2024 EXCLUSIVE EARLY RELEASE: THE STATUS OF AMERICAN ABORTION FACILITIES

By Anne Reed with Sarah Neely and the Operation Rescue Investigative Team

Post-Roe America: Number of Abortion Clinics Holds Steady, But Wait Times Hit New Low as Virtual Back-Alley Abortion Suppliers Triple in Number

Washington, D.C. — The number of operational brick-and-mortar abortion clinics held somewhat steady in 2024; all things considered. Twenty-nine clinics closed or halted abortions, while 46 clinics opened or resumed abortions. Twenty other clinics no longer see patients in person and were moved into the virtual pill supplier category, resulting in an overall net decrease of three abortion clinics, from 670 in 2023, to 667 in 2024.

This trend of abortion clinics abandoning the concept of meeting with patients in person emphasizes the difficulty abortion facilities are experiencing securing and retaining abortionists. It also draws attention to the allure of mail-order chemical abortion pills for profit-focused abortion centers, made more appealing by easier access and decreased operational costs. This trend also reveals a serious deficiency in the quality of care for pregnant women – the segment of society for which the abortion cartel claims to advocate.

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Planned Parenthood, America’s abortion giant, has not only joined this lucrative trend with its new abortion app “PP Direct,” it also now offers gender-subversive drugs through 45 of its 49 affiliates – it also now offers gender-subversive drugs
through 45 of its 49 affiliates – American tax money at work..

Following the fall of Roe, 14 states remain abortion free in 2024, including: Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, and West Virginia. Four more states have heartbeat protection laws that typically protect unborn babies after 6 weeks gestation: Florida, Georgia, Iowa, and South Carolina.

“There is no doubt that abortion facilities are struggling to survive in this post-Roe environment,” said Operation Rescue President Troy Newman, “and, as we conduct our extensive investigations, we continue to see evidence that abortion clinics are facing challenges hiring and keeping abortionists.”

“Pro-life laws not only protect unborn children directly, but they also play a key role in appropriately stigmatizing abortion. As pro-life Americans continue to work through every legal method possible to save innocent lives, we can trust that the 2022 overturn of Roe v. Wade is also playing a vital part in changing hearts – not all of them, but many.”

On that note, Operation Rescue celebrates with former abortionist, Dr. Forrest Smith, who recently came to faith in Christ. In 2024, Smith repented after decades of committing abortions and is now calling for an end to the horrific practice.

Newman asserted, “Dr. Forrest and I have been in talks for several years, and I am elated to see him begin his journey of sanctification while becoming involved in the movement to speak up on behalf of innocent children in the womb.”

The Rolling Twenties

The early 2020s have witnessed significant milestones associated with the legality of abortion, most notably the overturning of Roe v. Wade in 2022. That monumental decision was followed by a tidal wave of state ballot initiatives designed to codify a right to abortion in state constitutions, as well as a few intended to constitutionally protect unborn children.

“With Roe finally gone,” said Newman, “the abortion cartel is doing all it can to secure protections for its lucrative child-killing in whichever state it can. Thankfully, many states have pushed back on this agenda resulting in 19 states drawing hard lines in the sand that protect unborn children, whether it is for all nine months of pregnancy or from six weeks and beyond.”

That resistance is yielding results. In 2020, there were 706 active abortion clinics, compared to 667 brick-and-mortar clinics currently in operation.

A total of 238 brick-and-mortar abortion clinics have closed or halted abortions since 2020. Considering various other factors, such as clinics that opened, reopened, or resumed abortions, the U.S. has experienced a net reduction of 39 abortion clinics, a 6% drop, since the beginning of this decade.

“When clinics close,” said Newman, “babies are saved.”

BY THE NUMBERS

National Abortion Clinic Numbers

Tracing back to 1991, there were 2,176 abortion clinics in operation across America. Today, that number has dwindled to less than 700.

“When comparing thousands of clinics in the nineties to just 667 clinics left operating in 2024,” said Newman, “we take great joy in the remarkable 69% decline we’ve seen, and contributed to, through decades of diligent pro-life activism.”

Operation Rescue began conducting its annual survey in 2009. In those fifteen years, abortion clinic numbers have fallen from 844 to 667, a 21% reduction. Since 2020, alone, 238 clinics have closed.

2024 in Focus

Twenty-nine clinics closed or halted abortions, either permanently or temporarily, in 2024. This is the second lowest number of closures since 2013, when Operation Rescue began tracking this data point.

Of those 29 abortion clinic closures, 16 (55%) were pill-only clinics and 13 (45%) were surgical clinics. On the other hand, of the 46 clinics that opened or resumed abortions, 14 (30%) were surgical clinics, and 32 (70%) were pill-only clinics. Overall, pill-only clinics are facing more instability than surgical clinics, with frequent openings, closures, and shifts to virtual pill supplier status.

Clinic Market Share: Planned Parenthood Vs. Independents

Planned Parenthood comprised less than half (45%) of the 29 abortion clinic closures in 2024 and the bulk (70%) of the 46 clinics that either opened, reopened, or resumed abortions. The abortion giant is more capable of enduring financial hardship due to the massive amount of taxpayer funding it receives.

According to its most recent annual report, Planned Parenthood received a staggering $699.3 million in taxpayer funds in fiscal year 2022-2023. That increased rapidly from previous years when, from 2019 to 2021, taxpayer funding averaged $592 million annually.

As a result, Planned Parenthood increased its market share of abortion clinics nationwide from 54% in 2023 to 58% in 2024.

However, that abundance in taxpayer funding may change drastically once President Elect Donald J. Trump takes office. Trump has already announced his plans to create the Department of Government Efficiency (DOGE), with Elon Musk and Vivek Ramaswamy at the helm. Both men recently announced plans to make deep cuts in government spending, mentioning the abortion giant by name as an example of “federal overspending.”

In the meantime, however, Planned Parenthood is pushing for more profits from the death of children in the womb. Expanding its presence in the virtual back alley this year, Planned Parenthood developed a new app known as “PP Direct.” The app currently offers abortion pills by mail to six states. The paid abortion pill package includes “access to a dedicated support line” but does not include a telemed visit or any other form of legitimate medical oversight.

COST OF FIRST TRIMESTER ABORTIONS

Average Cost Falls

The average cost of a first trimester abortion secured through an abortion clinic fell from $637 to $605. This average does not include virtual suppliers but includes prices for surgical abortions, abortion pills administered in person, and mail-order/telemed abortions provided by brick-and-mortar abortion clinics.

The average price for surgical abortions rose by about $20, from $661 to $682, while abortion provided through in-person pill administration fell by $20. The price for Telemed/mail-order pills remained somewhat steady, falling by just $3.

Though 25 states had an overall decrease in pricing, some of the most drastic price hikes were in Nebraska, a state with only two clinics, and Utah, which has only four clinics.

On average, Planned Parenthood charges 11% less for surgical abortions and 4% less for pills when administered in person. However, the taxpayer-funded abortion giant charges 14% more than privately owned clinics for telemed/mail-order pills.

A significant variation in the average price is observed for mail-order pills when shipped from brick-and-mortar clinics ($531), hybrid virtual suppliers ($487), and fully virtual suppliers ($359). (See “EXPOSÉ: THE VIRTUAL BACK ALLEY” below for an indepth look at virtual categories.)

Fully virtual suppliers operate exclusively online, in the shadowy corners of cyberspace, most often forsaking telemedicine options altogether. The pills are shipped with minimal overhead and virtually no accountability, enabling the reduced costs.

SURGICAL VS CHEMICAL

Clinic Type Trends

Since 2009, a steady trend of decreasing surgical clinics and a corresponding increase in the number of pill-only chemical abortion clinics has been observed. However, Planned Parenthood initiated a reversal of that trend in 2023. By 2024, the overall pattern shifted, with surgical clinics increasing in number while pill-only clinics declined.

However, when observing Planned Parenthood and independent clinics separately, it was noted that the abortion giant increased the number of clinics in both categories, while privately owned clinics experienced a decline in both categories.

Even after these shifts, independent clinics still have considerably more surgical clinics (214 vs 163) but far fewer pill-only clinics (65 vs. 225). At the close of the 2024 survey, Planned Parenthood operated 388 total clinics compared to 279 privately owned clinics.

A significant number of independent abortion clinics are offering gender-subversion drugs, and most Planned Parenthood affiliates are capitalizing on this lucrative, population-reducing initiative. According to the abortion giant’s most recent annual report (2022-2023), the drugs are pushed by 45 of the 49 affiliates that manage abortion clinics and referral centers across the country.

“An abortionist might spend an hour killing several innocent babies then spend another hour forever sterilizing vulnerable young people,” said Newman. “These facilities are a dark, bloody, hopeless stain on humanity.”

GESTATIONAL AGES

Abortion Clinics Extend Gestational Limits Beyond Safety Protocols

In 2023, 59% of abortion clinics nationwide limited abortions to the first 14 weeks, and 20% committed abortions at 20 weeks and beyond. In 2024, those numbers shifted modestly, with a 5% increase in clinics limiting abortions to 14 weeks and a 3% decrease in clinics committing abortions after 20 weeks.

For a more detailed and precise analysis, however, gestational cut-off ranges were assessed independently in 2024 for surgical abortions versus pill abortions provided by brick-and-mortar clinics.

Gestational Limit Categories for Pill Abortions

Sixty-four percent of abortion clinics have gestational cut-off limits set between 11 and 13 weeks for abortion pills. This range indicates a significant majority of clinics provide abortion pills to women beyond the FDA’s limit of 10 weeks. Twenty-six percent administer or mail pills from 7 to 10 weeks, and the remaining 10% that limit the pills to 6 weeks or less are located in states with heartbeat protection laws in place.

Gestational Limit Categories for Surgical Abortions

Nearly one-third (30%) of abortion clinics commit surgical abortions at 20 weeks or later.

Thirty-seven percent of abortion clinics limit the gestational age to 13.9 weeks and under for surgical abortions. However, it should be noted that heartbeat protection laws in four states drive up the number in that category considerably, especially in Florida, which currently has the third highest number of abortion clinics – all of which are now required to limit abortions to far less than 14 weeks.

Latest Gestational Limits Nationwide

The latest gestational age at which pills are administered at clinics nationwide is 13 weeks – three weeks beyond the FDA approved limit.

The maximum gestational age documented during the survey for surgical abortions is 39 weeks. However, a significant number of clinics evaluate circumstances on a case-by-case basis to perform abortions beyond the stated limits. This is especially prevalent in the state of California.

As of 2024, eight states and the District of Columbia have no gestational limits on the books, allowing abortion through all nine months of pregnancy. Those states include: Alaska, Colorado, Maine, Minnesota, New Jersey, New Mexico, Oregon, and Vermont.

Six more states are likely to join this horrific list after enshrining abortion in state constitutions this past November: Arizona, Maryland, Missouri, Montana, Nevada and New York. Though some of these states enshrined abortion up to “viability,” those amendments offered no definition of the term. With no clear definition of “viability,” these amendments will undoubtedly open the door for unfettered, full-term abortions.

In nine states, the age at which abortions are performed has been extended – by four weeks on average. Of the 36 states with legalized abortion, 25% house one or more clinics that commit abortions beyond the maximum gestational age documented in 2023.

ABORTION WAIT TIMES

Wait Times in Every Category

The national average wait time for abortions plummeted in 2024 – by far becoming the lowest wait time since Operation Rescue began documenting this data point in 2017. The average wait time fell from 8 days in 2023 to an average 5.5 days in 2024, a 45% decrease. The lowest wait time recorded before 2024 was 6.6 days in 2018.

This significant decline in wait time indicates decreasing demand for abortion clinics. Given the rapid rise of virtual suppliers, it can be inferred that more women are choosing the riskier route of mail-order pills from suppliers that typically mail them right away, with delivery taking about three days. (The chart below does not include data for virtual suppliers.)

EXPOSÉ: THE VIRTUAL BACK ALLEY

Mail-Order Abortion Pills with No In-Person Visit: The History, the Consequences

In 2024, the U.S. Supreme Court (SCOTUS) heard arguments in a prominent case against the U.S. Food and Drug Administration (FDA) for its dangerous loosening and abandonment of critical safeguards for women prescribed the chemical abortion drug mifepristone. Alliance for Hippocratic Medicine (AHM) v. U.S. Food and Drug Administration (FDA) was originally filed in 2022, six years after the two-step abortion drug regimen (mifepristone and misoprostol) was approved for up to 10 weeks of pregnancy, but only when paired with a required in-person medical consultation.

That safeguard, however, was suspended in 2021, during the COVID-19 pandemic. In January 2023, the FDA made the decision to permanently eliminate a required in-person visit. That same month, the agency changed the label of mifepristone to allow retail pharmacies to distribute the drug.

In August 2023, the Biden administration appealed the 2022 case to SCOTUS after a unanimous panel for the U.S. Court of Appeals for the Fifth Circuit ruled that the FDA must restore crucial safeguards. The safety requirements were removed again pending a decision by the Supreme Court.

In early 2024, Operation Rescue joined AHM’s legal battle appealing the U.S. Court of Appeals for the Fifth Circuit. Oral arguments were heard by SCOTUS on March 26, and on June 13, a disappointing judgment from the High Court indicated the plaintiffs lacked legal standing to challenge the FDA’s regulatory actions regarding mifepristone.

While that case has reached its end, the possibility remains of future lawsuits challenging the FDA’s decisions related to the abortion-inducing drugs.

President-elect Trump also recently nominated Robert F. Kennedy to lead the Department of Health and Human Services, which oversees the FDA. While Kennedy has no moral qualms with abortion, he has been very outspoken against Big Pharma and drug companies that choose profit over safety. On those grounds, alone, it is very probable Kennedy would be willing to hold abortion pill manufacturers accountable, investigate abortion pill deaths and injuries, or even re-establish previous safeguards, including required in-person visits and a much earlier gestational cut-off.

Meanwhile, however, the number of dangerous, virtual back-alley abortion pill suppliers is steadily growing, luring women into attempting dangerous, at-home abortions with low prices and easy access.

“Concerning abortion pills, it is deeply concerning to consider the appalling lack of oversight and accountability, and the disturbing consequences we are already witnessing,” said Newman. “How many life-altering injuries and unnecessary deaths will be needed to establish standing for a lawsuit that ultimately addresses the dangerously under-regulated drugs?”

Pills Now Mailed by Abortion Clinics

Of 674 total clinics in 2024, 189 offered the option of abortion pills with no in-person visit or ultrasound, an increase of 4 clinics since 2023. Since 2022, when Operation Rescue first began tracking this data point, the number has more than doubled. Abortion clinics continue to jump on this dangerous, easy-profit bandwagon, knowing no agency will hold them accountable when women are injured or die.

A total of 19 states house abortion clinics offering telemed/mail-order abortions: California, Colorado, Connecticut, Illinois, Massachusetts, Maryland, Maine, Michigan, Minnesota, Montana, New Hampshire, New Mexico, Nevada, New York, Pennsylvania, Rhode Island, Virginia, Vermont, and one in Wyoming. Planned Parenthood’s vast size and extensive reach allow it to easily utilize abortionists for “site-to-site” telemedicine abortions, giving it a significant advantage over privately owned abortion clinics.

In 2024, Operation Rescue added the names of two women to its archive of abortion-related maternal deaths: 28-year-old Amber Nicole Thurman and 41 year-old Candi Miller. Both died in 2022 after taking the mifepristone and misoprostol abortion pill regimen. The grievous facts about these two tragic and preventable deaths were withheld from the public until a Senate committee hearing in September 2024.

These heartbreaking deaths were used during the Senate hearings in attempts to discredit Georgia’s heartbeat protection law (HB 481), known as “The Life Act,” that had gone into effect prior to their deaths in 2022. On October 1, soon after the Senate committee hearing exploited the deaths of these two women, a Georgia court struck down HB481. However, the Georgia Supreme Court reinstated it one week later.

Newman added, “Again, this is a realm where the upcoming Trump administration and appointee RFK can make a decided difference. We know women are dying from these dangerous abortion pills, especially when taken with little or no medical oversight. If the pro-life movement stands united in holding drug companies and abortion pill suppliers accountable for these egregious deaths, we have the opportunity to win back some ground – which will save preborn lives as well as the lives of their mothers.”

Dangerous Expansion of Virtual Back-Alley Abortions

Due to the radical, irresponsible deregulation of abortion pills, the number of virtual pill suppliers Operation Rescue annually surveys nearly tripled since last year, increasing from 20 virtual suppliers to a new total of 58. That’s a staggering 190% increase in dangerous, back-alley abortion pills by mail. And that increase does not even include the growing number of brick-and-mortar abortion clinics that have added abortion pills by mail to their abortion services.

This and other key data points collected by Operation Rescue during this survey of virtual distributors created a unique overview of virtual trends not previously available anywhere else.

For the purposes of this survey, a “virtual pill supplier” is any abortion business that offers abortion pills through a virtual process with no option to meet with an abortionist in person. Most of these dangerous virtual “clinics” ask women to provide little more than an ID and the answers to a few questions before providing the two-drug regimen for at-home, chemical abortions. Some will even provide the drugs to women who are not pregnant. Of course, these suppliers have no way of verifying whether the drugs will be used for nefarious purposes, like forcing another woman to unknowingly ingest abortion pills.

With the Food and Drug Administration (FDA) rolling back nearly all protections for women daring to self-administer chemical abortions, these virtual suppliers are the fastest growing trend in the abortion industry. Mainly online, these “clinics” are simple-to-implement cash cows for any abortionist with a prescription pad and domain name.

“Of course, since the abortion industry always follows the greediest path,” reflected Newman, “brick-and-mortar clinics have also begun doing all they can to cash in on this virtual back-alley abortion method.”

Hybrid Virtuals, A New Category

This shift towards virtual pills by brick-and-mortars accounts for a large portion of the 190% increase Operation Rescue found in 2024. A growing number of virtual pill suppliers are operating out of physical buildings.

Initially, Operation Rescue created the category of “virtual” to track online abortion pill peddlers that did not offer any option to meet with an abortion provider in person. However, virtual options are changing. To best capture these fast-moving developments in virtual trends, Operation Rescue created two separate categories: “fully virtual” and “hybrid virtual.”

Unlike “fully virtual” suppliers, most “hybrid virtuals” have a brick-and-mortar building. While other types of in-person services may be provided, they still only provide abortion pills through a virtual process, either mailing the pills or allowing them to be picked up without a scheduled in-person visit. Others are online-only (no building) with a virtual process, but they still require abortion medications to be picked up at a pharmacy or other facility.

This growing number of hybrids – with much higher overheads than fully virtual suppliers – have caused a significant increase in the average cost of virtual pills. In 2023, the average cost for a virtual abortion was $237. In 2024, that average cost rose to $402, a 70% increase.

This spike in cost is closely associated with the inclusion of telemed visits, more often required by hybrid pill suppliers.

Telemed Trends by Virtual Suppliers

Ninety percent of hybrids still require a telemed visit with the abortionist, which often results in pricing like an in-person abortion pill appointment. The average cost of virtual abortions at these hybrid clinics is $487. However, when we tease out the telemed component, we see that the average cost for pills with a required telemed visit goes up to $512; when no telemed visit is required the average cost drops to $200.

The same is true of fully virtual suppliers. When a telemed visit is required, the average cost of a virtual abortion is $488. When no telemed visit is required, that cost drops to $179.

While the abortion lobby claims this lack of oversight is because abortion pills are safe and should be normalized as at-home care (the complete opposite of their cries during decades of defending the necessity of Roe), this cost difference actually creates an alarming message for women: Unless you’re willing to pay more than twice the price, you’re on your own.

Currently, only 10% of hybrids offer virtual abortions with no required telemed. This is possibly due to the higher operational costs of a brick-and-mortar business. They likely cannot afford to only offer the much cheaper, non-telemed abortions.

However, a whopping 43% of fully virtual suppliers have no problem foregoing any video or phone consultations with a doctor or nurse practitioner before shipping off dangerous medications to women who may have even marked false answers on a questionnaire.

A woman who might be weeks past the approved gestational limit for chemical abortions need only provide a different LMP (last menstrual period) date to easily obtain abortion pills without any verification that might take place during a telemed or in-person visit.

Furthermore, whether these distinct types of virtual distributors require telemed or not, none of them are able to perform an ultrasound on a woman to rule out complications like ectopic pregnancies, which can be fatal when untreated and impossible to medically confirm through just an email questionnaire.

Virtual Supplier Wait Times and Dangerous Gestational Cut-offs

Though booking a required telemed appointment may cause some variation in individual wait times, on average, abortion pills ship from both “fully virtual” and “hybrid virtual” suppliers in 3 business days. Endless fear mongering from the abortion lobby that abortion access would be greatly curtailed in a post-Roe America is blatantly false. Abortion pills are more readily available than ever before.

In addition, despite the FDA only approving the use of abortion pills up to 10 weeks in pregnancy, the average gestational cut-off for virtual suppliers in 2024 is just over 11 weeks. However, when looking at individual cut-off times, it is important to note that 17% of virtual suppliers allow a cut-off date well past 11 weeks. Some go as far as 13 weeks. The later in pregnancy a woman takes the abortion pills, the higher her risk of complications like an incomplete abortion, hemorrhaging, and sepsis.

The previously referenced 41-year-old Candi Miller, a Georgia woman with numerous health complications, died during an at-home abortion. She ordered abortion pills from Aid Access, one of the virtual suppliers that offers the abortion regimen up to 13 weeks.

ProPublica, which broke the story, stated Miller’s family did not know how far along she was in the pregnancy. The “investigative” news agency didn’t seem to make any efforts to dig further on this point, despite having collected many other intimate details of Miller’s death, including reviewing her autopsy and death records. If those records suggested a gestational age based on the “unexpelled fetal tissue” found during the autopsy, ProPublica left that information out of its article.

ProPublica’s reporting also downplayed the fact that, had Miller been seen at any legitimate OB/GYN office, she would have undoubtedly been referred to a specialist due to her health issues and advanced age, whether she chose an abortion or not.

Aid Access does not require a telemed visit, and certainly not with a specialist. In fact, there is no evidence that Miller was required to take any further steps by the virtual supplier to confirm whether her answers to their short online survey reflected her actual health situation. Miller could have even foregone the survey and simply ordered abortion pills for “future use,” a second option on the Aid Access website.

The abortion lobby immediately blamed Miller’s death on Georgia’s six-week abortion ban, ignoring the most obvious truth: Miller was given unchecked access to dangerous abortion medications, and the complications ended her life. That unchecked access, with substandard medical oversight, is a situation wholly and adamantly created by the abortion cartel, and supported by the U.S. Food and Drug Administration (FDA), not the pro-life movement.

Virtual Abortions in Abortion-Free States

At least four virtual suppliers identified during this survey offer abortion pills by mail to all fifty states, regardless of state laws protecting children in the womb. Many wonder how abortion providers get away with this in abortion-free states, but laws are only as strong as the willingness and ability to enforce them.

After the fall of Roe, 17 states passed shield laws for abortionists, making it clear that no cooperation would be given to out-of-state attorneys general attempting to prosecute those who provided abortion pills in states where chemical abortions are banned. Another five states issued executive orders stating the same.

Virtual suppliers offering abortion pills by mail to all 50 states are either based in states with shield laws or outside the U.S.

This shield law strategy is not surprising. Abortionists are rarely held accountable for their crimes, as learned by decades of documenting abortion injuries, patient deaths, sexual misconduct by abortionists, and an array of other crimes committed.

Newman stated, “Abortionists continue to exist as a privileged class of ‘physicians’ who cannot be touched. Their barbaric work of child-killing is too sacred to ever be lessened by disciplinary actions, meanwhile preborn children and their mothers pay the cost. States that have enacted these shield laws are only ensuring more women in more states will be exploited, injured, and possibly even killed by greedy pill peddlers who are now considered above the law.”

ABORTION AT THE STATE LEVEL

While the virtual suppliers nearly tripled in number, the number of fully operational brick-and-mortar abortion clinics fell by three. Though only a slight decrease, this is the fourth consecutive year that this survey has observed a decrease in the number of abortion clinics.

Legislative Protections from Conception to Birth

States that protect unborn children from conception to birth, albeit with rare exceptions and always for the life of the mother, are categorized by Operation Rescue as “abortion free.” These 14 states considered abortion free at the close of the 2023 survey have remained abortion free in 2024, protecting the lives of an immeasurable number of innocent babies:

Alabama
Arkansas
Idaho
Indiana
Kentucky
Louisiana
Mississippi
Missouri
North Dakota
Oklahoma
South Dakota
Tennessee
Texas
West Virginia

Heartbeat Protection Laws

In 2024, heartbeat protection laws took effect in Florida and Iowa, adding to the states of Georgia and South Carolina that protect babies typically from the 6-week gestational mark.

Ballot Initiatives to Amend State Constitutions

In 2022, pro-life ballot initiatives failed in Kansas, Kentucky, and Montana while

pro-abortion ballot initiatives enshrined abortion in California, Michigan, and Vermont. The losses in these six states were staggering.

In particular, the failure of Kansas citizens to pass the pro-life ballot initiative had a significant impact, resulting in the state’s adherence to a previous Kansas Supreme Court ruling that upheld the right to abortion under the state’s constitution. As a result of enshrining abortion in the constitution, Kansas has seen a 201% increase in abortions since its historically lowest count of abortions in 2016. A staggering 277% increase is projected by the end of 2024.

In 2023, Ohio citizens passed a pro-abortion ballot referendum. At that point, Ohio’s attempt at overcoming an initiative to enshrine abortion in the state constitution was the most successful among the states, securing 57% of the needed 60% threshold. As a result of that loss, however, Ohio’s temporarily blocked heartbeat protection law was permanently struck down in October 2024.

In November 2024, pro-abortion ballot initiatives passed in seven more states:

Arizona
Colorado
Maryland
Missouri
Montana
Nevada
New York

As a result, counting Kansas, a right to abortion has been enshrined in the constitutions of 12 states. In addition, a city-wide ballot initiative failed to make Amarillo, Texas, a sanctuary city for the unborn.

However, the 2024 general election resulted in significant wins in three states. Florida, Nebraska, and South Dakota became the first states to defeat pro-abortion ballot referendums. Nebraska also passed a pro-life amendment constitutionally protecting unborn babies after the first trimester, which aligns with the state’s current 12-week limit established legislatively in 2023.

The Worst of the Worst

California, by far, has the highest concentration of abortion clinics, followed by New York, Florida, Washington, Illinois, Michigan, Colorado, and Virginia. With the 2024 enactment of Florida’s heartbeat protection law and the failure of the pro-abortion ballot initiative, the number of clinics in the state of Florida is expected to fall drastically in the upcoming year.

Virginia seemed to have experienced the worst expansion of abortion, adding five abortion clinics and extending the latest gestational age from 21.9 weeks to 25 weeks. The number of Virginia clinics that commit abortions beyond 20 weeks also increased by 3.

STATE SNAPSHOTS

ALASKA

Total Number of Clinics: 3

Number of Surgical Clinics: 3

Number of Medical Clinics: 0

Number of Clinics with Telemed: 0

Difference from 2022: No Change

Average cost of an abortion: $800

Average wait time for an abortion: 10 Days

Latest Gestational Age: 17 Weeks, 6 Days

Number of clinics that go beyond 20 weeks: 0

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. Abortion is legal through all nine months of pregnancy. There are no gestational limits in this state.

ARIZONA

Total Number of Clinics: 8

Number of Surgical Clinics: 7

Number of Medical Clinics: 1

Number of Clinics with Telemed: 0

Difference from 2022: +1 Clinic

Average cost of an abortion: $797

Average wait time for an abortion: 8 Days

Latest Gestational Age: 16 Weeks

Number of clinics that go beyond 20 weeks: 0

Status of state abortion laws: Bans the use of telemedicine to distribute abortion drugs. In November, Arizona voters enshrined a right to abortion up to “viability” in the state constitution. With no stated definition of “viability,” the amendment will likely cause the current 15 week limit to be struck down.

CALIFORNIA

Total Number of Clinics: 163

Number of Surgical Clinics: 61

Number of Medical Clinics: 102

Number of Clinics with Telemed: 46

Difference from 2022: +1 Clinic

Average cost of an abortion: $724

Average wait time for an abortion: 5 Days

Latest Gestational Age: 24 Weeks

Number of clinics that go beyond 20 weeks: 23

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. In November 2022, California voters approved an initiative that completely protects abortion and can remove all gestational limits. California boasts the most liberal abortion laws in the U.S.

COLORADO

Total Number of Clinics: 22

Number of Surgical Clinics: 9

Number of Medical Clinics: 13

Number of Clinics with Telemed: 14

Difference from 2022: +1 Clinic

Average cost of an abortion: $655

Average wait time for an abortion: 6 Days

Latest Gestational Age: 39 Weeks

Number of clinics that go beyond 20 weeks: 4

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. In November, Colorado voters enshrined a right to abortion in the state constitution. The amendment also forces insurance health plans to cover abortion procedures. There are no gestational limits in this state.

CONNECTICUT

Total Number of Clinics: 16

Number of Surgical Clinics: 6

Number of Medical Clinics: 10

Number of Clinics with Telemed: 14

Difference from 2022: No Change

Average cost of an abortion: $718

Average wait time for an abortion: 6 Days

Latest Gestational Age: 24 Weeks

Number of clinics that go beyond 20 weeks: 2

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. Abortion is allowed until “viability” but has exceptions in the third trimester for the life of the mother. Viability is set in this state between 24 and 26 weeks.

DELAWARE

Total Number of Clinics: 2

Number of Surgical Clinics: 2

Number of Medical Clinics: 0

Number of Clinics with Telemed: 0

Difference from 2022: -1 Clinic

Average cost of an abortion: $550

Average wait time for an abortion: 9 Days

Latest Gestational Age: 15 Weeks, 6 Days

Number of clinics that go beyond 20 weeks: 0

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. Abortion is allowed until “viability” but has exceptions for the life of the mother, rape or incest. Viability is usually set in this state around 20 weeks.

DISTRICT OF COLUMBIA

Total Number of Clinics: 4

Number of Surgical Clinics: 4

Number of Medical Clinics: 0

Number of Clinics with Telemed: 1

Difference from 2022: No Change

Average cost of an abortion: $541

Average wait time for an abortion: 6 Days

Latest Gestational Age: 31 Weeks, 6 Days

Number of clinics that go beyond 20 weeks: 2

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. Abortion is legal through all nine months of pregnancy. There are no gestational limits.

FLORIDA

Total Number of Clinics: 50

Number of Surgical Clinics: 47

Number of Medical Clinics: 3

Number of Clinics with Telemed: 0

Difference from 2022: No Change

Average cost of an abortion: $605

Average wait time for an abortion: 5 Days

Latest Gestational Age: 6 Weeks

Number of clinics that go beyond 20 weeks: 0

Status of state abortion laws: Bans the use of telemedicine to distribute abortion drugs. Abortion is limited to six weeks with exceptions for fetal anomaly, life of the mother, rape and incest. In November, Florida voters defeated a constitutional amendment that would have enshrined a right to abortion up to viability.

GEORGIA

Total Number of Clinics: 12

Number of Surgical Clinics: 7

Number of Medical Clinics: 5

Number of Clinics with Telemed: 1

Difference from 2022: No Change

Average cost of an abortion: $580

Average wait time for an abortion: 3 Days

Latest Gestational Age: 6 Weeks

Number of clinics that go beyond 20 weeks: 0

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. Abortion is limited to 6 weeks with exceptions for life of the mother, rape, incest or a lethal fetal anomaly. However, litigation around the law is still ongoing.

HAWAII

Total Number of Clinics: 2

Number of Surgical Clinics: 2

Number of Medical Clinics: 0

Number of Clinics with Telemed: 0

Difference from 2022: No Change

Average cost of an abortion: $850

Average wait time for an abortion: 9 Days

Latest Gestational Age: 19 Weeks, 6 Days

Number of clinics that go beyond 20 weeks: 0

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. Abortion is allowed until “viability.” Viability is set in this state between 24 and 26 weeks.

ILLINOIS

Total Number of Clinics: 29

Number of Surgical Clinics: 17

Number of Medical Clinics: 12

Number of Clinics with Telemed: 4

Difference from 2022: No Change

Average cost of an abortion: $554

Average wait time for an abortion: 6 Days

Latest Gestational Age: 27 Weeks

Number of clinics that go beyond 20 weeks: 10

IOWA

Total Number of Clinics: 2

Number of Surgical Clinics: 1

Number of Medical Clinics: 1

Number of Clinics with Telemed: 0

Difference from 2022: -3 Clinics

Average cost of an abortion: $881

Average wait time for an abortion: 5 Days

Latest Gestational Age: 6 Weeks

Number of clinics that go beyond 20 weeks: 0

Status of state abortion laws: Bans the use of typical telemedicine to distribute abortion drugs by requiring patients to do in-person visits as part of the process. In July 2024, a law limiting abortion to six weeks (or when a heartbeat can be detected) finally went into effect after a ruling from the Iowa Supreme Court. Exceptions include fetal anomaly, life of the mother, rape and incest.

KANSAS

Total Number of Clinics: 7

Number of Surgical Clinics: 5

Number of Medical Clinics: 2

Number of Clinics with Telemed: 0

Difference from 2022: +1 Clinic

Average cost of an abortion: $726

Average wait time for an abortion: 6 Days

Latest Gestational Age: 21 Weeks, 6 Days

Number of clinics that go beyond 20 weeks: 3

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. In 2022, a right to abortion was enshrined in the state constitution. In July 2024, the Kansas Supreme Court utilized the new amendment to craft two opinions which struck down numerous long-standing abortion regulations, including the removal of a ban on gruesome dismemberment abortions. Other litigation is ongoing and more pro-life laws are expected to be struck down. For now, abortion remains limited to 22 weeks.

MAINE

Total Number of Clinics: 5

Number of Surgical Clinics: 3

Number of Medical Clinics: 2

Number of Clinics with Telemed: 5

Difference from 2022: -17 Clinics*

Average cost of an abortion: $543

Average wait time for an abortion: 7 Days

Latest Gestational Age: 21 Weeks, 6 Days

Number of clinics that go beyond 20 weeks: 1

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. In 2023, Maine passed a law allowing abortion through all nine months, if deemed necessary. Necessity is left to the doctor. There are no gestational limits in this state.

*17 Clinics were moved to the Hybrid Virtual category.

MARYLAND

Total Number of Clinics: 25

Number of Surgical Clinics: 14

Number of Medical Clinics: 11

Number of Clinics with Telemed: 10

Difference from 2022: +1 Clinic

Average cost of an abortion: $531

Average wait time for an abortion: 3 Days

Latest Gestational Age: 38 Weeks

Number of clinics that go beyond 20 weeks: 4

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. Abortion is allowed until “viability” but has exceptions for the life of the mother or if the unborn child has a genetic defect or deformity. Currently, viability is still set in this state between 24 and 26 weeks. However, in November, Maryland voters enshrined a right to abortion through all nine months of pregnancy.

MASSACHUSETTS

Total Number of Clinics: 15

Number of Surgical Clinics: 7

Number of Medical Clinics: 8

Number of Clinics with Telemed: 3

Difference from 2022: -1 Clinic

Average cost of an abortion: $654

Average wait time for an abortion: 8 Days

Latest Gestational Age: 24 Weeks

Number of clinics that go beyond 20 weeks: 5

MICHIGAN

Total Number of Clinics: 25

Number of Surgical Clinics: 15

Number of Medical Clinics: 10

Number of Clinics with Telemed: 14

Difference from 2022: No Change

Average cost of an abortion: $637

Average wait time for an abortion: 6 Days

Latest Gestational Age: 24 Weeks

Number of clinics that go beyond 20 weeks: 9

MINNESOTA

Total Number of Clinics: 9

Number of Surgical Clinics: 5

Number of Medical Clinics: 4

Number of Clinics with Telemed: 7

Difference from 2022: +1 Clinic

Average cost of an abortion: $973

Average wait time for an abortion: 6 Days

Latest Gestational Age: 23 Weeks, 4 Days

Number of clinics that go beyond 20 weeks: 2

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. In 2023, the Minnesota legislature passed a bill that established a right to abortion in the state constitution. That same year, legislators repealed a 1974 abortion law that limited abortion to viability. There are no longer any gestational limits in this state.

MONTANA

Total Number of Clinics: 6

Number of Surgical Clinics: 3

Number of Medical Clinics: 3

Number of Clinics with Telemed: 6

Difference from 2022: +1 Clinic

Average cost of an abortion: $670

Average wait time for an abortion: 3 Days

Latest Gestational Age: 21 Weeks, 6 Days

Number of clinics that go beyond 20 weeks: 2

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. Abortion is allowed until “viability” but has exceptions for the life of the mother. Viability is currently set in this state between 24 and 26 weeks. In November, Montana voters enshrined a right to abortion up to “viability” in the state constitution. However, the new amendment offers no stated definition of “viability,” so the current cut-off could be extended.

NEBRASKA

Total Number of Clinics: 2

Number of Surgical Clinics: 1

Number of Medical Clinics: 1

Number of Clinics with Telemed: 0

Difference from 2022: -1 Clinic

Average cost of an abortion: $1,073

Average wait time for an abortion: 12 Days

Latest Gestational Age: 11 Weeks, 6 Days

Number of clinics that go beyond 20 weeks: 0

Status of state abortion laws: Bans the use of telemedicine to distribute abortion drugs. Abortion is limited to 12 weeks with exceptions for the life of the mother, rape or incest. In November, Nebraska voters rejected a right to abortion in the state constitution and, instead, enshrined protections for the preborn during the second and third trimester of pregnancy.

NEVADA

Total Number of Clinics: 8

Number of Surgical Clinics: 5

Number of Medical Clinics: 3

Number of Clinics with Telemed: 2

Difference from 2022: -1 Clinic

Average cost of an abortion: $609

Average wait time for an abortion: 3 Days

Latest Gestational Age: 23 Weeks, 6 Days

Number of clinics that go beyond 20 weeks: 2

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. Abortion is limited to 26 weeks with exceptions for the life of the mother. In November, Nevada voters enshrined a right to abortion up to “viability” in the state constitution. However, the new amendment offers no stated definition of “viability,” so the current cut-off could be extended.

NEW HAMPSHIRE

Total Number of Clinics: 7

Number of Surgical Clinics: 4

Number of Medical Clinics: 3

Number of Clinics with Telemed: 3

Difference from 2022: +1 Clinic

Average cost of an abortion: $562

Average wait time for an abortion: 10 Days

Latest Gestational Age: 24 Weeks

Number of clinics that go beyond 20 weeks: 1

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. Abortion is limited to 24 weeks with exceptions for the life of the mother and fatal fetal anomaly.

NEW JERSEY

Total Number of Clinics: 36

Number of Surgical Clinics: 17

Number of Medical Clinics: 19

Number of Clinics with Telemed: 0

Difference from 2022: +2 Clinics

Average cost of an abortion: $496

Average wait time for an abortion: 3 Days

Latest Gestational Age: 28 Weeks

Number of clinics that go beyond 20 weeks: 8

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. Abortion is legal through all nine months of pregnancy. There are no gestational limits in this state.

NEW MEXICO

Total Number of Clinics: 10

Number of Surgical Clinics: 6

Number of Medical Clinics: 4

Number of Clinics with Telemed: 5

Difference from 2022: No Change

Average cost of an abortion: $622

Average wait time for an abortion: 4 Days

Latest Gestational Age: 38 Weeks

Number of clinics that go beyond 20 weeks: 4

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. Abortion is legal through all nine months of pregnancy. There are no gestational limits in this state.

NEW YORK

Total Number of Clinics: 75

Number of Surgical Clinics: 44

Number of Medical Clinics: 31

Number of Clinics with Telemed: 29

Difference from 2022: -2 Clinics

Average cost of an abortion: $633

Average wait time for an abortion: 6 Days

Latest Gestational Age: 27 Weeks, 6 Days

Number of clinics that go beyond 20 weeks: 7

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. Abortion is allowed until “viability” but has exceptions for the life of the mother. Viability is set in this state at 24 weeks. In November, New York voters enshrined a right to abortion in the state constitution that will extend through all nine months of pregnancy.

NORTH CAROLINA

Total Number of Clinics: 16

Number of Surgical Clinics: 14

Number of Medical Clinics: 2

Number of Clinics with Telemed: 0

Difference from 2022: +1 Clinic

Average cost of an abortion: $627

Average wait time for an abortion: 9 Days

Latest Gestational Age: 12 Weeks, 6 Days

Number of clinics that go beyond 20 weeks: 0

Status of state abortion laws: Bans the use of telemedicine to distribute abortion drugs. Due to a bill passed in 2023, abortion is now limited to 12 weeks with exceptions for the life of the mother or a fatal fetal anomaly.

OHIO

Total Number of Clinics: 9

Number of Surgical Clinics: 8

Number of Medical Clinics: 1

Number of Clinics with Telemed: 0

Difference from 2022: No Change

Average cost of an abortion: $759

Average wait time for an abortion: 9 Days

Latest Gestational Age: 22 Weeks

Number of clinics that go beyond 20 weeks: 3

Status of state abortion laws: Bans the use of telemedicine to distribute abortion drugs. Abortion is limited to 22 weeks with exceptions for the life of the mother. In 2023, Ohio voters enshrined a right to abortion in the state constitution. In October 2024, a county judge citing that new amendment struck down a six-week ban that passed in 2022 but was blocked by previous litigation.

OREGON

Total Number of Clinics: 12

Number of Surgical Clinics: 7

Number of Medical Clinics: 5

Number of Clinics with Telemed: 0

Difference from 2022: No Change

Average cost of an abortion: $718

Average wait time for an abortion: 6 Days

Latest Gestational Age: 26 Weeks

Number of clinics that go beyond 20 weeks: 2

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. Abortion is legal through all nine months of pregnancy. There are no gestational limits in this state.

PENNSYLVANIA

Total Number of Clinics: 15

Number of Surgical Clinics: 8

Number of Medical Clinics: 7

Number of Clinics with Telemed: 8

Difference from 2022: -2 Clinics

Average cost of an abortion: $552

Average wait time for an abortion: 7 Days

Latest Gestational Age: 28 Weeks

Number of clinics that go beyond 20 weeks: 3

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. Abortion is limited to 24 weeks with exceptions for the life of the mother.

RHODE ISLAND

Total Number of Clinics: 2

Number of Surgical Clinics: 2

Number of Medical Clinics: 0

Number of Clinics with Telemed: 2

Difference from 2022: -1 Clinic

Average cost of an abortion: $715

Average wait time for an abortion: 9 Days

Latest Gestational Age: 22 Weeks

Number of clinics that go beyond 20 weeks: 1

SOUTH CAROLINA

Total Number of Clinics: 3

Number of Surgical Clinics: 3

Number of Medical Clinics: 0

Number of Clinics with Telemed: 0

Difference from 2022: No Change

Average cost of an abortion: $716

Average wait time for an abortion: 8 Days

Latest Gestational Age: 6 Weeks

Number of clinics that go beyond 20 weeks: 0

Status of state abortion laws: Bans the use of telemedicine to distribute abortion drugs. Due to a law passed in 2022, abortion is now limited to six weeks with exceptions for the life of the mother, fatal fetal anomaly, rape, or incest.

UTAH

Total Number of Clinics: 4

Number of Surgical Clinics: 2

Number of Medical Clinics: 2

Number of Clinics with Telemed: 0

Difference from 2022: +1 Clinic

Average cost of an abortion: $624

Average wait time for an abortion: 8 Days

Latest Gestational Age: 17 Weeks, 6 Days

Number of clinics that go beyond 20 weeks: 0

Status of state abortion laws: Bans the use of telemedicine to distribute abortion drugs. Abortion is limited to 18 weeks with exceptions for the life of the mother, fatal fetal anomaly, rape, or incest. A near-total ban went into effect in June 2022 but a judge blocked the law while litigation is ongoing. In March 2023, a law passed that would not allow any abortion clinics to be licensed past January 1, 2024. That law is also blocked and in litigation.

VERMONT

Total Number of Clinics: 6

Number of Surgical Clinics: 2

Number of Medical Clinics: 4

Number of Clinics with Telemed: 6

Difference from 2022: +2 Clinics

Average cost of an abortion: $555

Average wait time for an abortion: 6 Days

Latest Gestational Age: 21 Weeks, 6 Days

Number of clinics that go beyond 20 weeks: 1

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. Abortion is legal through all nine months of pregnancy. There are no gestational limits in this state.

VIRGINIA

Total Number of Clinics: 20

Number of Surgical Clinics: 18

Number of Medical Clinics: 2

Number of Clinics with Telemed: 10

Difference from 2022: +5 Clinics

Average cost of an abortion: $545

Average wait time for an abortion: 6 Days

Latest Gestational Age: 25 Weeks

Number of clinics that go beyond 20 weeks: 5

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. Abortion is limited to 26 weeks with exceptions for the life of the mother.

WASHINGTON

Total Number of Clinics: 33

Number of Surgical Clinics: 15

Number of Medical Clinics: 18

Number of Clinics with Telemed: 0

Difference from 2022: +6 Clinics

Average cost of an abortion: $665

Average wait time for an abortion: 6 Days

Latest Gestational Age: 26 Weeks

Number of clinics that go beyond 20 weeks: 7

WISCONSIN

Total Number of Clinics: 3

Number of Surgical Clinics: 2

Number of Medical Clinics: 1

Number of Clinics with Telemed: 0

Difference from 2022: +1 Clinic

Average cost of an abortion: $675

Average wait time for an abortion: 13 Days

Latest Gestational Age: 19 Weeks, 6 Days

Number of clinics that go beyond 20 weeks: 0

Status of state abortion laws: Bans the use of telemedicine to distribute abortion drugs. Abortion is limited to 21 weeks with exceptions for the life of the mother. When Roe fell in 2022, an 1849 abortion went into effect, but it was immediately challenged and subsequently blocked. A second petition filed by Planned Parenthood Wisconsin in February asked the Wisconsin Supreme Court to clarify if abortion is protected by the state constitution. The Wisconsin Supreme Court heard oral arguments for both cases in November, but no opinion has been handed down.

WYOMING

Total Number of Clinics: 1

Number of Surgical Clinics: 1

Number of Medical Clinics: 0

Number of Clinics with Telemed: 1

Difference from 2022: No Change

Average cost of an abortion: $600

Average wait time for an abortion: 6 Days

Latest Gestational Age: 23 Weeks, 6 Days

Number of clinics that go beyond 20 weeks: 1

Status of state abortion laws: Allows telemedicine to distribute abortion drugs via mail. Abortion is allowed until “viability” but has exceptions for the life of the mother. Viability is set in this state between 24 and 26 weeks. In November, a Wyoming state judge struck down two pro-life laws that went into effect shortly after the fall of Roe. One would have made the state abortion-free, and the second was a first-of-its-kind ban on medication abortions. Both were previously blocked while litigation was ongoing. An appeal on behalf of both laws is likely to follow.

This report may be republished with inclusion of the following acknowledgement: “This article was originally published by Operation Rescue, a leading pro-life, Christian activist organization dedicated to exposing abortion abuses, demanding enforcement, saving innocent lives, and building an abortion-free America.“

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