The increasingly hostile political and legal climate for abortion rights and access in the United States requires reconsideration of longstanding systems of state-mandated abortion reporting. Data on abortion incidence and trends are critical for understanding changes in the abortion access landscape and, in turn, can be vital in shaping public policies to improve reproductive health access and outcomes. However, the current climate has escalated the risk of mandated data collection being used to stigmatize, harass, or even prosecute abortion patients and providers—including in situations where abortion care is provided and obtained legally.
The Trump administration has made clear its determination to implement the hard-right agenda laid out in Project 2025, which calls for a federal mandate requiring all states to collect extensive and intrusive information on every abortion provided. New threats also loom at the state level, where several anti-abortion state governments have taken unprecedented actions to weaponize state-mandated abortion reporting. This has included efforts in Indiana to make reports on individual abortions part of the public record—a move that serves no public health purpose and that could directly imperil patients and providers.
Such developments suggest that the benefits of state-mandated abortion reporting no longer outweigh the risks, a shift that is likely to accelerate as anti-abortion policymakers double down on punitive approaches to data collection while using the resulting data to further restrict abortion rights and access.
This shift in the risk–benefit ratio means that state-mandated abortion reporting is no longer an approach that best serves the interests of public health. States should therefore change their laws and regulations to end the mandated collection of such data and instead consider alternative models of data collection, such as voluntary surveys of providers, that can mitigate risks to patients and clinicians.
Current Policy Landscape
Mandated abortion reporting refers to regulatory regimes in which abortion providers are required by federal, state or local law or regulation to submit specific forms or reports for every abortion they provide. Currently, 46 states and the District of Columbia have some form of mandated abortion reporting. In most of these states, individual-level data (not including patient names) are reported; in a few states (currently, Massachusetts and Illinois), providers report statistics in aggregate. Most of these states publish annual reports using the data they collect from abortion providers; in addition, the federal Centers for Disease Control and Prevention (CDC) has, for decades, partnered with states to compile aggregate state-level statistics on abortions in the United States. While the CDC does not require states to submit abortion data, most states do so, based on the information they have collected through their own reporting requirements. The information collected in these reports varies by state but typically includes the names of the medical facility and the clinician providing abortion care, the patient’s demographic characteristics (e.g., age, race, ethnicity, marital status and number of previous live births), the patient’s residence details (e.g., state or locality), the gestational duration of the pregnancy and the type of abortion provided.
State data on abortion can serve an important purpose as a public source of data on a common reproductive health outcome. There are longstanding concerns, however, about the completeness of the data resulting from state-mandated abortion reporting. In 2020, the last year for which comprehensive data are available from both the CDC and the Guttmacher Institute, state reports compiled by the CDC captured only about two-thirds of the abortions that were counted in a national census conducted by Guttmacher; at the state level, there is also substantial variation over time and between states in the completeness and scope of the abortion data collected.
Recent trends in abortion reporting policies
In many states, anti-abortion policymakers have seized on abortion reporting as an additional tool for restricting access. This strategy of co-opting abortion reporting to advance a political agenda has generated multiple requirements that serve no public health purpose—mandating that providers report on the reasons their patients sought abortion care, that providers reaffirm their compliance with state-mandated counseling and parental notifications, and in some cases, that they submit ultrasound images to accompany their reports.
More recently, some states have introduced even harsher reporting requirements. For example, the Attorney General of Indiana has pushed for public disclosure of individual terminated pregnancy reports, arguing that this violation of confidentiality is necessary for law enforcement. This chilling move has raised alarms about patient privacy and safety, especially in smaller communities where an individual’s identity could potentially be deduced. Other states have followed similar paths. Oklahoma’s laws mandate the collection of extensive personal information from patients, which can compromise their privacy and safety. Louisiana requires providers to report detailed information about the abortion procedures they offer, which can be used to target and harass them.
In a countervailing trend, several states have relaxed their reporting requirements to be less burdensome or have stopped requiring abortion reporting altogether. In February 2024, Michigan abolished its mandatory abortion reporting system, which had been in place since 1979. This move was part of a broader effort to protect reproductive rights following the approval of a 2022 ballot measure that amended the state constitution to guarantee the right to reproductive freedom. In 2023, Minnesota repealed several abortion reporting requirements, including those that mandated reporting on the patient’s reason for seeking an abortion, method of payment, and other extraneous data. Meanwhile, Illinois has reformed its abortion data collection methods to better protect patient privacy, including collecting only aggregate data from providers and limiting the amount of information collected.
Weighing the risks
The deteriorating abortion access landscape and the specter of more punitive and intrusive state and federal abortion regulations should factor into any assessment of state-mandated abortion reporting. In the current political and legal environment, the potential benefits of reporting requirements are often outweighed by serious risks. These include:
Abortion exceptionalism
It is exceptionally rare for medical procedures to be subject to mandated reporting in state or federal systems. Births and deaths are tracked by vital statistics systems for specific demographic and governance purposes (and to meet federal requirements for the issuance of birth and death certificates); infectious diseases are in some cases subject to mandatory reporting to aid in contact tracing and to avert epidemics. The provision of abortion care does not fit into either of these categories. Notably, miscarriage and the treatment of miscarriage (which typically involves medical interventions identical to those used in abortion care) is not commonly subject to state reporting requirements outside of those needed to register a fetal death certificate at certain points in pregnancy. The premise that abortion care specifically and uniquely requires state surveillance both increases abortion stigma and perpetuates the idea that abortion should stand apart from other health care. It also contributes to longstanding patterns of exceptionalizing abortion in state and federal law, including medically unnecessary regulations that mandate waiting periods and biased counseling prior to abortion provision.
Criminalization of patients and providers
Mandated reporting can increase the risk of pregnancy criminalization—in which the criminal legal system is used to punish or penalize pregnant people deemed insufficiently protective of their pregnancies or suspected of seeking an abortion. In such an environment, abortion reporting requirements can contribute to a culture of surveillance that puts patients and providers at risk of being harmed by the legal system….
Undermining the patient–provider relationship
Mandated reporting frequently requires providers to question abortion patients on topics that don’t serve a broader public health purpose, are not relevant to providing high-quality care and may stigmatize abortion. For example, requirements that providers question patients about their reasons for terminating a pregnancy inject the government into the patient–provider relationship and imply that patients need to justify accessing a standard form of reproductive care.
[The analysis continues at length, looking at repealing or reforming state-mandated abortion reporting, and then developing a new approach. It closes with this:
The right policy now and in the future
Ending state-mandated abortion reporting—or at a minimum significantly overhauling current requirements to ensure patient and provider safety—is a concrete way to adapt policies to meet the needs of the current moment. Abortion rights and access face unprecedented threats from an anti-abortion trifecta in Washington, DC and from anti-abortion state governments and activists who seek to restrict reproductive autonomy even in states where abortion is broadly legal.
However, the abolition of government-mandated abortion reporting is not just the right policy when abortion access faces imminent threats; it is also the best approach in contexts where abortion rights appear to be more secure. As outlined in this analysis, state-mandated abortion reporting systems are harmful in themselves—for reasons ranging from abortion exceptionalism to the administrative burdens they generate—and that is reason enough to repeal these policies.
Acknowledgements
To ensure this analysis reflected a range of perspectives, the Guttmacher Institute implemented a stakeholder engagement process that included more than 50 national and state policy advocates, reproductive justice advocates, abortion providers, public health officials, researchers, abortion funds and legal experts. While it was not possible to connect with everyone in the field with expertise on this topic, the authors feel confident that we reached a diverse and broad cross section of experts whose opinions and responses are reflective of overall movement trends. We are grateful to these stakeholders for their generous insights and ideas. Ultimately though, this position paper reflects Guttmacher’s analysis of the policy and legal landscape and our commitment to centering the safety and privacy of abortion patients and providers. The authors are speaking as the Guttmacher Institute and not for other stakeholders. (This analysis was edited by Ian Lague.)
SOURCE: Guttmacher Institute, by Kelly Baeden, Joerg Dreweke, March 2025