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A Verywell Report: Abortion Access Ranked By State

Key Takeaways

• A Verywell analysis finds that 39% of reproductive-aged women in the United States live in counties that do not have an abortion provider.
• The worst states for abortion access are West Virginia, Missouri, and Wyoming.
  
• The best states (and districts) in the U.S. for abortion access are Washington D.C., Maine, and California.

Changes that have been brewing for decades are on the cusp of overturning Americans’ access to abortion. Just this month, Texas made headlines when the state passed a law banning abortions after six weeks.

Since the inception of the law, also known as the Texas Heartbeat Act, abortion clinics have had to turn away people seeking an abortion after six weeks. 

But in many states nationwide, people are already facing escalating restrictions and low numbers of abortion providers.

Verywell Health compiled data on abortion laws and providers for each of the 50 states. This data gives us a glimpse at the current number of abortion providers in each state and county, as well as abortion restrictions that are currently reducing access.

Our analysis finds that a large portion of America’s reproductive-aged women live in areas of the country that do not have access to abortion providers. In fact, 39% of women in the U.S. of childbearing age live in counties that do not have an abortion provider.

While the data looks at women aged 15 to 44, this does not represent all people in need of an abortion.

Top 3 Worst States for Abortion Access

To determine the bottom three states for abortion access, we looked at the percentage of the state’s population of reproductive-aged women that live in counties without abortion providers. 

The bottom three states for abortion access are:

• West Virginia
• Missouri
• Wyoming

West Virginia 

In West Virginia, there's only one abortion provider in the entire state, comprised of 55 counties. Of its population of reproductive-aged women, 90% (290,741) live in counties of the state that do not have an abortion provider.

There are also multiple restrictions on abortion access put in place by the state of West Virginia. These include:

• Restrictions before viability
• Restrictions for minors
• Restrictions on the funding and insurance that patients can use to pay for abortions
• Requirement for all those pursuing abortions to be given counseling

What Is Viability?

Viability is the point at which a fetus can sustain survival outside the uterus. A fetus generally reaches viability between 24 and 28 weeks after the last menstrual period.

Medical professionals other than a doctor can prescribe abortion pills, but these visits need to be in-person (no telemedicine). West Virginia has a 24-hour waiting period and a law in place banning abortions after 21 weeks, 6 days gestation. 

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The one clinic in West Virginia only offers medical abortions through 11 weeks and in-person surgical abortions up to 16 weeks.

Missouri

Missouri is similar to West Virginia in that it has only one abortion provider in its 115 counties. There are 1,100,168 Missouri women between the ages of 15 and 44 living in counties without an abortion provider—94% of the state's reproductive population. 

The state also has restrictions on:

• Abortion at viability
• Abortions in minors
• Regulations on the sources of funding or insurance that patients can use for abortions
• Requirements for abortion patients to seek counseling before having the procedure

Missouri restricts the use of abortion pills to in-person prescription by a physician (no telemedicine) and requires a 72-hour waiting period.

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However, both medical (through 11 weeks) and surgical (through 21 weeks, 6 days gestation) abortions are available at Missouri's one clinic, located in St. Louis, Missouri.

Wyoming 

While Wyoming does have two abortion providers, they’re both in Jackson, Wyoming. That leaves 22 counties and a total of 96% (103,800) of the state’s women of reproductive age without access to abortion. 

Wyoming has also enacted state laws that:

• Place restrictions on abortion starting at viability
• Added abortion restrictions for minors
• Restricted the funding and insurance options that patients can use to pay for abortion procedures 

Wyoming requires a physician to prescribe medical abortion pills, but they can be prescribed over a telemedicine visit. So, a patient in one county can get a medical abortion by having a telemedicine visit with a doctor in another county.

Wyoming technically allows abortions until viability, but the two clinics listed in the Abortion Finder database only provide medical abortions (not surgical abortions) up to 10 weeks gestation.

How We Gathered This Data

To look at abortion access across the U.S.’s 50 states, we gathered abortion provider data from the Abortion Finder database. The abortion provider data comes from the ANSIRH Abortion Facility database, the National Abortion Federation, the Planned Parenthood Federation of America, the Abortion Care Network, and some unaffiliated independent clinics. The team at Power to Decide verifies the data monthly.

We gathered information about each state’s abortion laws through the Guttmacher Institute’s An Overview Of Abortion Laws database, which is up to date as of September 1, 2021. We gathered population data for individual states and counties through the U.S. Census American Community Survey, which is current as of 2019, the most recent data available.

However, there are some caveats to this data:

• The Abortion Finder database includes both in-person and virtual providers, so some of the listed providers in a given state are online-only.
• Population numbers use a 5-year estimate determined from 2019 data, so it may have changed since it was collected.
• Our ranking by percent of the population doesn’t consider the restrictions individual states have placed on abortion, like S.B. 8. 
  

Special Mention: Texas

Forty-six percent of Texas’s reproductive population lives in counties that do not have abortion providers. While this is a middle-of-the-road number, a new law adds intense restrictions on who can get abortions and when. 

Abortion access in Texas became the most restrictive in the U.S. on September 1, 2021, as the U.S. Supreme Court stood down in the face of Senate Bill 8 (S.B. 8).

The new S.B. 8 law bans abortions after six weeks—a time before many people even know they are pregnant.

Texas OB-GYN Responds to State Abortion Ban

Top 3 Best States for Abortion Access

From the data we’ve collected, the top three best states (and districts) for abortion access, based on the percent of reproductive-age women who live in countries without an abortion provider are:

• Washington, D.C. 
• Maine
• California

Washington, D.C.

Washington, D.C. has seven abortion providers in one county. Zero percent of D.C.'s population of 186,335 women between 15 and 44 live in a county without an abortion provider. 

Medical abortions are available through telemedicine in Washington, D.C. There are no limits on the pregnancy stage, a waiting period, or required counseling to access an abortion.

Washington's laws do put restrictions on the funding of abortions and insurance coverage of abortions. 

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Maine 

Another East Coast state, Maine, comes in at number two. With 22 abortion providers in 15 counties, Maine has only one county without a provider.

Ninety-nine percent of the state’s population of 232,114 women aged 15 to 44 live in counties with abortion providers.

Prescription medical abortions are available through telemedicine through three separate telehealth-only abortion clinics. In addition, there is no waiting period to get an abortion. 

That said, Maine’s laws restrict abortions starting at viability, and only a few clinics in the Abortion Finder database offer in-person abortions. Most only provide medical abortions before 11 weeks. 

California

The most-populated state in the U.S., California, comes in at number three on our list. California has 163 abortion providers spread over 36 counties. That means 22 of California’s 58 counties do not have an abortion provider.  

But because these countries are sparsely populated, the percent of women of reproductive age that live in counties without an abortion provider is still low. With 8,061,728 women of reproductive age in California, only 247,849 (3%) live in areas without access to an abortion provider. 

California’s laws put restrictions on abortions at viability, but there is no waiting period. Medical abortions are available through telemedicine, offered by four clinics in California. 

Even these three states are lagging behind other countries on abortion access and reproductive rights. For example, the Netherlands, which has one of the lowest abortion rates globally, allows access to abortions up to 21 weeks with a five-day waiting period. In addition, abortions for those living in the Netherlands are paid for by the government or health insurance.

Resources for Accessing Abortion

If you’re living in a state with restricted access to abortion, you may still have a few options. 

You may be able to access mail-ordered medical abortion pills. Research during the pandemic has supported the idea that these medications are safe, effective, and prescribing them over a telemedicine visit can reduce exposure to COVID-19. However, 19 states currently prohibit doctors from prescribing medical abortion pills through telemedicine.

For those with access to transportation, the ability to take time off work for an extended period, and money to pay out of pocket for their abortion, it’s possible to travel to another state to access abortion care, pick up pills, or conduct a telemedicine visit. 

If your resources are limited, there are multiple options to get assistance obtaining an abortion. 

• The free National Abortion Federation hotline at 1-800-772-9100 can provide information about abortion, resources, and financial help getting an abortion.
• The National Network of Abortion Funds can also help you find local financial assistance. Visit them online for more information.
• The Plan C Guide to Getting Abortion Pills lists potential options for telemedicine medical abortions and creative ideas to work around existing laws.
• For more information on the legality of international telemedicine providers, visit the ReproLegal Helpline or call 844-868-2812. They provide free and confidential legal advice that can help people assess their specific situation and level of risk for using some of these telemedicine providers.