As conservative lawmakers work to restrict online access to abortion medication, a new report shows how popular it has become for women who live in states that have outlawed abortion.

Researchers from the University of Texas at Austin led a team that analyzed 15 months of prescription data from Aid Access, one of the largest online abortion telemedicine providers.

They found 84% of Aid Access’s more than 118,000 online prescriptions went to patients living in abortion-ban states.

The South and Midwest had the highest rates of patients accessing telemedicine abortion. Rates were also greater in high-poverty areas or where people would have to travel more than 100 miles to reach an abortion clinic, according to the report, which published this month.

Aid Access is able to mail abortion medications to residents in all 50 states — even those in states with abortion bans — thanks to shield laws in Democratic-led states. Shield laws are designed to minimize the legal risks for people who provide or access abortions across state lines.

Currently, 22 states and Washington, D.C., have reproductive care shield laws, either through legislation or by executive order, according to a report from University of California, Los Angeles School of Law.

Eight of those states — California, Colorado, Maine, Massachusetts, New York, Rhode Island, Vermont and Washington — specifically protect telehealth abortion providers regardless of where their patient is located.

Shield laws, along with difficulty accessing in-person abortion services in abortion-ban states, have contributed to a rise in medication and telehealth abortions since the U.S. Supreme Court overturned the federal right to abortion in 2022, clearing the way for state bans. With telehealth abortion, patients have a virtual appointment with a clinician who can prescribe abortion medication, which is then filled by a licensed pharmacy and mailed to the patient.

Research has shown telehealth medication abortion is effective and safe, and comparable to in-person medication abortion.

Medication abortion accounted for nearly two-thirds of all clinician-provided abortions in states without bans in 2023, the most recent data available from the Guttmacher Institute, a research and policy organization focused on advancing reproductive rights.

But as abortion medication use rises, so have conservative efforts to ban it.

This year, more than a dozen states introduced bills to bar access to medication abortion by criminalizing its sale, purchase or distribution, according to Guttmacher.

One such bill in Texas, which could have been a blueprint for medication abortion restriction in other states, was specifically aimed at groups like Aid Access. It would have allowed private citizens to sue for at least $100,000 anyone who provided abortion pills in Texas. The bill passed the Texas Senate but died in the House in May.

Earlier this year, the state of Louisiana criminally charged a New York physician under its abortion ban law for allegedly providing abortion pills to a Louisiana teen via telehealth. New York, which passed a shield law in 2023, refused Louisiana’s request to extradite the doctor.

Last month marked the first federal test of shield laws, when a Texas man sued a California doctor for allegedly mailing abortion pills to his partner.

This week, a Texas woman filed a federal lawsuit against Aid Access and against a man who she said impregnated her, then spiked her drink with abortion pills. She is also suing the Dutch doctor who founded Aid Access, alleging Aid Access and its founder mailed abortion-inducing drugs in violation of Texas and federal law.

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Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org.

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