In the first year after the U.S. Supreme Court overturned Roe v. Wade, an estimated 1 in 10 abortions were provided by online-only clinics, according to new data released Thursday by the Guttmacher Institute, a nonprofit that researches reproductive health and advocates for abortion access.
Guttmacher’s ongoing Monthly Abortion Provision Study for the first time shows state-level estimates of the proportions of abortions provided via medication and by online-only clinics. Researchers found that in the majority of states without total abortion bans, most people are terminating with abortion pills. The data builds on a previous finding that 63% of all clinician-provided abortions in the U.S. in 2023 were through medication.
“We’re publishing these data at a time in which medication abortion is under threat from many angles, particularly medication abortion provision via telemedicine, and we’re finding that this is a really key pathway to abortion access for people all around the country,” said Isabel DoCampo, a senior research associate at the Guttmacher Institute, who co-authored the data analysis.
Despite its widespread use and high safety record, medication abortion could soon become much harder to access if the Trump administration — in line with the GOP blueprint Project 2025 — tries to ban telemedicine abortion or prevent the mailing of abortion pills, which are also used to treat miscarriages and other health conditions. There is also an ongoing federal lawsuit over the U.S. Food and Drug Administration’s approval of mifepristone, the first in a two-drug abortion regimen. In a recent development, GenBioPro, the country’s largest manufacturer of abortion pills, joined the lawsuit as a defendant.
The Monthly Abortion Provision Study estimates the number of abortions provided by clinicians in states without total abortion bans between January 2023 and November 2024, based on data collected from abortion providers and using a statistical model. It defines medication abortion as either being “prescribed at an in-person clinic visit, or via telemedicine from a brick-and-mortar or online-only clinic.”
Guttmacher excluded from its study self-managed abortions or telemedicine abortion in states with total abortion bans, though online medication abortion is available to people living in states with abortion bans. The states excluded were: Alabama, Arkansas, Idaho, Kentucky, Louisiana, Mississippi, North Dakota, Oklahoma, South Dakota, Tennessee, Texas and West Virginia. Data about online-only clinics was unavailable for states that restricted telemedicine in 2023.
“Our estimates of medication abortion provision are likely an undercount,” DoCampo said.
Wyoming had the highest estimated proportion of medication abortion (95% of all abortions) and abortions via online-only clinics (60%), while the District of Columbia had the lowest proportion of medication abortions, at 44%, and also via online-only clinics (7%).
Other states with high proportions of medication abortion include: Montana (84%),
Georgia (83%), Nebraska (83%), Vermont (81%) and Delaware (77%), with lower proportions in Ohio (46%), Florida (55%), Massachusetts (57%), Michigan (58%), New York (58%).
Iowa had the second-highest proportion of online-only clinics (29%), followed by Delaware (28%), Nevada (24%), Colorado (22%) and Minnesota (21%).
DoCampo said state differences in proportions of medication abortions and online-only clinic usage can’t be attributed to any one thing, but to a variety of factors, including a state’s abortion laws, population and clinic density, telemedicine availability, and insurance reimbursement rates for medication versus procedural abortions.
Wyoming — with its low population density, few clinics and (at the time of the study) restrictive abortion policies — was high on the list of states reporting more medication abortions. But so was Delaware, which is much more urban and has a higher density of clinics and fewer restrictions. Meanwhile, Ohio, which is densely populated, has few clinics and has a mix of restrictive and protective abortion policies, had the lowest state proportion of medication abortion, and did not have data for online-only clinics.
“It’s really interesting to see diverse environments with similar proportions of medication abortion provision,” DoCampo said.
She noted the data does not reflect the preferences of all abortion seekers.
“Medication abortion, even though it does represent the majority of abortions in most U.S. states without total bans, might not be the preferred abortion method for folks,” DoCampo said. “Black individuals and individuals who are below the federal poverty line often tend to prefer procedural abortion to medication abortion.”
But in many states, medication abortion has become the most available method. Guttmacher data published in 2024 found a 5% nationwide decline in brick-and-mortar clinics that provide procedural abortions.
