When the U.S. Supreme Court overturned Roe v. Wade in 2022, many predicted abortion access would collapse. Instead, something unexpected happened: abortions have increased every year since, and nearly one in three are now obtained through telehealth.
By December, 29% of all abortions in the United States were being accessed via telemedicine, according to the Society of Family Planning's latest #WeCount report. For providers who help patients navigate state abortion bans, these numbers reflect something profound about human ingenuity and persistence.
"We like to say the genie is out of the bottle," said Elisa Wells, co-founder and access director at Plan C, which provides information about accessing abortion pills online. "Now that people know that they can get safe, fast, effective, affordable care through the mail, there's no going back."
Legal battles continue to rage. Louisiana has led a coalition of 21 states in suing to block the shipment of mifepristone across their borders, arguing that the FDA overstepped when it allowed the pill to be prescribed without an in-person visit. The Supreme Court recently restored telehealth access to mifepristone while a lower court hears the case, and abortion opponents are pushing the Trump administration to further restrict the pills' availability.
But telehealth experts say they're ready. If mifepristone faces new restrictions, many providers will immediately pivot to misoprostol alone. The drug is FDA-approved to treat ulcers and widely used off-label for miscarriages, labor induction, and ending pregnancies. Because the FDA doesn't typically regulate off-label use, states would face significant hurdles to banning it.
"There would have to be some finding that it is not safe or effective for ulcer treatment, something that there's no argument anyone could possibly show," said David Cohen, a law professor at Drexel University and national expert on abortion law.
Some organizations are already operating one step ahead. Carafem, a telehealth abortion provider, switched exclusively to misoprostol back in 2021 when the Supreme Court temporarily reinstated in-person dispensing requirements. The company "has been prepared for this possibility ever since," said Melissa Grant, co-founder and chief operating officer. Other groups direct patients to medications sourced from outside the U.S. through organizations like Aid Access and online pharmacies in India.
Cohen remains skeptical that even aggressive enforcement could stop the flow of pills. "We've had the 'War on Drugs' for what, half a century, maybe longer?" he noted. "And everyone, if they wanted, could find illegal drugs within minutes, and have it probably delivered to their doorstep within hours."
For Wells, the numbers tell the story: access is growing, not shrinking. "The fact that we're here talking about 29% of all abortions happening via telehealth is remarkable," she said. "People have found a way."