The vise-like tightening of abortion access across the country is bringing more people to Massachusetts to end their pregnancies.
New data from the state Health Department show a 16 percent increase in the number of out-of-state people receiving abortions here in 2022, as well as a rise in the use of medication, instead of surgical procedures, to terminate pregnancies.
A federal appeals court ruling Wednesday that imposed new restrictions on one of the drugs used for medication abortions could further fuel the migration of abortion seekers to Massachusetts if it stands, experts said, since the state is known as a safe haven for reproductive health. (Those restrictions are on hold, under a stay issued earlier by the Supreme Court, which has not yet decided whether it will hear the case.)
The new data show that 920 out-of-staters received abortions here last year, compared to 792 in 2021. Their numbers accounted for just over 5 percent of all abortions in 2022. This comes as the overall number of abortions in Massachusetts continues to decline.
Rebecca Hart Holder, president of Reproductive Equity Now, an advocacy group, said the numbers are likely to keep climbing. Massachusetts is not experiencing the surge in states that border ones that have banned abortions, such as Illinois, which is seeing a flood of people from Missouri, she said.
The appeals court ruling would allow the abortion pill mifepristone to remain legal but with significant limits on patients’ ability to access it. The medication, part of a two-drug combination used to end early pregnancies, could not be sent through the mail or prescribed via telemedicine, according to the decision, nor could it be prescribed by professionals who are not physicians. Under the ruling, patients would have to make three doctor’s visits to obtain the medication.
“We don’t expect to see huge numbers traveling to Massachusetts instantaneously. But we do believe this is a tidal wave and as more states ban abortion care, Massachusetts will see the impact,” Holder said.
“States like ours that have stood up for access to abortion will be seen as providing access to safe care,” she said.
The number of abortions provided to out-of-state people had been steadily falling since 2002 when they accounted for more than 6 percent in Massachusetts. It had reached a low point of just under 3 percent in 2013, but jumped up over the past two years.
The number of people seeking medication abortions — a two-step protocol of prescriptions that can be taken to end an early pregnancy up until about 10 weeks — has also increased.
In 2022, 52 percent of the total abortions in Massachusetts were by medication, compared to just under half in 2021.
The number of medication abortions had been climbing in Massachusetts and was at about 43 percent of the total in 2019, the year before COVID. Then, prescriptions were made far more accessible by pandemic-era changes by federal regulators. Before the pandemic, the medications could only be dispensed to patients in person by specially certified providers. They are now available by telehealth, website, and mail.
“Medication abortion increased in popularity, not just in Massachusetts but nationwide,” Holder said.
“It really tracks with the fact that people didn’t want to go into the doctor’s office [earlier in the pandemic] and they knew it was a safe alternative early in the pregnancy,” she said.
Another factor behind the popularity of medication abortion, Holder said, is that it can be done in the privacy of a person’s home, even as political and legal pressures mount, and a cascade of states seeking to limit abortion have imposed new limits on this method.
But Elizabeth Janiak, director of social science research at the Planned Parenthood League of Massachusetts, noted new research from the Guttmacher Institute that indicates people of color and those with low incomes are more likely to seek surgical rather than medication abortions.
“Seeing those trends reminds us that not everyone wants medication abortion,” Janiak said. “So to keep things equitable we need to make sure people have a choice between procedural and medication care.”
Overall, the total number of abortions, both medication and others, in Massachusetts has continued to fall, from more than 26,000 in 2001, to 17,757 last year. Reproductive rights advocates say that reflects improved access to contraception, despite attempts to tighten that access.
That is especially noticeable in the plummeting number of abortions among teenagers over the past two decades. The percentage among 16- and 17-year olds, for instance, dropped from about 4.4 percent of all abortions in Massachusetts in 2006 to 1.8 percent last year.
Janiak, from Planned Parenthood, said another explanation may be comprehensive sex education in the state, which leads to fewer unintended pregnancies. She said a law known as the PATCH Act (for Protecting Access To Confidential Care) may also have removed hurdles for some teens seeking contraception, because it allows them to request that health insurance documentation about care they may have sought not be sent to their parents.
In late 2020, Massachusetts lawmakers enacted the Roe act, which secured the right to abortion in state law. The act allowed a teenager to have an abortion without parental consent beginning at age 16, rather than 18. The latest state data show a slight increase since 2020 in the number and percentage of that age group getting abortions. In 2020 1.4 percent of all abortions in Massachusetts were among 16- and 17-year-olds. Last year, that inched up to 1.8 percent.
The state’s Roe act also allowed abortions after 24 weeks of pregnancy in cases of “fatal fetal anomalies” or “where the fetus was incompatible with sustained life outside the uterus,” exceptions that were not allowed previously.
In 2021, the first year those exceptions took effect, there were 37 abortions after 24 weeks of gestation — the highest number since 2013. Last year, that inched up to 41 such procedures, still a tiny fraction of the thousands of abortions in 2022 in Massachusetts.
Felice J. Freyer contributed to this story. Material from wire reports was also used.
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