Medication abortions involving the drug mifepristone now represent the majority of abortions in America.
Its use has grown since the federal government eased access to it starting in the pandemic — allowing pills to be prescribed online and sent by mail or picked up at pharmacies. Also, some states have passed shield laws that protect clinicians who prescribe and mail pills into states with abortion bans or restrictions.
The Supreme Court is considering changes that would tighten access to the drug by requiring a doctor to give pills to a patient in person.
A growing share of medication abortions are prescribed by telemedicine, where patients communicate with a clinician online, via chat or video, and the pills are shipped in the mail. At least one in six abortions, around 14,000 a month, was conducted via telehealth from July through September 2023, according to research from the Society of Family Planning, which conducts a census of abortion providers.
Medication abortion has long been the most typical form in Europe, but it was less common in the United States until the Covid-19 pandemic, when visits to clinics became more difficult and the Food and Drug Administration changed its telemedicine regulations.
In 2020, medication abortions tipped over 50 percent, according to research from the Guttmacher Institute, which surveys abortion providers. The share has continued to grow since then: According to a recent Guttmacher report, medication abortions represented 63 percent of all legal abortions in 2023. But that data is an underestimate, since it did not include the pills mailed across state lines under shield laws. (It also doesn’t count pills obtained outside the formal health system, usually from overseas.)
If the Supreme Court decides to uphold the Fifth Circuit’s ruling restricting mifepristone access, that number is expected to fall substantially. The ruling would prevent providers from mailing pills to patients directly, and would prevent patients from filling a prescription in a pharmacy, instead requiring every patient visit an abortion provider to receive the pills in person. It would also restrict prescribing to doctors alone, eliminating abortions now prescribed by nurse practitioners, midwives and other health professionals. That change would limit access to abortions in every state, not just those that have legally restricted access since Roe was overturned.
Abortion pills shipped from outside the country may fill some of that gap. In the early months after states began banning abortions, shipments of such pills increased substantially. But they have been largely replaced by pills prescribed and mailed by U.S. health care providers under shield laws. If the mailing of mifepristone is banned, more women could again turn outside the U.S. medical system.
