Two years after the Supreme Court’s Dobbs decision overturned Roe v. Wade, many expected the number of abortions in the United States to plummet. With 12 states enacting total bans and six more instituting early gestational limits, abortion access in much of the country has become more restricted. Yet new reports show that the overall number of abortions has not declined — in fact, by some measures it has increased.
The Society of Family Planning’s #WeCount project estimates 1.14 million abortions occurred in the U.S. in 2024, up from 1.05 million in 2023. This surprising increase has one primary driver: the rapid rise of mail-order, telemed-facilitated abortions. Unlike surgical abortions that occur in more regulated abortion facilities, chemical abortions can now be obtained within a few clicks online. Customers fill out digital forms, receive prescriptions from clinicians — often across state lines under “shield laws” — and pills are shipped directly to their homes. By late 2024, telemed abortions accounted for roughly one-quarter of all abortions nationwide, with some estimates much higher.
The cost factor has accelerated this trend. A brick-and-mortar abortion facility charges a median of $600 for a chemical abortion, while virtual clinics charge around $150, 75% less. For many women concerned with finances, online options seem accessible, discreet, and affordable. But this digital revolution in abortion has come at a high cost to public health, transparency, and accountability.
The Guttmacher Institute just released preliminary data from its Monthly Abortion Provision Study showing a 5% decline in clinician-provided abortions in the first half of 2025 compared to the same period in 2024. Guttmacher also reported an 8% decline in the number of patients traveling across state lines for abortions. While some headlines may seize on these numbers as evidence that abortions are decreasing, the truth is more complicated.
Guttmacher itself admits that these figures reflect only “clinician-provided abortions” in states without total bans. The numbers do not account for the explosion of abortions facilitated through shield-law provisions and mail-order pills, particularly in states where abortion is otherwise prohibited.
A recent JAMA study confirms the scale of this hidden trend.
Between July 2023 and September 2024, Aid Access, a major virtual abortion pill provider operating under shield laws, mailed more than 118,000 abortion pill packs nationwide. Strikingly, 84 percent of those went to women in states with near-total or telemedicine bans. So, even as Guttmacher records declines in clinic-based procedures, tens of thousands of abortions are still occurring outside the brick-and-mortar health care system and beyond any reliable reporting.
This is not simply a matter of statistics. The shift to mail-order abortion has introduced a new level of complexity.
Historically, abortion reporting in the United States has been questionable, but at least measurable. The CDC has long collected data from states, though reporting is voluntary and excludes some of the nation’s largest, such as California and New York. The Guttmacher Institute has conducted its own surveys, but those rely on facility self-reporting. And neither system accounts for the underground surge of abortion pills delivered by mail.
Telemed providers, particularly those operating under shield laws, are not required to report demographic details, complications, or even whether the abortion was completed. At best, researchers can track the number of pill packs mailed, which tells us nothing about the outcomes.
The lack of reliable data has real consequences.
How many women suffer complications from incomplete abortions, hemorrhage, or infection? How many underage girls are obtaining abortion pills without parental knowledge? How many mothers change their minds after swallowing the first pill, desperate for a way to reverse what they have done? None of these questions can be answered when abortions take place outside of regulated medical settings and beyond any reporting requirements.
The risks to women’s health are being brushed aside.
Proponents of chemical abortion point to studies claiming the pills are safe and effective, but those studies largely involve women who obtained care in clinics with follow-up protocols in place. They do not capture the self-managed, mail-order abortions happening today, where women are left to handle potential complications on their own. Even the JAMA researchers acknowledged their study’s limitations, noting that they could measure only pill distribution, not health outcomes, and that their analysis was conducted at the county level rather than the individual level.
In short, no one really knows what happens after the pills arrive in a woman’s mailbox.
What we do know is troubling.
Shield laws embolden abortion providers in permissive states to undermine the laws of pro-life states, mailing pills to women and girls in defiance of local restrictions. Cross-border accountability is nearly impossible. Even worse, abusers are increasingly using these pills to exploit women — coercing them into unwanted abortions, secretly slipping drugs into their food or drink, or pressuring them to take the pills in isolation without medical support. These stories are surfacing across the country, yet they remain largely untracked because of the lack of oversight.
With no uniform, federally mandated system of abortion reporting, the nation is left guessing about the true scope of abortion in America.
The Guttmacher Institute’s new data should be viewed with caution. A reported decline in “clinician-provided” abortions is not a decline in abortion itself. Rather, it is a measure of how much abortion has shifted underground, into mailboxes and across borders, where oversight is nearly nonexistent. Until abortion reporting is required across all states and includes telemed and mail-order abortions, the numbers will remain incomplete and misleading.
The Dobbs decision created a hopeful turning point for protecting life, but the surge in mail-order abortions threatens to undo that progress in hidden ways. While abortion facilities close in one state, packages of pills cross state borders and come in unseen. While state legislatures pass protections, shield laws undermine them with impunity. And while researchers publish numbers, the real-world details about the safety of women and the lives of their children are left uncounted.
The fight for life is no longer confined to clinics and courtrooms. It now extends into the digital marketplace and the mailbox. To protect women and children, we must shine a light on the hidden crisis of mail-order abortion and demand accountability, transparency, and genuine care.
Andrea Trudden is vice president of communications at Heartbeat International