As use of telehealth for medication abortion grows, new data offer window into patient population

STAT News – Monday, August 11, 2025
By Katie Palmer

Telehealth is increasingly an option for pregnant people seeking abortions in the United States — even those who live in states that have banned them. By the end of 2024, a quarter of the country’s abortions were provided via telehealth, with clinicians writing online prescriptions for mifepristone and misoprostol and mail-order pharmacies sending the medications to patients.

Studies have shown that the provision of medication abortion via telehealth services is both safe and effective at the same levels as in-person care, whether visits are performed in live video visits or text-based exchanges. But the future of such services is uncertain, as anti-abortion groups and some legislators are still seeking to restrict access.

On Monday in JAMA, researchers published a county-by-county breakdown of more than 118,000 online prescriptions from one of the largest telemedicine abortion providers, Aid Access, capturing the demographics of patients accessing medication abortion online. The study isn’t a complete look at telehealth abortion trends in the U.S. But it provides “a deeper view than what we’ve had before,” said Ushma Upadhyay, a public health scientist at the University of California, San Francisco.

Population-based rates of telemedicine abortion were highest in Southern and Midwestern states, particularly those with abortion bans, during a 15-month period starting in July 2023. That’s when several telehealth abortion providers, including Aid Access, began prescribing medication abortion under state shield laws intended to protect abortion care providers who treat patients in areas with bans. In those 15 months, 84% of Aid Access’ prescriptions went to patients in states with near-total abortion bans or bans specifically on telemedicine abortion. Notably, rates of abortion provision were higher in areas where people had to travel farther to the nearest clinic, and in counties with higher poverty levels.

The study “confirms that telehealth really changed the abortion care landscape,” said Upadhyay, echoing results from a June report by the Society of Family Planning she co-chaired that found telehealth abortion care surged in the summer of 2023. Telehealth access only recently became more common after the Food and Drug Administration lifted the requirement for in-person dispensing of mifepristone during the Covid pandemic. That requirement was permanently removed by the Biden administration in 2023.

Telehealth’s growth is not just a product of state shield laws, said professor of law Nicole Huberfeld, who co-directs Boston University’s program on reproductive justice. “It’s also a reflection of the necessity that exists across the country in places that were already maternity care deserts and or medically underserved areas.”

When patients visit a telehealth website that provides medication abortion, they undergo the same screening process they would in person, said Elisa Wells, co-founder of Plan C, an informational site about self-managed medication abortion. A survey or provider will screen for medical contraindications like bleeding disorders or factors that might put a patient at risk of an ectopic pregnancy. If medication is prescribed, a patient will receive information about when and how to follow up with questions or concerns, and how to spot signs of an incomplete abortion.

In-person abortion care, including both procedural and medication abortion, remains much more common than telehealth. But “there’s growing support in the community for this model because restrictions have become tighter, and the likelihood of people accessing procedural or clinic-based abortion is becoming nonexistent in many states,” said Subasri Narasimhan, a public health social scientist at the Emory School of Medicine.

Even in states where in-person abortion care is legal and readily available, telehealth abortion can be preferred because of the convenience it offers. “There’s the travel, there is the time off work, the stigma of having to go to an abortion clinic and sit in a waiting room,” said Upadhyay. Telehealth can also be more affordable: Aid Access and similar sites often offer a sliding payment scale, with many visits and prescriptions costing $200 or less.

Concern over restricted access to abortion care has driven several distinct surges in telehealth demand. Honeybee Health, a mail-order pharmacy that fulfills medication abortion prescriptions, reported in another JAMA journal that prescriptions spiked twice in 2022: first after the Supreme Court’s Dobbs ruling to overturn Roe v. Wade was leaked publicly, and then when the decision came down. Most of its medication was prescribed by online-only platforms like Aid Access. More recently, telehealth sites prescribing abortion medication reported spikes in demand after President Trump was elected to his second term.

Medication abortion’s safety, and telehealth’s by extension, has been called into question repeatedly by lawmakers and anti-abortion organizations during the second Trump administration. When asked during his Senate confirmation hearing whether he would end telehealth access to mifepristone, FDA Commissioner Marty Makary said he would “build an expert coalition” to review the medication’s postmarket safety data. On prodding from abortion opponent Sen. Josh Hawley, (R-Mo.), Makary has recently reaffirmed that he is “committed to conducting a review of mifepristone.”

At the same time, shield laws are being put to the test, as the authors of a JAMA editorial highlighted on Monday. Maggie Carpenter, a physician who practices abortion care via telemedicine, was the first to be criminally charged for prescribing over state lines, and is currently being protected by New York’s shield law against a lawsuit from Texas’ attorney general and criminal prosecution from Louisiana.

“Our laws are not yet a match for telehealth and its promises and perils,” said Huberfeld, who co-authored the editorial. “I think that we will continue to see that there is this mismatch so long as we are relying on state laws for regulating access to care.”

By the end of 2024, a monthly average of more than 12,000 medication abortions were provided to patients in states with bans or telehealth restrictions, according to data from the Society of Family Planning. As patients attempt to access abortion care, findings from Aid Access “underscore the public health importance of telemedicine, both as an alternative to the unsafe abortion methods that prevailed under abortion bans before Roe v Wade and as a means of reducing access disparities,” wrote the study’s authors.

“These are life-saving services for so many people, especially the poorest of the poor,” said Upadhyay. “These providers are really filling a public health gap where people need these services.”

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