Boston Globe | Since Roe v. Wade overturned, abortion rates have doubled in Mass. Here’s why.

By Sarah Rahal | Originally Published by the Boston Globe

In the years since the US Supreme Court’s decision overturning Roe v. Wade in 2022, Massachusetts has emerged as a major national provider of abortion care, with new state data showing terminations using medication have more than doubled, and most patients receiving care are from out of state.

The increase was driven largely by the rapid expansion of telehealth services in which providers can prescribe abortion pills, as well as a surge of patients traveling from states that imposed tighter restrictions following the Supreme Court decision.

The shift has been so pronounced that patients from other states now outnumber Massachusetts residents seeking abortion care.

“The state is playing a huge role in ensuring that abortion seekers throughout the country get the care they want, need, and deserve,” said Dr. Angel Foster, a physician with Cambridge Reproductive Health Consultants, which serves a significant number of telehealth patients through the Massachusetts Medication Abortion Access Project, or MAP.

According to data published by the Massachusetts Department of Public Health in December, there were 49,450 abortions in 2024, up from 24,355 in 2023 — a 103 percent increase. Much of that was largely from a dramatic increase in remote access to abortion medication, which has rapidly become the primary method statewide.

Telehealth abortions accounted for 30,900 cases in 2024, or about 62 percent — a steep climb from 5,745 cases in 2023, the first time the state began documenting telehealth.

Medication abortions, typically involving the drug mifepristone, represented more than 60 percent of all procedures, with surgical methods a smaller share.

The shift is a result of ongoing national debate over abortion access and the regulation of medication. Mifepristone has been at the center of legal and regulatory disputes, including efforts in October by the US Food and Drug Administration to tighten oversight. Massachusetts officials and providers have resisted by expanding access through state-level policies. The FDA also approved a generic version of the abortion pill in October.

After the US Supreme Court’s reversal of Roe v. Wade triggered various bans on abortion in numerous states, more people have been coming to Massachusetts for care. Of the total number of abortions in 2024, 27,836 involved out-of-state residents, compared with 21,407 Massachusetts residents. That marks a reversal from 2023, when in-state patients made up the majority, and 6,400 were from out-of-state.

Foster said the number of such cases has since likely surpassed DPH’s figures.

In 2024, her medication project served about 11,000 patients, but that number jumped to 25,000 last year. Now, Foster expects her organization to serve between 3,000 and 3,500 patients a month, nearly 40,000 in 2026.

“Our numbers have gone up, and I imagine they have for others as well,” she said, crediting state law and government leaders. ”It’s also attributable to our reproduction advocacy groups, abortion funds throughout the state, which together have become more protective of providers.”

Roughly 95 percent of her patients live in states with near-total abortion bans or restrictions, she said. MAP uses a “pay as much as you can afford” model and asks for a minimum payment of $5. Foster said MAP has not faced lawsuits as some physicians in New York and California have, and credits a shield law in effect in Massachusetts, which protects providers from out-of-state prosecution.

Many patients find MAP through “Plan C” websites, which direct them to several other telehealth and mail services. Most are under nine weeks of pregnancy, confirmed by self-report of their last menstrual period.

Massachusetts Citizens for Life, which opposes abortion, noted the DPH data omits information that was previously included, such as the types of facilities involved, a patient’s marital status, and whether a patient had previous abortions.

“It’s critical to note, however, that the state isn’t ‘hiding’ information. The truth is far worse than that,” said Myrna Maloney Flynn, president of the Walpole-based group. “The state can’t report on which women are having abortions because it does not know anything about these women, and neither do the abortionists who prescribe mifepristone.”

Demographic patterns remained largely consistent with prior years. Combined, women ages 20 to 34 accounted for more than 70 percent of all abortions. More than 96 percent of abortions occur in the first 12 weeks of pregnancy. Fewer than 100 people received an abortion after 24 weeks, 15 more than in the previous year, the DPH data show.

“The number of abortions later in pregnancy increased, but not significantly. There are people who do need abortion past 24 weeks and have been denied that care and have had to go out of state,” said Taylor St. Germain, interim president of Reproductive Equity Now, a nonprofit and New England advocacy group.

St. Germain frequently hears from providers who are increasing their telehealth capabilities. The group provides telehealth resources through its New England Abortion Care Guide, where patients can search for their nearest clinic, learn how to pay for care, and what to expect. It also has an Abortion Legal Hotline to connect providers with pro bono attorneys in Massachusetts.

“These numbers tell a story that Massachusetts is having a significant role in abortion care and that will continue to increase in 2026 based on what we’re hearing,” she said.