Here’s how abortion totals in Mass. changed after the ROE Act

Abortion had been trending downward for decades.

The full impact of the Supreme Court’s June decision on abortion has still to be felt in Massachusetts, which is likely to draw patients from states that now outlaw the procedure. But the Bay State is already seeing the effects of a law enacted in anticipation of the high court overturning Roe v. Wade.

Massachusetts Registry of Vital Records and Statistics data document the number of abortions performed each year in Massachusetts, as well as patient demographics. Newly available data for 2021 are the first to reflect changes since the ROE Act was enacted at the end of 2020.

That law secured the right to abortion in state law and expanded access in two main ways: by allowing a teenager to have an abortion without parental consent beginning at 16 years old, rather than 18; and by allowing abortions after 24 weeks of pregnancy in cases of fatal fetal anomalies.

Here’s a look at what the Massachusetts data show on how patterns were changing before the Supreme Court ruling.

1. Frequency of abortions

Abortion had been trending downward for decades in Massachusetts. In 1990, for instance, there were more than twice the number of abortions as last year. In 1979, there were 2.6 times more.

Last year, the number rose 2 percent from 2020, but the year-to-year change is likely a reflection of unusual circumstances: In 2020, the first year of the pandemic, the number of abortions plummeted, creating an artificially low point of comparison, said Elizabeth Janiak, director of social science research for the ASPIRE Center at Planned Parenthood League of Massachusetts. “To really put that in perspective, it would be important to tease out what are the effects of COVID and will those effects be continuing?” she said.

Still, specialists anticipate demand for abortion will increase in Massachusetts after other states restrict it. Indeed, Massachusetts has been changing its laws to prepare for just that. “We should not be surprised” that abortion is on the rise, said Myrna Maloney Flynn, president of Massachusetts Citizens for Life, an advocacy group that opposes abortion, suggesting that campaigns to expand abortion access in Massachusetts have served to promote the procedure.

2. Changes for teenagers

The 2021 data is the first to reflect the lowered age limit for abortions to 16. Previously, anyone younger than 18 had to have parental consent or a judicial order to have an abortion.

The data reflect a 7.6 percent increase in the number of 16- and 17-year-old abortion patients — again, above a level that was especially low in 2020. The number of teenagers in those age groups who had abortions in 2021 was the same as in 2018 — 256.

It’s unclear whether those rates will change much, given that teen pregnancy — like abortion — has been on the decline for three decades. In 2020, Massachusetts had the lowest teen birth rate in the country.

As in other recent years, teenagers represent a small share of those who have abortions in Massachusetts. Most people who have abortions are in their 20s.

3. Abortions after 24 weeks

Abortion is not allowed after 24 weeks of pregnancy in Massachusetts, except in certain circumstances, such as to save a patient’s life or if the pregnancy poses a substantial risk of grave impairment to their physical or mental health.

Those cases have been vanishingly rare: Only 3 of the 16,452 abortions performed in Massachusetts in 2020 occurred after 24 weeks of pregnancy. But the ROE Act added another exception, permitting abortions after 24 weeks in cases of lethal fetal anomalies or where the fetus was incompatible with sustained life outside the uterus.

In 2021, the first year those exceptions took effect, there were 37 abortions after 24 weeks of gestation — the highest number since 2013.

That number could feasibly increase more because the exception was broadened again in July. After learning of cases in which doctors denied abortions to patients with grave fetal diagnoses, legislators expanded the language. Now, a doctor can recommend an abortion after 24 weeks if there is a “lethal fetal anomaly or diagnosis,” or a “grave fetal diagnosis that indicates that the fetus is incompatible with sustained life outside of the uterus without extraordinary medical interventions.”

The effects of the expanded exception will not be evident in state records until next summer.

4. Out-of-state abortion patients

Likewise, the current data do not yet reflect the anticipated effects of the earthshaking Supreme Court decision issued in June. Since then, abortion bans with very limited exceptions have taken effect in at least 12 states, and two more states have restricted abortion to the first six weeks of pregnancy.

But the data show that Massachusetts was seeing an uptick in out-of-state patients before the Supreme Court ruling, perhaps as more states began limiting abortion access, if not as strictly.

The number of patients from outside Massachusetts who received abortions here increased from 593 in 2020 to 792 in 2021. That number, while larger than in recent years, is by no means a record; it was twice as high in the early 2000s. But it is expected to climb again as Massachusetts accommodates abortion patients from other states.

5. Medication abortions continue to rise

Medication abortions made up nearly half the abortions in Massachusetts last year after the prescriptions were made far more accessible by pandemic-era changes from the Food and Drug Administration and the Biden administration. Medication abortion refers to a two-step protocol of prescriptions that can be taken to end an early pregnancy — up until about 10 weeks. Until the pandemic, it could only be dispensed to patients in person by specially certified providers. It is now available by telehealth, website, and mail, and states seeking to limit abortion have begun imposing new limits on this method.