One year after the Dobbs decision, telehealth medication abortions are surging—but they’re under threat

By the time the Supreme Court announced its decision to overturn the constitutional right to an abortion last June, online abortion providers had already been preparing for what they viewed to be the worst possible outcome. An anonymous leak of the initial draft majority opinion had come weeks before, showing that the court was leaning toward overturning the precedent set in Roe. 

“We had been essentially waiting for it to happen,” says Carolyn Witte, cofounder and CEO of the holistic women’s health clinic, Tia. “Our approach was this is very likely, and we want to be prepared at the forefront versus reacting on the spot.” 

Tia hadn’t provided abortion care pre-Dobbs; they had instead referred patients to third-party locations that could provide abortions. After the opinion was leaked, Tia began preparing to offer medicated abortion themselves to patients in need. 

“The thinking behind that was ‘what are we going to do if there’s fewer places to refer our patients,’ particularly both in states like California even but also in restricted states and we needed to take a state by state approach,” says Witte. 

It’s now been a year since the court ruled against the constitutional right to abortion access in Dobbs v. Jackson Women’s Health Organization. What’s followed in that time has been a whiplash of policy changes and legal battles over the right to choose. Currently, 14 states have banned abortion outright, and 6 others have gestational limits on the procedure—ranging from 6 weeks in Georgia to 20 in North Carolina. On the other hand, 20 states have added new measures to bolster abortion rights. For instance, California, Illinois, and Massachusetts have protected abortion in their state constitutions while passing laws that protect patients and providers from laws in other states to shield medical abortions via telemedicine.

Despite this patchwork approach, the overall effect of the Dobbs ruling is quite clear: A Society of Family Planning report released in April said that in the six months following the decision, an average of 5,377 fewer abortions were provided in the U.S. each month. That decline carries with it serious ramifications for maternal and infant mortality and racial inequity. 

Given many states’ draconian trigger laws that went into effect immediately after the Dobbs’ decision was issued, telehealth clinics have become an even more significant force in the fight for access. Per the Society of Family Planning study, telehealth-provided abortions now make up 11% of all abortions, compared to just 4% in the year prior. And, according to the Guttmacher Research Institute, 53% of abortions in the U.S. are now performed using medications rather than surgery—a rising trend largely due to the increase in telemedicine around the rise of the pandemic. 

Kiki Freedman, cofounder and CEO of the virtual clinic, Hey Jane, says her organization has seen a 164% increase in patients post-Dobbs. The company has essentially doubled its team size since then to keep up with demand. “Brick-and-mortar clinics have, of course, experienced a surge in demand, so they’re seeing longer wait times,” she says. “And I think telemedicine services . . . can absorb a lot of that capacity to both reduce wait times for patients as well as free up some of that brick-and-mortar space.”

Hey Jane said in a report this week that it saw a substantial increase in patients seeking care in states whose neighbors have more restrictive abortion laws. The group said it saw a 301% increase in patients in Illinois, a 231% increase in Colorado, and a 178% increase in New Mexico. The company said it surpassed 30,000 patients getting safe abortion care in the past year. 

But telehealth is also facing its own battles. Even in states where abortion is still legal, many have targeted telehealth to curb abortion care. In fact, a report from the Guttmacher Institute shows that among the states that have not banned abortion, 12 have imposed restrictions on telehealth to limit medication abortions.

“There are going to be continued attempts by other states to restrict access to abortion care, but we’re also going to see the other side of the coin,” says Nancy Northup, president of the Center for Reproductive Rights. Other states have tried targeting mifepristone, which is used for medicated abortions. Wyoming’s governor implemented a ban targeting abortion pills earlier this year that was supposed to go into effect July 1. The medication, though, will remain legal in the state for now as a lawsuit goes through the courts.

A 2022 Washington Post-ABC News poll found that a large majority of Americans thought that Roe v. Wade should be upheld rather than overturned—by a nearly two-to-one margin. In another national survey, 80% approve of the FDA’s policy change allowing certified pharmacists to dispense medication abortion pills.

At the federal level, Democrats have for years been trying to pass the Women’s Health Protection Act, which would codify access to abortion. While those efforts have stalled in the Senate in the past, House Democrats are now introducing a discharge petition in an attempt to force a vote. “We have to try to make abortion as accessible as possible, including having the means by which women can get an appointment out of state, helping them with the transportation across that state, making sure that they are safe, and making sure that they are served,” says Democratic Congresswoman Judy Chu of California, one of the bill’s sponsors. 

And just this week, Senate Democrats brought to the floor four bills that would protect abortion access and contraception. The four bills were predictably blocked by Republicans—giving Democrats some much-needed ammunition in upcoming elections. Either way, abortion will likely play a determining factor in the upcoming elections.

Saturday marks exactly one year after Roe v. Wade was overturned. “This is a time to reflect on how much it has changed our lives,” says Chu. “Half the population of the United States has had their rights taken away. I think that many Americans are saying enough is enough: We can’t have young women with fewer rights than their grandmothers.”