In San Antonio, Texas, the waiting room at Alamo Women's Reproductive Services is empty just before the Supreme Court overturned Roe v. Wade on June 24, 2022.

Inside the Post-Roe Scramble to Count Abortions

On May 2, 2022 at 8:32 p.m., when Politico published a leaked draft of the United States Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, Jennifer Pepper was standing on Main Street in Disney World. Pepper is president and CEO of the Choices Center for Reproductive Health, a reproductive health clinic in Memphis, Tennessee, that began providing abortion care in 1974. She had traveled to Orlando to give a presentation at a conference and visited Disney World that evening to watch the fireworks. The air was warm and humid, the sun had just set, and Pepper was staring at Cinderella’s Castle when her phone erupted with messages and alerts.

“I remember kneeling down and feeling like I’d been gut punched,” Pepper said. “We knew it was going to happen, but seeing those words in black and white shattered any little bit of hope that maybe we had gotten it wrong.”

If the leaked opinion was legitimate, which Pepper believed it was, it would overturn the 50-year precedent set by Roe v. Wade — and upend the work of Choices and many other clinics. There was so much to figure out, so much chaos to manage, but Pepper put her phone away and watched the show, taking a few minutes of calm.

Jennifer Pepper, president and CEO of a reproductive health clinic in Memphis, Tennessee, said she felt gut punched when she first saw the Supreme Court’s Dobbs decision.

Visual: Choices Center for Reproductive Health

At the time, 13 states, including Tennessee, had trigger bans in place, meaning abortion would automatically be outlawed if Roe fell. Around a dozen others were considered certain or likely to ban or severely restrict it.

Without question, the overturning of Roe would cause seismic shifts to the landscape of abortion access in America. But what, precisely, would those shifts look like? Government agencies, along with some academic institutions and nonprofits, collect data on abortions in the U.S. — including patient demographics and the number of facilities that provide abortions — but they typically take years to publish the results. Abortion care providers and advocates wanted that data much faster, so they could track and respond to the repercussions of Roe’s fall as they happened.

“I know we have these assumptions about what people will do when faced with this truly awful situation, but we need to actually know what they do,” said Jenny O’Donnell, the senior director of research and evaluation at the Society of Family Planning.

In June 2022, the day before the Dobbs ruling officially came out, O’Donnell’s organization launched #WeCount, a national abortion reporting effort that aims to capture shifts in abortion access in as close to real time as possible. So far, their data suggests that thousands of people were unable to access abortion care in the months immediately following the decision; a new tranche of results is scheduled to be released next month.

The collection of abortion data in the U.S. can be a fraught endeavor, and the findings are sometimes harnessed to support political arguments on all sides of the abortion access debate. Academics, policy experts, and abortion providers say that #WeCount effort has offered critical insight on what post-Roe America looks like — even as it has highlighted the challenges of tracking abortions amid fractured reporting standards, growing numbers of self-managed abortions, and a heightened climate of fear.

“I immediately knew it would be important to know how people were moving and what access looked like in the months after Dobbs,” said Pepper. “Choices signed up. I said, ‘Of course we will participate.’”

Immediately after the Supreme Court overturned Roe v. Wade in June 2022, some clinics had to turn patients away. At Alamo Women’s Reproductive Services in San Antonio, Texas, an emotional staff member waits inside the clinic doorway to inform incoming patients about the change. Visual: Gina Ferazzi / Los Angeles Times via Getty Images

O’Donnell started thinking about the need for an effort like #WeCount in September 2021, after Texas passed Senate Bill 8, which effectively banned abortions after six weeks, and the U.S. Supreme Court permitted the law to stay in effect. That didn’t bode well for the Dobbs case. On informal phone calls with a small group of abortion researchers, O’Donnell said, a consensus formed: They needed to be ready to document the impact of state-level abortion bans if Roe were to fall.

Counting the number of abortions in the U.S. is no easy task. The Centers for Disease Control and Prevention collects abortion data as part of its annual vital statistics surveys, but that data takes a couple of years to be released, and it has omissions: Abortion data reporting requirements vary from state to state, and three states, including California, don’t require abortion providers to share numbers at all. Meanwhile, academic and nonprofit initiatives often focus on specific regions, or take years to publish their in-depth figures. With #WeCount, the goal was to track the impact of Dobbs on a month-to-month basis, and to release the findings within months, instead of years.

The Society of Family Planning does not typically conduct research. It’s a national membership organization of health care workers and academics, and it mostly supports research through grants, fellowships, continuing education, and a medical journal. For this new effort, SFP pulled together a steering committee of 12 researchers, from universities and from nonprofits, including the Guttmacher Institute, Ibis Reproductive Health, and Planned Parenthood. To fund the project, SFP reallocated funds that had been earmarked for other research funding opportunities, supported by an anonymous foundation.

“I know we have these assumptions about what people will do when faced with this truly awful situation, but we need to actually know what they do,” said O’Donnell.

“There was a collective agreement among the abortion research community that we needed a coordinated, expedited way to collect these data, because we couldn’t wait for two to three years to see the real impact of Dobbs,” O’Donnell said.  

To lead participant recruitment for the study, #WeCount hired Vanessa Arenas, a former deputy director of an Ohio abortion clinic. In April 2022, Arenas began the long work of reaching out to clinics across the country, asking them to begin submitting data to #WeCount. She worked from a database of over 700 providers, including freestanding clinics, private medical offices, hospitals, and telehealth organizations.

For an accurate count, #WeCount needed as many providers to join the effort as possible. That entailed drawing on existing relationships, asking for personal introductions, and trying to get people to respond to messages, as well as spending hours tracking down phone numbers and email addresses — which, for safety and security reasons, are not easy to find on the internet. Upon making contact, Arenas and her team had to convince providers to agree to share their data, which some can be reluctant to do.

According to Arenas, her experience on the provider side came in handy during recruitment. “I think it went a long way for providers to know that there was someone who understood their work leading this effort,” she wrote in an email to Undark, sent via an SFP spokesperson. “The relationships were critical to providers participating.”

The #WeCount team initially had a list of roughly 20 variables they were interested in tracking — gestational age and patient demographics, for instance. They got feedback from organizations that work closely with clinics to cut that list down to one.

Vanessa Arenas, the former deputy director of an Ohio abortion clinic, joined #WeCount to lead participant recruitment. She began asking clinics across the country to join the study in April 2022.

Visual: Courtesy Society of Family Planning

“They are getting crushed by that suffering, as well as making sure they can do their jobs, as well as if they need to shut or change their business model in a radical way,” O’Donnell said. “So the smallest ask is the most you possibly can ask.” SFP decided that their ask was for providers to count the number of abortions performed at their site each month.

They also decided to compensate providers for their time. Renumeration started at $1,000 for the first month of participation, and providers who had to pull data each month specifically for #WeCount, or had to pull the data by hand — as opposed to relying on an electronic system — were offered additional monthly payments.

Pepper, of the Choices clinic, said she appreciated that the research was narrow and focused in scope, and she helped connect SFP with other providers in her area.

“I was thrilled to hear that was their approach, because honestly I think that needs to be the approach to research and grant reports more often,” Pepper said. “Too often, people want to collect all the data and figure out what you want to look at or see on the backend, and that is so burdensome to the people providing the data for you.”

During the first two months of the initiative, 79 percent of all identified providers participated, representing an estimated 82 percent of all abortions provided in the U.S.

On October 28, 2022, #WeCount released its first report, estimating that 10,670 fewer people had abortions in the two months after the Dobbs decision than would otherwise have been expected.

“The findings of the #WeCount study, in some ways, was quite tragic,” said Allison Norris, an epidemiologist at Ohio State University and a #WeCount co-chair. “It’s documenting a huge burden and impact. 10,000 people were forced to take a path they didn’t want, and that has impacts on every aspect of their life in perpetuity.”

O’Donnell said the first round of data showed that the situation was highly dynamic. There was volatility at the state level as providers and lawyers waded through a tangle of new laws, old laws, gray areas, and injunctions; as lawsuits challenging abortion restrictions were filed; as clinics closed and opened; and as patients reacted to state-level changes, sometimes traveling long distances to access care.

Those findings, experts say, offer one glimpse into how the end of Roe has shifted access to legal abortion in the U.S. Still, there are gaps: In particular, the #WeCount effort doesn’t address how many people are self-managing abortions — for example, by ordering medications from unofficial online sources. There aren’t easy or reliable ways to track self-managed abortions because they happen outside of the formal health care system, and people use a variety of suppliers and methods.

“It’s always difficult to put an exact number [on] self-managed abortions,” said Abigail Aiken, an associate professor at the University of Texas’s LBJ School of Public Affairs.

Recently, some of Aiken’s research has focused on a source that does keep records. Aid Access is a telehealth provider that serves patients in all 50 states with a two-pronged model: In states where abortion is legal, eligible patients receive medication abortion in the mail from licensed providers; in states where it’s banned, patients fill out an online consultation and, if eligible, receive the medication in the mail, sent from an international pharmacy. In November 2022, Aiken and three colleagues — including Aid Access founder Rebecca Gomperts — published a study in the journal JAMA, reporting that in July and August 2022, the requests for pills received by Aid Access more than doubled after the Dobbs decision.

Aiken emphasized that the number of requests for medication abortion is not equivalent to the number of people who actually self-managed abortions using those medications. The patients may not have received the pills, or received them and not taken them, or received them and given them to someone else. The data, she stressed, shouldn’t be treated as a perfect counterpart to the #WeCount data or be interpreted as offsetting it. Instead, the number of requests serves as a window into how things were trending and the impact of the new legal landscape.

“In the absence of being able to count self-managed abortion, having a picture is better than nothing,” Aiken said. “For me, as we see in-clinic abortion declining, the question is, are we seeing increases in self-managed abortion? And the answer to that is yes.”

People on both sides of the abortion debate have found ways to use the #WeCount data. Pepper said that Choices plans to use the numbers as part of fundraising campaigns. In the past, this kind of data has also factored into abortion litigation. For instance, when the “undue burden” standard was in place (meaning if a law imposed an undue burden on people seeking abortion, it was unconstitutional), judges considered data documenting the impact that travel distance has on whether people access abortions.

The #WeCount data has also found an audience among those who oppose abortion access. “Do pro-life laws, whether state or federal, actually save lives?” asked senior staffers at the Charlotte Lozier institute, an anti-abortion research and advocacy group, in an op-ed published after #WeCount released its first report. “According to a new study from the pro-abortion WeCount coalition, the answer is ‘yes,’ with the number of abortions nationwide falling by 10,000 in the first two months after the Dobbs decision.”

“If you’re in Texas, it doesn’t matter if there’s a new facility in southern Illinois. It’s so far away that, if you are trapped, it might as well be on the moon,” Myers said.

The #WeCount data has also been used by academic researchers. Caitlin Myers is an economics professor at Middlebury College who studies the causal effects of abortion access. Since 2013, she has examined the effects of abortion clinic closures on patient travel, trying to answer the question: How far is too far?

“Most people who get trapped by distance get trapped by the first 200 miles,” Myers said. “So if you’re in Texas, it doesn’t matter if there’s a new facility in southern Illinois. It’s so far away that, if you are trapped, it might as well be on the moon.”

In 2019, Myers and her colleagues published an article forecasting the impact of abortion bans. If Roe were reversed and all high-risk states banned abortion, their model predicted that the national abortion rate would fall by 32.8 percent in the year after. Myers said the first round of #WeCount data aligned with those forecasts. Rather than saying that people were most likely getting trapped by abortion bans, she said, there was now evidence supporting it.

For Pepper, the data provided a quantitative perspective on the reality she was dealing with every day — one marked by tumult. She said it has helped her see the big picture, understand how things were shaking out across state lines, and ascertain how the Choices clinic fit into the new map.

On the day of the Dobbs decision, Choices’ phone system at the clinic crashed after receiving over 5,000 calls — what Choices normally gets in a week and a half — within a couple hours.

“We provided the first abortion in Memphis in 1974, and in fact we provided the last abortion in Memphis in August of last year,” Pepper said.

In August 2022, Danette Bingham, a staff member at Choices Center for Reproductive Health in Memphis, prepares an exam room. That month, Choices provided the last abortion in Memphis after nearly 50 years of offering the procedure. Visual: Andrea Morales /The Washington Post via Getty Images

In October 2022, Choices started seeing patients at a new location in Carbondale, Illinois, a three- to four-hour drive from Memphis. Pepper said Choices chose Carbondale because that’s where they believed people in the region would go. Indeed, according to the October #WeCount report, Illinois saw a 28 percent increase in abortions between April and August.

At least 66 abortion clinics across 15 states have closed since the Dobbs decision. Since opening in Carbondale, Choices has been fully booked, with most patients coming from Tennessee, Arkansas, Mississippi, and Texas, and the clinic is continuing to add and train staff members. Pepper believes the new location is performing an essential service, but she also knows there are thousands of patients who can’t make the journey to Illinois. Even if they could, there wouldn’t be the capacity to serve them.

“There are only 24 hours in a day and seven days in the week, so we are not going to be able to help everybody who needs help,” Pepper said. “There were never enough abortion providers and now there are even fewer. It is just a mass problem that does not work out in the favor of patients.”  

Rebecca Grant is a freelance journalist based in Portland, Oregon, who covers reproductive rights, health, and justice. She’s the author of the forthcoming book “Birth: Three Mothers, Nine Months, and Pregnancy in America.”