Three years after Roe v. Wade was overturned and more than a dozen states enacted near-total abortion bans, the number of abortions in America has risen — driven largely by telehealth and mail-order pills. 

Women living in states like Texas, Mississippi, and Missouri — where abortion is almost entirely banned — often travel to states like Illinois, New Mexico, or Colorado, where abortion remains legal and accessible. 

While it’s currently legal to cross state lines for abortion care, some lawmakers in restrictive states have proposed measures to penalize those who help others travel for the procedure, sparking legal battles over the right to interstate travel and medical privacy.

“While the pro-life movement has been celebrating the overturning of Roe, Rome has been burning. We didn’t foresee the storm cloud on the horizon. We were unprepared for what was coming,” the president, Mark Harrington, of an anti-abortion organization, Created Equal, tells The New York Sun. “High demand for abortion continues, and with the increased use of the abortion pill, it’s easier than ever for women to commit abortions.”

According to a new report by the Society of Family Planning’s WeCount project, which supports abortion rights, roughly 1.1 million abortions took place last year — an average of nearly 95,000 per month. A significant portion of that total, estimated to be one in four, was conducted through telemedicine, via mail-in prescriptions. Before the overturn, the United States averaged around 80,000 abortions per month. 

The senior legislative counsel on the state policy team at the Center for Reproductive Rights, Lizzy Hinkley, tells the Sun that the uptick “shows what we’ve always known.”

“Banning abortion does not stop women from having abortions; it just forces them to seek abortions outside the formal healthcare system,” she said. “We saw this before Roe v. Wade was decided in 1973, and we’re seeing it again now — once someone decides they need an abortion, they will go to great lengths to get one because they know it is the right decision for them.”

How It Works 

Typically, conservative states attempt to restrict abortion within their borders. In contrast, progressive states actively protect providers who prescribe abortion drugs to women living under those bans. So, how does one gain access to the medication even if a state prohibits the procedure?

The process is relatively straightforward: a woman completes an online form or virtual consult. If eligible, a provider in another state then prescribes mifepristone and misoprostol. The pills arrive by mail in a few days, and the pregnancy termination happens at home — without in-person medical oversight.

Approved by the Federal Drug Administration 25 years ago for use in early pregnancy, mifepristone was once limited to clinics. During the Covid-19 pandemic, however, the Biden administration eased those rules — later making them permanent — allowing telehealth prescriptions and pharmacy sales. Now, major chains like CVS and Walgreens dispense the pills in states where it’s legal.

A Legal Tug-of-War Between States 

Even as red states attempt to restrict access, however, blue states are erecting legal barricades in defense of telehealth abortion. California, Massachusetts, New York, and Washington have passed so-called shield laws that prevent state officials from cooperating with investigations into abortion providers who operate within their borders — even when those providers serve women in states where abortion is banned. 

These laws often include protections against extradition, prosecution, and even civil lawsuits.

“Shield laws in pro-abortion states, which protect abortionists from legal liability for breaking the law in pro-life states, are the bastion of abortion access for providers, and the reason why pro-life states struggle to end the practice despite having strong life-protecting laws,” the chief legal officer and general counsel, Steve Aden, for an anti-abortion organization, Americans United For Life, tells the Sun. 

He added: “Recent actions taken by states like Arkansas, Texas, and Louisiana to enforce their laws by bringing legal action against abortionists in-state can only go so far until the federal courts, and ultimately the Supreme Court, make it clear that pro-abortion states are constitutionally required to give ‘full faith and credit’ to the laws of pro-life states.”

Mr. Aden underscored that “the promise of Dobbs,” in pushing the matter back into the hands of states to decide, “can only be fully realized when pro-life state laws are respected and reinforced.”  

Ms. Daniel agreed that this legislation “effectively creates ‘safe harbor’ states for abortion on demand, no questions asked, undermining both state sovereignty and the rule of law.”

Not everyone shares that view. 

“Generally, most shield laws aim to ensure that patients in states where abortion is banned can get care from providers where it is legal while protecting both providers and patients from legal consequences,” the national director of abortion service delivery at Planned Parenthood Federation of America, Jen Castle, tells the Sun. 

“The patchwork legal landscape created by state abortion bans has led to deeply unequal access across the country. Providers in states where abortion is legal are faced with absorbing a growing share of all abortion patients, both in person and via telehealth where possible, with damaging effects for the entire health care system.”

Meanwhile, brick-and-mortar abortion clinics are closing their doors — not only in states with bans but also in states where abortion remains legal. Faced with fewer patients seeking surgical abortions, clinics in Illinois, New York, and California have cut hours — or closed altogether. For providers, telehealth is more cost-effective, requires fewer staff, and incurs lower overhead costs. 

Yet critics warn that self-managed abortions conducted without medical supervision can endanger women, particularly if complications arise or gestational age is miscalculated.

“Under Biden, the FDA recklessly loosened long-standing safety standards that once required in-person doctor visits and follow-up care. Now, dangerous abortion drugs are being shipped via mail, without proper screening for gestational age, ectopic pregnancy, or coercion, putting women at serious risk,” the director of legal affairs and policy council, Katie Glenn Daniel, at Susan B. Anthony Pro-Life America tells the Sun. 

“This was never about improving women’s access to health care; it’s about expanding abortion at any cost, even if it endangers women and girls.”

An ectopic pregnancy, where the embryo implants outside the uterus — often in a fallopian tube — can be life-threatening if untreated. 

Ms. Hinkley, however, argued that “there is no question about the safety of abortion pills.”

“Mifepristone has been used safely and effectively for over 20 years for both abortion and miscarriage care, which is why the FDA expanded access to it via telemedicine,” she continued. The pills “are a critical lifeline for women in the post-Roe landscape. For the many people who can’t afford to travel to another state, telemedicine is the only way left for them to get abortion care.”

The United States Food and Drug Administration states that mifepristone — typically used with misoprostol — terminates early pregnancies safely more than 97 percent of the time. Data show that among about 5.9 million medication abortions through December 2022, 32 deaths were reported — about 0.54 per 100,000 — with 0.4 percent of users experiencing major complications requiring hospitalization. 

Where the Courts — and the Culture — Are Headed

The future of telehealth abortion in the eyes of the courts is uncertain amid ongoing state and federal legal conflicts.

In June 2024, the United States Supreme Court upheld access to mifepristone, a key medication for telehealth abortions, rejecting challenges to its availability. Abortion-rights advocates view abortion’s future in America as driven by technology and access, not just laws. Their focus is on expanding telehealth and mail-order pills to protect reproductive rights everywhere while fighting restrictions and pushing for broader healthcare protections.

This national policy, however, now directly conflicts with new state laws passed after Dobbs. Republican-led states such as Texas, Louisiana, and Idaho have argued that permitting out-of-state doctors to prescribe and mail abortion drugs violates their sovereignty. 

In one high-profile case, Texas’s attorney general, Ken Paxton, filed a lawsuit against a New York-based doctor who prescribed pills to Texas residents. In February, a Texas judge entered a default judgment ordering the New York physician, Margaret Carpenter, to pay at least $100,000 and cease prescribing abortion pills to Texas residents, though New York authorities have refused to enforce the judgment under their shield law.

With Republicans now in control of both the White House and Congress, some in the anti-abortion movement see an opportunity to roll back the widespread availability of medication abortion. 

Project 2025, a conservative policy plan, aims to ban abortion pills by using an old law called the Comstock Act to stop them from being mailed. This 19th-century anti-obscenity law prohibits mailing “anything designed, adapted, or intended for producing abortion.” 

It also calls for taking away the Food and Drug Administration’s approval of mifepristone and shutting down the federal task force that supports reproductive health.

Others underscore that it will take more than legislation to halt abortion in America. 

Mr. Harrington emphasized that while battling legislation can feel like an uphill fight, the true focus of their movement should “get back to the business of changing culture.”

“We need to make abortion unthinkable to make it unlawful,” he added. “If Americans want abortion, the demand will be matched by the supply one way or another. That said, the law is a teacher, so we cannot give up on our legal and political attempts to protect unborn children. But we understand that politics is downstream from culture.”