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The Supreme Court’s decision to overturn Roe v. Wade accelerated efforts to criminalize abortion in the United States. Laws banning abortion have gone into effect in at least eight states since the decision came down in late June. More states are expected to restrict access soon.
But there is one abortion method states will have a hard time eradicating: medication abortion. The abortion pills available — mifepristone and misoprostol — are safer than Tylenol and have been approved by the FDA since 2000. They are only recommended for use up to 12 weeks of pregnancy though, so abortion pills will only help people who are still early in their pregnancy. Mifepristone blocks the hormone progesterone, preventing the pregnancy from continuing to grow in the uterus. Misoprostol causes cramping and bleeding to empty the uterus. Misoprostol is available over the counter in other countries and is also used as a treatment for ulcers.
“People deserve to have access to clinic support regardless of what state they live in,” said Ushma Upadhyay, an associate professor at the University of California, San Francisco who studies abortion, medication abortion, and telehealth abortion services. “Health is a basic human right and should be accessible to everyone.”
While states may ban abortion altogether — or specifically ban telemedicine, self-managed abortions, or sending abortion pills in the mail — practically speaking, these bans will be difficult to enforce. Illegal drugs like fentanyl and LSD are frequently sent through the mail and federal and local governments have generally not been able to stop it.
“How are they gonna stop people from getting it in the mail?” said Laurie Bertram Roberts, executive director of the Yellowhammer Fund, an abortion fund and reproductive justice organization that assists people in the Deep South. “You can’t stop abortion. You can’t stop people from being pregnant and not wanting to be pregnant. That’s what history shows us.”
We talked to experts and put together this brief explainer on how to access abortion pills by mail, the legal risks, and how to protect yourself from them.
Can I Get Abortion Pills by Mail?
It depends on where you live. At least eight states have banned most or all abortions. More state bans are expected soon. Nineteen states have passed restrictions that effectively make it impossible to obtain abortions by telemedicine in that state. Some states, including Louisiana and Tennessee, specifically criminalize sending abortion pills in the mail, while others, such as Arizona, make it illegal to deliver abortion medication.
For details on what is legal in your state, check state guides from news sources or organizations like Planned Parenthood, the Guttmacher Institute, the Center for Reproductive Rights, or the Kaiser Family Foundation. If you have questions, you can always call the Repro Legal Helpline to speak to an attorney for free.
In over 20 states, you can obtain abortion pills legally through telemedicine or an in-clinic visit. These days, many people prefer using telemedicine for abortion services because it is often more convenient and private than an in-clinic visit, said Upadhyay. With telemedicine, patients often do not need to find childcare or travel long distances to see a healthcare provider, and they don’t have to risk running into someone they know or being hounded by anti-abortion protesters outside of a clinic. Places that offer telemedicine for abortions include HeyJane, Just the Pill, Choix, Carefem, Abortion on Demand, and Pills by Post.
If you live in a state where you cannot obtain an abortion, you can still get abortion pills by driving to the nearest state where telemedicine is legal, taking your appointment there, and sending the medication to an address in that state, like the hotel you’re staying at. Another method involves using mail forwarding services to ship abortion pills to an address in a state where it is legal, then redirecting the mail from that address to your actual home address. Plan C, an information campaign run by public health advocates and social justice activists, has step-by-step accounts on its website detailing how mail forwarding and other options work.
“We have reports from patients in restricted areas — one in Texas who used the service to have pills mailed to a friend in Illinois, who then mailed it to her,” said Upadhyay, who is currently completing a study looking at the safety of three telehealth clinics, which analyzes data from over 6,000 patients. “We know that patients are getting creative. Patients are having the medications mailed to a post office box just across the border, like New Mexico if they’re from Texas. Or they’ll get a hotel room near the border and do the telehealth appointment.”
Another way to obtain abortion pills in restricted states is to use Aid Access, a nonprofit founded by Dutch physician Rebecca Gomperts. Aid Access connects patients in restricted states with doctors in Europe, who fill prescriptions for abortion medication using a trusted pharmacy in India, which sends the pills by mail. The medication typically arrives in one to three weeks and costs about $110, though financial help is available for people who need care but can’t afford it.
“Aid Access is reliable, credible, and will mail to addresses in restricted states,” said Upadhyay. “It’s very safe and very effective. My concern is that patients often want support when they’re going through an abortion. My fear is that people will go to emergency rooms in larger numbers and will be criminalized that way.”
Some online pharmacies also will ship abortion medication without a prescription from a doctor. Plan C lists pharmacies they have tested pills from and verified that orders did contain the correct medication. However, they do not operate the pharmacies and cannot vouch for the continued authenticity of those pharmacies.
Whatever route you choose, help is available. Organizations have stepped in to keep abortion accessible, even if your state has banned it. So if you get an abortion and have any concerns along the way, you can contact M+A Hotline (833-246-2632), a confidential and secure phone and text hotline for people who need support with abortions or miscarriages that is staffed by volunteer licensed clinicians. If you have legal questions, you can contact Repro Legal Helpline (844-868-2812), a free, confidential helpline. If you need financial assistance, you can contact your local abortion fund or call the National Abortion Federation Hotline (800-722-9100), a toll-free, multi-lingual hotline for abortion referrals and financial assistance in the U.S.
What Are the Risks?
Abortion pills are safe for up to 12 weeks of pregnancy, according to the World Health Organization. They may not be a safe option under certain circumstances, such as when a person has an ectopic pregnancy, a blood clotting disorder, significant anemia, or an intrauterine device (IUD).
People who obtain an abortion in states where it is banned also risk criminalization. While most abortion bans currently target providers, three states — Oklahoma, Nevada, and South Carolina — do explicitly ban self-managed abortions. And even when Roe was in place, police and prosecutors often found creative ways to criminalize people for their pregnancy outcomes. According to an analysis by the National Advocates for Pregnant Women (NAPW), over 1,700 people were criminalized for their pregnancy outcomes between 1973 and 2020. Prosecutors across the country have charged people who have had stillbirths or miscarriages with child abuse, murder, manslaughter, drug use, improper disposal of fetal remains, and misuse of a corpse. If a friend in another state sends you the pills, they may be at risk of criminalization as well.
People who obtain abortions are often criminalized when someone else reports them to the police. This could be a provider, a relative, or an ex-partner. If you obtain an abortion in a state where it is banned, you can minimize your risk of criminalization by telling as few people as possible and only people you trust.
“When it comes to legal risk, what we know from cases that we have already seen is that people often face legal consequences when they share information about their pregnancy outcomes with people and those people then report them to the police,” said Elizabeth Ling, senior helpline counsel for If/When/How, nonprofit, reproductive-focused legal aid network that runs the Repro Legal Helpline.
“The legal risks really depend on a person’s specific situation, as well as their identity,” Ling added. “The risk of criminalization is and always has been greater for those communities who have experienced greater state surveillance in this country: Black people, people of color, indigenous people, marginalized people, disabled people, and LGBTQ people.”
You do not need to disclose having an abortion to your provider. Abortions and miscarriages are indistinguishable from one another, so you can get help from a healthcare provider without telling them you terminated your pregnancy. If you have questions about your abortion as you are experiencing it, you can contact the M+A Hotline by phone or text.
How Can I Protect Myself?
Keep the number of people you tell about your procedure to a minimum, and only tell people you trust. Lean on the resources available to you via the M+A Hotline and the Repro Legal Helpline if you have any questions. Practice good digital safety and security by opting out of targeted advertisements, using search engines like DuckDuckGo that do not save your searches to their servers, using encrypted messaging apps like Signal, turning off location sharing on your devices, and using strong password protection on your devices. The Digital Defense Fund has a detailed guide full of helpful digital security tips to keep your healthcare choices private. So does the Electronic Frontier Foundation.
It is important to use browsers that do not store your search history and messaging apps that keep your conversations private because prosecutors have used people’s search history and text messages against them in the past. In 2018, prosecutors used an internet search for misoprostol to charge a woman with second-degree murder. In 2015, prosecutors used text messages to convict a woman for feticide and child neglect.
“I would implore folks to use encrypted messaging apps, to be careful who they share information with, and to protect their digital security and digital footprint and be very intentional about that,” said Dana Sussman, acting executive director of the National Advocates for Pregnant Women, a legal organization that defends the rights of pregnant people from criminalization. “Contact us or contact trusted resources to get information. Do not turn over your devices to law enforcement. Make them get a warrant.”
