A Surge of Overseas Abortion Pills Blunted the Effects of State Abortion Bans

But the tally also underestimates the number of abortions in some ways. It does not include people who ordered pills from other overseas websites. Aid Access is the largest such provider, but others have recently started or expanded. The data also excludes women who got an abortion outside the formal health system in another way, such as by ingesting herbs or crossing the border to Mexico to obtain an abortion pill that is sold over the counter as an ulcer medicine. These abortions are often clandestine and hard to measure.

“There is a large undercount of people who are self-managing their abortions, absolutely,” said Renee Bracey Sherman, an activist and the founder of We Testify, a group that shares abortion stories, including those of people who managed their own abortions. “Because people are sourcing them in their communities and because they are getting them in lots of different ways.”

The abortion pills are a two-drug combination of mifepristone and misoprostol that stops the development of a fetus and then causes a miscarriage. The process takes a few days. A small share of women who take them do not experience a complete miscarriage, and need follow-up care in a hospital.

The medications have been approved by the Food and Drug Administration and are offered by abortion providers in states where abortion remains legal. In recent years, more women have chosen medication abortion than in-clinic procedures. In December, the F.D.A. allowed abortion pills to be prescribed through telemedicine, without requiring a physical visit to an abortion clinic, though many states forbid it.

Skirting American laws, Aid Access connects patients with European doctors, then mails the pills from Indian pharmacies to patients in the United States.

It is illegal to sell prescription medicine to Americans without a prescription from a doctor licensed in the United States. Between 2000 and 2020, there were at least 61 cases in which people were criminally investigated or charged with managing their own abortions or helping someone do so, according to If/When/How, a legal group that supports reproductive rights.

And since the Dobbs decision, some states have tightened laws regarding medication abortion. They are hard to enforce, though, because the pills come through the mail, and overseas pharmacies are typically outside the jurisdiction of local law enforcement.