In 2019, the conservative demographer Lyman Stone demonstrated that, contrary to the claims of some liberal commentators, limitations on abortion access lowered abortion rates. In every case Stone examined, from Austria to Korea to Texas, abortion restriction in the law preceded a decline in total abortions. But after the US Supreme Court overturned Roe in 2022, the opposite appeared to happen: America’s total abortion rate increased, from an average of 79,600 abortions per month in 2022 to 98,880 per month in early 2025, according to estimates created from the Society of Family Planning.
The reason for this is not complicated. The thirteen states that restricted or banned abortion saw a stark decline in June 2022. The thirty-seven others, several of which added abortion to their state constitutions as a right, and some of which introduced incentives for abortion tourism from neighboring states, saw an increase.
But then, around June 2023, something strange happened. States with bans or restrictions saw a huge influx of “telemedicine” abortions. Texas went from zero to nearly 2,000 in the course of one month, all of them prescribed remotely. Something similar happened in Louisiana, Kentucky, and Tennessee. The explanation is that around this time, states like California and New York passed “shield laws” to insulate activist physicians from lawsuits when they prescribe chemical abortifacients to out-of-state women.
“Self-administered chemical abortion is the most common kind of abortion now,” explained Patrick Brown, a fellow at the Ethics and Public Policy Center. It isn’t just the state shield laws that have enabled this, he added. It’s also Covid-era rules passed by the Biden administration, which made it possible to obtain abortion pills after a virtual consultation with a physician, no in-person visit required.
Mifepristone, the most widely used abortion pill, was legalized by the Clinton-era Food and Drug Administration in 2000. At first, women who wanted it had to complete three doctor visits before the unborn child reached seven weeks gestation, the oldest age at which the FDA found the pill to be safe to use. The drug also had to be administered in the office by a physician, with mandatory follow-up visits and adverse event reporting. Under the Obama administration, the FDA rolled back all of these restrictions except one: Women still had to get the pill in person at a healthcare office.
“During the pandemic, the Biden administration paused the in-person requirement.”
During the pandemic, the Biden administration paused the in-person requirement, under the argument that abortions are “essential” healthcare. Doctors and medical persons could meet the requirement via telehealth. After Dobbs, Biden made this permanent policy, directing his HHS Secretary Xavier Becerra to identify “ways to ensure mifepristone is as widely accessible as possible, including when it is prescribed through telehealth and sent by mail.” The result was the 2023 revision of mifepristone’s Risk Evaluation and Mitigation Strategy (REMS), required by FDA for high-risk drugs. The revision, which permanently allowed mail order mifepristone with as little as one telehealth consultation, made obtaining abortion pills about as easy as getting an antibiotic—perhaps easier.
In 2023, Rosalie Markezich, a Louisiana resident, got pregnant and wanted to keep the child, but her boyfriend insisted she abort. When Markezich found herself alone with him in his car, the argument got heated. “To pacify him, I told him I would take the drugs,” Markezich told the Alliance Defending Freedom, but she planned to throw them up afterward. Unable to vomit effectively, Markezich found herself on the floor of the nearest bathroom, bleeding and crying as she delivered their dead child.
Markezich says her boyfriend used her email address to order mifepristone and misoprostol from a San Francisco-based acupuncturist, Dr. Remy Coeytaux. Louisiana prohibits abortion at all stages of pregnancy, and physicians convicted of providing abortions there face steep fines and up to 15 years in prison. But shield laws ensured that the only hurdle faced by Markezich’s boyfriend was a Zoom call.
Coeytaux did not respond to a request to comment, but referred the request to the Center for Reproductive Rights, which said: “While we can’t comment on this matter itself, one thing is clear—the state of Louisiana is going after doctors for allegedly harming women, yet they are enforcing an abortion ban that puts women’s lives at risk every day. Women continue to die from being denied abortion care.”
In September 2025, Louisiana Attorney General Liz Murrill filed a warrant for Coeytaux’s arrest, forcing to a head the question of whether doctors operating in states with permissive abortion laws can openly violate the laws of other states without consequence. Coeytaux is at the hub of at least two such charges, one in Louisiana and another in Texas. “Without a requirement for an in-person office visit to prevent coercion … anyone can obtain mifepristone and pressure or trick a woman into taking it,” said Murrill in a September legal filing.
That is precisely what Marine pilot Chris Cooprider appears to have done in Texas last April, before spiking his neighbor’s hot chocolate with one mifepristone and ten misoprostol pills, according to her lawsuit against him. Lengthy records of text messages between Cooprider and Liana Davis show the Marine ordered mifepristone online from Aid Access, an abortion pill vendor based in the Netherlands, and engaged in a months-long attempt to shame Davis into aborting their unborn child, whom Davis insisted she wanted to keep. Thirty minutes after drinking Cooprider’s concoction, Davis began hemorrhaging and cramping, and hobbled to the neighbor’s house to get a ride to the hospital. The pilot had already skipped town, ignoring texts and calls. In his countersuit, Cooprider claims Davis experienced a spontaneous miscarriage.
Other horror stories include a Florida woman accused of using mifepristone in an attempt to kill the unborn child of her ex-boyfriend’s new lover; a Florida man who swapped the label on an abortion pill bottle with that of an antibiotic to sham his pregnant girlfriend into aborting their child; and an Ohio surgeon who is accused of forcing mifepristone into his sleeping girlfriend’s mouth, having used his estranged wife’s identity to order the drugs online.
In a Senate hearing on January 14, Murrill listed two more instances of abortion pill abuse, both of which involved not only coercion but also mifepristone used well outside FDA’s approved ten-week gestational age. In her opening statement, Murrill said: “A pregnant woman, who took pills that [Dr.] Margaret Carpenter from New York mailed to her at twenty weeks gestation … ended up in the emergency room while her baby was left in a dumpster. Another twenty-week-old pregnancy, the baby was recovered in a toilet…These are not medical standards. There are no medical standards in any state that sanctions such irresponsible actions by a medical professional.”
The estimated rate of remote “telehealth” abortions, those prescribed by phone or over a Zoom call, went from 5 percent of all abortions in 2022 to 27 percent of all abortions in 2025, according to SFP. Remote abortions skyrocketed in states where abortion is banned after the introduction of shield laws. Fully 55 percent of all remote abortions in early 2025 happened under “shield laws.” That means they were approved by out-of-state doctors in direct contradiction of the state laws governing the person seeking an abortion.
As in Louisiana, Kentucky’s abortion limits have been tested by remote abortions. Unlike many states, Kentucky law requires doctors to report any abortions or attempted abortions that come under their care. Kentucky also tracks its own total abortion rate. In 2024, the latest year for which data has been published, the total number of legal abortions performed was nine.
“Kentucky’s abortion limits have been tested by remote abortions.”
Kentucky’s physician reporting requirement might be less effective if chemical abortions were less grisly. It is extremely common for a woman to visit the emergency room after taking mifepristone. The Ethics and Public Policy Center reported last spring that roughly 11 percent of mifepristone users incur serious adverse side effects. That number excludes a full 72 percent of post-mifepristone emergency room visits which did not rise to the level of a “serious adverse event.”
When 35-year-old Kentucky resident Melissa Spencer ordered abortion drugs online over Christmas, her ensuing hospital visit made national news. Spencer had what is called a “self-managed” abortion, a euphemism for abortions performed without any physician consultation or approval, on December 27, according to the Lexington Herald-Leader. After delivering her dead son, Spencer said she buried him on the backside of her property. (Local police later confirmed a shallow grave and the remains of a “developed” infant.) On New Year’s Eve, whether for guilt, lingering side effects, or some other reason, Spencer checked into a local health clinic and confessed to the doctor on duty. Abiding by state law, the physicians present called the police. In January, Spencer was indicted on one count of first degree fetal homicide, abuse of a corpse, and evidence tampering. The story caused enough of a hubbub that the local prosecutor filed a motion to dismiss the fetal homicide charge. As the local paper put it, “the [fetal homicide] law cannot be used to prosecute those who seek abortion care.”
On January 15, Gavin Newsom rejected Louisiana’s extradition request for Coeytaux, saying “California protects patients and their doctors…We will not be complicit in efforts to strip away their privacy, autonomy, or dignity.” New York Gov. Kathy Hochul has similarly rejected Murrill’s extradition of Carpenter, the woman who prescribed mifepristone to an out-of-state mother at twenty weeks gestation: “There’s no way in hell,” Hochul said.
Conservative states have responded with their own innovations. In September, Texas became the first state to allow private citizens to sue anyone who “manufactures, distributes, mails, transports, delivers, prescribes, or provides” medication abortion pills to Texans. This approach would seem to allow women who take mifepristone in Texas to seek retribution against almost any part of the abortion pill supply chain that allowed her to access it, and gain up to $10,000 in damages. The reward is a full order higher for the sibling, grandparent, or father of the unborn child who sues, at $100,000. Texas’s law explicitly prohibits prosecuting a mother who has a “self-managed” abortion. The first test case has already been filed: For the wrongful death of his unborn child, Texan Jerry Rodriguez is suing none other than Remy Coeytaux.
“Conservative states have responded with their own innovations.”
Meanwhile, Louisiana has classified mifepristone and misoprostol as controlled substances, the same category as opioids and hallucinogens. But, as Murrill acknowledged in the January Senate hearing, these measures can only go so far. “Shield laws,” as she noted, “protect providers from liability and effectively nullify laws in our states.” For Murrill, the Biden FDA is primarily responsible: “The 2023 REMS must be vacated. Until then, Louisiana’s efforts to protect mothers and their unborn children and to hold out-of-state abortion pill traffickers accountable for the harm they inflict, will be all but futile.”
You can’t prove bans work if you don’t have data. Only five years ago, tallying abortion totals was not a matter of guesswork. The Centers for Disease Control and Prevention collected and published a biannual report on the national abortion rate, with data collection performed on an annual basis. That stopped in 2022, when the Biden administration’s Dr. Debra Houry instructed her staff to “return state-submitted abortion data rather than analyze it.” Houry quit the CDC in 2024, but data in the biannual report covering 2023 and 2024 has yet to be published. The Trump administration, in the meantime, cut the Pregnancy Risk Assessment Monitoring System (PRAMS) program which once monitored abortion rates, as part of its broader federal employee overhaul in May 2025. Some reports suggest the delayed 2023 data may be published this spring, but this remains unconfirmed.
“State regulations on abortion provision are being more than offset by the huge increase in access to mail-order abortion medications,” Lyman Stone told me, affirming that the rates have almost certainly increased, but added that data on abortion rates is “rather poor.” Without the CDC keeping track, the only national organizations which publish a tally are progressive advocacy groups whose tabulators have great incentives to pad the numbers. The Society of Family Planning, whose numbers are cited in this piece, started gathering information immediately after the Dobbs decision in an explicit effort to prove the inefficacy of abortion bans.
To tally abortion rates, SFP uses a database of abortion providers across the United States, and pays a financial incentive to participating providers “for each monthly submission” of data on telehealth and in-person abortions performed. Where providers do not report tallies, SFP says it imputes a guess, based on “information from news articles, contacts known to the non-reporting clinics, knowledge of the abortion volumes by state, or the median #WeCount number.” Imputed numbers account for 19 percent of SFP’s data.
The Charlotte Lozier Institute, a pro-life organization for scientific, statistical, and medical research, has reviewed SFP’s data in depth alongside that of other organizations. One strength of the #WeCount numbers is that SFP includes mail-order abortions taking place under shield laws in places where abortion would otherwise be prohibited, a valuable insight. But the biggest weakness, according to CLI, is that the #WeCount data cannot be replicated. “No one except pro-abortion organizations like SFP and Guttmacher gets access to totals reported by centers and organizations themselves, and the two organizations do not publish raw totals by organization or by center,” Mia Steupert, the study author, writes. Lozier does not currently seek to collect a competing tally.
Tessa Cox, a senior research associate at Lozier, said that without CDC abortion reporting, and with “an increasing number of abortion drugs mailed under the radar via ‘shield laws,’ it is impossible to know with certainty the number of abortions occurring in the United States.”
Much of this increase, according to Cox, is the continuation of trends that began before Dobbs, particularly mail-order abortion, which was first allowed in 2021. “To improve national abortion data and stop the spread of abortion drugs over state and international lines, federal action is needed,” she said.
Mifepristone has turned out to be a bigger game changer than overturning Roe. Not merely has it made abortion harder to regulate, it has made it commonplace—normal. Those changes were starting to take off, with the help of more lenient mifepristone prescribing, before the Dobbs decision. Total abortion rates reflect this: The increase began in 2019-2021, not 2022, though they were clearly accelerated by telehealth abortions and shield laws protecting intrastate aggressors.
Such technological changes affect the abortion landscape at a deeper level than politics and policy. Today, a woman can abort her unborn child without ever telling anyone, flushing fetal remains down the toilet like any menstrual cycle; likewise, a man can buy pills and get his girlfriend to ingest them, with an effect that hardly looks different from a spontaneous miscarriage. Moreover, abortion providers, from the overseas drug vendors to the out-of-state acupuncturists prescribing them, may hide behind a laptop screen. Under these conditions, the fight for unborn lives takes on the flavor less of a moral crisis and more of an old man shaking his fist at the youths.
Then there is the fact that abortion has never been a primary element of the Trump brand. “Obviously, Trump 2.0 has delivered some smaller victories for pro-lifers,” said Brown, the policy analyst at EPPC. He mentioned Trump’s reinstating of the “Mexico City policy,” which blocks US government funding to NGOs that perform abortions, his defunding of Planned Parenthood for a year, and his pardons of twenty-three pro-life activists arrested for peaceful protests near abortion clinics. But as Brown said, “there are plenty of people within the GOP, including the current president, who just want the issue to go away.”
“Abortion was not nearly as motivating in 2024 as many strategists expected.”
Abortion was not nearly as motivating in 2024 as many strategists expected. Trump’s press office did not return a comment for this article, and some conservative commentators I reached out to declined for precisely that reason: Abortion is not the focus right now. “Even low-hanging fruit like reinstating the in-person requirement to be prescribed the abortion pill is an uphill fight,” Brown said. This is not for lack of popular backing: According to one survey, roughly 7 in 10 women support requiring a doctor’s visit before prescribing mifepristone.
HHS Secretary Robert F. Kennedy, Jr., in his Senate confirmation hearing, promised to conduct a safety review of mifepristone, which would likely involve a conversation about revising the 2023 REMS rules. That review has yet to be published, though FDA Commissioner Dr. Marty Makary recently reassured Americans that the study is underway.
Still, pro-life leaders I spoke with seemed optimistic. Kristi Hamrick, Vice President of Media and Policy at Students for Life, underscored how much of pro-life states’ ability to test new laws and see what sticks is only possible in a post-Roe landscape. “What has truly changed are our options and our conversations, because the Supreme Court no longer acts as a roadblock to protecting the most vulnerable among us,” she said.
Kelsey Pritchard, communications director at Susan B. Anthony Pro-Life America, called the increased total abortion rate a “‘bump’ in pro-abortion anger following Dobbs,” which is “likely to be temporary and short-lived.” Pritchard described an America that is more pro-life than the average newsreader might imagine: Pro-life identification is up, especially among young adults, and support for abortion on demand is down since Dobbs. A majority of Americans supported the reversal of Roe by 2023.
More to the point in the mifepristone era, “57 percent of liberal voters agree there should be more guardrails on these deadly drugs, not fewer,” Pritchard said. “That requires leadership at the national level to end bad policies from the Covid era, leadership we haven’t seen yet from the administration, but it should not take too much political courage to be on the side of the majority.”