Medication Abortion Expands Since Dobbs Ruling

While abortion rates in states with restrictions plunged in the 18 months since the Dobbs v. Jackson ruling that nullified a constitutional right to abortion, medication abortion has expanded in the U.S. since Roe v. Wade was struck down.

Taking mifepristone combined with misoprostol within the first 12 weeks of pregnancy was the most common abortion method in the U.S. before the Dobbs decision was handed down in June 2022.

Since then, the popularity of medication abortion has increased, with a poll released in March finding that majorities of Americans support medication abortion remaining legal and accessible for women to use at home to end early stage pregnancies.

In a June report, the Society of Family Planning found that abortion by telemedicine "increased by 85 percent compared to the pre-Dobbs period, going from comprising 5 percent of all abortions to 9 percent."

Dana Northcraft, founding director of Reproductive Health Initiative for Telehealth Equity and Solutions, told Vox that figure is likely an understatement.

"That number does not include telehealth visits by providers who also do brick-and-mortar visits, [and] it does not include self-managed abortions outside of the formal medical system," she said.

According to Vox, in the early post-Dobbs months, if a woman lived in a state that banned abortion, her access would come in the form of abortion pills procured from outside the U.S. by reproductive health care nonprofit Aid Access. Shipments could take two to three weeks to arrive.

Today, however, new organizations ship pills directly to women seeking abortions in more restrictive states from within the U.S., which drastically cuts down on the amount of time it takes to receive the medication in the mail.

"We're trying to shout this all from the rooftop," Elisa Wells, co-founder of Plan C, told Vox. "People are worried and there's a lot of questions out there — is this all legit? Are the pills actually going to arrive? And we're trying to say yes, these really are real routes of access."

Efforts to expand abortion access via telehealth were underway before the Supreme Court's decision to reverse Roe. The Food and Drug Administration (FDA) had long prohibited doctors from prescribing mifepristone without the patient being seen at an in-person appointment, despite objections from the American Civil Liberties Union and the American Congress of Obstetricians and Gynecologists.

During the COVID-19 pandemic, the Biden administration loosened this rule and the FDA permanently lifted its telemedicine restriction for mifepristone in December 2021.

"I think Dobbs just lit a fire under the innovations that were already underway," Kirsten Moore, director of the Expanding Medication Abortion Access project, told Vox. "[Telemedicine] was already happening during the pandemic and then in the post-Dobbs world everyone started thinking, 'Oh, wait, this is what we've got to do.'"

Expanded telemedicine was spurred into existence by the proliferation of shield laws that protect abortion providers who send medication to women living in states where abortion is restricted or banned.

Such telemedicine abortion shield laws are reportedly in place in New York, Massachusetts, Vermont, Washington, Colorado, and California, though not all have taken effect yet.

Julie Kay, co-founder of the Abortion Coalition for Telemedicine, told Vox shield laws are enabling 6,000 patients per month to receive abortion pills in states that have bans, with a major advantage being the faster delivery speed.

"We think people, including the media, are less familiar with the idea that you can have an abortion by mail and that the service of telehealth abortion is available in every single state — even those with bans," Wells said. "That didn't exist before Dobbs. That is the big change that's happened. People find it unbelievable, but it's also fantastic."

Apart from telemedicine, Vox reported that there is also an international supply chain of e-commerce websites that deal in abortion medication and ship to the U.S. It has grown substantially since the Dobbs decision and most of the sites do not require medical consultations, prescriptions or identification to procure abortion pills.

Community support groups, also called companion networks, are another access point for medication abortion pills. These groups provide free pills to women living in states that bar abortion access.

"You communicate with these groups via [encrypted messaging apps like] Signal, and you don't need a credit card or a bank account, which can be especially important for young people who might not have those resources," Wells said. "We know the volunteer networks well and we have no hesitation in recommending them."

The Supreme Court announced earlier this month that it would hear a challenge to mifepristone, which anti-abortion groups allege was illegally approved in 2000.

Advocates of abortion are bracing for the possibility that the court might impose restrictions on access, such as a ban on prescribing mifepristone for telehealth appointments.