The country runs a national count for cancer, for overdose deaths, and for maternal deaths. Every provider is required by law to report. Abortion is the exception — the CDC's count has been voluntary since 1969, and any state can simply opt out.
System 01
Cancer
0%
Mandatory
System 02
Overdose deaths
0%
Mandatory
System 03
Maternal deaths
0%
Mandatory
System 04
Abortion
0%
Voluntary
Bars show roughly how much of the national picture each system captures. The three mandatory systems reach near-complete coverage; the CDC's abortion count misses the states that decline to report — roughly 1 in 4 U.S. abortions.
Side by side
Four outcomes, four reporting systems
Cancer, overdose, and maternal deaths are all captured through reporting that providers are legally required to file. Abortion is the only one where a state's participation is a choice.
Outcome
Required to report?
National total possible?
How it's collected
Cancer
NPCR + SEER · since 1992
Yes — by lawReportable disease in every state.
YesNear-universal population coverage.
State cancer registries; hospitals, labs and physicians must file every case.
Overdose deaths
NVSS + SUDORS
Yes — by lawEvery death must be certified.
YesProvisional counts within months.
Death certificates feed the national vital-statistics system; drug detail added by state reviews.
Maternal deaths
PMSS + MMRCs · since 1986
Yes — by lawCaptured on the death record.
YesAll states included.
Vital records with a pregnancy checkbox; state review committees confirm each case.
Abortion
CDC Abortion Surveillance · since 1969
No — voluntaryNo state is required to send data to CDC.
NoCDC states it cannot report a U.S. total.
State health agencies choose whether to forward their aggregate counts to the CDC.
The reporting areas
Who sits out the count
Each year the CDC asks all 50 states plus D.C. (and New York City separately) to send their abortion data. For the most recent collection, four declined. Hover or tap any square.
Reports to CDCDoes not report
Hover a square to see its status.
Non-reporting areas for the 2022 collection: California, Maryland, New Hampshire and New Jersey. New York City reports as a separate area. Because participation is voluntary, the set of missing states can change from year to year — a national total cannot be assembled from the states that happen to opt in.
The size of the blind spot
What "optional" costs the count
~0%
of U.S. abortions happen in the four states that don't report to the CDC — invisible to the federal count.
Two counts of the same year
Guttmacher (independent survey)100%
CDC (voluntary reports)≈67%
The CDC's abortion total runs about a third below Guttmacher's independent estimate for the same year (2020) — and roughly 40% below Guttmacher's latest figure (2023) — largely because the biggest non-reporting states, especially California, are missing from it.
The fix
One national standard — the same one cancer already has.
The country already knows how to run a complete, credible health count. It does it for cancer, for overdose, for maternal death. Applying that same standard to abortion means one thing: every state reports the same de-identified aggregate numbers, on the same schedule, so the national picture is actually national.
01
Aggregate, not individual
Counts and characteristics — totals, gestational age, method — the way cancer and mortality data already work. No patient is named or tracked.
02
Uniform definitions
One shared case definition so states can't blur abortions into other categories, and the numbers are comparable across the map.
03
Every reporting area in
Participation set by a single national rule rather than left to each state — the feature that makes the other three counts complete.
To be exact about the ask: this is statistical reporting — de-identified aggregate counts from state health agencies, exactly the data the CDC's system already handles. It is deliberately not a registry of individuals. Naming that line up front is both the honest version of the argument and the strongest one: it asks only for the completeness that cancer, overdose, and maternal-death data already have.