In a decade in which dozens of abortion clinics were shut down by medically unnecessary state laws, around 14 states—mostly in the Northeast and West—have seen an increase in clinics, according to data from the Guttmacher Institute.

While the latest Guttmacher data is from 2017, other research, including a recent Abortion Care Network report focusing on independent clinics, indicates that clinics continue to close at an alarming rate. These closures include abortion clinics in states with Democratic-majority legislatures, like Whole Woman’s Health in Illinois, which closed in June, the same month Gov. J.B. Pritzker (D) signed a landmark pro-choice law.

Many states passed strict regulations as Democrats lost legislative majorities throughout the decade, though they clawed back some of those majorities in 2018. Across the United States, state lawmakers passed 394 abortion restrictions between 2011 and 2017. In 2019, these increasingly took the form of near-total abortion bans, despite their unpopularity and unconstitutionality.

The Guttmacher data indicates that states where the number of clinics increased also passed fewer restrictions on abortion. Of the eight states that added more than one clinic between 2011 and 2017—Connecticut, Maine, Maryland, Massachusetts, New Jersey, New York, Vermont, and Washington—none passed a single law restricting abortion. Many of the restrictions passed in other states are targeted regulations of abortion providers (TRAP). The reduction of abortion clinics in many states demonstrates the effectiveness of TRAP laws in reducing the availability of abortion.

Perhaps unsurprisingly in a decade marked by Republican domination on the state level, one of the biggest expansions was achieved not through political means but through technology and the work of organizers. Starting in 2016, Maine Family Planning (MFP) used its telemedicine program to bring abortion to Maine health-care centers in its network that had previously been limited to providing other reproductive health services.

“Using telehealth technology to provide abortion care meant that we could offer medication abortion at an additional 17 MFP sites, many located in underserved areas,” Deirdre Fulton-McDonough, director of communications at Maine Family Planning, told Rewire.News. “Patients who would otherwise have had to drive long distances to access services, potentially having to arrange for time off work or child care, were now able to access care much closer to home. At the time, Maine was just the third state where abortion was available via telemedicine, and we are proud of how this program helped knock down barriers to access especially for low-income and rural Mainers.”

Maine’s expansion of abortion services reduced the number of women of reproductive age living in counties without an abortion clinic from 55 to 24 percent from 2014 to 2017.

Many of the states, including Maine, that saw increases in clinics passed laws codifying abortion rights and adding other protections. In 2018, Maine elected a Democratic governor, Janet Mills, ending eight years under Republican Gov. Paul LePage, an abortion rights foe. Mills signed a law in June allowing more health-care providers, such as trained nurse practitioners and physicians’ assistants, to perform abortions. Think Progress reported that the bill could increase the number of abortion clinics in Maine that provide aspiration abortion from three to as many as 18. While many Maine family planning clinics already provide medication abortions up to 11 weeks’ gestation, aspiration abortions—the most common form of surgical abortion—can be performed up to 14 weeks.

Andrea Irwin, executive director of the Mabel Wadsworth Center in Bangor, Maine, said pro-choice laws in her state meant the clinic could focus on other reproductive services, including ensuring affirming abortion and prenatal care for transgender men, transmasculine people, and other groups of pregnant people beyond cisgender women.

“We’re really fortunate to be able to look at these other aspects beyond abortion care,” she told Rewire.News.

Also in New England, Vermont’s Democratic-led legislature codified abortion rights and advanced a 2022 referendum on a pro-choice constitutional amendment. Vermont added three clinics between 2011 and 2017.

Lawmakers in New York, where the number of clinics increased by 19 from 2011 to 2017, passed the Reproductive Health Act in 2019. The law repealed criminal abortion statutes, permitted abortions after 24 weeks in some situations, and clarified that trained nurse practitioners and physicians’ assistants can provide abortion services.

After Massachusetts repealed an outdated abortion ban in 2018, legislators introduced a variety of pro-choice laws in 2019, but the bills are still pending. Massachusetts added seven abortion clinics between 2011 and 2017.

On the opposite coast, Oregon Democrats passed the Reproductive Health Equity Act in 2017, a law that not only codified Roe v. Wade but required insurers to fully cover reproductive health care and barred discrimination against transgender and gender-nonconforming people in reproductive health coverage. The state was one of the first to defend the right to abortion against President Donald Trump, who has nominated more than 150 federal judges since taking office. From 2011 to 2017, Oregon added a single clinic.

Several of the states where clinics increased also added state funding for abortion services, required private insurers to cover abortion, or both. Maine, for example, passed a law in June that required all insurers cover abortion and provided state dollars to fund abortions through Maine’s Medicaid program. And in New Jersey, which added 17 abortion clinics between 2011 and 2017, Democratic lawmakers restored funding for Planned Parenthood in 2018.

California, which added one clinic during that time frame, announced in 2014 that insurers cannot refuse to cover abortion. Only 3 percent of California women of reproductive age live in a county without a clinic.