Mail-Order Abortions, Protected by Court for Now, Are Growing Rapidly

The Supreme Court, for now, has protected telehealth abortion, which accounts for a substantial and growing share of abortions in the United States.

One-fifth of abortions, an average of 17,000 per month, were done via telehealth from October through December, the most recent period for which data is available, according to WeCount, an organization that surveys abortion providers around the country. In telehealth abortions, pills are prescribed over video or via online forms, and do not involve an in-person visit between a clinician and patient.

The share of these abortions has grown rapidly in recent years; there were fewer than 4,000 in April 2022. The growth of mail-order abortion has been one of the main drivers of the unexpected increase in abortions nationwide since Roe v. Wade was overturned.

On Thursday, the court upheld broad access to the drug mifepristone, one of two pills used in medication abortion. It decided unanimously that anti-abortion plaintiffs lacked the right to challenge the Food and Drug Administration’s decisions about how the pills could be administered. Since 2021, the agency has allowed abortion pills to be prescribed online and mailed to patients.

Nearly half of telehealth abortions in late 2023, around 7,800 a month, were for patients in states where abortion is currently banned or substantially restricted. Shield laws in some states where abortion is legal protect clinicians who prescribe and mail pills to women in states with bans.

(The WeCount survey was conducted before the implementation of a Florida law banning abortions after six weeks of pregnancy, so it does not reflect any increases in telehealth abortions done under shield laws since that ban.)

With the legal status of mail-order abortion intact for now, it is likely that such abortions will continue to become more common. For women in states with bans, they provide a logistically easier and less expensive option than traveling to another state.

Also, increasing numbers of women in states where abortion is legal find it more affordable and convenient to order pills online. Some physical clinics now provide the option, and a number of start-up providers have emerged that specialize in this type of abortion. A smaller number of women order abortion pills online from pharmacies in other countries like India, although the share appears to have declined significantly since state shield laws were passed.

There are indications that telehealth is playing a big role in certain places, like rural states, the WeCount researchers said. In the second half of last year, it accounted for 50 percent of abortions in Wyoming, for example, compared with 7 percent in Washington, D.C.

“I think telehealth will only continue to grow as more people learn abortion can be had in this way,” said Ushma Upadhyay, a professor at the University of California, San Francisco School of Medicine and a chair of the WeCount effort. “It removes so many of the barriers.”

Katie Daniel, the state policy director for Susan B. Anthony Pro-Life America, said in a statement Thursday that it was “a sad day for all who value women’s health and unborn children’s lives, but the fight to stop dangerous mail-order abortion drugs is not over.” A growing body of evidence has found that telemedicine abortions are as safe as those offered in a physical clinic.

If the court had found for the litigants, a group of doctors who oppose abortion, the regulation of mifepristone would have reverted to the rules from 2000. At that time, patients seeking a medication abortion had to have three in-person appointments with a certified abortion provider, who had to prescribe and dispense the pills.

But the court’s ruling doesn’t necessarily settle the legal status of the pills. The justices did not consider whether the F.D.A.’s decisions to expand access to the pills were appropriate, only whether these particular plaintiffs were able to challenge them. Future cases could allow the court to revisit the question.