Abortion Is Increasing—
Mail-Order Abortion Pills Are to Blame

Abortion Is Increasing—
Mail-Order Abortion Pills Are to Blame

The number of mail-order abortions has skyrocketed following the Biden Administration’s reckless decision to remove the in-person dispensing requirement for the chemical abortion drug mifepristone.

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Key Points

Abortion is increasing in the United States, with more than 1 million babies aborted in 2024.

The largest driver of the abortion increase since 2020 has been mail-order chemical abortion pills.

Mail-order abortion endangers women, undermines state laws, and kills unborn babies.

President Trump can and should act to end the Biden Administration’s
mail-order abortion scheme.

Background

The number of total abortions in the United States has increased rapidly since the COVID-19 pandemic, despite the U.S. Supreme Court decision that overturned Roe v. Wade. During the same period, the number of mail-order abortions has skyrocketed following the Biden Administration’s reckless decision to remove the in-person dispensing requirement for the chemical abortion drug mifepristone. Our analysis of abortion data collected from pro-abortion sources suggests that mail-order abortion is the primary driver of the increase in overall abortions.

A study by the Restoration of America Foundation (ROAF) done in April 2025 found that more than 1 in 10 women who use the chemical abortion pill experience a serious adverse event.1  Abortion-by-mail is increasing this risk by bypassing in-person clinical evaluations. This lack of medical oversight from a qualified physician puts women at risk for coercion2 and poisoning3 and increases emergency room visits4 and hospitalizations.5 Under the mail-order abortion scheme, states are powerless to enforce pro-life laws and protect their citizens. President Trump has the power to end the Biden-era mail-order abortion policy and bring back commonsense regulation to the abortion industry.

Abortion Is Increasing in the United States

The 2022 Supreme Court decision in Dobbs v. Jackson Women’s Health to overturn the erroneous court precedent of Roe v. Wade that prohibited pro-life laws nationwide was the result of decades of pro-life scholarship, activism, and organizing. However, despite this landmark accomplishment, all available data suggests that abortion is increasing in the United States and has been since 2018.6 The Guttmacher Institute, a pro-abortion think-tank with close historical ties to Planned Parenthood, reported that abortions exceeded 1 million in the year 2024,7 a marked increase from the estimated 862,320 abortions in 2017.8 Combining data from Guttmacher and WeCount, ROAF estimates that there were 1,114,140 total abortions procured in 2024.9 Recent WeCount data from the first half of 2025 shows that monthly abortions increased that year, following the same trend since the Dobbs decision.10

Chemical Abortion Is Increasingly Prevalent Alongside the Rise of Mail-Order Abortion

Chemical abortion is the use of the medication mifepristone, most commonly followed by misoprostol, to end the life of a baby in utero and cause the expulsion of the baby from the uterus.11 Chemical abortion has been consistently increasing its market share over surgical abortions over the past decade, and chemical abortions now account for the majority of babies aborted in the United States. Chemical abortion constituted 63 percent of abortions in 2023, up from 53 percent in 2020 and 39 percent in 2017.12 Assuming that this 63 percent figure has remained steady for 2024, a conservative estimate would yield 753,940 chemical abortions in 2024.13

At the same time, the use of mail-order abortions has been rapidly increasing. Abortions obtained by telehealth (also referred to as mail-order abortions in this paper) accounted for roughly 27 percent of all abortions in the first half of 2025, up from 5 percent of abortions during April through June of 2022.14

The Proliferation of DIY, Mail-Order Abortions Is the Likeliest Cause of America’s Rising Abortion Rate

Our analysis of abortion data collected from pro-abortion sources suggests that mail-order abortion is driving the overall growth in abortion. Since hitting a low in 2017, the national abortion rate has seen a persistent and troubling climb. In 2019, the last full year that abortion by mail was clearly illegal, there were an estimated 916,460 abortions.15 Using our estimate for 2024, the overall growth in abortion from 2019 to 2024 was 22 percent.16 Over the same window, the U.S. population grew by just 2.9 percent.17 Had the abortion rate remained steady from 2019, there would have been 171,103 fewer abortions in 2024. WeCount estimates that 244,590 DIY abortions were facilitated by telehealth in 2024, including 120,380 sent to pro-life states with laws restricting abortion by gestational age or by mail.18 While other factors that could increase or decrease abortion usage cannot be ruled out, including lax state laws and changes in Medicaid funding, the data strongly suggests a direct correlation between the surge in total abortions and the expansion of DIY, mail-order abortion drugs.

The Biden Administration Removed Commonsense Safeguards to Legalize Mail-Order Abortion

Since the approval of the chemical abortion pill in 2000, the left has been working to systematically dismantle the medical safeguards designed to protect women. The Food and Drug Administration (FDA) allows the use of mifepristone only under a Risk Evaluation and Mitigation Strategy (REMS), regulations that are meant to ensure a medication’s safety and efficacy. These critical protections have been hollowed out several times since the original approval, including in 2016 under President Obama.19 The most devastating change has been the FDA’s action under President Biden to legalize mail-order abortions. In 2020, abortion activists seized on the COVID-19 pandemic to begin the process of allowing abortionists to send mifepristone by mail to expectant mothers. In July of 2020, an activist district court judge prevented the Trump FDA from enforcing the in-person dispensing requirements on mifepristone in response to a lawsuit from pro-abortion groups.20 In January of 2021, the Supreme Court stepped in to allow the FDA to enforce the in-person dispensing requirement while its appeal of the district court’s decision was pending,21 but during that six-month period, chemical abortion providers had begun selling pills by mail. In April 2021, the Biden Administration’s FDA acted to suspend the in-person dispensing requirement,22 using the COVID-19 public health emergency as a pretense, and it permanently suspended the requirement in December of 2021.23 The Biden FDA finalized the amended REMS in 2023.24 In justifying this policy change, the Biden Administration relied on limited studies and a lack of adverse event reports to the FDA Adverse Event Reporting System (FAERS). In this review, the FDA finds that the limited studies analyzed are “not inconsistent” with the conclusion that allowing mifepristone by mail would not alter its safety or efficacy, despite their own analysis showing higher rates of emergency room visits and hospitalization in telehealth abortion patients.25 Additionally, the Biden FDA relied on an analysis of the FAERS system to conclude that the original suspension of the in-person dispensing requirement in 2020 had not led to an increase in serious adverse events. However, the FDA under the Obama Administration removed most reporting requirements of adverse events in 2016.26 A research paper in 2021 comparing FAERS data with Planned Parenthood data concluded that the system is “inadequate to evaluate the safety of mifepristone abortions.”27 There was a legal challenge to the suspension of the in-person dispensing requirement in November of 2022. A decision by the U.S. Court of Appeals for the Fifth Circuit found that the suspension of the in-person dispensing requirement by the Biden Administration was likely “arbitrary and capricious” and thus violated the Administrative Procedures Act (APA),28 but the Supreme Court concluded that the plaintiffs in the lawsuit to overturn this illegal decision lacked standing,29 and thus the Biden policy stood. There are continued legal challenges to this policy change.30

President Trump Can and Should Dismantle the Biden Administration’s Mail-Order Abortion Scheme

The explosion in DIY, mail-order chemical abortions since the COVID-19 pandemic endangers women and is responsible for the deaths of hundreds of thousands of human lives in the womb. Federal policy on mifepristone also undermines President Trump’s promise to allow states to legislate on the abortion issue following the overturning of Roe v. Wade. As long as federal policy allows pro-abortion states to flood pro-life states with these dangerous pills, state laws restricting chemical abortion to protect the unborn will have little effect. Elected officials have been calling on the administration to act on this issue. In July, 22 attorneys general urged HHS and FDA leadership to complete a safety review of mifepristone and consider reinstating safeguards or pulling the drug off the market.31 Secretary of HHS Robert F. Kennedy Jr. and FDA Commissioner Marty Makary responded with a promise to conduct a new review of the safety of mifepristone, though no timeline for the results of this review has been announced.32 Recently, 51 U.S. senators signed a letter outlining concerns about mifepristone and calling on Secretary Kennedy and Commissioner Makary to address the harms of the mail-order abortion policy.33 Soon after, 175 members of the U.S. House of Representatives sent a letter raising similar points and sounding the alarm about the safety concerns found in the Biden Administration’s own review of abortion-by-mail studies.34 President Trump, Secretary Kennedy, and Commissioner Makary already have the tools at their disposal to reverse the legally and scientifically dubious decisions of the Biden Administration’s FDA and to reinstate the in-person dispensing requirement. The Trump Administration must act swiftly to restore commonsense medical safeguards to the chemical abortion pill.

REFERENCES

1ROA Foundation. (n.d.). Chemical abortion research.
https://www.roafoundation.org/chemical-abortion-research/

2The 19th. (2025, January 31). Minor abortion pills: Louisiana mother, New York doctor indicted.
https://19thnews.org/2025/01/minor-abortion-pills-louisiana-mother-new-york-doctor-indicted/

3NBC News. (2024, February 8). Texas attorney sentenced to 180 days in jail for poisoning pregnant wife with abortion pills.
https://www.nbcnews.com/news/us-news/texas-attorney-poisoned-pregnant-wife-abortion-medication-sentenced-18-rcna138065

4The Heritage Foundation. (2024, November 4). Evidence emergency room visits due to abortion complications have increased.
https://www.heritage.org/life/report/evidence-emergency-room-visits-due-abortion-complications-have-increased-the-fda

5Hyland, P., Raymond, E. G., & Chong, E. (2018). A direct-to-patient telemedicine abortion service in Australia: Retrospective analysis of the first 18 months.
Australian and New Zealand Journal of Obstetrics and Gynaecology, 58(3), 335–340. https://obgyn.onlinelibrary.wiley.com/doi/10.1111/ajo.12800 as compared to the FDA label for mifepristone: Food and Drug Administration. (2016). Mifeprex (mifepristone) tablets label.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/020687s020lbl.pdf

6Hyland, P., Raymond, E. G., & Chong, E. (2018). A direct-to-patient telemedicine abortion service in Australia: Retrospective analysis of the first 18 months. Australian and New Zealand Journal of Obstetrics and Gynaecology, 58(3), 335–340. https://obgyn.onlinelibrary.wiley.com/doi/10.1111/ajo.12800 as compared to the FDA label for mifepristone: Food and Drug Administration. (2016). Mifeprex (mifepristone) tablets label.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/020687s020lbl.pdf

7Guttmacher Institute. (n.d.). Induced abortion in the United States. https://www.guttmacher.org/fact-sheet/induced-abortion-united-states

8Guttmacher Institute. (2019). Abortion incidence and service availability in the United States, 2017.
https://www.guttmacher.org/report/abortion-incidence-service-availability-us-2017

9Guttmacher estimates that there were 1,038,000 abortions procured in 2024. However, current Guttmacher methodology notes that it undercounts abortions, including by excluding mail-order chemical abortion pills sent to states with total bans on abortion that originate in pro-abortion states with Shield laws. An estimate of abortions in that category is available from WeCount, which estimates a 76,140 were facilitated by Shield laws to total ban states in 2024.

10Society of Family Planning. (2025). #WeCount June 2025 data.
https://societyfp.org/research/wecount/wecount-june-2025-data/

11For an in-depth look at the history of the regulatory regimen surrounding chemical abortion until 2021, including the Food and Drug Administration’s approval process for mifepristone, we recommend the following source: Israel, M. (2021, January 28). Chemical abortion: A review. The Heritage Foundation. https://www.heritage.org/life/report/chemical-abortion-review

12Jones, R., & Friedrich-Karnik, A. (2024, March 12). Medication abortion accounted for 63% of all US abortions in 2023—an increase from 53% in 2020. Guttmacher Institute. https://www.guttmacher.org/2024/03/medication-abortion-accounted-63-all-us-abortions-2023-increase-53-2020

13Author’s calculations based on the number of total abortions in 2024 and a chemical abortion share of 63 percent.

14Society of Family Planning. (2025). #WeCount June 2025 data.
https://societyfp.org/research/wecount/wecount-june-2025-data/

15Guttmacher Institute. (2019). Abortion incidence and service availability in the United States, 2017.
https://www.guttmacher.org/report/abortion-incidence-service-availability-us-2017

16Author’s calculations.

17Federal Reserve Bank of St. Louis. (n.d.). Population [Data set].
https://fred.stlouisfed.org/series/POPTHM

18Society of Family Planning. (2025). #WeCount June 2025 data.
https://societyfp.org/research/wecount/wecount-june-2025-data/

19U.S. Government Accountability Office. (2018). Food and Drug Administration: Information on mifepristone for medical termination of pregnancy (GAO-18-292, p. 11). https://www.gao.gov/assets/gao-18-292.pdf#page=11

20American College of Obstetricians and Gynecologists. (2020). Letter to the FDA: Medication abortion [PDF].
https://www.acog.org/-/media/project/acog/acogorg/files/advocacy/pi-order-medication-abortion-71320.pdf

21Howe, A. (2021, January 12). Justices grant FDA request to block mail delivery of abortion pills. SCOTUSblog.
https://www.scotusblog.com/2021/01/justices-grant-fda-request-to-block-mail-delivery-of-abortion-pills/

22Ollstein, A. M., & Tahir, D. (2021, April 12). FDA lifts curbs on dispensing abortion pills during pandemic. Politico. https://www.politico.com/news/2021/04/12/abortion-pills-481092

23McCammon, S. (2021, December 16). Today is the FDA’s deadline to complete a review of its rules for abortion pill. NPR. https://www.npr.org/2021/12/16/1064951611/today-is-the-fda-s-deadline-to-complete-a-review-of-its-rules-for-abortion-pill

24Food and Drug Administration. (2026, January 17). Information about mifepristone for medical termination of pregnancy through ten weeks gestation.
https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/information-about-mifepristone-medical-termination-pregnancy-through-ten-weeks-gestation

25Food and Drug Administration. (2023). Summary review (Application No. 020687Orig1s025).
https://www.accessdata.fda.gov/drugsatfda_docs/summary_review/2023/020687Orig1s025SumR.pdf

26Food and Drug Administration. (2016). Medical review (Application No. 020687Orig1s020, p. 9). https://www.accessdata.fda.gov/drugsatfda_docs/nda/2016/020687Orig1s020MedR.pdf#page=9

27Cirucci, C. A., Aultman, K. A., & Harrison, D. J. (2021). Mifepristone adverse events identified by Planned Parenthood in 2009 and 2010 compared to those in the FDA adverse event reporting system and those obtained through the Freedom of Information Act. Health Services Research and Managerial Epidemiology, 8. https://pmc.ncbi.nlm.nih.gov/articles/PMC8724996/

28Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration, No. 23-10362, p. 49 (5th Cir. 2023).
https://www.ca5.uscourts.gov/opinions/pub/23/23-10362-CV1.pdf#page=49

29Food and Drug Administration v. Alliance for Hippocratic Medicine, 602 U.S. ___ (2024).
https://www.supremecourt.gov/opinions/23pdf/23-235_n7ip.pdf

30LaRose, G. (2025, October 9). Louisiana sues Food & Drug Administration to stop mailing of abortion medication. Louisiana Illuminator.
https://lailluminator.com/2025/10/09/fda-abortion/

31Kobach, K. W. (2025, August 13). Letter to HHS and FDA regarding mifepristone. DocumentCloud.
https://www.documentcloud.org/documents/26157662-mifepristoneletter081325/

32Democracy Forward. (2025, September 19). Letter to FDA and HHS [PDF].
https://democracyforward.org/wp-content/uploads/2025/09/Fda_Hhs_Letter-1.pdf

33Graham, L., et al. (2025, October 9). [Letter to HHS and FDA regarding mifepristone]. U.S. Senate.
https://www.lgraham.senate.gov/public/_cache/files/db3c8d4f-f16b-4393-9005-13461dcde9c2/letter-from-senator-graham-et-al-to-hhs-and-fda-re-mifepristone.pdf

34The Daily Wire. (n.d.). Reverse this wrong: Republicans push RFK to fix Biden’s abortion drug mistakes.
https://www.dailywire.com/news/reverse-this-wrong-republicans-push-rfk-to-fix-bidens-abortion-drug-mistakes