Changes in Induced Medical and Procedural Abortion Rates in a Commercially Insured Population, 2018 to 2022 : An Interrupted Time-Series Analysis

Ann Intern Med. 2023 Nov;176(11):1508-1515. doi: 10.7326/M23-1609. Epub 2023 Oct 24.


Background: During the COVID-19 pandemic, access to in-person care was limited, and regulations requiring in-person dispensing of mifepristone for medical abortions were relaxed. The effect of the pandemic and accompanying regulatory changes on abortion use is unknown.

Objective: To estimate changes in the incidence rate of induced medical and procedural abortions.

Design: Serial cross-sectional study with interrupted time-series analyses.

Setting: Commercially insured persons in the United States.

Participants: Reproductive-aged women.

Intervention: Onset of the COVID-19 pandemic in March 2020 and subsequent regulatory changes affecting the in-person dispensing requirement for mifepristone.

Measurements: Monthly age-adjusted incidence rates of medical and procedural abortions were measured among women aged 15 to 44 years from January 2018 to June 2022. Medical abortions were classified as in-person or telehealth. Linear segmented time-series regression was used to calculate changes in abortion rates after March 2020.

Results: In January 2018, the estimated age-adjusted monthly incidence rate of abortions was 151 per million women (95% CI, 142 to 161 per million women), with equal rates of medical and procedural abortions. After March 2020, there was an immediate 14% decrease in the monthly incidence rate of abortions (21 per million women [CI, 7 to 35 per million women]; P = 0.004), driven by a 31% decline in procedural abortions (22 per million women [CI, 16 to 28 per million women]; P < 0.001). Fewer than 4% of medical abortions each month were administered via telehealth.

Limitation: Only abortions reimbursed by commercial insurance were measured.

Conclusion: The incidence rate of procedural abortions declined during the COVID-19 pandemic, and this lower rate persisted after other elective procedures rebounded to prepandemic rates. Despite removal of the in-person dispensing requirement for mifepristone, the use of telehealth for insurance-covered medical abortions remained rare. Amid increasing state restrictions, commercial insurers have the opportunity to increase access to abortion care, particularly via telehealth.

Primary funding source: Health Resources and Services Administration.

MeSH terms

  • Abortion, Induced*
  • Adult
  • COVID-19* / epidemiology
  • Cross-Sectional Studies
  • Female
  • Humans
  • Mifepristone / therapeutic use
  • Pandemics
  • Pregnancy
  • United States / epidemiology


  • Mifepristone