Intersection of State Abortion Policy and Clinical Practice, 2019

Abortion is a safe and common medical procedure for women in the United States. In 2015, over 90% of reported abortions occurred in the first trimester. The abortion rate has fallen; it fell 26% between 2006 and 2015 among women aged 15 to 44 years. While abortion services are regulated by the same laws and policies that govern other medical services, many states have enacted abortion-specific regulations that can limit women’s access to abortion services and jeopardize the quality of care. Twenty-seven states require women seeking abortion to wait 18 hours or more before obtaining an abortion, and several require women to be counseled on topics unsupported by medical consensus or evidence, such as incorrectly telling women that abortion raises their risk of breast cancer. More recently, many states have developed specific requirements for clinics and physicians who provide medication abortions, with 34 mandating that only a licensed physician dispense the abortion pill and 17 of those states requiring that the physician be physically present, blocking the use of telemedicine to expand abortion access. Over 20 states have laws that impose a jail sentence on physicians if they perform abortions past certain state-established gestational limits, many of which are more restrictive than the federal standard of viability.

For many women, the extent of their abortion coverage under their health insurance is dependent on where they live. Since 1977, the Hyde Amendment has dramatically limited coverage of abortion under Medicaid as well as other federal  programs. Increasingly many states have enacted policies to restrict abortion coverage in the private insurance market. Currently, 26 states have laws that restrict insurance coverage of abortion in private ACA Marketplace plans and 11 of those states also ban abortion coverage in all state regulated plans.

The following chart series examines state policies related to abortion and their interaction with clinical practice.

  1. Nine in ten reported abortions in the United States occur in the first trimester. Between 2006 and 2015, the abortion rate decreased by 26%.
  1. 27 states require waiting periods before a woman may obtain an abortion.
  1. Many states require women to be counseled on topics lacking medical consensus of evidence.
  1. Twenty-Six states limit ACA or Private Insurance Coverage of abortions.
  1. The ACA permits states to ban abortion from exchange plans and require segregation of funds used to pay for abortion. Currently 26 states ban abortion coverage on the Marketplace. Eight states do not ban abortion coverage but do not offer any plans on their marketplaces that cover abortion.
  1. Many states impose a jail sentence for doctors who perform abortions past state established gestational limit.
  1. Many states have enacted specific requirements for medical abortions.
**This chart series is an update to the 2016 JAMA Infographic, Visualizing Health Policy: Intersection of State Abortion Policy and Clinical Practice