Nearly Two-Thirds of Abortions Were Done With Pills in 2023. Trump Could Ban the Drug.

We’re one week away from oral arguments in a Supreme Court case that could restrict access to the main abortion drug, mifepristone, and a little under eight months away from another high-stakes presidential election with a GOP nominee who could potentially ban abortion nationwide. Yet, despite conservatives’ war on reproductive rights—or perhaps because of it—more people are using medication abortion than ever.

Medication abortions accounted for 63% of abortions done in 2023, up from 53% in 2020, according to new research from the Guttmacher Institute published Tuesday. That works out to about 642,700 medication abortions last year, though it doesn’t include abortions done outside the formal healthcare system. Evidence suggests that self-managed abortions have also been increasing in recent years, so these numbers are likely an undercount.

And, on Tuesday, the Supreme Court will hear the mifepristone case in which plaintiffs want to undo the FDA’s 2021 change that allowed telemedicine prescriptions. The court could also use the case to revive a dormant abortion ban called the Comstock Act, but even if it declines to do so, a cadre of conservative activists is pushing a future Trump administration to enforce Comstock to ban the mailing of mifepristone nationwide—including to states where abortion remains legal. (The FDA-approved protocol involves both mifepristone and a second drug, misoprostol; only the former is at issue in the case and the latter can be used on its own to induce an abortion.)

In another analysis of the data released today, Guttmacher reported that the total number of abortions performed in the medical system was the highest in more than a decade. Yes, even despite all the state abortion bans currently in effect after the fall of Roe v. Wade. Guttmacher noted that the number of abortions increased for several reasons, including telehealth for medication abortion, increased financial support via abortion funds, and state policies improving access to care. (For example, so-called “shield laws” protect providers who send medication abortion to patients in banned states.) Clinics also worked to scale up care and people traveled to states without bans. While the number of abortions increased by 10% nationwide, states without total bans saw a 25% increase.

Improved access to pills is good for people who would have chosen that method anyway, but some are only opting for it as wait times at clinics have increased. “As abortion restrictions proliferate post-Dobbs, medication abortion may be the most viable option—or the only option—for some people, even if they would have preferred in-person procedural care,” Rachel Jones, principal research scientist at Guttmacher, said in a statement.

That said, the Guttmacher analysis notes that “any return to restrictions on medication abortion provision via telemedicine would be detrimental for people who either prefer or only have access to abortion using telemedicine.”

Medication abortions accounted for more than 60% of all abortions in the formal US health care system in 2023. Source: Guttmacher

This latest data underscores why abortion pills are a gigantic problem for the anti-abortion movement: People can still get their hands on pills even in states with bans, and sometimes for free.

They’ve known pills would be an issue for a while now, and that’s why they’re preparing ways for Donald Trump to crack down if he returns to the White House. Take Roger Severino, a former Trump official in the Department of Health and Human Services and now vice president of domestic policy at the Heritage Foundation, the group behind the 2025 Presidential Transition Project (nicknamed Project 2025). Project 2025 has written up detailed plans for Trump and Severino himself wrote in the Project 2025 memo that “abortion pills pose the single greatest threat to unborn children in a post-Roe world.” Severino calls for the FDA to reverse its approval of mifepristone and yank it from the market. But “as an interim step,” it should halt telemedicine abortions because, he claims, they violate “long-standing federal laws that prohibit the mailing and interstate carriage of abortion drugs.” A footnote explains that he’s referencing the Comstock Act by its statute number, 18 U.S.C. 1461 and 1462.

None of this is about science, women’s health or safety, or a true devotion to the laws of the United States. Anti-abortion activists are simply ripshit pissed that people are still getting abortions in ban states and that the total number of abortions hasn’t decreased, so they’re going to do whatever they can to change that.