5 reasons to read this story
- Find out what happens when the only way to access abortion care is to break the law.
- Learn why fear is becoming one of the biggest barriers to abortion in the U.S.
- Gain an insight into how ordinary people seeking abortion services are navigating a raft of bans, costs and surveillance.
- Understand the risks faced by the providers of abortion care.
Discover a system that is stretched to breaking point as a result of falling numbers of abortion travel.
When Dr. Margaret Carpenter arrived at her New York office one morning earlier this year, she expected a routine day. Instead, she learnt she had been indicted by a grand jury in Louisiana, accused of allegedly prescribing abortion pills online to a patient in Baton Rouge.
The charge, a felony under Louisiana law, carried the threat of a decade-long prison sentence. Carpenter, who has never practiced medicine in that state, became the first doctor to face criminal charges for sending abortion pills to a patient in another state since the US Supreme Court overturned Roe v. Wade in 2022.
As news spread, Carpenter’s inbox became flooded with messages of support from patients, colleagues, and advocates. Overnight, she became a symbol of resistance in the fight for access to abortion.
For nearly five decades, U.S. federal law guaranteed a nationwide right to abortion and limited how far states could go to restrict this. That framework collapsed in 2022, when the Supreme Court’s decision in Dobbs vs. Jackson removed constitutional protection and handed full authority back to individual state governments. This has resulted in a fragmented system of different laws, one that not only determines whether abortion is available, but also influences whether people feel safe to pursue care at all.
Fewer abortion journeys, same demand
The shift is evidenced by the latest travel data. Abortion-related travel in the U.S, which surged immediately after the Dobbs case, is now declining, not because fewer people are seeking an abortion, but because accessing care has become riskier and more intimidating.
In the first half of 2025, approximately 74,490 people traveled to states where there was no total ban on abortion to obtain the necessary care, which represents an 8% decrease from the same period in 2024, when around 80,870 people made similar journeys.
At first glance, this decline might suggest falling demand. But researchers and providers explain that the opposite is true because abortions are increasingly being undertaken outside traditional clinics, through telemedicine, informal networks, or at home, with official data failing to capture these methods.
Behind the numbers is a growing reality – for many, travel is no longer a viable option.
When travel becomes impossible
Traveling to receive abortion care poses significant logistical challenges and financial burdens. The costs add up with transportation, accommodation, time off work, and childcare arrangements, all taking a toll. These barriers often lead to delays, pushing patients further into their pregnancies and limiting their options.
The impact is stark. In 2024, over 3,000 people traveled to Florida for care but after the ban, that number dropped to 1,130. Virginia has become a key option for the Southeast, but even then, residents may be hesitant to travel far. Those who cannot make the journey may be forced to continue their pregnancy.
The costs are staggering. Travel expenses have more than doubled from US$179 to US$372 which excludes accommodation, childcare, or lost wages. After the ban on abortions came into effect, travel time jumped from 2.8 hours to 11.3 hours, with more overnight stays being required.
But cost and distance are only part of the story. Increasingly, fear itself is becoming the decisive factor.
Fear of legal repercussions as a barrier
Even when travel remains constitutionally protected, fear of prosecution is stopping people from seeking abortion care across state borders. Strict state laws and digital surveillance are creating anxiety, with concerns that data from apps and online searches could be used as evidence.
While this chilling effect is uneven, it is nevertheless pronounced and disproportionately hits low-income communities the hardest.
As fear closes off traditional routes to care, many people are turning to a different solution, one that avoids travel altogether.
Telehealth revolution: Abortion by mail
A recent report highlighted the growing reliance on purchasing online abortion medication in those states where abortion is banned.
The biggest change has been the rapid rise of telehealth medication for abortion. In states with “shield laws”, providers can prescribe and mail abortion pills to patients in states where abortion is banned, thus eliminating the need for travel.
Abortion travel is declining, not because demand has fallen but because, from January to June 2025, 27% of abortions in the U.S. were provided via telehealth, up from 25% at the end of 2024. Abortion medication now accounts for over 63% of clinician-provided terminations, contributing to a decade-high national abortion total despite widespread state bans.
Self-managed abortions are increasing, aided by community networks, online vendors, and shield laws. Groups such as Aid Access mail abortion medication to all 50 states, leveraging shield laws in Democratic-led states, which protect both providers and patients. Currently, 22 states and Washington, D.C. have shield laws in place to protect reproductive care. Notably, an estimated 40,890 abortions were provided under shield laws to those living in states with abortion bans in late 2024, marking an increase from 35,250 earlier in the year.
However, the growth of telemedicine has also triggered a legal backlash.
States push back
Republican-led states are moving to restrict abortion pills being sold via mail. Texas has become the latest battleground. Its new abortion law, House Bill 7, provides for civil penalties from upwards of US$100,000. While patients themselves cannot be sued, the law allows private citizens to bring cases against providers in a legal model that is designed to deter state care through fear of litigation.
Anti-abortion activists have already pledged to sue providers that mail abortion pills to Texas. Experts comment that the dispute is likely to end in the U.S. Supreme Court.
The American Civil Liberties Union has stated that the law will create fear among manufacturers and providers, encourage neighborly surveillance, and isolate pregnant women in Texas.
However, medical providers have vowed to continue to provide abortion services in Texas despite the new law. Major telehealth practices will keep prescribing and mailing abortion medication, citing laws in other states that protect them from Texas lawsuits.
“If anything, this law just makes people more determined to help Texans access abortion pills,” commented Elisa Wells, Director of Plan C, which provides information on abortion medication.
U.S. – a global outlier
Abortion law in the U.S. now varies dramatically by state. Forty-one states have bans in place, including 13 with a total ban and 28 with gestational duration-based bans.
Internationally, the trend is moving in the opposite direction. Over the past three decades, more than 60 countries have expanded abortion rights while only four have rolled these back – Poland, El Salvador, Nicaragua, and the United States.
Last month, the U.S. boycotted its UN human rights review for the first time with the Trump Administration’s decision drawing criticism from human rights advocates and UN officials.
An uncertain road ahead
For now, abortion access in the U.S. is being reshaped by a patchwork of laws, lawsuits, and workarounds.
Abortion travel is declining. Telemedicine is rising. Fear is spreading.
As cases like Dr Carpenter’s move through the courts, the question facing millions is no longer whether abortion is legal, but whether it is reachable.
In 2023, black women died in childbirth at 3.5 times the rate of white women. “We’ll see more births, more maternal and infant deaths, and worse care inequities,” explained Regina Davis Moss, President and CEO of In Our Own Voice: National Black Women’s Reproductive Justice Agenda.
