Abortion Bans Did Not End Demand... They Changed How Patients Access Care

New research finds that telehealth has overtaken interstate travel as an abortion-access route for residents of states with total bans.

When the Supreme Court overturned Roe v. Wade in 2022, abortion access fractured across state lines. Clinics closed in states with total bans, patients began traveling hundreds of miles for appointments and abortion funds faced overwhelming requests for transportation, lodging, childcare and other support.

Now, new research shows another significant shift: More residents of states with total abortion bans are receiving abortion medication through telehealth than traveling to another state for in-person care.

A study published Oct. 22 in JAMA Network Open examined abortion access in the 13 states that maintained total bans from 2023 through 2025. Researchers estimated that telehealth abortions provided by U.S.-licensed clinicians operating under shield-law protections increased from 24,460 in 2023 to 90,460 in 2025.

During the same period, the estimated number of residents who traveled across state lines for abortion care fell from 89,620 to 64,590.

By 2025, telehealth provision exceeded interstate travel across the ban states collectively. It had also become the primary route for residents obtaining abortions through U.S.-based clinicians in Alabama, Arkansas, Louisiana, Mississippi, Oklahoma and Texas.

The findings do not suggest that abortion bans reduced the need for care. Instead, they show how patients and providers have adapted to an increasingly divided health-care system.

What are shield laws?

Shield laws are state protections intended to reduce the legal risk faced by clinicians who provide reproductive health care that is lawful in their own state, including care delivered to patients living elsewhere.

Eight states have enacted protections that apply when clinicians prescribe abortion medication through telehealth to patients in states where abortion is banned or heavily restricted. Following a virtual consultation, the medication can be mailed directly to an eligible patient.

These protections do not erase the legal uncertainty surrounding interstate abortion care. States differ in the scope of their shield laws, and officials in states with bans may challenge providers or attempt to obtain patient information. The evolving legal environment means access can remain complicated even when a clinician is willing to provide care.

Still, the new numbers demonstrate how consequential these laws have become. The study found that, by 2025, most abortions obtained through U.S.-based clinicians by residents of six ban states were provided using telehealth and shield-law protections.

Separate national tracking from the Society of Family Planning has documented a similar rise. Its #WeCount project reported that more than half of telehealth abortions in December 2025 were provided under shield laws.

Telehealth can remove some—but not all—barriers

For some patients, telehealth can eliminate the need to take time away from work, arrange childcare, pay for a hotel or find transportation across multiple states.

Those burdens do not fall equally.

People with low incomes may have less flexibility to miss work or pay travel expenses upfront. Patients living in rural communities may already face long distances to reproductive-health providers. Those experiencing intimate-partner violence may not be able to travel without a partner noticing. Immigration concerns, disability, health conditions and limited access to transportation can create additional obstacles.

Telehealth may offer another route to care when crossing state lines is financially or physically impossible.

But it has not eliminated the need for in-person services. More than 64,000 residents of total-ban states were still estimated to have traveled for abortion care in 2025.

Patients may need or prefer a procedure rather than medication. Some may be beyond the gestational period served by a telehealth provider, have a medical condition requiring in-person evaluation or need treatment following a pregnancy complication. Others may lack a private mailing address, reliable internet service or a safe place to communicate with a provider.

The decline in travel should therefore not be interpreted as evidence that abortion funds, practical-support networks or clinics in states where abortion remains available are no longer needed.

What the study cannot tell us

The estimates require careful framing.

Researchers counted medications mailed by clinicians under shield-law protections as telehealth abortions. But receiving medication does not confirm that a person used it or completed an abortion. Some patients may have obtained medication from more than one source.

The study also did not capture every path patients use. Its estimates excluded pills obtained through community-support networks, overseas providers and websites selling medication without a prescription.

Researchers additionally relied on modeled estimates when providers did not submit complete data. Missing information was more common among online clinics in 2025, creating some uncertainty around the exact totals.

The study documents a strong change in access patterns, but it does not prove that telehealth alone caused interstate travel to decline. Financial assistance, clinic capacity, changing state policies and other factors may also have influenced where and how patients obtained care.

It also did not assess individual medical outcomes. The U.S. Food and Drug Administration maintains that mifepristone is safe and effective when used as directed under its approved conditions. However, this particular study focused on the number and location of services—not effectiveness, complications or patient satisfaction.

The larger story is adaptation, not disappearance

Abortion bans can close clinics and restrict clinicians, but they do not eliminate pregnancy, health complications or patients’ decisions about whether to continue a pregnancy.

The rise of telehealth abortion illustrates how care can shift when traditional access points disappear. In many ban states, medication now travels even when patients cannot.

That change may reduce the financial and logistical burden for some people, but it has also created a system dependent on technology, mail delivery and legal protections that can vary from one state to another.

We believe reproductive-health access is being reorganized around the restrictions patients face, and that those with the fewest financial, geographic and social resources remain the most vulnerable when any pathway closes.