By Chuck Donovan

Next month, three full years will have passed since the U.S. Supreme Court reversed the 1973 Roe v. Wade decision. In that time, there has been no shortage of drama. Protests have taken place outside the homes of justices of the court. An attempted assassination was turned away at one justice’s home, and the perpetrator has pled guilty. In 2024, 10 states voted on ballot questions regarding abortion, seven of which resulted in state constitutional protection for a more or less unlimited right to abortion up to birth.

The Republican Party has largely muted its opposition to legal abortion, diluting its multi-decade national pro-life platform planks. An effort launched by the national Democratic Party to make abortion legal to term everywhere and a centerpiece of its 2024 campaign for the White House went down in flames with Kamala Harris. Now in office, President Trump has proceeded to restore a number of policies barring abortion funding, but further actions — like defunding Planned Parenthood, securing safeguards or other limits on abortion pill distribution, and protecting pain-capable unborn children federally — remain up in the air.

Thematically, the Trump administration continues to insist that abortion is a matter for state policy determination. The political aim may be in the process of realization, as discussions of abortion have become less frequent at the national level. Three years in, however, the status of abortion in the United States post-Dobbs is taking shape, if not yet an established trend. The truth appears to be that while Roe v. Wade has been reversed, the effects of Roe have scarcely been touched.

That is the main finding of a new and exhaustive study* of U.S. abortion numbers released by Mia Steupert, M.A., of the Charlotte Lozier Institute (CLI). Anyone who has studied abortion data knows that it can be an exercise in deep frustration. The federal system in America has many advantages, but national data collection and interpretation are not among them. For decades, the reports of the leading private abortion data collector, the Guttmacher Institute, showed totals 30% higher than the Centers for Disease Control’s (CDC) abortion surveillance reports, which trailed several years behind the coverage period. The Guttmacher reports were more detailed but nonetheless covered only what abortion businesses were willing or able to share. Comparisons year over year and reporting of abortion complications were topic areas not easily susceptible to tracking.

For various reasons, irrespective of Dobbs, these tasks have become even more difficult in the past several years, challenges the Steupert paper seeks to address. As before, national abortion reporting is voluntary. Existing state reports are not uniform. But in recent years, certain numbers have become more elusive. Several states have relaxed or rescinded their abortion reporting requirements. The Food and Drug Administration dropped its mandatory reporting of non-fatal abortion injuries after the use of the mifepristone-misoprostol regimen. An ever-growing percentage of abortions are taking place at home and/or utilizing abortion pills obtained via the mail or other delivery systems. Advance provision is taking place, both privately and in some cases via state governments, so that procurement of abortion drugs does not necessarily mean that they were consumed and an abortion occurred. A small, but nonetheless meaningful, number of abortions are chemically initiated but fail or are reversed medically. Policies change year after year so mifepristone, for example, may be prescribed later in pregnancy. As always, injuries occurring in the process of abortion, whether at a brick-and-mortar facility or in a bathroom, are treated in third-party facilities and may elude data capture.

A proper response to this situation would be for Congress and the new administration to overhaul the statutes and policies regarding data collection on this and other issues. The National Center for Health Statistics (NCHS) at the CDC is the prime collector and analyst of health statistics for the U.S. and is currently wrestling with the Office of Management and Budget over a variety of large datasets it says have been taken offline and are unavailable to the public. Restoring those datasets would be valuable, but more needs to be done, including improving the comprehensiveness and timeliness of data on health and social concerns.

The Steupert paper strives to utilize existing analyses by groups that favor legal abortion and have privileged access to the nation’s 777 (by CLI’s count) brick-and-mortar abortion facilities that offer drug-induced or surgical abortions. CLI also found that drugs to induce abortion are currently made available by some 142 U.S.-based groups or centers and via an additional eight websites or organizations it describes as “operating outside the formal U.S. health care system.”

The lead statistic for the report comes from the Society for Family Planning, a self-described advocacy group connected with academic institutions like the University of California-San Francisco and the University of Pittsburgh that makes research grants to a variety of academic institutions. The data show 1,121,450 abortions were carried out from July 2023 through June 2024 inside the formal health care system, with many thousands more self-managed abortions outside that system, including some carried out with imported abortion drugs.

The increase is disturbing, but it represents a trend, Steupert notes, that predates the Dobbs ruling. Abortions not only increased in the second full year since the decision but have risen 11% since 2020. Abortion totals in the United States dropped markedly, and steadily, between 1990 and 2018, when the current upturn began and continued through the second half of the first Trump administration and the Biden administration. Data shows that states that have protected the unborn by statute, like Texas and Florida, have seen sharp reductions in reported abortions, but overall counts have been driven upward by a variety of legal developments and industry practices. Steupert writes:

“The hypothesis that total abortions would inevitably decrease post-Dobbs did not account for the questionable legal strategies pro-abortion states were willing to implement which only exposed and exploited loopholes in pro-life laws. From taking advantage of the FDA’s pre-Dobbs decision to allow mail-order telehealth abortions with no in-person requirement, to shipping abortion drugs into pro-life states from pro-abortion states under shield laws, to deeming certain states ‘abortion havens,’ pro-abortion states have circumvented the inability of women in pro-life states to obtain brick-and-mortar abortions.” [citations omitted]

Steupert also notes, and other analysts agree, that the data does not suggest that the Dobbs ruling has not saved lives — abortion totals might be higher had the Supreme Court not decided as it did. The shift from in-clinic abortions to self-induced procedures, combined with relentless campaigns that assert that abortion pills are safer than Tylenol, may have been enough on their own over the past decade to make abortion seem like another form of Plan B. Blurring the two has long been a social policy objective of the industry. The direct response to that must come from women’s own and acknowledged adverse experiences with the pills, combined with new efforts to gather and assess clinical data on the aftermath of abortions conducted at home, including psychological sequelae.

One other implication exists. Advocates of abortion desire to go one step further than making abortion a state issue; they wish to make it an unobserved, non-issue. While three years out from the Dobbs ruling isn’t long, it is already becoming clear that the absence of federal action, including regarding abortion drugs and the range of needed family and maternal support, limits what individual states can do to check a shielded, and medically lawless, abortion industry. Making America healthy again without affirming the value of every mother and baby’s life will be very difficult indeed.

Chuck Donovan served in the Reagan White House as a senior writer and as Deputy Director of Presidential Correspondence until early 1989. He was executive vice president of Family Research Council, a senior fellow at The Heritage Foundation, and founder/president of Charlotte Lozier Institute from 2011 to 2024. He has written and spoken extensively on issues in life and family policy.