The future for abortion access is already here

Despite many states banning and restricting abortion, the number of abortions in the U.S. has increased since the Supreme Court overturned the constitutional right to abortion in Dobbs v. Jackson Women’s Health Organization.

In 2020 — the year before Texas became the first state to ban abortion — the number of abortions in the U.S. was 930,160. In 2023, there were 1,026,700 abortions in the U.S. — an increase of close to 100,000, or 11 percent. How do we make sense of this increase?

Abortion pills are used in approximately two-thirds of all abortions today. Telehealth abortion, where health care providers consult with patients online and mail pills to them, was first allowed by the Food and Drug Administration (FDA) in 2020 and now makes up over 20 percent of abortions in the country.

Whereas in-clinic abortion costs $568 on average, telehealth abortion is available for much less. Virtual abortion clinics offer telehealth abortions with FDA-approved pills to people of any age in all 50 states, including states that ban health care providers within their borders from offering abortion. Prices range from $150 all the way down to $95.

And international telehealth services will likely become a huge source of supply if the Comstock Act is misapplied in the U.S. to prevent the mailing of abortion pills.

Outside the medical system, grassroots activists have pioneered new avenues for abortion access, creating robust alternative delivery systems. These include community networks sharing abortion pills for free in states banning abortion. It also includes websites selling pills very inexpensively. After Dobbs, as demand increased, prices plummeted on such websites, which are now selling generic abortion pills for as little as $39 with three to six-day delivery. Estimates are that these alternative delivery systems served more than 70,000 women in the two years after Dobbs.

Abortion pills are medically very safe. While no state so far explicitly criminalizes using this medication, there is some legal risk in places with anti-abortion prosecutors.

These technological and service delivery innovations have disrupted the typical ways anti-abortion groups have tried to block access to abortion, including by regulating brick and mortar clinics out of existence, encircling them with threatening crowds and even terrorizing them with bombings, arson, burglary and murders. Telehealth services have enabled people to access abortion privately, conveniently and affordably, without having to take time off work, find child care, travel long distances and cross threatening protest lines.

Advocates have put forward other strategies as well, including getting abortion pills in advance of needing them and missed period pills, (that is, abortion pills used without first taking a pregnancy test), which research has shown has psychological benefits for women who feel stigma around abortion. Washington state now allows pharmacists to prescribe abortion medications, and other states are considering this option.

Research just published in the New England Journal of Medicine shows that a double dose of the prescription emergency contraception ella (ulipristal acetate), taken with misoprostol, can be effective for abortion when taken as directed. In fact, using just misoprostol, which causes uterine contractions that can expel the products of conception, has been shown to have efficacy rates of between 82 and 100 percent in a systemic review of misoprostol alone. And researchers are also studying the feasibility of over-the-counter abortion pills.

We know that banning abortion does not stop abortion. In fact, nations banning abortion have similar rates of abortion to nations allowing it. In the U.S. so far, technological and service delivery innovations have stayed ahead of the tidal wave of anti-abortion laws over the last decade.

No matter what the Trump administration does, international telehealth services, websites that sell pills and community networks will fill the gaps left by unjust laws trying to block abortion access.

Carrie N. Baker, J.D., Ph.D., is the Bauman Professor of American Studies and chair of the Program for the Study of Women, Gender and Sexuality at Smith College in Northampton, Mass. She is author of “Abortion Pills: U.S. History and Politics” (Amherst College Press, 2024).

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