Mail-Order Abortion Access Transcends State Lines

mail order abortion pill

Verywell Health / Daniel Fishel

Key Takeaways

  • State laws limiting abortion rights and clinic closures nationwide have made it increasingly difficult to access abortion services in recent years.
  • Receiving medication abortion via telehealth and undergoing the abortion process at home is safe and effective.
  • With the possibility of further abortion rights restrictions, demand for mail-order abortion services may become even greater.

The right to abortion care is being curtailed nationwide, and the reversal of Roe v. Wade is expected to restrict abortion services further. Telemedicine providers have played a key role in offering abortion care online, particularly in states with limited or banned abortions. And mail-order abortion pills could become even more prominent in the coming months.

Through telehealth services, people seeking to terminate a pregnancy can get a prescription for the abortion pill­­­­ virtually and place an order. Several companies cropped up in early 2022 after the Food and Drug Administration (FDA) announced that it would permanently allow abortion pills to be available via mail order.

However, this access is curtailed by some state laws. Thirty-two states require licensed physicians to provide abortion pills, although research shows that nurse practitioners, physician assistants, or nurse-midwives can also dispense them safely.

What Is the Abortion Pill?

What is commonly called the abortion pill is actually a regimen of two different medications. The first, called mifepristone, is an oral drug that blocks progesterone—a hormone essential to the development of a pregnancy. The second, called misoprostol, is taken soon after or up to 48 hours later. Misoprostol causes the uterus to cramp and bleed, clearing the pregnancy as might happen during a miscarriage.

In 21 states, telehealth is explicitly outlawed or the prescribing physician must be physically present when the pills are taken, effectively banning abortion via telemedicine.

States with “trigger laws” are likely to prohibit most forms of abortion now that the Court has overturned Roe v. Wade. But even with these limitations, telehealth services may help improve access to abortion care and ease the burden on clinics in states where access to in-person clinical care is still permitted.

“The telehealth model allows us to support patients who are eligible to receive abortion care from home to do so quickly and safely. We hope that this will support general capacity issues, helping to reserve in-person visits for patients who require or prefer in-person care,” Cindy Adam, MS, CEO of the sexual and reproductive health clinic Choix, told Verywell in an email. “We see telehealth as part of a greater effort to expand and improve access to abortion care during a time where restrictions are ever-growing.”

Medication Abortion via Telehealth Is Safe and Effective

The majority of U.S. abortions are now induced with medication rather than done surgically, according to preliminary data from the Guttmacher Institute.

Medication abortion may be performed in the first 10 weeks of pregnancy, though health providers may prescribe it “off-label” after that time period for some patients. When taken in the first nine weeks of pregnancy, the abortion pill is 99.6% effective at terminating pregnancies. And using telehealth for medical abortion can be as safe as receiving the service in-person—one study shows fewer than 0.3% of medical abortion recipients experienced adverse events.

“One of the greatest benefits of telemedicine abortion care is that eligible patients can receive all of their care safely from home with an evidenced-based clinical evaluation and ongoing clinical support,” Adam said. “Most patients are able to receive care without requiring a physical exam, ultrasound, or blood work.”

Adam said medication abortion isn’t necessarily more “self-managed.” When receiving abortion care at a brick-and-mortar abortion clinic, she added, the patient typically takes the mifepristone pill at the clinic. But the actual abortion process won’t begin until after taking the misoprostol pill, which most patients do at home.

To support patients, many telemedicine abortion service providers offer optional consultation, follow-up calls, and support hotlines.

Undergoing the abortion process at home can minimize certain burdens, like the cost of traveling to clinics and finding childcare. Plus, undergoing the process at home can minimize how much time a person needs to spend away from work or other responsibilities, traveling to clinics, and managing appointments. 

Plus, telemedicine may cost less out-of-pocket than in-person medical and surgical abortion services, depending on the provider and insurance coverage. For instance, Hey Jane offers medical abortion by mail for $249, compared to an average cost of $737 from some other medical abortion providers in California.

Increasing Demand for Mail Order Abortion Pills

In some states, like Colorado and Illinois, brick-and-mortar clinics have already seen an increase in requests for appointments and longer wait times, Adam said. In six states, there is only one abortion clinic left in the state, according to the American Civil Liberties Union. Nearly four in 10 women live in a county without an in-person or virtual abortion provider.

Hey Jane operates in six states, which together account for more than half the abortion services nationwide. Kiki Freedman, co-founder and CEO of Hey Jane, said these places are seeing an influx of out-of-staters seeking abortion care from both in-person and virtual providers.

“Already, Hey Jane has seen an increase in patients reporting that they’re coming to Hey Jane because of longer-than-expected appointment wait times, which suggests to us that bans in places like Texas are already having a ripple effect,” Freedman said in a statement to Verywell. “Losing Roe would only magnify that.”

In some cases, people are turning to overseas providers for the pills. The non-profit Aid Access was founded by a physician in the Netherlands to send mifepristone and misoprostol pills to people in the U.S. regardless of state laws. In states with heavier abortion restrictions, European physicians can write a prescription and the pills are shipped from a pharmacy in India.

Demand for Virtual Abortion Services Grows

Traffic from online abortion sites Plan C and Aid Access skyrocketed after the Supreme Court draft document leaked in May, Politico reported. This included many queries about getting abortion pills before becoming pregnant.

“It is outrageous that patients should have to order abortion pills for ‘what if,’ scenarios,” Anjani Kolahi, MD, a family medicine physician in California and fellow with Physicians for Reproductive Health, told Verywell in an email. “Family planning—deciding if and when to parent—is part of healthcare.”

Keeping a stash of condoms, birth control, and a supply of emergency contraception on hand may provide peace of mind for people who can become pregnant and may lack access to reproductive health care, Kolahi said.

Mifepristone has a five-year shelf life, and misoprostol can be stored for two years. Daniel Grossman, MD, director of Advancing New Standards in Reproductive Health at University of California, San Francisco, suggested in a tweet that clinicians should consider providing a dose of abortion medication just so people can have it on hand.

But doing so may come with some risks.

“When it comes to keeping a supply of abortion pills on hand, it is important to understand there are risks associated if abortion is criminalized in a person’s state and a person may be prosecuted for taking abortion pills,” Kolahi said. “We can expect some level of policing and surveillance, and patients may become fearful of seeking reassurance or advisement in a healthcare setting if needed after taking medications.”

As telehealth abortion services expand their reach by accepting more forms of insurance and improving translation services, people may increasingly rely on virtual providers for their reproductive health needs.

“As understanding about abortion care via telehealth grows—and as access continues to get more restricted—we anticipate even greater influxes of patient care requests,” Adam said.

What This Means For You

You can access abortion services via telehealth from various companies and organizations—Plan C, Hey Jane, Choix, Carafem, and Aid Access are a few of your options.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Weitz TA, Taylor D, Desai S, et al. Safety of aspiration abortion performed by nurse practitioners, certified nurse midwives, and physician assistants under a California legal waiverAm J Public Health. 2013;103(3):454-461. doi:10.2105/AJPH.2012.301159

  2. Kaiser Family Foundation. The intersection of state and federal policies on access to medication abortion via telehealth.

  3. Ireland LD, Gatter M, Chen AY. Medical compared with surgical abortion for effective pregnancy termination in the first trimesterObstet Gynecol. 2015;126(1):22-28. doi:10.1097/AOG.0000000000000910

  4. Grossman D, Grindlay K. Safety of medical abortion provided through telemedicine compared with in personObstet Gynecol. 2017;130(4):778-782. doi:10.1097/AOG.0000000000002212

  5. Endler M, Lavelanet A, Cleeve A, Ganatra B, Gomperts R, Gemzell-Danielsson K. Telemedicine for medical abortion: a systematic review. BJOG. 2019;126(9):1094-1102. doi:10.1111/1471-0528.15684

By Claire Bugos
Claire Bugos is a health and science reporter and writer and a 2020 National Association of Science Writers travel fellow.