Abortions in the United States have nearly doubled since the Supreme Court overturned Roe v. Wade, according to the Society of Family Planning’s latest #WeCount report, which counted nearly twice as many abortions in 2025 as in 2021. The surge is attributable almost entirely to the rapid expansion of telehealth medication abortion, a method that now accounts for 29% of all abortions nationwide.
Dr. Angel Foster, a reproductive health specialist who leads the Massachusetts Medication Abortion Access Project, said her group ships abortion pills to about 3,500 patients a month across the country, including in states that have banned abortion. The project operates a telehealth model in which patients receive a prescription after an online consultation and the two-drug regimen — mifepristone followed by misoprostol — is mailed to them.
On the first weekend of May, a federal appeals court ruled that mailing mifepristone was illegal under Louisiana’s lawsuit challenging the FDA’s approval of the drug and its telehealth prescribing. Foster said she told patients they had three options: receive a refund, wait to see if the legal situation changed, or receive only misoprostol — the second drug in the regimen — which studies have suggested is less effective and can cause more side effects such as nausea and vomiting.
Foster said the vast majority of patients chose to proceed with misoprostol alone. “They didn’t care,” she said. “Their response was: ‘Whatever can get to me the fastest.’”
The Supreme Court later restored telehealth access to mifepristone while the case continues in lower courts, and Foster said her group did not ultimately have to mail misoprostol-only packages that weekend. But she said the episode illustrated the resilience of the telehealth abortion model.
“We like to say the genie is out of the bottle,” said Elisa Wells, co-founder and access director of 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.”
If mifepristone is restricted, many telehealth groups say they will immediately switch to using only misoprostol. Misoprostol is FDA-approved to treat ulcers and is widely used off-label for miscarriage management, labor induction and abortion. David Cohen, a law professor at Drexel University and an expert on abortion law, said the FDA generally does not regulate off-label use of drugs. “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,” Cohen said.
Carafem, a telehealth abortion provider, switched to misoprostol-only in 2021 when the Supreme Court temporarily reinstated an in-person dispensing requirement for mifepristone. Co-founder Melissa Grant said the company “has been prepared for this possibility ever since.” Other organizations are directing patients to mifepristone from outside the U.S. through groups such as Aid Access and online pharmacies in India.
Cohen compared the difficulty of stopping the flow of abortion pills to the decades-long “War on Drugs.” “Everyone, if they wanted, could find illegal drugs within minutes, and have it probably delivered to their doorstep within hours,” he said.
Project 2025, a conservative blueprint for the second Trump administration written by the Heritage Foundation, called abortion pills “the single greatest threat to unborn children in a post-Roe world.” Anti-abortion groups are increasingly vocal about their frustration with the administration over the pills’ availability.
“People’s patience is at an end on this point,” said Kristi Hamrick, vice president of media and policy for Students for Life of America, which recently met with the Justice Department to push for enforcement of the Comstock Act, an 1873 law that bans mailing anything intended to produce an abortion.
Louisiana’s lawsuit, backed by 21 states, argues that the FDA under former President Biden acted illegally in allowing mifepristone to be prescribed without an in-person visit. “Without that change, activists in New York and California could not blanket pro-life states like Louisiana with mifepristone by mail,” the suit states. Gabriella McIntyre, a lawyer for Alliance Defending Freedom, which partnered with Louisiana, said: “Stopping the FDA’s unlawful mail-order mifepristone scheme will surely decrease the number of chemical abortions across the country.”
There are signs the administration may be feeling political pressure, though it is tempered by concerns that further abortion restrictions could hurt Republicans in the midterm elections. The FDA’s long-promised safety evaluation of mifepristone — which abortion opponents see as a potential avenue for restricting the drug — may be moving forward, Hamrick said. She called the evaluation a “unicorn” that feels “mythical” and said it is “taking too long.”
If mifepristone is restricted and providers switch to misoprostol-only regimens, Hamrick said anti-abortion groups are ready to highlight what they see as increased risks. “We call it the new coat hanger,” she said, accusing providers of prescribing the drug “knowing it fails more often, knowing that the complications are worse, because they’re so committed to online distribution of pills for the purpose of abortion.”
Foster acknowledged that patients need to be informed about what to expect with any medication abortion, but said “our experience globally suggests that if you continue to give additional doses of misoprostol, you can get comparable success rates.”
Foster said her group has seen a recent spike in demand, especially from patients in Louisiana, and attributed it to all the media coverage. “Maybe this is the first time you’ve been exposed to that,” she said.