Most abortions in the United States are medication abortions, and telehealth has become an increasingly common way to access abortion pills — especially since the US Supreme Court’s Dobbs decision revoked the federal right to an abortion.
In the last few months of 2023, nearly 1 in 5 abortions nationwide — about 17,000 each month — were medication abortions in which the pills were mailed to a patient after a remote consultation with a clinician, according to a new report from #WeCount, a research project led by the Society of Family Planning. When #WeCount started collecting data from abortion providers in April 2022, about 4% of all abortions were medication abortions provided through telehealth.
Medication abortion is a method by which someone ends their pregnancy by taking two drugs — mifepristone and misoprostol — rather than having a surgical procedure. The US Food and Drug Administration approved the drugs for abortion use more than two decades ago, and the regimen is approved for use up to 10 weeks gestation.
During the Covid-19 pandemic, the FDA provided regulatory flexibilities that allowed for broader access to medication abortions through telehealth. Earlier models often required patients to visit a clinic for ultrasounds or other in-person tests, but options for fully remote screening and use of mail-order pharmacies became more widely available in 2021.
Telehealth abortions have surged in recent months as newer policies offered protection for people in states with abortion bans or severely limited to access care, the new report shows. Over the past year, five states where abortion is legal — Colorado, Massachusetts, New York, Washington and Vermont — have enacted shield laws that allow providers in those states to prescribe medication abortion drugs via telehealth to people living in states with bans or restrictions.
More than 40,000 people accessed telehealth abortions under shield laws in the second half of 2023, according to the new report. And by December, nearly a 10th of all abortions in the US — about 8,000 a month — were telehealth abortions provided under shield laws.
Research has long found that medication abortion is safe and effective, and recent studies have shown that to be true even when the patient gets the medicine through a telehealth appointment.
In addition to further supporting evidence that medication abortion provided through the mail is highly effective and safe, a study published in the journal JAMA Internal Medicine on Monday found the experience to be timely and broadly acceptable among patients.
More than 90% of people who had abortion medication delivered through the mail said they were satisfied with the experience. Nearly all said they maintained their confidentiality through the process, and more than 85% said they received the medication within three days. The medication abortion was reported to be medically successful in about 98% of the cases, and the rare adverse events that did occur — less than 5% of people sought medical care — were not related to the mail-order dispensing, the study found.
Recent data from Guttmacher Institute, a research and policy organization focused on sexual and reproductive health that supports abortion rights, shows that there were 1 million abortions in the US in 2023, the highest rate in more than a decade and a 10% jump from 2020.
The new #WeCount report supports these findings and shows that abortions are increasing in the US, even when those provided under shield laws are excluded from the trends.
“Even as the total national number of abortions nationally has increased, we can’t lose sight of the fact that access to in-person abortion care has virtually disappeared in states where abortion is banned,” Dr. Alison Norris, co-chair of the #WeCount project and professor at The Ohio State University’s College of Public Health, said in a statement. “The loss of clinic-based care — which makes up more than 80% of abortion care — is a devastating loss to access for people across wide swaths of the country.”
In the year and a half after the Dobbs decision, there would have been about 145,000 more in-person abortions if it had not been banned in 14 states, according to estimates from the #WeCount report.
But medication abortion, including telehealth abortion, has become a more common option than ever.
“It’s pretty incredible how many barriers get removed from the process” with telehealth abortion, said Dr. Ushma Upadhyay, co-chair of the #WeCount project and professor at the University of California, San Francisco’s Advancing New Standards in Reproductive Health. “It’s not just the ease and access, but telehealth is able to deliver abortion at a much lower cost.”
It’s filled some of the gaps created by abortion bans, but building broader awareness of and trust in telehealth abortion remains a challenge, she said. But at the end of 2023, nine states where abortion remained legal still had restricted telehealth abortions in some way — requiring an in-person ultrasound or counseling before the procedure, for example.
Telehealth abortion is “especially important for individuals living outside metropolitan areas, in low-income communities, or where high-quality reproductive and maternity care services are lacking because of legislative restrictions,” a group of family medicine physicians wrote in an editorial that was published in JAMA Internal Medicine on Monday. Primary care physicians are an “untapped resource” that can help abortion access through clinics or telehealth, they wrote.
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But legal threats challenge the future potential of telehealth abortion, too. Mail service is managed by the federal government, and a change to the administration could threaten mail-order delivery of abortion pills and patients who receive them, Upadhyay said.
And in March, the US Supreme Court heard arguments in a case that could severely limit access to mifepristone, the primary drug used for medication abortions.
“Access to medication abortion through telehealth continues to play an ever-increasing role in abortion care nationwide — even as the Supreme Court weighs the fate of telehealth abortion care,” Upadhyay said in a statement. “The need for abortion care across the country demands that providers, advocates, and lawmakers continue to come together to innovate new strategies to help people access abortion care.”
CNN’s Jen Christensen contributed to this report.
