More abortions are taking place by telehealth, raising the stakes for anti-abortion advocates’ efforts to stop abortion pills from being prescribed across state lines.

The share of elective abortions in states without bans performed by online-only clinics rose four percentage points to 14% in 2024, according to new data published Tuesday from the Guttmacher Institute, the pro-abortion research arm of Planned Parenthood. More than 145,000 medication abortions were provided by online-only clinics in states where abortion is legal.

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Guttmacher’s study does not include any data from the 12 states that have prohibited elective abortions following the overturning of Roe v. Wade in 2022, making the 145,000 figure an underestimate. 

Eight states have enacted so-called “shield laws” with the intention of providing telemedicine providers who prescribe abortion pills to patients in states where elective abortions are prohibited. 

The Guttmacher study says that the total national number of abortions via online-only clinics “is almost certainly higher than this, as the 14% does not include shield law provisions into states with total abortion bans.”

The Society for Family Planning, a pro-abortion group, last year estimated that roughly 34,500 medication abortions were provided in the first half of 2024 in states with total abortion bans from providers in states with shield laws.

If trends stayed constant throughout 2024, that means about 214,000 abortions nationwide were provided by online-only clinics. 

Telemedicine abortion and shield laws are quickly becoming central to contemporary debates on abortion policy, putting a severe strain on the state-by-state position that President Donald Trump has championed for the Republican party’s post-Roe rhetoric.

A civil case against a New York telemedicine physician who prescribed mifepristone to a pregnant woman in Texas is widely expected to escalate to the Supreme Court. Texas argues that New York’s shield law violates the Lone Star State’s ability to execute its own laws prohibiting elective abortion. 

The same New York doctor is also facing criminal charges in Louisiana after being indicted this spring for her involvement in a case of coerced abortion against a minor. 

Anti-abortion advocates have waged a protracted legal fight against the abortion pills mifepristone and misoprostol. Last year, the Alliance for Hippocratic Medicine argued before the Supreme Court that patients who obtained abortion pills online have no physician to turn to in the event of complications. The court did not rule on the merits of the case, dismissing it on technical grounds.

In a case connected to the AHM litigation, federal judge Matthew Kacsmaryk of Texas earlier this year ruled that Idaho, Kansas, and Missouri can proceed with their lawsuits to challenge the Food and Drug Administration’s loosening of restrictions that have allowed the mifepristone to be prescribed online. 

Before the COVID-19 pandemic, patients seeking a mifepristone abortion needed a physical examination from the provider to determine the gestational age of the fetus and ensure that it was not an ectopic pregnancy, a life-threatening condition.

Despite the proliferation of telemedicine abortions, the majority of abortions in 2024 were still provided by brick-and-mortar facilities.

According to the new report, the total number of abortions increased by less than 1% last year, to roughly 1,038,100 clinician-approved procedures in states without a total ban. 

The number of abortions in the United States has increased by 12% since 2020, according to the Guttmacher Institute.