The first nationwide count of telehealth abortions includes pills mailed to states with abortion bans by clinicians in states with shield laws.The NewsA growing share of abortions is now being administered through telemedicine, with clinicians prescribing mail-order abortion pills after online consultations, according to the first nationwide count of telehealth abortions in the U.S. medical system. At least one in six abortions, around 14,000 a month, was conducted via telehealth from July through September, the most recent months with available data.How It WorksPills are prescribed by virtual-only providers and by clinics that also offer in-person services. Patients fill out an online questionnaire or meet with a clinician via video or text chat. This method began nationwide in 2020, when the Food and Drug Administration began allowing abortion providers to mail pills without an in-clinic visit during the pandemic.Some of the prescriptions included in the new count were given to patients in states where abortion is banned, a new development made possible by shield laws. These laws protect clinicians in states where abortion is legal when they prescribe and mail pills to patients in states where it is not. Shield laws were in effect in Colorado, Massachusetts, New York, Vermont and Washington during the period covered by the new data, and California has since passed one.Why It MattersThe growth of telemedicine abortion has made it easier and often less expensive for women to get abortions, particularly if they live far from an abortion clinic or in one of the roughly one-third of states that have banned or substantially restricted abortions since the Supreme Court’s Dobbs decision in 2022.Activists, legislators and prosecutors in the states with bans are working to stem the flow of these mail-order pills. But they have so far proven hard to regulate.The new data, from WeCount, a research group that collects abortion numbers from providers nationwide and supports abortion rights, suggests that the overall number of abortions provided by clinicians in the United States is slightly higher now than it was before the Dobbs decision.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Several insurers will cover abortions through Hey Jane, a start-up online provider, just as courts threaten to hobble the industry.The legal effort to ban mail-order abortion pills came along just as the fledgling telehealth industry became a more accepted and entrenched part of abortion care.This week, Hey Jane, one of more than a dozen virtual abortion providers that have no physical locations, began contracting with the insurers Anthem Blue Cross Blue Shield of Connecticut, Empire Blue Cross Blue Shield of New York and Sana, which provides health plans for small businesses nationwide. Hey Jane also already accepted Aetna in eight of the nine states in which it operates.It’s unusual for insurers to cover telehealth abortions, and most virtual clinics are cash only. The clinics are new, and insurance coverage for abortion varies widely. In the year before Roe v. Wade was overturned, just a third of abortion patients used insurance. Some states require private insurers to cover abortions, while others bar it. Federal law prohibits the use of Medicaid for most abortions, though 16 states use state funds to cover them. But even plans that do cover abortion don’t generally include these new telehealth providers in their networks.Health insurers tend to cover treatments that are widely accepted by clinicians and cost-effective, and Hey Jane’s insurance partnerships are the latest sign that virtual abortion clinics are seen by the health care industry as a safe, in-demand option. They also tend to be less expensive than in-clinic procedures for both patients and insurers.“In abortion care, as in so many other areas of health care, we believe expanding telehealth’s role is a huge lever” for making care more accessible and affordable, said Will Young, chief executive of Sana.Not all insurers are ready to cover this new way of providing abortions, said Gaby Santana, head of business at Hey Jane. For example, some require live visits, over video, while Hey Jane sees most of its patients through messaging. Other insurers told Hey Jane they only contracted with clinics with a physical location. “Our goal is to make this as big and accessible as possible,” Ms. Santana said. “That’s why we want to bring on more states and more payers.”The abortion pills mifepristone and misoprostol are packaged at Dr. Kaul’s clinic, Maitri Wellness, to be mailed to patients. Jackie Molloy for The New York TimesNew data shows telehealth accounts for a rapidly growing share of abortions, and Honeybee, the largest online pharmacy supplying mail-order abortion pills, said it was filling more than 10,000 prescriptions a month.Yet these clinics could also be hobbled just as they are starting to grow. The Fifth Circuit ruled last week that the Food and Drug Administration should ban telemedicine prescriptions and delivery by mail for mifepristone, the first of two drugs typically prescribed to induce abortions. It’s a temporary order while a Texas court considers whether to overturn the drug’s approval altogether. The Supreme Court ruled Friday that mifepristone would remain available until Wednesday at midnight while it had time to review the case.The F.D.A. first allowed telemedicine abortion in 2020, following an emergency court decision made early in the pandemic and after extensive data demonstrated that it was a safe and effective way to offer abortion pills to patients. It made the policy permanent in 2021. Pharmacists must get a special certification to dispense mifepristone, and report data about each prescription, said Jessica Nouhavandi, co-founder of Honeybee. “I had to literally create protocols and train pharmacists,” she said. “Most don’t even learn about this in school.”Most of the start-up clinics operate in only a few states; they must have a clinician licensed in each state in which they see patients. Some are financed by investors or grant makers as they figure out how to build a profitable business. Few have lawyers on staff to help them navigate the recent legal challenges.They have formed an unofficial network to help one another, with group chats about electronic medical records or legal questions. A nonprofit called Plan C provides consulting and sometimes small grants, and a database of providers.They have begun discussing what they will do if the court case prompts the F.D.A. to take mifepristone off the market. Many are preparing to offer just the second medicine, misoprostol, which is effective when used alone to end a pregnancy, but can bring more side effects.Dr. Rachna Kaul runs Maitri Wellness, a solo primary care practice in New Jersey. But she started offering telemedicine abortions during the pandemic, and now her office mails dozens of pill packs a day into three states where she is licensed. She charges cash prices for patients who can afford the service, and uses grants to cover the costs for patients who cannot. Dr. Kaul said adding the service was easier for her than many of her peers because she was self-employed. “In the beginning, we didn’t have any funding, so we took it all out of our own pockets,” she said. “I could do any other work and make so much more money. This is such a huge need.”Juniper Midwifery, which provides 175 medication abortions a month to women in six states, is run by two midwives with day jobs at a New York City hospital and clinic. They operate out of their homes or on the go.“It’s just the two of us,” said Marisa Poverman, who started Juniper with Jillian Barovick. “We’re still in a grass-roots phase of things. So this week has felt a little bit tenuous. Are we going to be able to keep doing this and providing access to people in this way?”Juniper saw its first patients in August. Ms. Poverman built the website using WordPress, and their husbands took their headshots. They raised money from friends and family to get it off the ground, and now have a grant from New York State. They accept cash only, and use the grant to subsidize prices or provide free care to patients who need it.Hey Jane, by contrast, is among the most established of the providers, with $9.6 million in venture capital investment and 40 employees. Abortion on Demand and Aid Access operate in the largest number of states. (A separate branch of Aid Access also operates in states where abortion is illegal by connecting women with doctors and pharmacies abroad.)Carafem is another larger operation, a provider that offers telehealth abortions in 16 states and also has a few physical clinics. Melissa Grant, the chief operating officer, said one of the hardest parts of her operation had been learning the varying rules in each state.Questions about insurance coverage reflect these complications — and often amplify them. Ms. Grant said her providers work hard to help patients figure out what their insurance covers, and are trying to persuade more health plans to work with the company.“Not everyone’s plan covers abortion,” she said. “When you put telehealth on top of it, unfortunately there’s a lot more carriers that deny care.”Even if they do have coverage, not all patients want to use it, said Dr. Stephanie Colantonio, a primary care physician who offers telemedicine abortion in California through Luna Flow Health. “Some patients are so nervous about privacy and security that they prefer to pay out of pocket,” she said.

Women can no longer get a legal abortion in two states.Although Roe v. Wade remains the law of the land, women can no longer get a legal abortion in two states, Oklahoma and South Dakota. In at least one other, Missouri, the only clinic is booked and not accepting new appointments. And in a fourth state, Wisconsin, clinics will not schedule abortions for after the end of the Supreme Court’s term in late June.Before May 2, when a draft Supreme Court opinion that would overturn Roe was leaked, there had been at least one abortion clinic in every state. But in some states, health care providers aren’t waiting for the actual decision to be issued to start operating as if Roe were overturned.“It’s already happening,” said Caitlin Myers, a professor of economics at Middlebury College who studies abortion accessibility. She is leading a national survey of abortion clinics and supplied data on her recent findings, which was verified by The New York Times.The changes in the last few weeks suggest how quickly an overturning of Roe could reduce abortion access across the South and Midwest, which would be a hard-fought victory for the anti-abortion movement. A survey published Wednesday by the Guttmacher Institute found that abortions had increased around the country between 2017 and 2020, reversing decades of declines. Around one in five pregnancies ended in abortion during that period.Roe guarantees a constitutional right to abortion until the point of fetal viability, around 23 weeks, and without it, around half of states are expected to ban the procedure. Many of those states already had limited access — six had a single clinic, and three had two — and various restrictions that made abortions harder to get. Now it is changing from hard to impossible, at least without crossing state lines.In Oklahoma, clinics have stopped operating because the state passed a new ban, even though it clearly conflicts with Roe. “We haven’t had abortion for two and a half weeks,” said Susan Braselton, a clinic escort and a board member of the Roe Fund in Oklahoma, which helps patients finance abortions. Ms. Braselton said she had expected intervention from the courts to stop the law from being enforced: “I would never have thought this would happen.”Jim Olsen, a Republican state representative in Oklahoma who has been a leader on adding several abortion restrictions in the state, said, “This is something that people have worked on and prayed for for 50 years, so it’s a tremendous victory.”Read More on the U.S. Abortion DebateEvolving Language: As they fight for abortion rights, progressive groups and organizations are adopting more inclusive terms, such as “pregnant people” and “cheastfeeding.”Sports: The end of Roe v. Wade could have far-reaching implications for college athletes across the nation — and Oklahoma’s mainstay softball championships in particular.Without Exception: While most of the population supports carve-outs allowing abortions in cases like rape or incest, many of the bans that would go into effect after Roe do away with them.Mental Health: Anti-abortion groups argue that having an abortion can affect a woman’s mental health. But a new study shows that being denied one can be more harmful.The only clinic in South Dakota, Planned Parenthood in Sioux Falls, which also served patients from North Dakota and Minnesota, performed its last abortion Monday, even though the state has not yet banned it. Abortions at the clinic were already sporadic. A Minnesota doctor flew in around once a month to provide them.And in some other states, legal abortion has become much more scarce. In Idaho there were four clinics, but Planned Parenthood in Boise closed June 1. At another, Compassionate Abortion Care in Boise, the only doctor is set to take a summer vacation, and staff members are telling patients that abortion may not be legal by the time he returns. A third is offering only medication abortion.At Planned Parenthood clinics across the country, phone recordings tell callers that abortion remains legal and accessible, but some have stopped scheduling abortions.A banner at the top of the website for Planned Parenthood of Wisconsin says: “Our doors are open. Planned Parenthood of Wisconsin will continue to help patients get the care they need — including safe and legal abortion. No matter what.” But the organization there decided to stop offering any new appointments for abortion after June 25, anticipating that the court might release its opinion two days later, on its last scheduled decision day. Wisconsin still has an 1849 law on the books criminalizing abortion.Dr. Allie Linton, the organization’s associate medical director, said the decision was in part because of worries that it would be hard to contact patients if their appointments needed to be canceled. She also said the group’s leaders were “cognizant of the significant trauma that might come for patients and staff if we are in the middle of a procedure or the middle of a procedure day, and have to tell patients we cannot provide care.”The Wisconsin clinics have made contingency plans on days this month when the Supreme Court has been expected to issue opinions. Many members of the staff plan to spend the week of June 27 training at new clinics in Illinois, anticipating they may need to relocate so that Wisconsin patients can travel there to obtain care.At Planned Parenthood Great Northwest, which operates clinics in Hawaii, Alaska, Washington, Idaho, Indiana and Kentucky, five clinics closed last month as the organization started shuffling resources. Idaho, Indiana and Kentucky are expected to ban most abortions if Roe is overturned, so the organization is trying to expand telemedicine abortion in the remaining states and to help patients get to out-of-state providers.As clinics schedule new patients, they are warning them that the legal status of abortion may be in flux. “Our patient navigators, when they are scheduling, they give patients a heads up and say, ‘Hey, just so you know, there may be a legal change,’” said Katie Rodihan, a spokeswoman for the clinics.Danika Severino Wynn, the vice president for abortion access at the Planned Parenthood Federation of America, said in a statement that local affiliates were independently deciding what to do as the court’s decision nears.“Planned Parenthood affiliates in these states that are extremely hostile to abortion access are being forced to make the difficult decision whether or not to suspend providing abortion services following the court’s decision, due to their state’s legal landscape,” she said. The State of Roe v. WadeCard 1 of 4What is Roe v. Wade?

Most abortions overseas involve pills, and the method is used in about half of legal U.S. abortions. It also seems to be the future of illicit abortion.Taking pills to end a pregnancy accounts for a growing share of abortions in the United States, both legal and not. If the Supreme Court overturns Roe v. Wade as expected, medication abortion will play a larger role, especially among women who lose access to abortion clinics.What is medication abortion?It’s a regimen of pills that women can take at home, a method increasingly used around the world.The protocol approved for use in the United States includes two medications. The first one, mifepristone, blocks a hormone called progesterone that is necessary for a pregnancy to continue. The second, misoprostol, brings on uterine contractions.When can it be used?The Food and Drug Administration has approved medication abortion for up to 10 weeks of pregnancy. World Health Organization guidelines say it can be used up to 12 weeks at home, and after 12 weeks in a medical office.Is it effective, and is it safe?Yes on both counts.In U.S. studies, the combination of these pills causes a complete abortion in more than 99 percent of patients, and is as safe as the traditional abortion procedure administered by a doctor in a clinic. A variety of research has found that medication abortion has low rates of adverse events, and a recent Lancet study found that patients are generally satisfied with it. Growing evidence from overseas suggests that abortion pills are safe even among women who do not have a doctor to advise them.“Some people still assume we’re talking about something dangerous or done out of desperation, but increasingly this information is becoming more mainstream,,” said Abigail R.A. Aiken, an associate professor at the University of Texas at Austin who leads a research group there on medication abortion.Who uses this method?About half of people who get legal abortions in the United States (and three-quarters in Europe). During the pandemic, medication abortion became more common because patients wanted to avoid going to clinics in person, and a change in federal law made it easier for them to get prescriptions via telemedicine.It usually comes down to patients’ personal preference, said Dr. Maria Isabel Rodriguez, an associate professor of obstetrics and gynecology at Oregon Health and Sciences University, who has worked on abortion research and policy design. “Some people like surgical, because it’s over with faster, they’re able to have anesthesia, and it’s finished in a defined time,” she said. “Medication can feel more private, some want it at their own home, some say it feels more natural for them, and some say it feels more possible to process a loss.”Medication abortion is also used by those who live in a place that restricts legal abortion or by those who can’t reach a clinic. The U.S. abortion rate is higher than officially reported by doctors, evidence suggests, because people are ordering pills online. That invisible abortion rate may rise if more states move to ban abortion.Who prescribes abortion pills?Doctors with a special registration required by the F.D.A.But it recently lifted rules that required an in-person appointment. That means more providers are offering medication abortions through telemedicine. The doctor and patient meet online, then the doctor sends pills to the patient’s home through the mail. (Some brick-and-mortar pharmacies have become certified to fill prescriptions for the pills, but this is not yet common.)New start-ups that specialize in telemedicine abortions, like Hey Jane and Just the Pill, have begun offering the service in states that allow it. But 19 states prohibit pills from being prescribed by telemedicine or delivered via mail. In those places, patients still need to see a doctor in person to pick up the pills. Other states ban medication abortion after a certain number of weeks.If Roe is overturned, about half of states are expected to ban abortion altogether, and medication abortion is expected to become a legal battleground.What about pills from overseas?Online pharmacies overseas sell the pills. An organization called Aid Access offers women in all 50 states advice and prescriptions from European doctors before shipping pills from India. These extralegal channels are becoming more popular as abortion becomes harder to access in some states. After Texas enacted a law in September that banned abortion after about six weeks, requests to Aid Access for abortion pills tripled.The F.D.A. has asked these groups to stop sales of these medications into the United States, saying they circumvent U.S. drug safety protocols. But researchers who have analyzed the pills in laboratories have found that pills ordered using these services are generally authentic.The second of the two medications in the official regimen, misoprostol, can also end a pregnancy when used alone. It is around 80 percent effective on its own, although it sometimes has to be taken more than once. That pill is also used to treat ulcers, and is available over the counter in many countries, including Mexico. But the only F.D.A.-approved method in the United States is to use both pills.The Issue of Abortion Around the WorldCard 1 of 8An evolving landscape.