Columnist Carrie Baker: Abortion pill access rose after Dobbs ruling, COVID

Carrie N. Baker



Published: 10-25-2023 7:08 PM

In nations banning abortion across the world, activists have created community support networks facilitating access to abortion pills. In June 2022, when the Supreme Court eliminated constitutional abortion rights in Dobbs v. Jackson Women’s Health Organization and many states banned abortion, U.S. activists were ready to create their own alternative supply systems for abortion pills.

Over the last several years, in anticipation of the Supreme Court overturning Roe v. Wade and in response to the COVID pandemic, activists developed interstate telemedicine abortion services and community support networks that are now providing abortion pills to people living in all 50 states, including states with bans. As a result, abortion pills are now more accessible and affordable than ever before.

Two medications are used for early abortion: mifepristone, which blocks the effects of the pregnancy-sustaining hormone progesterone; and misoprostol, a commonly used ulcer medication that causes contractions to expel pregnancy tissue. Used in combination, these medications are 98% effective in the first 12 weeks of pregnancy and safer than Tylenol.

Before COVID, abortion pills were hard to access and expensive. Despite being safe and easy to use, the abortion pill mifepristone was more heavily restricted than opioids. The FDA allowed only certified physicians to dispense abortion pills, which they were required to do in person — an unusual and medically unnecessary requirement.

These restrictions combined with an expensive medical system meant that patients had to pay an average of $560 for an abortion with pills at U.S. clinics, despite the fact that the pills are used at home and cost only $2-3 per dose to manufacture.

During COVID, reproductive health advocates challenged these FDA restrictions in court, leading to a shift in FDA policy to allow telemedicine abortion for the first time. As a result, clinicians could prescribe the medication remotely and mail abortion pills to patients for a much lower cost. Telemedicine abortion clinics quickly sprouted up in about half of states.

After Dobbs, several states passed telemedicine abortion provider shield laws that allowed clinicians licensed in those states to provide telemedicine abortion to people living in any state. With these new protections, telemedicine abortion providers began serving patients in states with abortion bans.

One interstate telemedicine abortion clinic, Aid Access, recently reported they are mailing abortion pills to 5,500 people living in states with abortion bans each month. Whereas before COVID, patients had to travel hundreds of miles to brick-and-mortar clinics, walk a gantlet of protesters and pay on average $560 for medication abortion, now they can obtain these pills from the privacy of their own homes for a sliding scale fee of up to $150 in all 50 states.

Access to these safe and easy-to-use medications has increased outside of the medical system as well. In response to new abortion bans, community support networks such as Red State Access, Las Libres, AccessMA, and WeSaveUs began sending free abortion pills to people living in states banning abortion. Meanwhile, increased demand led to a proliferation of websites selling pills, which dropped their prices from hundreds of dollars before Dobbs to as low as $37 per dose today.

Information about these community support networks and vetted websites selling pills is readily available from the organization Plan C (, which conducts research and publicly shares information about how people are accessing abortion pills in the United States. Confidential support services have developed, including the Miscarriage +Abortion Hotline with medical professionals ready to assist people using abortion pills, the Reprocare Healthline providing logistical and emotional support, and the Repro Legal Hotline available to answer legal questions — all at no charge.

People can also find support at the abortion subreddit run by OARS, the Abortion Online Resource Squad. A new online chatbot named Charley helps abortion seekers in all 50 states find quick, accurate and confidential abortion information, tailored to their individual needs and circumstances.

These seismic changes in abortion pill access have broken through decades of political and medical barriers that have limited access to abortion pills. The climate of fear and intimidation created by the anti-abortion movement led to overregulation of this safe and easy-to-use medication and few clinicians willing to navigate these burdensome restrictions, which blocked increased access and drove up prices. New pathways for accessing abortion pills spurred by COVID and Dobbs have finally freed mifepristone from the vise grip of these unjust political and medical barriers.

Anti-abortion extremists are now trying once again to limit access to abortion pills in a lawsuit currently on appeal at the Supreme Court, but the cat is out of the bag. Even if they win this lawsuit, the robust alternative supply networks established in the wake of Dobbs will persist. The creative actions of reproductive health advocates in response to COVID and Dobbs have ripped away decades of political and medical red tape and finally placed abortion pills directly in the hands of people who need them.

Carrie N. Baker is a professor in the Program for the Study of Women and Gender at Smith College and a regular contributor to Ms. Magazine. She has a forthcoming book with Amherst College Press on the history and politics of abortion pills in the United States.