Did Dobbs make any difference? Guttmacher reports over 1M abortions in 2023
[Most of this info is also available as a Twitter/X thread here.]
A new Guttmacher report shows abortions in 2023 are at the highest level since 2012. At an estimated 1,026,690 abortions, the 2023 number is a 10% increase over 2020 levels. Does this mean Dobbs (the 2022 Supreme Court decision to overturn Roe v. Wade) and the dozen or so state abortion bans since haven’t make any difference?
No, it doesn’t.
Why did abortions start increasing in 2017?
To understand what effect Dobbs (and then state abortion bans) had on abortion rates, we have to consider what factors were contributing to the rise in abortion in the years prior to Dobbs, and how Dobbs interplays with those factors. After decades of decline, annual abortions started increasing in 2017. Why? Researchers aren’t really sure.
Guttmacher reported an 8% increase in abortions from 2017 to 2020. The report consider possible explanations, but with no concrete conclusions. The total number of abortion clinics in the country hadn’t changed much. They didn’t find major changes in the types of contraceptives people used. There was an increased proportion of abortions done via pills, but telemedicine hadn’t yet taken off, so the change in access wouldn’t be huge.
In the same time period, teen pregnancy rates continued their longstanding decline. Gallup saw an increase in Americans’ preference for larger families. And from 2017 until at least the pandemic (2020), Gallup also found Americans reported comparativelyhigh economic confidence.
Guttmacher did report some legal expansions of abortion access, including some states allowing Medicaid to pay for abortions. However there are also many restrictions implemented in the same time frame. The overall shift in the legal landscape from 2017 to 2020 didn’t appear to be huge either.
So far it’s unclear why abortions started rising, which makes it trickier to separate out the different variables affecting abortion numbers now.
Still, we have many indications that regulations affect rates. Guttmacher talks about this repeatedly in their own report.
Why did states without bans see abortion increases in 2023?
According to the Guttmacher 2023 report, from 2020 to 2023 abortion increased nationally by 10%. This average masks major differences between states:
- Ban states: states with abortion bans saw major decreases in abortion (often recorded as “few or no abortions”).
- Non-border states: States that didn’t have abortion bans, but also didn’t border ban states, saw abortions increase 17%.
- Border states: states that didn’t have abortion bans, but bordered ban states, saw abortion increase 37%.
Abortion advocates had to put forth “monumental efforts” to lessen effects of bans.
The greater increases in states bordering ban states were due largely to people from ban states traveling to get abortions. They were able to do so at these levels primarily because, as Guttmacher put it, “drastic loss of access in states with bans has been counterbalanced by monumental efforts” from abortion advocates to make up the difference.
It takes monumental efforts to dampen the effects of abortion bans, because the effects are substantial.
Relaxed abortion regulations in pro-choice states contributed to abortion increases.
Border states saw abortion increases not only because of visiting residents from ban states, but also because their own residents started getting more abortions. This would explain why non-border states also saw substantial abortion increases. What factors contributed to the non-travel-related abortion increases? Guttmacher lists several:
- The rise of “pills by post” (telemedicine abortion): Abortion pill use “increased considerably” in the wake of COVID, when the FDA stopped requiring providers to dispense the pills in person.
- The increase in “shield laws”: pro-choice states passing laws to protect their abortion providers from liability for breaking the laws in pro-life states (primarily mailing abortion pills to states which have banned them)
In a separate report, Guttmacher notes that a record number of states have passed abortion protections in 2023:
In 2023, state policymakers across the country enacted 129 measures protecting abortion access. These protections included policies protecting the legal right to abortion, improving and expanding patient access, supporting the health care workforce, improving clinic safety and security, and expanding insurance coverage for abortion access.
Guttmacher
Just as it’s true that abortion bans and restrictions decrease abortion rates, abortion protections and expansions increase abortion rates. These are two sides of the same coin: abortion policies significantly influence abortion rates.
Did the residents of abortion ban states actually get fewer abortions?
Pro-choicers have and likely will continue to try to interpret the Guttmacher 2023 report as evidence that laws against abortion don’t decrease abortions.
Almost as if they anticipated this interpretation, the Guttmacher researchers included a section of their report titled “Increases Do Not Negate the Impact of Anti-Abortion policies.” They discussed the resources required for people to travel to get abortions. They talked about people who got abortions outside “the formal health care system” (meaning illegally).
And they briefly ackowledged that “some were forced to continue their pregnancies”–meaning anti-abortion policies resulted in some people not getting abortions at all.
[Read more – 5 reasons to talk about women who don’t regret being denied abortion]
Abortion restrictions have historically increased birth rates.
Previous research has suggested that, at least in the near-term, after abortion laws get more permissive, births decrease, and after laws get more restrictive, births increase. For example:
States legalizing abortion experienced a 4% decline in fertility relative to states where the legal status of abortion was unchanged.
“Roe v Wade and American fertility,” Levine, Staiger, Kane, & Zimmerman, American Journal of Public Health, 1999 February; 89(2): 199-203
Approximately one-fourth of women who would have Medicaid-funded abortions instead give birth when this funding is unavailable … Studies have found little evidence that lack of Medicaid funding has resulted in illegal abortions.
“Restrictions on Medicaid Funding for Abortions: A Literature Review,” Henshaw, Joyce, Dennis, Finer, & Blanchard, Guttmacher Institute, June 2009
I estimate an increase in the birthrate of 4% to 12% when abortion is restricted. In the absence of anti-abortion laws, fertility would have been 5% to 12% lower in the early twentieth century.
“The Effect of Anti-Abortion Legislation on Nineteenth Century Fertility,” Laney, Demography, 2014 Jun; 51(3): 939-948
The 2021 Texas Heartbeat Law increased birth rates.
Johns Hopkins Bloomberg School of Public Health used statistical modeling accounting for live birth data from all 50 states as well as other confounding factors, and ultimately calculated that there were 9,799 more births than would be expected in Texas absent the heartbeat law. The researchers, who are abortion rights advocates, explained:
Our findings strongly suggest that a considerable number of pregnant individuals in Texas were unable to overcome barriers to abortion access.
Analysis Suggests 2021 Texas Abortion Ban Resulted in Nearly 9,800 Extra Live Births, July 2023
Abortion bans enacted since Dobbs increased birth rates.
A November 2023 report on the birth rates of pro-life states compared to controls since Dobbs found similar results.
Our primary analysis indicates … approximately 32,000 additional annual births resulting from abortion bans.
The Effects of the Dobbs Decision on Fertility, November 2023
The effects of abortion regulations (or lack thereof) are immense.
At Secular Pro-Life, we talk about how we want to decrease both the demand and supply of elective abortion. Decreasing demand looks like cultural changes to humanize children in utero, better support for pregnancy and parenthood, improved efforts to prevent pregnancy, and countless related endeavors. Decreasing supply looks like restricting or banning elective abortion.
Of course it’d be easier if opposing abortion only required decreasing demand. Decreasing demand is pretty uncontroversial. Theoretically pro-choice people should have just as much interest in most of the methods for decreasing the demand for abortion. No one should be seeking abortion because she feels she specifically doesn’t have a choice.
But decreasing supply is also crucial. The laws are crucial. They have enormous effects on cultural perception of what society has deemed ethical, who society has decided merits protection. They also have enormous effects on how many abortions actually happen.
The fact that pro-choice states and abortion activists have to scramble and struggle to undo the effects of bans in a minority of states underscores this reality. Their best counterargument to the effects of the law is “Well if we dramatically relax the law elsewhere, more people will get abortions.” Right. Because laws matter
All the more reason for the pro-life movement to keep striving to change hearts, minds, and ultimately actual policies. Laws against abortion are unequivocally a crucial part of this puzzle.
