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Telehealth requests for medication abortion doubled in more than a third of states in the months after the U.S. Supreme Court reversed Roe v. Wade, according to new work from University of Washington researchers.
The study was published in medical journal JAMA Network last month, and builds on research that has documented rising demand nationwide for abortion medication through telehealth services. This care, shown to be as safe and effective as in-person options, has become especially popular among people who live farthest from an abortion-care clinic, according to the report.
We're not the only people to document the increase in telehealth use — but what we've added is that distance does really still matter," said Anna Fiastro, the paper's senior author and a researcher at the UW School of Medicine. "Telehealth is a lifeline for people far from clinic-based care."
As of last year, about a quarter of abortions provided in the U.S. were done so via telehealth, Fiastro said. The study she and her team just published aims to further examine that aspect of abortion care, hoping to better understand where these patients live and how that might play a part in where they seek mifepristone and misoprostol.
Fiastro and other researchers analyzed more than 16,000 requests submitted during a 15-month time period to Aid Access, one of the largest telemedicine abortion providers, which mails the pills for abortion and miscarriage treatment to all 50 U.S. states and other countries.
Data from 18 states where abortion care remains legal — including Washington, California, Massachusetts, Minnesota, New York, Oregon and others — was included in the report, which looks at requests between November 2021 and February 2023, or before and after the Dobbs v. Jackson Women's Health Organization decision.
In those 18 states, researchers found telehealth abortion requests jumped about 155% in the eight months after Dobbs, as compared to the prior eight months.
The majority of requests came from people before their sixth week of pregnancy, and who had no children. The rate of requests also tended to be highest in counties at least 100 miles from a clinic, both before and after Dobbs, according to the report.
Data from Washington state provided one of the clearer examples of that, Fiastro said. Request rates here tended to be higher in more rural counties with fewer or no options for in-person abortion care, including on the Olympic Peninsula and in Central and Eastern Washington, according to the study.
But while the report found the monthly rate of requests on average increased the further people lived from abortion-care clinics, requests also rose among people who lived closer, lead author Amy Willerford, a third-year medical student at UW, wrote in a statement.
"We were surprised to see that even people who lived near clinics — sometimes just down the street — still used telehealth services," Willerford wrote.
This more recent study looked only at data from states where abortion care remains legal, but a different report published over the summer that compiled Aid Access' orders nationwide found that more than 80% of prescriptions went to states with near-total abortion bans or bans specifically on telemedicine abortion.
Mifepristone, one of the common abortion pills, was approved by the Food and Drug Administration in 2000, but telehealth options started becoming widely available only in the past eight years or so, Fiastro said. The Society of Family Planning found this year that telehealth abortion care surged in the summer of 2023, after the FDA temporarily lifted the requirement for in-person dispensing of mifepristone during the COVID-19 pandemic.
The Biden administration made that change permanent in 2023.
Nationwide, the total number of abortions has increased slightly since the 2022 Dobbs ruling, according to the Society for Family Planning report. In 2024, there were 1.14 million abortions, up from about 1.05 million the prior year. That's likely due to multiple factors, including expanded access to telehealth, according to a KFF brief published this summer.
In-person abortion care, including procedural and medication abortion, is still more common than telehealth, but as more studies around the topic emerge, researchers have learned patients "really like telehealth care," Fiastro said. "They find it to be really private, affordable and accessible," she added.
At Aid Access and similar sites, many virtual visits and prescriptions cost $200 or less, according to STAT News. And for those who live far from a clinic, it eliminates the need to travel or take time off work, Fiastro said.
Other studies have come to similar conclusions about telehealth medication abortion and distance from a clinic, including one published in February in the American Journal of Public Health, which Fiastro also worked on.
The Trump administration has repeatedly questioned the safety and efficacy of abortion pills, which are used in nearly two-thirds of abortions, according to the Guttmacher Institute. In September, Health and Human Services Secretary Robert F. Kennedy Jr. announced the FDA would conduct a new review of the medication — though the federal agency also approved another generic version of mifepristone last month, prompting pushback from anti-abortion groups.
The option to take mifepristone and misoprostol to end early pregnancies and manage miscarriages is supported by the country's major medical organizations, including the American College of Obstetricians & Gynecologists and the American Medical Association.
Fiastro noted this study looks at data from only one provider, Aid Access, and that similar services also provide telehealth medication abortion, including in Washington. The report also does not rank which counties in the data set reported the highest request rates, she said.
"This is just one piece of the puzzle, Fiastro said.
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