More than 50 abortion clinics across the country have closed or stopped offering the procedure since a heavy wave of legislative attacks on providers began in 2010, according to The Huffington Post’s nationwide survey of state health departments, abortion clinics and local abortion-focused advocacy groups.

At least 54 abortion providers across 27 states have shut down or ended their abortion services in the past three years, and several more clinics are only still open because judges have temporarily blocked legislation that would make it difficult for them to continue to operate. Nebraska and Massachusetts have each added one clinic since 2010, and the other 21 states and the District of Columbia, most of which have not passed new anti-abortion laws since 2010, were unable to accurately count their clinics because their health departments do not license abortion providers separately from other kinds of medical providers. The Huffington Post’s tally did not include hospitals that provide abortions.

“This kind of change is incredibly dramatic,” said Elizabeth Nash, state issues manager at the Guttmacher Institute, a reproductive health research organization. “What we’ve been seeing since 1982 was a slow decline, but this kind of change … [is] so different from what’s happened in the past.”