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ABSTRACT & COMMENTARY
Assessing the Availability of Procedural, Later Abortion Services Pre- and Post-Dobbs
July 1, 2025 6 minutes read
By Annalise Panthofer, MD, and Lisa Bayer, MD, MPH
Synopsis: From 2021 to 2023, the number of publicly advertising procedural abortion facilities in the United States decreased 11%. Of those that persisted, 28% of facilities decreased their gestational age limits and 21% increased their gestational age limits.
Source: 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. 2025;145(1):e31-e36.
The 2022 Supreme Court case Dobbs v. Jackson Women’s Health Organization overturned the constitutional right to abortion in the United States, returning control of abortion regulation back to individual states. Since this ruling, the abortion landscape in the United States has continued to change, responding to state restrictions and bans on reproductive care. In 2022, approximately 7.2% of abortions in the United States took place after the first trimester.1 This number is expected to grow post-Dobbs, particularly in states with legally protected abortion, which absorb abortion restrictive-state patients presenting at a later gestational age.2 This has been postulated to be the result of increasing requirements to travel out of state for care, which incurs time spent coordinating travel and finances.3-7
Compared to first-trimester abortions, the majority of which now are medication-managed post-Dobbs, procedural abortions and induction abortions are the mainstays of second- and third-trimester abortions. As stated earlier, second-trimester abortions constitute the minority of all abortions and third-trimester abortions are even more rare, most commonly performed for lethal fetal anomalies. This study assessed changes in the number of publicly advertising procedural abortion facilities from 2021-2023 in the United States, as well as changes in the gestational age limits of these facilities over the study period. The study was performed using the Advancing New Standards in Reproductive Health (ANSIRH) Abortion Facility Database. Facilities were identified through a series of online searches, and details regarding services provided were confirmed directly with facilities through “mystery shopper” calls. The study included facilities that were open and provided procedural abortions in 2021, 2022, or 2023. Summary statistics were used.
This study found that while the number of publicly advertising abortion facilities increased from 2021-2023, the majority of these new facilities were found to provide medication abortion only. There was an overall 11% decrease (from 473 to 421) in the facilities offering procedural abortion, including the complete loss of procedural abortion facilities in 13 states. Among the 473 facilities offering procedural abortion in 2021, 115 discontinued these services by 2023, while 354 facilities continued providing procedural abortion over the study period. Among those facilities that continued providing procedural abortion services, 99 decreased their gestational age limit, 73 increased their gestational age limit, and 179 made no change to their gestational age limit. By 2023, 30 new procedural facilities opened, 19 previously medication-only facilities began providing procedural abortion care, and 15 hospital-based services began to publicly advertise. The South was affected most significantly by these reductions, with no access to procedural abortion in East South Central and West South Central states. The number of facilities providing procedural abortion at or after 24 weeks decreased from 60 to 50 during the study time period. Although the median publicly advertised gestational age stayed the same at 16 weeks, the national upper limit increased from 32 weeks in 2021 to 34.6 weeks in 2023.
Commentary
In 2022, approximately 173,684 procedural abortions took place, the most common type of abortion for greater than 10 weeks’ gestation. Procedural abortions account for 72.4% of abortions at 10 to 13 weeks’ gestation, 94.9% to 98.1% of abortions at 14 to 20 weeks’ gestation, and 80.0% of abortions at ≥ 21 weeks’ gestation.1 Medication abortions made up the majority of the remaining abortions in these gestational age ranges while intrauterine instillation or hysterotomy/hysterectomy were rare (< 0.1% to 0.4% of abortions).1 Following the Dobbs decision, 41 states enacted some form of abortion ban. Twelve states have a total abortion ban and 29 states have a ban based on gestational duration, according to the Guttmacher Institute’s most recent report.8 As a result, more than one-third of reproductive age individuals capable of pregnancy now live more than one hour from an abortion facility.9 Although self-managed medication abortion using online vendors likely has bridged some lack of access for these patient populations, this intervention generally is only an option for pregnancies less than 10 to 11 weeks’ gestational age.10 After this point, procedural abortion typically is the mainstay of treatment and its access is not only contingent on the legislative landscape, but also on a patient’s physical access to a procedural facility.
This study highlights the importance of facilities publicly advertising their abortion services, which can help reduce barriers for patients seeking this care. It demonstrates a small but important trend of hospitals transitioning from referral-only to publicly advertised abortion services, which provides critically important services for later abortion care and high-risk patients needing hospital-based care. Ongoing efforts are necessary to dismantle these barriers to improve transparency and expand access for patients requiring this care. One limitation of the study is how facilities are identified through the ANSIRH Abortion Facility Database. Facilities included in this database must publicly advertise and, thus, exclude clinics or hospitals that also provide abortion care through referral only. Although the true number of procedure abortion facilities may be higher than reported, it also is important to acknowledge that many patients seek abortion care through online searches without a referral.
This study identified an overall 11% decrease in the number of procedural abortion facilities. However, this reduction would have reached 24% in the absence of newly established facilities and the expansion of existing medication-only abortion facilities to offer procedural services. Indeed, there has been a national effort to compensate for the barriers imposed by Dobbs, with non-restrictive states reporting significant absorption of neighboring restrictive states’ abortion needs and accommodating these demands with the construction of new facilities bordering restrictive states.2,11-13 In addition, although 28% of facilities decreased their gestational age limit, 21% increased their gestational limit, and the national upper limited increased, reflecting the need to accommodate later gestational ages in the setting of increased barriers to access care. The shifting legal landscape post-Dobbs has created significant changes in the availability of facilities offering procedural abortion care, particularly in southern states. Despite these changes, the need for such care remains, and evidence already demonstrates that patients, providers, and organizations are willing to travel long distances and establish new facilities to maintain access to these essential services.
Annalise Panthofer, MD, is an OB/GYN Resident Physician, Oregon Health and Science University, Portland, OR.
Lisa Bayer, MD, MPH, is Associate Professor, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
References
1. Ramer S, Nguyen AT, Hollier LM, et al. Abortion surveillance — United States, 2022. MMWR Surveill Summ. 2024;73(7):1-28.
2. Mandelbaum AD, Nacev EC, Fuerst MF, et al. Impact of the Dobbs decision on abortion services from a large tertiary center in Oregon. Contraception. 2024;136:110484.
3. Rader B, Upadhyay UD, Sehgal NKR, et al. Estimated travel time and spatial access to abortion facilities in the US before and after the Dobbs v Jackson Women’s Health decision. JAMA. 2022;328(20):2041-2047.
4. Pleasants EA, Cartwright AF, Upadhyay UD. Association between distance to an abortion facility and abortion or pregnancy outcome among a prospective cohort of people seeking abortion online. JAMA Netw Open. 2022;5(5):e2212065.
5. Keefe-Oates B, Fulcher I, Fortin J, et al. Use of abortion services in Massachusetts after the Dobbs decision among in-state vs out-of-state residents. JAMA Netw Open. 2023;6(9):e2332400.
6. Makleff S, Blaylock R, Ruggiero S, et al. Travel for later abortion in the USA: Lived experiences, structural contributors and abortion fund support. Cult Health Sex. 2023;25(12):1741-1757.
7. White K, Sierra G, Evans T, Roberts SCM. Abortion at 12 or more weeks’ gestation and travel for later abortion care among Mississippi residents. Contraception. 2022;108:19-24.
8. Guttmacher Institute. State bans on abortion throughout pregnancy. March 26, 2025. https://www.guttmacher.org/state-policy/explore/state-policies-abortion-bans
9. Harvey SM, Larson AE, Warren JT. The Dobbs decision — exacerbating U.S. health inequity. N Engl J Med. 2023;388(16):1444-1447.
10. Aiken ARA, Wells ES, Gomperts R, Scott JG. Provision of medications for self-managed abortion before and after the Dobbs v Jackson Women’s Health Organization decision. JAMA. 2024;331(18):1558-1564.
11. Owda R, Scheerer J, Compton SD, et al. The potential impact of neighboring states’ bans on abortion volume in a haven state. Contraception. 2023;124:110062.
12. Riley T, Fiastro AE, Benson LS, et al. Abortion provision and delays to care in a clinic network in Washington state after Dobbs. JAMA Netw Open. 2024;7(5):e2413847.
13. Kapos S. America’s abortion access divide is reshaping blue-state border towns. Politico. Jan. 11, 2023. https://www.politico.com/news/2023/01/11/abortion-access-blue-state-border-towns-00077367
From 2021 to 2023, the number of publicly advertising procedural abortion facilities in the United States decreased 11%. Of those that persisted, 28% of facilities decreased their gestational age limits and 21% increased their gestational age limits.
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