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More than a million abortions were provided in the U.S. in 2023. That's a major finding from a report published Tuesday by the Guttmacher Institute, a research organization that supports access to abortion.

To be precise, researchers estimate there were 1,026,700 abortions in 2023. "That's the highest number in over a decade, [and] the first time there have been over a million abortions provided in the U.S. formal health care system since 2012," explains Isaac Maddow-Zimet, a data scientist with Guttmacher.

The Guttmacher report also found that medication abortions rose to 63% of all abortions in 2023, up from 53% in 2020. The research was conducted by surveying all in-person and virtual abortion providers in the country and adding up their abortion counts. Guttmacher has been doing this research since 1974.

The findings do not surprise Dr. Anitra Beasley, an OB-GYN and professor at Baylor College of Medicine in Houston, who was not involved in the study. She says the trend was suggested by earlier research – and in fact she thinks the true number is even higher than what was measured in the report.

"This is probably an undercount because they are not looking at abortions that happen outside of the formal health care system," she explains. Uncounted abortions include those that happen when someone gets abortion medication from a friend or over-the-counter at a pharmacy in Mexico, for example.

She says those "self-managed" abortions are certainly happening, but it's extremely hard to measure them in national counts.

The fact that the number of abortions continues to rise may be counterintuitive given the fact that the U.S. Supreme Court overturned Roe v. Wade in 2022. Access to abortion has been severely restricted in more than a dozen states since the last time Guttmacher published a comprehensive national count. In 2020, Guttmacher reported that there were 930,160 abortions in the U.S.

"Certainly the increase in availability of medication abortion through telemedicine is a big part of this story – that's something that really wasn't largely available in much of 2020 and is much more available now," Maddow-Zimet says. "But we also saw increases in the proportion of abortions provided through medication abortion at brick-and-mortar facilities as well."

Under current FDA prescribing rules, medication can be used to end a pregnancy until 10 weeks of pregnancy, and it can be prescribed through a virtual appointment without affecting the medication's safety or efficacy.

Those rules are the focus of another Supreme Court case scheduled to be argued next week. A group of anti-abortion rights plaintiffs will argue that FDA incorrectly decided to simplify access to mifepristone, one of two medicines used in medication abortions. The high court's decision, expected this summer, could upend access to mifepristone for abortion and miscarriage care.

"We don't know what the Supreme Court will decide, and we don't know exactly what the impact will be, except that it will create potentially more of that confusion and difficulty for people both providing care and needing to access care," Maddow-Zimet says.

He adds that although tens of thousands of people living in states where abortion is banned have been able to travel to receive abortions, and clinics and abortion funds have scaled up to meet the demand of traveling patients, it's unclear if that can continue long term.

Beasley agrees. "It's really important to realize that the increase in abortion access [despite restrictions] is not an accident," she says. "It's a lot of people working really, really, really hard in order to make sure that abortion is still accessible to people who need it. So even though the top line number is higher, it does not mean that access is overall better."

When it comes to the landscape of reproductive health access after the fall of Roe v. Wade, Maddow-Zimet says, "we don't know what normal looks like in this context – policies keep changing, we keep seeing really big changes in access."

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