, an abortion done with pills, ideally but not necessarily with a health worker available by phone — is often the best of a series of bad options. Abortion pills are overwhelmingly safe, and they’re cheap. There is a potential legal risk to the groups and individuals providing the pills, but those groups have either figured out a legal work-around, or decided to assume some level of risk.

The rise of self-managed abortion, and tremendous efforts to spread the word about the self-managed option, hasn’t just created a back door past abortion bans in conservative states; it has raised awareness in more liberal ones, too. I suspect that many women taking advantage of self-managed options live in states where abortion is legal. And pre-Dobbs, they may not have known that they could get safe abortion pills on their own.

I also suspect that the widely-reported and shocking overturning of Roe put abortion access in the spotlight, and some number of women who hadn’t really thought about it before were suddenly on notice that they had options — whether their home state legally allowed those options or not. People whose lives are unstable because of poverty or addiction are often the first to be dissuaded by abortion restrictions and other barriers. The huge post-Dobbs outcry, and the surge of information on how and where to get a safe abortion in the wake of Dobbs, almost surely handed new information to women who may not have gotten it otherwise — even if abortion had been legal in their home states before the decision.

Also, a shocking number of people just have no idea what’s legal and what isn’t when it comes to abortion, and generally do not bother to find out unless circumstances require it. A Kaiser Family Foundation poll from earlier this year found that, in states where abortion is legal, one in ten people believed the procedure was outlawed, and 44% weren’t sure if it was legal or not. That means that, even well after Dobbs, a majority of people who live in states where abortion is legal don’t know it. And it’s even worse in states where the procedure is banned: 13% of people who live in those states mistakenly think abortion is legal, and 47% say they don’t know if it’s legal or not. And these numbers are much better than they were in the months before Dobbs, when huge chunks of the US public had no idea what the law was when it came to abortion.

So that’s the good news: Many more women seem to have realized abortion is an option — a big thanks to the anti-abortion movement for that one. Many women in abortion-hostile states were able to jump through a lot of hoops to end pregnancies they did not want. And thanks to Dobbs and the medication-abortion emphasis it drove, many women across the US were able to get abortion-inducing drugs that they may otherwise have not been able to access.

But this data does not suggest that every woman who wanted an abortion got one. It is almost surely true that there are legions of women in abortion-hostile states (and some likely in pro-choice states) who were forced by law or circumstance or both to carry pregnancies they did not want, and to have babies they were not prepared for. Those women are no doubt suffering the consequences of “pro-life” policies in states that don’t care much about life outside of the womb.

What this data does show is what abortion rights advocates have long said: That abortion bans don’t end abortion. They make it harder to get. They risk women’s lives. But they don’t stop abortions from happening — except among the most vulnerable, whose lives are the most turned upside-down by a forced pregnancy, and who get the least help and the most shame from “pro-life” conservatives.

xx Jill