While pro-abortion advocates in the private and public sphere claim that abortion is healthcare, they are doing everything they can to demedicalize it, including advocating for eliminating or loosening abortion reporting requirements in states across the country (i.e. Michigan’s new law removing reporting requirements). While other public health metrics are tracked and mandated to be reported to […]
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While pro-abortion advocates in the private and public sphere claim that abortion is healthcare, they are doing everything they can to demedicalize it, including advocating for eliminating or loosening abortion reporting requirements in states across the country (i.e. Michigan’s new law removing reporting requirements). While other public health metrics are tracked and mandated to be reported to the Centers for Disease Control and Prevention (CDC), abortion reporting in the United States is entirely voluntary at the national level. As a consequence, no central repository of abortion data exists in the United States. Researchers, public health scientists, and the public therefore do not know the true number of abortions that occur each year, in part because some of the highest volume abortion states (California, Maryland, and New Jersey) do not report any data through their own health departments or to the CDC. Instead, the public must rely on the pro-abortion Guttmacher Institute’s estimates, released only sporadically, to get any approximation of the total number of abortions occurring in those high abortion-volume states. In 2020, Guttmacher Institute estimated that 154,060 abortions occurred in California and 30,750 in Maryland, which if reported to the CDC would have increased the total number of abortions in the U.S. by 30% (620,327 to 805,137). Michigan, New Hampshire, and North Dakota also do not report any abortion data.[1] The CDC’s 2020 abortion total estimate is 50% lower than the 2020 abortion total that Guttmacher estimated.
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Further illustrating the deficient state of abortion reporting is the fact that, in 2021, the total number of abortions states detailed in their respective public reports was 9% lower than the total reported by the CDC and 14% lower for drug-induced (also known as “chemical”) abortion totals. The total number of abortions that occur each year in America, however, is not the only important public health data point that the public does not have related to abortion; Americans also do not know the true number of babies born alive during abortions, late-term abortions, abortion-related complications, as well as abortion-related deaths that occur each year. Even in the states that do report, the quality of data varies widely.
This paper evaluates each state’s abortion reporting requirements and publicly accessible abortion reports (or lack thereof). It is an update to CLI’s 2016 survey of abortion reporting across the country, and analyzes state-wide, regional, and national trends that could inform public health officials and policymakers.
Complete, high-quality, and transparent abortion data should be the goal of everyone who values government transparency and women’s health. Some believe that because so many states have enacted pro-life protections post-Dobbs, there is no need to report abortion statistics anymore. This notion could not be further from the truth. Now that Dobbs has placed the authority to enact protections for unborn children in the hands of the American people and their elected representatives at the federal and state levels, it is more critical than ever to have access to good data so that the impact of those abortion policies can be evaluated. Even the CDC agrees that accurate abortion data is important for public health in terms of measuring unintended pregnancies and tracking changes in clinical practice. The CDC has highlighted the importance of accurate and thorough abortion reporting as far back as 1997 when its handbook on abortion reporting said that abortion data “are very important from a demographic and public health viewpoint.” Consequently, abortion policy must be grounded on the most accurate, comprehensive, and up-to-date statistical information and health data. This paper seeks to enrich the states’ ability to answer that call in a post-Dobbs world.
In 2016, CLI released a pioneering paper titled “Abortion Reporting: Toward a Better National Standard,” which ranked the 52 reporting areas (50 states, NYC, and D.C.) in terms of their abortion reporting laws and published reports. CLI found that states’ abortion reports and reporting requirements varied greatly, and collectively, the state of abortion reporting in America was in disrepair. Much like today, multiple states did not report any data at all. Oklahoma’s abortion reporting requirements ranked first with a score of 77 out of 100, with the seven states that did not report any data at the time tying for last with a score of zero.[2] Since the release of CLI’s 2016 paper, much of the abortion landscape has changed, necessitating a new approach to ranking these states. Below, three factors will briefly be discussed that have both necessitated an update to CLI’s 2016 paper and drastically altered the abortion landscape: changes in abortion reporting laws at the state or local level, changes to the Food and Drug Administration’s drug-induced abortion regulations, and changes in how states are reporting abortion after the Dobbs v. Jackson Women’s Health Organization decision.
Changes in Abortion Reporting Laws Since 2016
One of the main impetuses in CLI updating its 2016 paper was that, in the eight years since it was written, 22 reporting areas have enacted changes to the abortion reporting requirements, some to improve reporting, and others to weaken. A brief categorization of those changes can be found below and a more detailed table with citations can be found in Appendix A.
Strengthened reporting: Arizona, Arkansas, D.C., Idaho, Indiana, Kentucky, Louisiana, Missouri, Montana, Nevada, North Carolina, South Carolina, Tennessee, Texas, West Virginia, and Wyoming (16 total reporting areas)
Weakened reporting: Illinois, Maine, Michigan, Minnesota, New Jersey, North Dakota (6 total reporting areas)
Given the legislative and judicial developments in these 22 reporting areas, CLI sought to re-rank them according to the quality of their abortion reporting requirements and reports.
Post-2021 Changes to the Drug-Induced Abortion FDA REMS and How Abortion Data is Being Impacted
Another change in the abortion policy landscape that motivated CLI to update its 2016 paper was the FDA’s recent decisions to change its Risk Evaluation and Mitigation Strategy (REMS) for drug-induced abortion. FDA ignored its own safety requirements regarding the abortion drugs mifepristone and misoprostol for the purpose of increasing access to the drugs. In April 2021, the FDA announced the temporary suspension of its requirement for women to have an in-person medical visit prior to obtaining a drug-induced abortion.[3] In December 2021, the FDA made that suspension permanent, making mifepristone available by mail. In January 2023, the FDA announced that retail pharmacies (chain and independent) could start dispensing abortion drugs to patients with a prescription from a certified provider if they became REMS certified.[4]
All of these actions by the FDA contributed to the increased use of drug-induced abortion since 2021, though abortions had been on the rise prior to that year, as well. According to the CDC, drug-induced abortions increased by 8.5% from 2020 to 2021. In states that reported 2020 to 2022 abortion data, drug-induced abortions increased by an average of 28% in the states that reported increases from 2020 to 2022. (To see the states’ drug-induced abortion data broken down, see Table 2 in Appendix A. [5]) The significant increase in drug-induced abortions can be visualized by looking at the increases in drug-induced abortions according to the CDC abortion surveillance reports since 2018:
With this increasing use of drug-induced abortion, especially by mail, come challenges for reporting and tracking data. The number of abortions by mail cannot be tracked. The number of pills mailed can be tracked, but not the number of women who actually take the pills to induce an abortion. This poses a significant public health issue because it is known that drug-induced abortions are more dangerous for women than surgical abortions. In response to the general increased use of drug-induced abortion and the subsequent expectation of increased complications, some states have enacted detailed complications reporting laws that have greatly enhanced the overall quality of their abortion reports. These states include: Arkansas, Idaho, Indiana, Kentucky, Missouri, North Carolina, and Texas (Appendix A, Table 1). However, only two states’ most recent reports (Nevada and Oregon) document the number of drug-induced abortions by telemedicine and the number of drug-induced abortions initiated in an abortion facility.[6]
The surge and inability to track abortion drugs shipped via the mail has only been compounded by some states’ decisions, post-Dobbs, to prioritize shielding doctors from prosecution who ship abortion drugs into – states that have enacted protections of unborn babies at varying gestational limits (see, for e.g., New York’s SB S1066B, signed into law in June 2023). The impact of the Dobbs decision on the abortion policy landscape will be discussed briefly in the ensuing section.
Changes in Abortion Reporting Due to the Dobbs Decision
After North Dakota’s life at conception law took effect post-Dobbs, the state Department of Health mistakenly decided it no longer needed to collect and report abortion data. But this decision failed to account for the fact that North Dakota’s law has exceptions, which will mean that some abortions, though likely not many, could still occur in the state. The data associated with those abortions are no less important than the data associated with elective abortions.
Still more concerning, while the Dobbs decision is responsible for the prevention of elective abortions in many states including previously high abortion-volume states like Texas, the U.S. abortion landscape prior to Roe v. Wade suggests that abortions will become increasingly concentrated in states with little to no limits on when an abortion can be performed. Recent research on interstate abortion commerce trends and the concentration of abortions in pro-abortion states that border pro-life states, like Illinois, New Mexico, and Maryland support these concerns. As one example, the Guttmacher report titled “Monthly Abortion Provision Study” suggests a doubling of abortions on out-of-state women in Illinois.
Not only does this new trend highlight the need for federal protections for the unborn (as one’s zip code should not determine whether one lives or dies), but the increasing percentage of abortions performed in pro-abortion states means that, due to the current politicization of abortion reporting, the states with the highest abortion totals will likely be those whose reporting is of poor quality (such as Illinois, New Mexico, or New York State) or that do not report at all. This will leave the public, government agencies, and researchers with even less information than they already have.
In light of the foregoing changes, CLI designed an improved scoring method to respond to the changes in abortion legislation at the state level, changes in how abortions are performed, and where the majority of abortions will be performed going forward. This new score design is discussed in the following section.
Due to the changes described in the preceding section, a slightly different methodology was needed and therefore used to re-rank states’ abortion reporting requirements and public reports. The first steps of the re-ranking process remained largely the same as those used in 2016. Every state’s abortion reporting statute and administrative rules were collected.[7] After a thorough review of what each state’s statute and administrative codes required in their public abortion reports, CLI cross-checked to see if there were any discrepancies between what states’ statutes required and what their public reports actually included. To address these discrepancies, CLI emailed the respective states’ health departments in an effort to obtain explanations. (To see which reporting areas’ health departments did not answer CLI’s questions, refer to Table 3 in Appendix B.) In some instances, state statutes did not specifically enumerate topics to be included in their abortion reports, but rather said that the reports must include all information included in the form provided to abortionists and sent to the states’ departments of health for every abortion that occurred in the state. This is why CLI requested that states send updated abortion provider reporting forms.
After this initial step, CLI reached out to every reporting area’s Department of Health for an updated copy of the state’s abortion reporting forms. These forms are required to be filled out for every abortion performed and are then sent to the Department of Health and used to compile the states’ public-facing abortion reports devoid of any personally identifying information. For the states that enacted abortion limits post-Dobbs, CLI specifically requested that they send a version of the form that complied with their new laws. In the remaining states, CLI requested reporting areas send any updated versions of the forms sent to CLI in 2016. As Table 4 in Appendix B shows, the statuses of these inquiries were mixed.
After these initial steps, CLI sought to update the 2016 study’s scoresheet used to score each state’s abortion reporting requirements and reports to better reflect the current reality of abortion policy and access.[8] To do this, the new scoresheet removed abortion reporting topics that very few or no states (including those with relatively good abortion reporting requirements) included in their annual abortion reports. These topics include the length and weight of aborted children, the sex of the aborted child, the cost of preparing the report for the state, and the pre-existing maternal conditions of those who obtained abortions. CLI also removed topics/questions that, while important overall, are not critical to surveying the state of abortion reporting in 2024. This included the method of reporting (electronic or paper), the form that the information takes in the reports (tables or graphs), and whether the report can be distributed in multi-media formats. The updated sample scoresheet can be found as Figure 2 in Appendix D.
In addition to removing outdated or less critical categories, new data points were added to the updated scoresheet. These include whether drug-induced abortions were performed in an abortion facility or via telemedicine, the numbers of abortion by month, the name of the facility where the abortion was performed, and whether the information in the report includes data for all abortions that occurred in the state, not just those performed on residents in the state. Topics related to the ability of researchers to access and use states’ public reports with transparent and complete data were also added to the scoresheet. These include the strength of states’ statutes relating to abortion reporting and the completeness of the data. Given the ability of researchers to track whether and how changes in legislative environments are affecting the number of abortions performed in reporting areas and the reality that drug-induced abortion has increased significantly, the added categories sought to reflect a 2024 abortion policy and access landscape. Data points included in the 2016 scoresheet that continue to be of significance, such as patient confidentiality, complications related to abortion procedures, and born-alive data, however, were preserved.
Another major change to the scoresheet was in how CLI scored states’ abortion reporting requirements and reports from 2016. In 2024, CLI assigned two scores: an access score worth a total of 6 points and a completeness score worth a total of 38 points which, when combined, sum to a total of 44 possible points. For scoring purposes, the totals were converted into percentages that represented an area’s overall abortion reporting score. Each category within the scoresheet was worth one point. A half point was assigned to a category if the data was delayed, either in the sense that the data came from previous years compared to the rest of the data assessed in the scoresheet, or in the sense that the data came from the information that the state submitted to the CDC’s annual abortion surveillance report.
The access and completeness scores focus on different but equally important aspects of sound abortion reporting. The access score is determined by:
The completeness score is determined by:
Following the revision of the scoresheet, every state was scored, and the totals were added up resulting in an updated ranking of state abortion reporting requirements and reports. Those results will be discussed in the subsequent section.[9]
Table 1 below contains the ranking and total score for each reporting area CLI evaluated.[10] Total scores range from zero (for the several states that publish no annual report for abortions performed in the state) to 80% or 35 out of 44 possible points. Both the median and average scores were 16 out of 44, or 36%. There were 13 reporting areas below the 25th percentile, 14 in the 25th to 49th percentile, 12 in the 50th to 74th percentile, and 13 in the 75th to 100th percentile.
Table 1 – 2024 Ranking & Total % Scores of 52 Reporting Areas’ Abortion Reporting Requirements and Reports
Prevalence of Collected Information
As the total scores among the 52 reporting areas indicate, the quality and completeness of abortion reporting requirements and reports varies greatly. CLI measured how many reporting areas collected each category of information (completeness score) and how many reporting areas satisfied the access requirements. To see those results and the public health importance of each data point according to the CDC, see Table 6 in Appendix C. Importantly, there is not a single category out of 38 possible categories that all 52 reporting areas report on. Of the 46 reporting areas that do report abortion data, there were only three categories that all 46 areas report on (age, state of residence, and abortion method).
Other conclusions from Table 6 include the fact there are only five categories that more than 80% of the reporting areas report on, and 12 categories that less than 10% of the reporting areas report on. This table also shows that in 2021, when drug-induced abortions composed 56% of all abortions in the United States according to the CDC, only two reporting areas’ 2022 annual abortion reports specified whether the drug-induced abortions in their state were performed in office or via telemedicine (Nevada,[11] and Oregon[12]). Furthermore, while research shows that drug-induced abortion poses more of a threat to women’s health than surgical abortion, only three reporting areas report complications that occur at the time of any abortion procedure (drug-induced or surgical), 17 report complications that were documented by a providing center after the procedure, 16 require other facilities to report post-abortion complications, and only 15 reporting areas detail the type of complications that women suffered.
In 1997, the CDC revised its “Handbook on the Reporting of Induced Termination of Pregnancy,” first published in 1978. This handbook was the agency’s way of providing guidance to reporting areas regarding their collection and reporting of abortion data. The Handbook was supposed to serve as a model for use by the states, D.C., and New York City. It laid out the data points that states should collect, the public health reasoning behind collecting such data points, and how best to collect those data points. However, the reality is that in 2024, only three states (Arizona, Indiana, and Kentucky) collect all 14 of the data points that the United States Reporting of Induced Termination of Pregnancy (USRITP) handbook suggested reporting on.[13] There is not one data point that all 52 reporting areas collect, and of the 14 data points the CDC suggests for collection, only 3 data points are reported on by the 46 reporting areas that do report abortion data. For more details on this data, see Table 7 in Appendix C.
Changes Since the 2016 Rankings
While it is difficult to compare the 2024 raw scores to those from 2016 because of the change in methodology, it is still feasible and important to assess the changes in the rankings of the 52 reporting areas.[14] Kentucky made the most progress in terms of its place in the rankings, going from 43rd place in 2016 to being tied for 4th place in 2024. Another state that made vast improvements in terms of their ranking was Massachusetts, which went from being tied for 46th place to being tied for 24th. Similarly, Florida made considerable progress and went from 40th place to being tied for 24th. Nevada and Wyoming were two other states that made progress in their overall ranking for abortion reporting requirements. Michigan had the biggest fall in the rankings, going from being tied for seventh place to be tied for last in 47th place. Other states whose rankings fell from 2016 include Minnesota, which ranked second in 2016 but fell to being tied for 10th, and Illinois, which went from being tied for 13th in 2016 to 42nd place in 2024.
The main change between the 2016 and 2024 reviews is that abortion reporting is now strongly linked to the reporting areas’ attitudes toward abortion. Whereas in 2016 when CLI found that “the quality of state abortion reporting is not strongly linked to other measurements of the states’ attitude toward abortion as measured by its political climate or public policies toward legal abortion,” this is no longer the case. Consequently, abortion reporting itself has become a highly politicized, partisan legislative issue.
In 2024, while most reporting areas (38) had weak reporting scores (<50% total reporting score), 10 out of 14 reporting areas with strong reporting scores (≥50%) also had strong gestational laws (limits at 15 weeks of gestation, 12 weeks, 6 weeks/heartbeat legislation, or life at conception laws). Only four reporting areas with strong reporting scores had weak gestational laws (no gestational limit, no effective gestational limit[15]/24 weeks/viability, 22-week gestational limit, and 18-week limit). Of the reporting areas with weak reporting scores (38 in total), 28 had weak gestational laws. To see the partisan nature of these results arranged graphically, see Figure 1 below. Furthermore, if one looks at Table 1 in Appendix A of the 16 reporting areas that made changes strengthening their reporting requirements, 12 have strong gestational laws and only 4 have weak gestational laws. Of the six reporting areas that made changes that weakened their reporting requirements, five have weak gestational laws and only one has a strong gestational law.
Figure 1 – The Distribution of States by Gestational Laws and Abortion Reporting Scores[16]
Figure 1 Legend:
-4= No gestational limit
-3= No effective gestational limit (either a viability limit or 24 weeks of gestation limit)
-2= 22 weeks of gestation limit
-1= 18 weeks of gestation limit
0= 15 weeks of gestation limit
1= 12 weeks of gestation limit
2= 6 weeks of gestation limit/heartbeat legislation
3= Life at conception legislation
Strong gestational law = 15 weeks, 12 weeks, 6 weeks/heartbeat, or life at conception
Strong reporting score = total score 50% or greater
Weak gestational law = No gestational limit or no effective gestational limit (viability limit, 24-week limit, 22-week limit, or 18-week limit)
Weak reporting score= total score less than 50%
Contrasting with the change in CLI’s 2016 findings on the nonpartisan nature of abortion reporting, CLI’s 2024 review confirmed its earlier findings that reporting areas with the highest abortion rates often had the weakest reporting scores. In 2024, eight of the reporting areas among those with the top 10 highest abortion rates had total reporting scores less than 50%, with three having a reporting score of 0 (New Jersey, Maryland, and California). Furthermore, of the 12 reporting areas with abortion rates higher than the 2020 national average (14.4 abortions per 1,000 women ages 15-44) calculated by Guttmacher Institute, 10 had weak reporting scores. Lastly, of the states with the top 10 lowest abortion rates, seven had strong reporting scores (>50%). To see the full table of reporting areas by abortion rate and reporting score, please see Table 8 in Appendix C.
The major new finding of this 2024 examination of abortion reporting is that reporting has become a partisan issue. However, the main finding from the 2016 overview of reporting remains the same: the state of abortion reporting in the United States remains poor in comparison to other countries whose data is so complete, voluminous, and accurate that they are used in international records-linkage studies. While a number of states have certainly made progress in improving their abortion reporting requirements, the fact that the highest reporting score in this analysis is 80% demonstrates the critical need for continued efforts toward a better national standard for transparent and quality abortion data. The need is even more pressing as abortion is being demedicalized despite the dangers associated with both abortion drugs and surgical abortion.
While the 2024 examination of reporting requirements showed that a reporting area’s score generally correlates with its public policies regarding abortion and abortion rates, some reporting areas did serve as outliers. The states of Kansas and Pennsylvania have permissive gestational limits. However, both have reporting scores of 50% or greater (57% and 61% respectively), with one of the three placing in the top 10 of total reporting scores. Minnesota was a model reporting area highlighted in CLI’s 2016 abortion reporting review because of the sheer volume and high quality of information that the state shared. However, the state has made changes that will significantly degrade the quality of their future abortion reports. Kansas and Pennsylvania are good models for states that have permissive gestational limits but view abortion reporting as an important public health policy that can aid research and regulation. These two states are showing that good, complete, and accurate public health data can be a nonpartisan issue.
Outliers with life-protecting gestational laws but weak reporting scores (<50%) include Florida, Georgia, Louisiana, Mississippi, Missouri, North Carolina, North Dakota, South Carolina, Tennessee, and West Virginia. While many of these states have made vast improvements to their reporting requirements since 2016, all 10 have significant room for improvement and can look at the states with good reporting requirements as models for future action.
Given that the state of abortion reporting remains poor and has become correlated with state and local policies toward abortion, a federal mandate for states to report abortion data to the CDC would be important for ensuring a high standard of transparent, complete, and quality abortion data that could improve public health research and ultimately protect the wellbeing of women and their unborn children. It is highly unlikely that the states that do not report any abortion data, with potential exceptions for New Hampshire and North Dakota based on their current leadership, will start reporting such data in a post-Dobbs world.
In 2022 and 2023, federal legislation titled the “Ensuring Accurate and Complete Abortion Data Reporting Act” was introduced. However, both years the bill never made it out of committee. This or similar policies would be a good step towards improving abortion reporting in the U. S. While the demographic standards included in the legislation are critically important to understanding the demographics of women obtaining abortions, the bill could be expanded to include additional critical information such as complications reporting. Model reporting standards could include all the information found in the Figure 2 scoresheet in Appendix D, as the categories of information included touch on critical public health data points (abortion complications, born alive data, etc.). In addition to potential federal action, all states have the responsibility to pass legislation to improve state reporting requirements. While it will be difficult to motivate states with no or weak gestational limits to do so, it is critical for those who care about public health and protecting women and babies to continue educating lawmakers and the public about the importance of accurate and complete abortion reporting.
Any federal or state-level legislation should mandate the reporting of at least:
All of these minimum requirements respond not only to current gaps in the reporting requirements that presently exist, but also to problems that plague the two victims of any abortion: the woman and her unborn child.
LifeNews Note: Mia Steupert, M.A. is a research associate for the Charlotte Lozier Institute, where this originally appeared.
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