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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Illinois serves as a crucial access point for abortion services and sees the most out-of-state patients in the country.

Since Roe v. Wade was overturned in June 2022, Planned Parenthood of Illinois has seen the largest increase in abortion services than any other state. About 25% of its patients are from out-of-state.

Julie Uhal, program manager of strategic initiatives and impact measurement for Planned Parenthood of Illinois, said they planned for an initial surge but sustained high patient volume has strained their resources. She explained they saw up to a dozen out-of-state patients per month before Roe was overturned.

"We're seeing 800, 900, 1,000 out-of-state patients every single month," Uhal reported. "That hasn't changed. That's remained constant for three years now because abortion bans don't stop the need for abortion care. They just make it more difficult for people to access."

Uhal pointed out many out-of-state patients are uninsured or have insurance in other states which cannot be used in Illinois. Combined with rising health care costs, lower reimbursement rates and threats to Medicaid, she said Planned Parenthood faces financial difficulties, which have already forced them to close four clinics this year.

Planned Parenthood is the largest provider of sexual and reproductive health care in the state. More than 40% of local patients use Medicaid to cover the cost of services, which in addition to abortion care includes birth control, cancer screenings, STI treatment and prenatal and gender-affirming care. Without Medicaid funding, Planned Parenthood of Illinois said it would need about $16 million a year to continue providing services at its current rate.

"A lot of people don't realize that many Planned Parenthood clinics are in areas that are otherwise health care provider deserts for access," Uhal emphasized. "For a lot of people, going in for a birth control appointment might be the only time they see a doctor that year."

Uhal stressed the burden of accessing common health care continues to be placed on the patient since states banned abortion services. The recent Supreme Court ruling which set a precedent to allow states to exclude Planned Parenthood from Medicaid will only worsen the burden. She added helping patients to navigate emotional and logistic barriers to care has been just as important as providing them with care.

"One in four people that can get pregnant will have an abortion at some point in their lifetime," Uhal explained. "So it's really important for people to know that they're not alone. There shouldn't be as much shame and stigma surrounding this as there is."

Planned Parenthood of Illinois opened the Carbondale Health Center in 2023 to help meet the increased demand for services, particularly for patients traveling from the South. About 90% of patients there come from out-of-state.


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Abortion rights advocates in Kentucky are concerned as the Department of Health and Human Services has revoked a policy requiring hospitals to provide abortion care in emergency situations.

Known as the Emergency Medical Treatment and Labor Act, the rule offered federal protection for the procedure, particularly in Kentucky and other red states with near total abortion bans.

Tamarra Wieder, Kentucky state director for Planned Parenthood Alliance Advocates, said stripping away protection will be catastrophic for women in rural counties who already face barriers to care.

"We know in a state like Kentucky that people have already turned up at emergency rooms because of our abortion restrictions," Wieder pointed out. "Doctors have been forced to wait until patients were at life-threatening situations, sepsis, hemorrhage, before they are able to provide care."

According to the National Institutes of Health, pregnancy complications are the fifth-most common reason women of reproductive age visit the emergency room.

Weider added rural communities across the Commonwealth suffer the nation's worst family planning and sexual health outcomes and continue to struggle with access to safe and convenient obstetric and reproductive health care.

"I think it's really important to note that 57% of Kentucky's rural hospitals no longer offer obstetric services, 57%," Weider emphasized.

Kentucky's Human Life Protection Act, passed by lawmakers in 2019, banned all abortions except to save the life of the mother and it went into effect immediately after the Supreme Court overturned Roe v. Wade in 2022. The same year, voters in the Commonwealth rejected a ballot measure which would have amended the state constitution to explicitly deny the right to an abortion.

Arizona doctors have filed a lawsuit to overturn a set of restrictions which they argue interfere with access to abortion care. Arizona voters last year passed Proposition 139 which enshrined the fundamental right to an abortion, up until fetal viability, in the state's constitution.

Gail Deady, senior attorney, Center for Reproductive Rights, which is representing some of the plaintiffs in the case, explained that the abortion rights that were secured because of the measure do not go into effect automatically, and existing laws that limit access must be challenged before they can be struck down under Prop 139.

"This lawsuit is intended to honor the will of the voters and it looks to strike down the most onerous abortion restrictions that are currently on the books in Arizona," she said. "The theory behind this case is that these restrictions do not have any medical basis, they do not make abortions safer."

Deady explained that some of the restrictions include forcing doctors to turn away patients if they suspect a fetal genetic diagnosis is the reason for a patient seeking care, requiring patients to wait at least 24 hours before obtaining abortion care, and banning the use of telehealth for abortion. Mailing abortion pills - like mifepristone - is also prohibited. Conservative, anti-abortion advocates have expressed support for the restrictions, its's unclear if they'll oppose the lawsuit.

Deady argues many Arizonans are facing negative consequences as a result of the laws. She adds that it also means a delay in receiving the care most Arizonans supported last year, and added that Arizona has what she calls a "two-trip" law which requires patients make two separate visits to a clinic.

"Just to hear mandatory, state-scripted information about abortion that often is not medically correct, it spreads misinformation and is designed to make people feel ashamed of the decision that they've made which has now been recognized as a constitutional right in Arizona," she explained.

Deady said her organization is currently advocating for the restrictions to be blocked during litigation. The state attorney generals' office is currently examining the complaint.