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America 2024

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Reproductive rights in America

Despite state bans, abortions nationwide are up, driven by telehealth.

Elissa Nadworny

Abortion rights activists at the Supreme Court in Washington, D.C. on March 26, the day the case about the abortion drug mifepristone was heard. The number of abortions in the U.S. increased, a study says, surprising researchers. Drew Angerer/AFP via Getty Images hide caption

Abortion rights activists at the Supreme Court in Washington, D.C. on March 26, the day the case about the abortion drug mifepristone was heard. The number of abortions in the U.S. increased, a study says, surprising researchers.

In the 18 months following the Supreme Court's decision that ended federal protection for abortion, the number of abortions in the U.S. has continued to grow, according to The Society of Family Planning's WeCount project .

"We are seeing a slow and small steady increase in the number of abortions per month and this was completely surprising to us," says Ushma Upadhyay , a professor and public health scientist at the University of California, San Francisco who co-leads the research. According to the report, in 2023 there were, on average, 86,000 abortions per month compared to 2022, where there were about 82,000 abortions per month. "Not huge," says Upadhyay, "but we were expecting a decline."

Shots - Health News

What's at stake in the supreme court mifepristone case.

The slight increase comes despite the fact that 14 states had total abortion bans in place during the time of the research. According to the report, there were about 145,000 fewer abortions in person in those states since the Dobbs decision, which triggered many of the restrictive state laws.

"We know that there are people living in states with bans who are not getting their needed abortions," says Upadhyay. "The concern we have is that that might be overlooked by these increases."

Florida, California and Illinois saw the largest surges in abortions, which is especially interesting given Florida's recent 6-week ban that started on May 1.

Abortion rights opponents demonstrate in New York City, on March 23. Some states' abortion bans are known as "heartbeat bills," because they make abortion illegal after cardiac activity starts, usually around six weeks of pregnancy. Kena Betancur/AFP via Getty Images hide caption

Abortion rights opponents demonstrate in New York City, on March 23. Some states' abortion bans are known as "heartbeat bills," because they make abortion illegal after cardiac activity starts, usually around six weeks of pregnancy.

The latest report also captures for the first time the impact of providers offering telehealth abortions from states with protections for doctors and clinics known as shield laws – statutes that say they can't be prosecuted or held liable for providing abortion care to people from other states.

Between July and December 2023, more than 40,000 people in states with abortion bans and telehealth restrictions received medication abortion through providers in states protected by shield laws. Abortion pills can be prescribed via telehealth appointments and sent through the mail; the pills can safely end pregnancies in the first trimester.

The report includes abortions happening within the U.S. health care system, and does not include self-managed abortions, when people take pills at home without the oversight of a clinician. For that reason, researchers believe these numbers are still an undercount of abortions happening in the U.S.

Tessa Longbons Cox is a senior research associate at Charlotte Lozier Institute, a research organization that opposes abortion. She says the WeCount report, "highlights a concerning trend" that policies around mail-order abortion pills are boosting abortion rates. "By recklessly removing in-person medical visits and safeguards, abortion advocates have put women's health and safety last," Longbons Cox says in a statement.

Accounting for the increases

A major factor in the uptick in abortions nationwide is the rise of telehealth, made possible in part by regulations first loosened during the coronavirus pandemic.

According to the report, telehealth abortions now make up 19% of all abortions in the U.S. In comparison, the first WeCount report which spanned April 2022 through August 2022 showed telehealth abortions accounted for just 4% of all abortions. Research has shown that telehealth abortions are as safe and effective as in-clinic care.

"It's affordable, it's convenient, and it feels more private," says Jillian Barovick, a midwife in Brooklyn and one of the co-founders of Juniper Midwifery , which offers medication abortion via telehealth to patients in six states where abortion is legal. The organization saw its first patient in August 2022 and now treats about 300 patients a month.

A Supreme Court abortion pill case with potential consequences for every other drug

"Having an in-clinic abortion, even a medication abortion, you could potentially be in the clinic for hours, whereas with us you get to sort of bypass all of that," she says. Instead, patients can connect with a clinician using text messages or a secure messaging platform. In addition to charging $100 dollars for the consultation and medication – which is well below the average cost of an abortion – Barovick points to the cost savings of not having to take off work or arrange child care to spend multiple hours in a clinic.

She says her patients receive their medication within 1 to 4 business days, "often faster than you can get an appointment in a clinic."

A study published in JAMA Internal Medicine on Monday followed about 500 women who had medication abortions with the pills distributed via mail order pharmacy after an in-person visit with a doctor. More than 90% of the patients were satisfied with the experience; there were three serious adverse events that required hospitalization.

In addition to expansions in telehealth, there have been new clinics in states like Kansas, Illinois and New Mexico, and there's been an increase in funding for abortion care – fueled by private donors and abortion funds.

The impact of shield laws

During the period from October to December 2023, nearly 8,000 people per month in states with bans or severe restrictions accessed medication abortions from clinicians providing telehealth in the 5 states that had shield laws at the time. That's nearly half of all monthly telehealth abortions.

"It's telemedicine overall that is meeting the need of people who either want to or need to remain in their banned or restricted state for their care," says Angel Foster, who founded The MAP, a group practice operating a telehealth model under Massachusetts' shield laws. "If you want to have your abortion care in your state and you live in Texas or Mississippi or Missouri, right now, the shield law provision is by far the most dominant way that you'd be able to get that care."

Foster's group offers medication abortions for about 500 patients a month. About 90% of their patients are in banned or restrictive states; about a third are from Texas, their most common state of origin, followed by Florida.

"Patients are scared that we are a scam," she says, "they can't believe that we're legit."

Since the WeCount data was collected, additional states including Maine and California have passed shield laws protecting providers who offer care nationwide. The new shield laws circumvent traditional telemedicine laws, which often require out-of-state health providers to be licensed in the states where patients are located. States with abortion bans or restrictions and/or telehealth bans hold the provider at fault, not the patient.

The NPR Politics Podcast

One small pill — one big court case.

Existing lawsuits brought by abortion opponents, including the case awaiting a Supreme Court decision, have the potential to disrupt this telehealth surge by restricting the use of the drug mifepristone nationwide. If the Supreme Court upholds an appeals court ruling, providers would be essentially barred from mailing the drug and an in-person doctor visit would be required.

There is also an effort underway in Louisiana to classify abortion pills as a controlled substance.

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• Abortion rights

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Using ideas from game theory to improve the reliability of language models

A new “consensus game,” developed by MIT CSAIL researchers, elevates AI’s text comprehension and generation skills.

May 14, 2024

A better way to control shape-shifting soft robots

A new algorithm learns to squish, bend, or stretch a robot’s entire body to accomplish diverse tasks like avoiding obstacles or retrieving items.

May 10, 2024

Creating bespoke programming languages for efficient visual AI systems

Associate Professor Jonathan Ragan-Kelley optimizes how computer graphics and images are processed for the hardware of today and tomorrow.

May 3, 2024

Three from MIT named 2024-25 Goldwater Scholars

Undergraduates Ben Lou, Srinath Mahankali, and Kenta Suzuki, whose research explores math and physics, are honored for their academic excellence.

May 2, 2024

Fostering research, careers, and community in materials science

MICRO internship program expands, brings undergraduate interns from other schools to campus.

May 1, 2024

Natural language boosts LLM performance in coding, planning, and robotics

Three neurosymbolic methods help language models find better abstractions within natural language, then use those representations to execute complex tasks.

MIT Emerging Talent opens pathways for underserved global learners

Learners across 24 countries build technical and employment skills in a collaborative community.

April 25, 2024

Study demonstrates efficacy of MIT-led Brave Behind Bars program

Programming course for incarcerated people boosts digital literacy and self-efficacy, highlighting potential for reduced recidivism.

April 24, 2024

MIT scientists tune the entanglement structure in an array of qubits

The advance offers a way to characterize a fundamental resource needed for quantum computing.

Mapping the brain pathways of visual memorability

For the first time, researchers use a combination of MEG and fMRI to map the spatio-temporal human brain dynamics of a visual image being recognized.

April 23, 2024

This tiny chip can safeguard user data while enabling efficient computing on a smartphone

Researchers have developed a security solution for power-hungry AI models that offers protection against two common attacks.

To build a better AI helper, start by modeling the irrational behavior of humans

A new technique can be used to predict the actions of human or AI agents who behave suboptimally while working toward unknown goals.

April 19, 2024

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Stem cells articles from across Nature Portfolio

Stem cells are cells that have the capacity to self-renew by dividing and to develop into more mature, specialised cells. Stem cells can be unipotent, multipotent, pluripotent or totipotent, depending on the number of cell types to which they can give rise.

Cells destroy donated mitochondria to build blood vessels

Organelles called mitochondria are transferred to blood-vessel-forming cells by support cells. Unexpectedly, these mitochondria are degraded, kick-starting the production of new ones and boosting vessel formation.

• Chantell S. Evans

Targeting RNA opens therapeutic avenues for Timothy syndrome

A therapeutic strategy that alters gene expression in a rare and severe neurodevelopmental condition has been tested in stem-cell-based models of the disease, and has been shown to correct genetic and cellular defects.

• Silvia Velasco

Related Subjects

• Adult stem cells
• Cancer stem cells
• Embryonic germ cells
• Embryonic stem cells
• Epigenetic memory
• Haematopoietic stem cells
• Heart stem cells
• Intestinal stem cells
• Mammary stem cells
• Mesenchymal stem cells
• Multipotent stem cells
• Muscle stem cells
• Neural stem cells
• Pluripotent stem cells
• Regeneration
• Reprogramming
• Self-renewal
• Skin stem cells
• Stem-cell differentiation
• Stem-cell niche
• Totipotent stem cells
• Transdifferentiation

Latest Research and Reviews

An improved epigenetic counter to track mitotic age in normal and precancerous tissues

DNA methylation (DNAm) clocks can track mitotic age, but their potential use for cancer risk prediction remains less explored. Here, the authors develop a DNAm counter of total mitotic age (stemTOC) that shows an increase of mitotic age in normal tissues and precancerous lesions.

• Andrew E. Teschendorff

CEBPA restricts alveolar type 2 cell plasticity during development and injury-repair

Cell plasticity underlies development and regeneration. Here, the authors show that mouse lung alveolar type 2 cells undergo maturation postnatally and their plasticity is restricted by CEBPA and increases upon viral infection.

• Dalia Hassan
• Jichao Chen

Direct conversion of cardiac fibroblasts into endothelial-like cells using Sox17 and Erg

Regeneration of cardiac endothelial cells is challenging as these cells must receive proper cues for tissue formation and integrate in the pre-existing vasculature. Here, Farber et. al identify Sox17-Erg as an efficient combination to reprogram cardiac fibroblasts into endothelial-like cells both in vivo and in vitro.

• Gregory Farber
• Yanhan Dong

Low-adhesion culture selection for human iPS cell-derived cardiomyocytes

• Tetsutaro Kikuchi
• Katsuhisa Matsuura
• Tatsuya Shimizu

Jag1/2 maintain esophageal homeostasis and suppress foregut tumorigenesis by restricting the basal progenitor cell pool

Dysregulation of basal progenitor cells induces esophageal tumorigenesis but the underlying mechanism is less explored. Here, the authors show that Jag1/2 deficiency promotes expansion of basal progenitor cells, leading to reduced squamous epithelial differentiation and enhanced formation of squamous cell carcinoma in the foregut.

• Haidi Huang
• Yongchun Zhang

Nuclear actin structure regulates chromatin accessibility

Intranuclear actin contributes to nuclear structure. Inducing actin remodeling within the nucleus regulates chromatin accessibility, and is associated with phenotypic outcomes in mesenchymal stem cells. As such, dynamic actin remodeling may modulate gene expression.

• Janet Rubin

News and Comment

Connie Eaves (1944–2024)

• Gerry Krystal
• Xiaoyan Jiang

Rebalancing the aged immune system

• Hannah Walters

Connie J. Eaves (1944–2024)

• Nagarajan Kannan
• Aniruddha J. Deshpande

Treating a type 2 diabetic patient with impaired pancreatic islet function by personalized endoderm stem cell-derived islet tissue

Prometheus 2.0: drug-induced liver regeneration arising

• Jan S. Tchorz

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