An abortion provider shipped almost 120,000 packs of abortion pills to US residents between July 2023 and August 2024 – nearly 100,000 of whom lived in states that outlaw the procedure or have laws on the books that ban the mailing of abortion pills, according to a new study published in the prestigious medical journal Jama on Monday.
To the shock of experts, the number of abortions performed in the US rose in the three years since the US supreme court overturned Roe v Wade and paved the way for more than a dozen states to ban virtually all abortions. Much of that rise has been driven by the use of abortion pills, or medication abortion, and providers’ ability to supply the pills through telehealth.
US abortion providers performed 1.14m abortions in 2024 – the highest number on record in recent years, according to data from #WeCount, a Society of Family Planning project. By the end of the year, #WeCount found, a full quarter of all abortions were being facilitated through telehealth.
This study, which was led by a University of Texas at Austin professor and studied shipments from the telemedicine abortion service Aid Access, more fully fleshes out the portrait of US abortion access, as it is the first to examine abortion pill provision at the county level. The poorer a county was, the more likely its residents were to order abortion pills, researchers discovered.
Counties where the poverty rates hovered between 10% and 20% had provision rates that were 1.63 times higher than counties where the poverty rate was lower than 5%. In counties where the poverty rate was above 20%, the provision rate was 1.93 times higher than in richer counties.
Abortion pill provision rates were also more than three times higher in states that ban abortion compared with those that do not. In states that specifically ban telemedicine abortion, the provision rates were more than twice as high. Counties that were located farther from abortion clinics were also likely to see higher rates of abortion provision.
Aid Access ships to all 50 US states through the use of “shield laws”, which have been adopted by a handful of blue states in the years since the repeal of Roe. These laws aim to guard abortion providers from out-of-state prosecutions; if an abortion provider living in a state with a shield law ships pills across state lines, they are in theory protected from liability. But these laws have yet to be tested in court.
Late last year, Texas sued a New York doctor over allegations that she had mailed abortion pills to a Texas woman. After the doctor, Margaret Carpenter, failed to show up for a court date, a judge ruled against her by default and ordered her pay a fine of more than $100,000. Citing New York’s shield law, a New York state clerk has repeatedly refused to enforce the fine. The Texas attorney general, Republican Ken Paxton, sued the clerk in July.
Experts widely expect that the dispute, which tests the relationships between states that ban abortion and those that protect it, will eventually reach the US supreme court.