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 Montana measure that would have implemented harsh penalties for medical providers who did not give life-sustaining care to newborns was voted down last week.

Lawmakers brought forward the so-called Born-Alive Infant Protection Act for the exceedingly rare cases when a baby is born alive after an abortion, or born severely premature.

Opponents say it was misleading and unnecessary, since infanticide already is illegal.

Hillary-Anne Crosby, campaign coordinator and communications lead for the No on LR-131 campaign, said there are tragic situations when infants are born with fatal health conditions.

Families can make choices in these situations, such as to hold the infant or baptize and read last rites.

But she said LR-131 would have mandated "life saving care," which would have meant taking an infant away from its parents.

"We're certainly excited," said Crosby, "but more so just relieved on behalf of those providers that would have been torn between, 'Do I honor and respect a family's wishes or do I obey a law that I know to be cruel and unethical?'"

If the measure had passed, health-care providers found to have violated the law faced fines up to $50,000 and 20 years in prison.

While the measure has been lumped in with other abortion measures across the country, it was referred to the ballot by the 2021 Montana Legislature before the Dobbs Supreme Court case allowing states to decide on abortion. It would not have directly affected access to abortion.

Crosby said unfortunately, the lawmakers that crafted this legislative referendum did not consult with the people who would have been impacted.

"They should have reached out to these experts," said Crosby, "they should have reached out to these families to better understand what kind of support they need and what kind of laws just further traumatize them, and I really hope that that was a lesson that they took away, in that you cannot legislate what you're not even willing to try to understand."

Even with the Dobbs ruling, the Montana Supreme Court has ruled the state Constitution protects abortion access under its right to privacy.

However, now that Republicans have a supermajority in the Legislature, lawmakers could move to change this in 2023.

Crosby said she believes the "no" vote on LR-131 should be a sign that Montanans don't want this kind of change.

"We do really think that LR-131 sent a pretty clear message that Montanans value our privacy and we value our private medical decisions," said Crosby. "So hopefully they'll take that cue and they will trust and respect and support Montanans' wishes. But if not, we'll be there to remind them."

Last week's midterm elections saw conservative Republicans shore up their majorities in Wyoming's legislature, and Janna Farley - communications director with the American Civil Liberties Union of Wyoming - said reproductive-rights activists will have a heavy lift reversing what many see as government overreach on women's bodily autonomy.

Abortion rights came under immediate fire in the 2022 legislative session when a trigger bill banning abortion after the U.S. Supreme Court overturned Roe v. Wade was signed by Gov. Mark Gordon.

"The bill was passed with a large majority of legislators in both chambers in favor of it," said Farley. "Abortion is still legal in Wyoming while a lawsuit that contests the ban moves ahead."

Plaintiffs in the suit point to Article 1, Section 38 in Wyoming's constitution - which says "Each competent adult shall have the right to make his or her own health-care decisions."

Defenders of the trigger ban argue that article was created in response to the Affordable Care Act, and that the state's constitution does not include the word abortion.

While many believe that ending a pregnancy is an unnecessary loss of life, Farley noted that in many instances, access to abortion is critical to save the life of the pregnant person.

"The reasons for people having an abortion is something best left to a person and their health-care team, their doctors, their physicians," said Farley. "Politicians should not be in the exam room with you, making those decisions for you."

If the court rules in favor of reproductive-rights groups on the trigger ban law, Farley said the Legislature still wants to limit abortion access, and expects a new law would be introduced in the next session.

She said after the Supreme Court turned abortion rights over to states, protecting access will mean challenging the new status quo.

"If we want to change the political landscape in Wyoming, we're going to need people to get involved," said Farley. "If abortion access is going to be left to the political process like this, those of us who care about reproductive rights have to get engaged."

Minnesota is preparing for a state government described as a "pro-choice" trifecta. Those supporting abortion access say having Democrats in control creates opportunities.

The midterm election saw the DFL maintain control of offices for governor and attorney general, while adding power within the Legislature, and party leaders say they're ready to go on offense when it comes to reproductive rights.

Megan Peterson, executive director of the group Gender Justice, said Minnesota's Constitution protects abortion rights, but argued the state should be proactive in permanently removing restrictions which are currently blocked. She added addressing barriers such as affordability need consideration.

"To make sure that anyone who needs to receive abortion care actually has the ability to do so," Peterson explained.

Party leaders acknowledged under past majorities, they did not have enough pro-choice votes, but they feel confident it will not be an issue moving forward. Following this summer's U.S. Supreme Court decision to overturn federal protections, Minnesota became a "safe-haven" state for abortion care after a number of surrounding states sought to enact bans.

Rep. Melissa Hortman, DFL-Brooklyn Park, Speaker of the House, said they will be responding to what voters wanted because of the candidates they supported.

"People made a statement," Hortman contended. "They wanted the power that they have to bring about a state that protects their rights, their personal freedoms, and our liberties, and this is a majority that will do just that."

Hortman emphasized it is also important to cement protections because of how retirement requirements could reshape the Minnesota Supreme Court. A number of statewide candidates on the Republican ticket argued the abortion issue was a distraction from other voter concerns, including crime and inflation.