Despite bans, the number of abortions in the US has doubled in recent years.
In 2025, nearly twice as many abortions were performed in the United States as in 2021—the year before the Supreme Court overturned Roe v. Wade with its landmark Dobbs decision on June 24, 2022. By December 2025, 29% of all abortions were performed via telemedicine, writes NPR.
Abortion Rights: A History of the Issue
In 1973, the US Supreme Court, in Roe v. Wade, recognized that the Constitution protects a woman's right to an abortion. The Court then derived this right from the more general right to privacy. As a result, at the federal level, it was established that states cannot completely ban abortion, at least in the early stages of pregnancy.
The situation changed radically on June 24, 2022, when the Supreme Court ruled in Dobbs v. Jackson Women's Health Organization, the only clinic in Mississippi that performed abortions. The ruling was based on a state law that prohibited abortions after 15 weeks of pregnancy, a move that contradicted previous practice based on the Roe case.
On the subject: Louisiana seeks extradition of California doctor who sent abortion pills to patient
In this decision, the Court explicitly stated that the Constitution does not guarantee a right to abortion. In doing so, it overturned the legal position established in Roe v. Wade. The Court thus again delegated the power to regulate abortion to the states.
Following this, a number of regions almost completely banned induced abortion. Other states, on the contrary, enshrined abortion rights at their level and began providing such services more actively.
But the decision had another consequence: mailing abortion pills has become a widespread practice, and opponents of induced abortion may simply not be able to stop it.
Doctor Foster's Backup Plan
It was the first weekend of May. A federal appeals court had just ruled that mailing mifepristone, the drug used in the most widely used medical abortion method in the United States, was illegal.
Angel Foster, a reproductive health specialist, leads the Massachusetts Medication Abortion Access Project, which sends abortion pills to about 3,500 patients each month across the country, including in states where abortion is illegal.
She offered patients three options: they could get their money back, they could wait to see if the legal situation changed, or she could send only misoprostol, the second drug already used in most medical abortions.
Mifepristone and misoprostol, when combined, are considered the clinical "gold standard" for medical abortion. Misoprostol can also be used alone to induce an abortion, but, as Foster cautioned, some studies show that this is less effective. Furthermore, the process can take longer and be more difficult, with more side effects, including nausea and vomiting.
However, the overwhelming majority of patients responded the same way: just send it.
"They didn't care," Foster said. "They said, 'The main thing is that it comes as quickly as possible.'"
Abortions surge after Supreme Court ruling
Two important facts are often missed in the public perception of the abortion debate.
First, in 2025, there were almost twice as many abortions in the United States as in 2021—that is, the year before the Supreme Court overturned Roe v. Wade with its landmark Dobbs decision on June 24, 2022. These data are presented in the Society of Family Planning's latest #WeCount report. By December 2025, 29% of all abortions were performed via telemedicine.
Second, after the Dobbs decision, the mailing of abortion pills became widespread.
States where abortion is illegal are waging large-scale legal battles to try to cut off mifepristone supplies to their territories.
A temporary pause in May was part of a lawsuit filed by Louisiana; the U.S. Supreme Court decided to restore access to mifepristone via telemedicine while the case is heard in a lower court.
Meanwhile, abortion opponents continue to press the Trump administration to tighten access to these drugs—either through safety reviews by the Food and Drug Administration (FDA) or through more stringent measures.
There is no turning back
Many telemedicine providers who help patients obtain abortions don't have any particular concerns.
"We're saying the genie is out of the bottle," said Eliza Wells, co-founder of Plan C, an organization that provides information on how to get abortion pills online.
"Now that people know they can get safe, fast, effective and affordable care through the mail, there's no going back," she concluded.
If access to mifepristone is restricted, many telemedicine services will immediately switch to misoprostol-only regimens, service providers say.
Misoprostol is FDA-approved for the treatment of ulcers and is also widely used off-label to induce labor and terminate pregnancies.
Even if individual states try to ban misoprostol, the agency itself typically doesn't regulate off-label use of the drug, explains Drexel University law professor and abortion law expert David Cohen.
"It would have to be proven that it was unsafe or ineffective for treating ulcers, and no one could do that," he assured.
Some telemedicine companies already resorted to this option in 2021, when the Supreme Court temporarily reinstated the requirement that mifepristone be dispensed only in person with a doctor.
Carafem, a telemedicine abortion provider, switched to misoprostol alone at the time and is prepared for that scenario, said Melissa Grant, co-founder and COO.
Using a global supply chain
Other organizations are already referring patients to mifepristone providers outside the US, through groups like Aid Access and through online pharmacies in places like India.
Cohen believes that even if the Trump administration tries to enforce the Comstock Act (an 1873 law prohibiting the mailing of obscene materials and anything intended to facilitate abortion), it will be extremely difficult to stop the flow of pills.
"We've been fighting a war on drugs for half a century, maybe longer," he stated. "And anyone can find illegal substances, even have them delivered to their door within hours."
Anti-abortionists do not approve of "chemical" termination of pregnancy.
Project 2025, a plan prepared by the conservative Heritage Foundation for a second Trump administration, calls abortion pills "the world's most serious threat to unborn children since the overturning of Roe v. Wade," and anti-abortion activists are growing increasingly vocal about the administration's handling of the issue.
"People's patience is wearing thin," said Christy Hamrick, vice president of media and policy at Students for Life of America.
Representatives of the group recently met with officials from the U.S. Department of Justice to discuss the anti-abortion movement's priorities, particularly the implementation of the Comstock Act.
The ability to circumvent state bans through telemedicine has become a key goal of a Louisiana lawsuit now being heard in a federal appeals court.
The lawsuit, supported by 21 other states, alleges that the FDA under the Biden administration acted unlawfully by allowing mifepristone to be prescribed without an in-person doctor visit.
Without this ruling, the lawsuit says, "activists in New York and California would not have been able to mail mifepristone en masse to states with bans, such as Louisiana."
Because medical abortion is now the most common method of terminating a pregnancy in the United States, restrictions on mifepristone will also affect states where abortion is legal.
"Ending the illegal FDA-approved mifepristone mailing scheme will undoubtedly reduce the number of chemical abortions nationwide," said Gabriella McIntyre, an attorney with Alliance Defending Freedom, which co-filed the lawsuit with Louisiana.
There are signs the administration is feeling the pressure, though it is tempered by concerns that new abortion restrictions could hurt Republicans in the midterm elections this fall.
Anti-abortionists, in turn, continue to increase pressure.
In particular, the FDA's long-sought safety review of mifepristone may be moving forward. Such a review could give the administration the opportunity to restrict the drug's use. Hamrick believes it's too early to talk about this, calling the long-promised review a "unicorn."
"She seems like something mythical," Christie concluded. "I want to see her already. But everything is dragging on too long."
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Thinking about a future with misoprostol alone
If access to mifepristone is restricted and providers switch to misoprostol-only regimens, abortion opponents are prepared to emphasize the risks.
Hamrick said doctors will prescribe the drug "knowing that it has a higher failure rate and that complications are more severe because they support the online distribution of abortion pills."
Telemedicine providers agree that patients should understand what to expect with any medical abortion.
"World experience shows that by continuing to take additional doses of misoprostol, comparable efficacy rates can be achieved," Foster assured.
As a result, she concluded, she didn't have to send misoprostol-only kits to patients that May weekend because the Supreme Court stayed the lower court's decision pending the trial.
But if necessary, the pills would still reach the patients, she concluded.
The organization has recently seen an increase in demand, particularly from patients in Louisiana. Foster believes that increased media coverage is reaching people who previously didn't know they could get abortion pills online: "You might be hearing about it for the first time."
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