Access Denied: The Proliferation of American Medical Abortion Laws, 2000–2018

Abstract

Medical abortion is a safe, effective, and often preferred method of terminating an unintended pregnancy, but access can be made difficult by the laws of a state. Despite modern efforts to prevent unintended pregnancies in the U.S., they comprise almost half of pregnancies and 95% of abortions, signifying that abortion is a necessary and desired healthcare service. This study's purpose is to describe the proliferation of American medical abortion access laws between 2000 and 2018. Policy surveillance methods were used in 2018 to collect 7 types of U.S. medical abortion access restriction laws in place as of December 1, 2018. Statutory histories were reviewed in 2019 to record the laws' years of enactment, substantive amendment, and repeal. A total of 35 states restricted medical abortion access as of 2018. Medical abortion laws increased from 16 in 2000 to 96 by 2018, and only 1 was repealed. A total of 25 states had multiple laws restricting medical abortion access in 2018. Medical abortion access laws surged from 2010 to 2017, but none were passed in 2018. Medical abortion access is generally most restricted in Midwestern and Southern states and least restricted in Western and Northeastern states. Although evidence demonstrates medical abortion's safety and efficacy, its access is increasingly limited by law in many states. Further research examining the impacts of these laws on women's health and the consequences of unintended births on women, children, families, and society is needed.