Access to Abortion
Introduction
Topic of Interest : Factors contributing to abortion accessibility across the United States.
Question:
In what state is abortion the most accessible according to our analysis of facilities, costs, and estimated counts of completed abortions?
About the Data
Data Sources:
Estimated counts per state are provided by the Guttmacher Institute’s “Monthly Abortion Provision Study”
Costs of medicated abortion web scraped from NIH publication: Upadhyay, et al. (2024). Pricing of medication abortion in the United States, 2021-2023. Perspectives on sexual and reproductive health, 56(3), 282–294. https://doi.org/10.1111/psrh.12280
Facility estimates provided by: Schroeder et al. Trends in abortion services in the United States, 2017-2023. Advancing New Standards in Reproductive Health, University of California, San Francisco, 2024.
Methodology and Discussion:
All data used in this project comes from reputable sources. The decision to focus this project on data from 2023 resulted from varied temporal ranges covered in each data source; 2023 being the only overlapping year.
The Guttmacher Institute (GI) is a highly respected research organization that is recognized as the leading source for data on sexual and reproductive health. Entities like the CDC and WHO rely and cite these statistics. However, abortion data is notoriously difficult to estimate with certainty due to the ongoing factors of abortion stigma and under-reporting. The GI’s Monthly Abortion Provision Study that this project draws from produces abortion estimates through a statistical model that combines data collected from monthly samples of U.S abortion provider reports with historical data on the caseloads of US providers. This is meant to mitigate some of the uncertainty present in direct provider reports. And according to the GI, as more data is collected, estimated for past months become more precise; this means that the 2023 data is as accurate as possible. That said, this data does not include self-managed abortions, meaning medicated abortion acquired from websites or community support systems without clinician intervention and non-medical alternative methods outside clinical settings, which are becoming increasingly frequent. This is a major gap in data-accuracy, but it is nearly impossible to address given the anonymity and abundance of these sites.
The facility data set used in this project is sourced from the Advancing New Standards In Reproductive Health (ANSIRH) Report on Trends in Abortion Services in the United States, 2017-2023. The ANSIRH is a collaborative research group from UCSF and their methods have been peer-reviewed and approved by UCSF. Their methodology included targeted web-searches for abortion clinics in every state and any city with a population of 100,000 or larger. They then contacted every facility through the telephone and gathered price, location, and types of abortions provided. In 2023 they also included telehealth data and data from Aid Access and Abuzz (the two major international providers of mail-order abortions). Their population data is sourced from the US Census. The only potential deficiency in this data-source is the absence of facilities that do not publicly advertise their services online.
The price data set was scraped from a study published through a peer-reviewed journal focusing on the latest developments in the field of sexual and reproductive health. This study acquired price data from the ANSIRH Report. We recognize that the price and facility data originate from the same location. Our rationale for using the study comes from our desire to utilize the web scraping skills learned in this course. This would not have been possible from the pdf report. Crucially, the price data used in this project reflects median and mean costs across multiple sources of medicated abortion (Clinics, Telehealth, Aid Access, and Abuzz). Also, we do not account for insurance coverage within this price data set. Prices are all estimates of out-of-pocket costs.
Glossary
Reproductive Aged Women (RA women): Refers to individuals identified in the Census data as female and within the age range of 15-49 years old.
Medicated Abortion: Refers mainly to the drug combination of Mifepristone and Misoprostol used to terminate and expel pregnancy, although there are times when only Misoprostol is used due to the stricter regulations
Brick and Mortar Clinic: A physical, in-person abortion provider as opposed to telehealth services or mail-order providers.
Aid Access / Abuzz: International organizations that mail abortion pills to individuals in the U.S, often serving patients in states with restrictive laws.
Self-Managed Abortion: An abortion obtained and carried out without direct clinical supervision.
Access Score: A composite 0-100 index computed for this project that equally weighs 4 components: abortion rates per 1,000 RA women, RA women per facility, median medication cost, and policy environment.
Distribution of Abortions Across the United States
These graphs investigate the distribution of estimated abortion counts across the United States, looking at total counts and counts in relation to the reproductive aged population. When examining the total number of abortions, the states with the highest abortion counts (California, New York, Illinois, and Florida) also have some of the highest populations in the country. This informed us of the need for a population-dependent analysis, which measures the number of abortions per 1,000 women of reproductive age. When considering population, much of New England and the West Coast appear to have high abortion rates, a finding consistent with the greater access to abortion services in those regions. Notably however, New Mexico has the highest rate of abortions per 1000 reproductive aged women. In addition, there are far fewer abortions in the South in relation to population, which aligns with the more restrictive laws in place within the South.
Distribution of Abortion Facilities Across States
These graphs shows the number of abortion facilities that exist in each U.S. state. When looking just at the number of facilities, California stands out as having far greater number than the rest of the country. New York also seems to have more than the rest of the U.S. However, measuring the number of facilities per 10,000 women of reproductive age shows that Maine has the highest number of abortion facilities relative to its population. The western region of the country also has a relatively high number of abortion facilities, while the South has considerably fewer facilities available relative to its population. Something we found particularly interesting was the vertical line of states (Montana, Wyoming, Colorado, New Mexico) with above-average facility ratios. These are all considered “Rocky States” and New Mexico does have the highest abortion to population ratio, but there is no clear rationale beyond that for why this pattern has emerged.
Abortion Facility Availability and Abortion Counts
These maps show us how facility availability interacts with the number of abortions in a given state. As can be seen, the states with more abortions per facility tend to have far fewer facilities in relation to their population, indicating that there is greater stress being put on those facilities. Abortion clinic scarcity is especially prevalent in the southern states, with most only having 1-2 clinics to serve their entire state populations. States that appear grey were so extreme that they needed to be removed from the color scale for clarity, but the values for those states can be viewed by panning over the state.
Medication Costs Across States
These graphs show how medication cost varies across states. The median medication cost was chosen because it is less sensitive to skewness and extreme values than the mean. As a result, it gives us a more representative measure of what a typical person is likely to pay. Interestingly, the highest median costs were in the states with more lenient abortion laws, such as New England and Western states, while the lowest median costs were in the Southern region of the country. This is likely because individuals in highly restrictive states may be more likely to purchase abortion pills from non-clinical routes like Aid Access, an international company that ships abortion pills for a total cost of $150.
This graph displays the number of abortions per 1000 women of reproductive age as well as the median medication cost of getting an abortion. It shows how the cost of medication interacts with the number of abortions per 1000 RA women. It does not seem that high medication costs are necessarily associated with fewer abortions per 1000 RA women, indicating that other factors may play more of a role in access to abortion, although financial costs still remain an important barrier for many, even if their effects are not clearly reflected in state-level abortion rates.
Comparison With Current Policy
This comparison uses the current abortion policy classifications from the Guttmacher Institute to examine the relationship between state-level abortion protections and restrictions and abortion rates providing insight into how abortion rates vary across different policy environments. It does appear that states with high abortion rates have fewer restrictions in place, and that states with more restrictions have far fewer abortions. This analysis also shows the role of abortion sanctuary, or refuge, states. New Mexico, Colorado, Illinois, and Minnesota, which have strong abortion protections in place, border several states with restrictive abortion policies and exhibit relatively high abortion rates, suggesting that some individuals may travel across state lines to access care.
Tying Everything Together
This map visualizes a composite Access Score (0-100) calculated for each state using four equally weighted components: abortion rate per 1,000 RA women, women per facility (reversed, so fewer women per facility scores higher), median medication cost (reversed, so lower costs score higher), and policy environment based on the Guttmacher Institute classifications. A score of 100 represents the most accessible, while a score of 0 reflects the lowest accessibility. Hover over any state to view its individual component values and final score.
The ten highest-scoring states are concentrated in New England and the West Coast, with Vermont, Maine, and New Mexico leading the ranking. These states share strong legal protections, high facility availability relative to population, and abortion rates well above the national average. The ten lowest-scoring states are largely in the South and Midwest, where highly restrictive policies, extreme facility scarcity, and very low abortion rates compound one another. Notably, several bottom-ranked states, including Tennessee, Indiana, and Alabama, have just one or two facilities serving their entire reproductive-age population, making physical access the defining barrier regardless of medication cost.
Conclusion
This project set out to answer one central question: in what state is abortion most accessible? Drawing on data from the Guttmacher Institute, ANSIRH, and NIH, we examined four dimensions of access: abortion rates, facility availability, medication costs, and policy environment. After careful analysis of each dimension, we scored every state with a composite “Access Score”.
The results reveal a consistent pattern. States in New England and the West Coast, led by Vermont, Maine, New Mexico and Oregon, score highest across nearly every dimension. At the bottom of the rankings, Tennessee, Texas, Indiana, and Alabama received a near zero access score, showing extreme facility scarcity and the most restrictive abortion policies.
Across all of our analyses, facility availability came out as a strong determinant of abortion access. States with more facilities in relation to their population consistently had higher abortion rates, regardless of cost. Ironically, states with the lowest medication costs tended to be in the most restrictive Southern states and they also had the lowest abortions in relation to their populations. This paradox can likely be linked to the growing use of sites like Aid Access and other mail-order providers that ship to restrictive states, which pull down the cost.
Our findings also show the role of refuge states. New Mexico, Colorado, Illinois, and Minnesota sit at the borders of highly restrictive states and show high abortion rates that likely reflect cross-state travel.
However, several important limitations should be noted. Self-managed abortions (an increasingly common and untracked method) are absent from the Guttmacher Institute’s estimates, meaning true abortion rates in restrictive states are likely underestimated. The Access Score is also sensitive to the weights assigned to each component; equal weights were used here, but different weights would shift individual state rankings. Finally, all data reflects 2023 conditions.