In 2020, just over half of abortions were performed in clinics that specialize in abortion. The rest were performed in clinics that offer abortion in addition to other family planning services.
The Guttmacher Institute estimates that in 2020, 96% of abortions were performed in clinics and only 4% in doctors’ offices or hospitals. The majority of abortions in clinics were performed in clinics that specialize in providing abortion care, but many were performed in clinics that offer a wide range of other sexual and reproductive health services, such as contraception and STI treatment. Most abortions are performed by physicians. However, in 19 states and the District of Columbia, advanced practice clinicians (APCs), such as nurse practitioners and midwives, are allowed to perform medical abortions. In contrast, 31 states prohibit clinicians other than physicians from providing abortion services.
Even before the Dobbs decision, access to abortion services was highly unequal across the country. The proliferation of restrictions in many states, especially in the South, has significantly reduced the availability of services in some regions. Following the overturning of Roe v. Wade, these geographic disparities are likely to increase as more states ban abortion services entirely.
While procedural abortions must be performed in a clinical setting, medical abortion can be performed in a clinical setting or via telemedicine. Access to medical abortion via telemedicine has been limited for many years by a Food and Drug Administration (FDA) restriction that allowed only certified clinicians to dispense mifepristone in a medical facility. The drug could not be mailed or picked up at a retail pharmacy. However, in December 2021, the FDA permanently revised its policy and no longer requires clinicians to dispense the drug in person. Additionally, in January 2023, the FDA finalized a change that allows retail pharmacies to dispense the medication abortion pill to patients with a prescription.
While some states regulate the use of mifepristone as an abortion method, the Biden administration argues that the FDA has regulatory authority over all drugs, including mifepristone. This could lead to future litigation, as the state’s authority to regulate healthcare will be pitted against the federal government’s authority to regulate drugs through the FDA.
However, even in some states that have not banned abortion, telemedicine may not be available. Many states have established restrictions prior to the Dobbs decision that limit the use of telemedicine abortion by requiring abortion patients to take the pill in a physical clinic, requiring ultrasound for all abortions, setting their own policies on the dispensing of medications used for abortion, or outright banning the use of telemedicine for abortion care. As of November 2022, of the 33 states that had not banned abortion, eight had at least one of these restrictions in place, effectively banning telemedicine for medical abortion.
Medical abortion has become a major legal front in the fight for abortion access across the country. Many cases have been filed in federal courts regarding aspects of the FDA’s regulation of medical abortion, as well as the mail-order distribution of the medication. One notable ongoing case is Alliance for Hippocratic Medicine v. FDA, where the plaintiffs are challenging the FDA’s authority and approval process for mifepristone. The plaintiffs also argue that an 1873 obscenity law, the Comstock Act, prohibits the mailing of any medication used for abortion. In April 2023, a U.S. Supreme Court ruling allowed the current FDA regulations to remain in effect while the case is pending in the courts. This means that mifepristone remains available for medical abortion in a clinic or via telemedicine, if state law allows it.