By Carrie N. Baker for Ms. Magazine
Broadcast version by Lily Böhlke for Texas News Service/Public News Service

As the Supreme Court has allowed the Texas abortion ban to stand and is now poised to overturn Roe v. Wade this summer, people in states with restrictive abortion laws are finding creative ways to obtain abortion pills online, made easier by a recent increase in telemedicine abortion providers in many states.

In December, the FDA permanently lifted a longstanding in-person distribution requirement for the abortion pill mifepristone. In many states, this opened the door to telemedicine abortion, where providers screen patients online or by phone then mail them abortion pills. People in 24 states and DC can now access telemedicine abortion legally from providers within their states for as little as $150, with some services discounting the price to zero, if needed.

But 19 states have laws prohibiting telemedicine abortion. In these states, evidence suggests that people are finding new ways to access abortion pills, says Elisa Wells, co-director of Plan C, an organization that conducts research and publicly shares information about how people are accessing abortion pills in the U.S.

"As politicians continue to pass unjust laws that restrict access to these safe and effective medications, we know that people are finding alternate ways to access them," said Wells. "We have a section on our website about creative ways people are accessing pills when they live in restricted areas to help people understand what we know people are doing and how to do it. There is absolutely no reason why modern telehealth abortion care should be restricted based on your zip code, and these folks are finding effective workarounds to get the care they need."

Many people are getting abortion pills from outside of the U.S. by ordering them directly from online pharmacies. Researchers at Plan C have vetted many of these online pharmacies by ordering abortion pills from them and testing the pills for quality. On their website, Plan C lists websites that send quality medication, along with cost and shipping time, including Secure Abortion Pills (for $200, delivery in 14 days), Abortion Rx ($239, eight days), Generic Abortion Pills ($291, six days), Buy MTP Kits ($301, six days), Abortion Privacy ($380, five days) and Online Abortion Pills ($480, four days). These pharmacies do not require a prescription to obtain abortion pills.

Another option many people are using is ordering abortion pills through the Austria-based health care provider Aid Access, run by Dr. Rebecca Gomperts. Aid Access offers physician-supervised telemedicine appointments using online forms and then ships abortion pills to patients in the U.S. In states that restrict telemedicine abortion, the pills are shipped from India, which can take several weeks. In these states, Gomperts charges a sliding scale fee of up to $110.

A third option people in restrictive states are using is mail forwarding services to access telemedicine abortion care from health care providers located in U.S. states that allow it. Because providers are only allowed to mail pills to patients who have an address in the states where the provider is licensed to practice, people are renting a mailing address from mail forwarding services such as iPostal1.com or Anytime Mailbox to use for the telemedicine consultation. Then, they request the service to forward the pills to them in their home states.

"We actually did our own investigation to see if mail forwarding was possible, you know, in the same way that we order and test pills from online pharmacies to see what's involved in that," said Wells. They found mail forwarding did work.

On their website, Plan C details the process of how people are using mail forwarding to order abortion pills. People are renting an "address" in a state that has legal online abortion services for about $8-10 for one month plus a $25 online notary fee to get set up. They then do an online consultation with a provider in the state where they've rented the mailbox and list the forwarding service address as their shipping address.

Since clinicians are only allowed to serve people in the states where they are licensed, if asked, patients say that they are in the state where the clinic is located when doing the online, video or telephone consultation. Those who use a credit card for payment state needing to list the correct billing address associated with their credit card. This did not affect their ability to have the pills shipped to the forwarding service address.

When the mail forwarding service tells them that a package has arrived at their "address," they ask for it to be forwarded to them at their home address. Sometimes there is a small fee for this, about $5. The rental is only needed for one delivery, so can be canceled after one month.

Using this method, people who live in states with restrictions on abortion health care have been able to access abortion pills by mail through U.S.-licensed clinicians.

"You have to jump through a few hoops to get a mailing address," said Wells. "You have to provide two forms of ID and you have to have an electronic notarization done. It's all online so you don't have to go anywhere. You just have to upload some documents, and you have to pay some fees, about $40 total to get it set up and rent the address for a month. It does add a little bit of a delay-about four to five days."

As an alternative, some people ask friends who live in a state that has telemedicine abortion access if they can have the pills shipped to the friend's address and then pick it up from them. People who do this list their name followed by "c/o friend's name" and then the full address. This helps prevent the package from being marked "addressee unknown" or "return to sender."

Others use "general delivery" at a U.S. Post Office on the state border to reduce the distance they have to travel. "General delivery" means that mail is sent to a person at a specific U.S. office and the person receiving the mail goes there in person to pick it up with an ID that matches the name on the package. There is no need to set up a post office box and no charge for this service.

To use general delivery, people identify a nearby state that offers pills by mail. For instance, if they live in Tennessee, they could order from a service that is located in Georgia, Virginia or Illinois, depending on which state is closest to their location. Then, they look at a map to find the closest border town in the other state. For instance, someone living in Chattanooga, Tenn., might identify Rossville, Ga., as the closest town with a U.S. post office. Not all post offices offer general delivery, but many do. People can check to see if general delivery service is offered at a particular post office by searching for the town name on the U.S. Postal Service website.

After verifying that a post office will accept a general delivery package, they then contact a provider in the state that provides telehealth abortion and schedules a consultation. If asked, they say they are located in the same state as the provider at the time of the consultation. They provide the "general delivery" address to the clinic. They track the delivery using information provided by the clinic and go to the post office in person when the package has arrived. They make sure to take identification that matches the name on the package.

Wells warns that using creative ways to access pills without having to travel to another state may open people up to unjust prosecution.

"Lawyers have told us that a person is doing nothing wrong when they access pills in some of these creative ways, yet we know that some people have been criminalized for obtaining and taking pills on their own, and we know that criminalization in general falls heaviest on people who are already marginalized by our systems," said Wells. "We always advise people to check with the free Repro Legal Helpline if they have questions about their legal risk. We want people to have as much information as possible so they can make the best decision for their situation."

While people are finding creative ways to access abortion pills in states that restrict access, reproductive health advocates express frustration that they have to do so.

"Our whole system is broken," said Wells. "Our medical system is broken. Our justice system is broken. We have modern medical health care available to us in the form of these pills and telemedicine. There is absolutely no reason why they shouldn't be available to people across borders from doctors who are knowledgeable and willing to provide the service."

Carrie N. Baker wrote this story for Ms. Magazine.


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A majority of South Dakotans have voted to maintain a strict abortion ban but other factors are shifting the landscape for reproductive care in the state.

Of the 10 states voting on abortion during the 2024 election, South Dakota was one of three to keep a ban in place.

Kim Floren, director of the Justice through Empowerment Network, which provides financial assistance to people seeking abortions, said the state's view on the issue is not new but concern is growing over how the federal government may affect reproductive rights.

"I'm feeling the panic from people who are in areas that maybe haven't experienced what we've experienced as far as barriers go," Floren noted. "The reality is that we as a community can figure out how to take care of one another."

The Justice through Empowerment Network provides assistance with travel and transportation, child care, lodging, interpreters, birth control and medical procedure funding. Floren pointed out the organization supports 30 to 40 people per month. The final tally for Amendment G, which would have established a right to abortion in the state's constitution, was 41% for and 59% against.

South Dakotans voted in 2006 and 2008 against near-total abortion bans but Floren stressed since then, President-elect Donald Trump's first term made people feel "emboldened to be more vocal." Still, she acknowledged his second term will begin in a different context than his first.

"Before Dobbs, we did not have all of these reliable, safe websites where you can order abortion pills from and have them sent to your house for extremely cheap," Floren observed. "In some ways, access here has gotten better."

Floren added Gov. Tim Walz of Minnesota will return to his post after running for vice president on the Democratic ticket. Walz in 2023 signed a bill protecting patients who travel to Minnesota for abortion care and their providers from legal penalties in other states.


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It is now up to Wisconsin Supreme Court justices to decide the fate of an abortion law from the mid-1800s.

A circuit court determined last year an 1849 law does not apply to "medically consented" abortions in Wisconsin. The high court heard arguments Monday about whether a 1985 state law overrides the older one, allowing abortions before the point at which a fetus could survive outside the womb.

Jenny Higgins, professor of obstetrics and gynecology at the University of Wisconsin-Madison, said while the impact of this case is critically important, even if the 1849 law is determined to be unenforceable, returning to the status quo would mean a dire landscape for abortion access.

"Even though abortion is technically available at clinics in Wisconsin right now, it's heavily restricted," Higgins explained. "Because of insurance and Medicaid prohibitions, people have to pay out-of-pocket for a service that should be covered by insurance."

The 1849 law, which was brought to light after Roe v. Wade was overturned by the U.S. Supreme Court, prompted a statewide freeze on abortion services for more than a year. Higgins noted if Wisconsin's high court rules the law still applies today, the state would be looking at another abortion freeze.

Abortion access disproportionately affects those who are already the most marginalized, Higgins pointed out. She noted while people from all walks of life may find themselves needing abortion care, factors like poverty and racism make it much harder for some to achieve reproductive autonomy, compared to those with more economic and social resources.

"Those effects make it much harder for folks to be able to access contraceptive care, be in relationships that are stable and healthy and communicative, to be able to see past the end of the day into one's future if you are, again, mostly focused on your own economic scarcity or figuring out how to feed your kids, or figuring out how not to get evicted," Higgins outlined.

The 1976 Hyde Amendment, established three years after Roe v. Wade, prohibits the use of federal funds for abortion. Higgins hopes federal lawmakers will focus more on this amendment when considering the barriers to abortion care.


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Strong reactions are pouring in from both sides as Missouri voters made history by adding abortion rights to the state constitution.

The decision to pass Amendment 3, the "Right to Reproductive Freedom Initiative," makes Missouri the first state to overturn a near-total statewide abortion ban. Advocates and opponents are now gearing up for future battles.

Jamie Morris, executive director and general counsel of the Missouri Catholic Conference in Jefferson City, said he is disappointed with the passage of the amendment but emphasized his organization's pride in the conference's efforts, despite limited resources, and vowed the fight is not over.

"From the church's perspective, win or lose, we were going to continue to advocate for policy to help address the needs of women to help them choose life to begin with," Morris explained. "So that not only you're dealing with, necessarily, the supply of abortion, but also the demand."

In addition to abortion rights, Amendment 3 protects access to contraception and reproductive health services.

Meanwhile, pro-choice advocates in Missouri including Planned Parenthood and the ACLU are celebrating the passage of the amendment, while filing a lawsuit to block some restrictions, including parental consent for minors and continued regulatory oversight of abortion services.

Maggie Olivia, senior policy manager for the advocacy group Abortion Action Missouri, applauded the vote.

"I could not be more proud of the first steps that we are taking together as Missourians to dismantle the decades of political infringements on our access to abortion and, frankly, all reproductive care," Olivia stressed.

Missouri was among nine states with abortion rights measures on the 2024 general election ballot. Amendment 3 takes effect Dec. 5.


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