Trends in Abortion Facility Gestational Limits in the United States, 2017-2021

Facility gestational limits for abortion can be set based on state law, provider training, or other factors. Most states have a legal limit on the number of weeks of gestation after which an abortion cannot be performed. A better understanding of abortion facility gestational limits can support efforts to expand access to abortion care throughout pregnancy.

We assessed abortion facility gestational limits and compared them with the state legal gestational limit for each year between 2017 and 2021. We also aimed to evaluate changes over this period in facility-level gestational limits for abortion.

This serial, cross-sectional study used the Advancing New Standards In Reproductive Health Abortion Facility Database to evaluate trends in abortion facility gestational limits over time. Data were collected through mystery shopper calls to abortion facilities identified through systematic internet searches, and data were updated annually. Descriptive statistics were used to calculate the median and mean abortion facility gestational limits for each state and geographic region.

The number of open abortion facilities increased in this time period, from 774 in 2017 to 790 in 2021. The number of facilities offering medication abortion increased from 736 to 773, while those offering procedural abortion decreased from 538 to 473. The range of gestational limits increased only marginally over time. In 2021, 51% of states (n = 22) with legal gestational limits did not have a facility that provided abortion services up to the legal limit. Facility gestational limits varied by geography, with the West South Central region having the lowest median gestational limits in 2021 of all geographic regions. Of the 10 states where no facility offered abortion after 16 weeks, only one had a legal prohibition against doing so.

Even before abortion access was drastically reduced in 2022 with the Dobbs v. Jackson Women's Health Organization U.S. Supreme Court decision, almost one-half of states did not have a facility that provided abortion up to the state legal limit. Barriers to expanding abortion access throughout pregnancy include factors besides state law, and addressing these barriers can help to expand access to abortion in states where abortion is still legally accessible.