How Telehealth Abortions Changed the Politics of Choice

Technology outpaces restrictive laws

The Guttmacher Institute tells the story of a dramatic change in how abortions are conducted.

One of the mysteries of the 2024 election is why anger over the Supreme Court Dobbs decision overturning Roe v. Wade, which was credited as a factor in motivating Democratic voters in 2022, didn’t make much difference.

One reason may be that the new state-level restrictions on abortion have been, in practice, less strict than many feared, in part because of the combination of two growing technologies, telehealth and medication-based abortion.

Boston-based public radio station WBUR, which leans left, has a report that brought these facts home in a concrete way:

“Massachusetts saw a substantial increase in abortions in 2023, the first full year after the U.S. Supreme Court overturned Roe v. Wade. According to state data obtained by WBUR, Massachusetts doctors and other health care providers facilitated 24,355 abortions last year, a 37% increase from 2022,” WBUR reported. “More than half of these procedures, 65%, occurred using pills that induce an abortion. Most of the change can be explained by a nearly seven-fold rise in patients from outside the state.”

The Guttmacher Institute, which defends reproductive rights, reports that “Medication abortion provided via telemedicine is as safe and effective as provision in a health care facility.” It also says that “Medication abortion using mifepristone was first approved for use in the United States by the U.S. Food and Drug Administration (FDA) in 2000,” and has grown to 63 percent of all abortions in 2023, from zero percent in 2000. 

In other words, even if a woman lives in a state with draconian restrictions on abortion, she can use her cellphone or computer to talk to a doctor or pharmacist in a state like Massachusetts or New York or Illinois that has more permissive abortion laws, and have the medicine sent by mail.

The combination of mail-order pharmacies, telehealth, and medication abortions creates a reality today that is different from that when Roe was decided in 1973.

That’s not an endorsement of overturning Roe or of imposing restrictions on abortion at the state, local, or national level. Not every medical situation can be handled by telehealth and mail order.

It is, though, a reminder that the law is not the only variable affecting abortion access. Technology and markets matter too. They have a way of moving more quickly than politicians or judges can predict—and in the direction of choice. 

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