Abortion pills, mifepristone saw surge after Supreme Court ruling

Less than a quarter of a century ago, abortion pills could not be legally obtained from a U.S.-based medical provider.

Now, they are the most common method of terminating a pregnancy — used by 3 out of 5 abortion patients in the U.S.

Americans’ use of medication abortion has rapidly expanded since 2000, when the FDA approved the use of mifepristone, one of the two drugs used in the most common medication abortion regimen.

Over the last eight years, the U.S. Food and Drug Administration has steadily relaxed its rules to allow patients to take mifepristone up to 10 weeks into pregnancy and receive it by mail after a telemedicine appointment.

Abortion care has begun to shift from in-person visits to the mailbox. Just four years ago, there were no online-only U.S. abortion clinics dispensing abortion pills. But during the COVID-19 pandemic — and after the Supreme Court’s 2022 overturning of the constitutional right to an abortion — virtual abortion clinics began to take on an increasingly significant role.

If the Supreme Court decides to order a reversal of recent FDA rules, limiting patients from obtaining mifepristone at pharmacies or through the mail without an in-person visit, abortion services could be restricted even in blue states like California.

Here are some of the numbers on abortion pill usage in the U.S.:

How many medication abortions take place each year in the U.S.?

About 642,700 medication abortions took place in 2023 within the formal healthcare system, according to the Monthly Abortion Provision Study from the Guttmacher Institute, a Washington based nonprofit research group committed to advancing sexual and reproductive health in the U.S.

This number is likely an undercount, as it does not include self-managed medication abortions outside of the formal healthcare system or abortion pills mailed to anyone in the 14 states where abortion is banned.

What percentage of abortion patients in the U.S. use medication abortion?

According to Guttmacher, medication abortions accounted for 63% of abortions in 2023 — a massive jump from zero in 2000 and 53% in 2020.

This percentage does not include self-managed abortions or abortion pills mailed to anyone in a state where abortion is banned.

Guttmacher does not have state-level medication abortion data.

How many states limit the mailing of abortion pills?

Twelve states — other than the 14 states where abortion is banned — have passed laws mandating at least one in-person clinic visit, according to the health news service Kaiser Family Foundation.

Twenty-four states, including California, have no telehealth medication abortion restrictions.

Still, the legal landscape is hazy. Some online-only abortion clinics, such as Europe-based Aid Access, allow U.S. doctors in blue states with “shield laws,” legislation designed to protect them from prosecution, to prescribe and mail pills to patients in restricted states.

How many Americans get medication abortion by mail?

There’s no complete national data on the number of self-managed medication abortions. But research suggests more American women began to access abortion pills via mail in recent years as they experienced limited clinic access during the COVID-19 pandemic, states imposed abortion restrictions, and abortion pills became more readily accessible.

Data from Aid Access, a service run by European doctor Rebecca Gomperts that began shipping abortion pills to Americans in 2018, shows that requests for self-managed abortion through online telemedicine nearly tripled after the Supreme Court overturned Roe vs. Wade.

In 2022, requests from U.S. patients to Aid Access for self-managed medication abortions jumped from an average of 83 a day before the Supreme Court’s abortion decision was leaked to 214 a day after the court decision was formally announced, according to research led by Abigail Aiken, associate professor of public affairs at the University of Texas at Austin. Demand increased in all states, but the largest increases were in states that have enacted total or near-total abortion bans: Louisiana, Mississippi, Arkansas, Alabama and Oklahoma.

The Society of Family Planning, a global nonprofit group that specializes in “abortion and contraception science,” recently estimated that 16% of abortions in the U.S. were provided via telehealth in September 2023, with 13,770 telehealth abortions resulting in medications being dispensed via mail from online-only and brick-and-mortar clinics.

This data includes abortion pills mailed to people in states with bans or restrictions on telehealth abortion.

How many U.S. clinics offer medication abortion?

About 789 facilities in the U.S. offered medication abortion in 2022, according to data from Advancing New Standards in Reproductive Health, a research program at UC San Francisco.

The number of facilities providing telehealth abortion care and mailing abortion pills soared from 52 in 2020 to 243 in 2022.

How have telehealth abortion services expanded since the COVID-19 pandemic?

In 2020, there were zero online-only clinics providing medication abortion.

By 2022, 69 virtual clinics provided care via telehealth in 23 states and D.C., according to ANSRH’s Abortion Facility Database. Most of the new clinics are concentrated in the Northeast and West.

How many Californians get medication abortion by mail from virtual-only clinics?

According to the Society for Family Planning’s October 2023 #WeCount report, 7,510 telehealth abortions in California were provided by virtual-only clinics in the first six months of 2023.

This figure does not include telehealth abortions from brick-and-mortar clinics.