Abortion Trends in 2019 and 2020

Tessa Longbons  |  21 October 2021

Abortions in the United States increased in 2018, and available 2019 state abortion statistics indicate that the increase continued into the following year.[1] Chemical abortions were the driving factor. As of September 2021, 39 states had released 2019 abortion reports, showing that abortions increased overall by more than two percent from 2018. In the 33 states that reported the number of chemical abortions performed in 2018 and 2019, chemical abortions rose by 12 percent.

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Due to changes wrought by the COVID-19 pandemic, these trends accelerated in 2020. Mifepristone, one of the drugs used in the chemical abortion process, has been regulated since its approval by the Food and Drug Administration (FDA) in 2000. Mifepristone is governed by a Risk Evaluation and Mitigation Strategy (REMS) that attempts to reduce the risks associated with the drug.[2] However, in July of 2020, a district court blocked a portion of the REMS that requires medical professionals to administer mifepristone in person, thereby clearing the way for abortion via the mail. In April of 2021, the FDA officially suspended enforcement of that aspect of the REMS for the duration of the pandemic.[3] Chemical abortions surged in 2020, at least partially as a result of this change to the REMS.

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Seventeen states have released 2020 abortion statistics as of October 2021, of which 15 reported the types of abortion procedures performed in both 2019 and 2020.[4] In these 15 states, total abortions increased by 2.5%. The increase was driven almost entirely by chemical abortions, which increased by 26 percent from 2019. In contrast, surgical abortions actually declined by 17 percent between 2019 and 2020. In every single state, chemical abortions composed a larger share of the total in 2020 than they did the previous year; in fact, in 12 of the 15 states, over half the abortions were chemical.

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In Alaska, chemical abortions rose by 46 percent in 2020, and in North Dakota, they jumped by 106 percent, even though total abortions in both states declined from 2019. Colorado and Nebraska both reported total abortions increased by 15 percent from the previous year; in both these states, chemical abortions increased while surgical abortions declined.

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These changes in 2020 may serve as a preview of what states may experience if the REMS are permanently eliminated. The FDA is conducting a review of the mifepristone REMS with a decision expected by November 1, and it is possible that the REMS may be entirely removed.[5] Representatives Maloney, DeGette, Lee, and Pressley have cosponsored a resolution pressing the FDA to make that decision, arguing that the REMS represent “needless restrictions” that make abortion difficult to access.[6] Currently, 84 members of Congress have joined the resolution as cosponsors.

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Facing the possibility that the FDA may remove all restrictions on mifepristone, some states have codified their own regulations to limit chemical abortion and protect women’s health. In 2021, Arizona, Arkansas, Indiana, Montana, Oklahoma, and Texas each passed legislation to implement or strengthen chemical abortion regulations.[7] The new legislation enacts many protections the FDA will potentially discontinue, ensuring that mifepristone is dispensed only by licensed physicians and that women are provided with physical examinations. In addition, the legislation provides for strengthened abortion reporting. Similarly, the governor of South Dakota issued an executive order requiring that mifepristone be dispensed in person only, and that data collection be improved.[8]

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Abortion numbers may be modified as additional states release reports for 2019 and 2020, but the overall trends are unlikely to change. The growing prevalence of chemical abortions will probably continue, although most states have not yet released data for 2021. As chemical abortions have a complication rate several times that of surgical abortions, the shift from surgical to chemical abortion will likely be reflected in more abortion complications nationwide.[9] Increasingly, it will be up to individual states to curtail the spread of dangerous chemical abortions and make sure that complications are tracked and publicly reported.

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[1] Longbons, T. (2021). U.S. Abortion Trends: 2019 and Preliminary 2020. Charlotte Lozier Institute. American Reports Series Issue 19.

[2] U.S. Food and Drug Administration (2021). Questions and answers on Mifeprex.

[3] Longbons, T. (2019). The impact of chemical abortion by mail. Sebastian’s Point.

[4] See state reporting from A.K., AR, CO, FL, IN, KS, KY, MI, NE, ND, OH, OK, SC, SD, and TX. See https://lozierinstitute.org/state-abortion-reporting/

[5] Joint Mot. to Stay Case Pending Agency Review, Chelius v. Becerra, Civ. No. 1:17-00493 JAO-RT (D. Haw.).

[6] H.R. 589, 117th Cong. (2021)

[7] Arizona SB 1457; Arkansas HB 1402 and HB 1572; Indiana HB 1577; Montana HB 171; Oklahoma SB 778 and SB 779; Texas S.B. 4

[8] S.D. Exec. Order No. 2021-12 (September 7, 2021).

[9] Niinimaki, M. (2009). Immediate complications after medical compared with surgical termination of pregnancy. Obstetrics & Gynecology, 114(4), 795-804.

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