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1.1 Million Abortions. 65% Use Pills Delivered by Mail.
1.1 million abortions were provided by clinicians in the U.S. in 2025. 65% used medication, primarily mifepristone delivered by mail or pharmacy. Telehealth prescriptions accounted for 24% of all abortions, up from 12% in 2023. About 15,000 abortions per month were provided under state shield laws that protect providers prescribing across state lines.
65% of abortions use medication. The Comstock Act of 1873 could ban mailing it. The Supreme Court blocked the Fifth Circuit 7-2 in May 2026. Justice Thomas’s dissent called for prosecution.
The Comstock Act of 1873 prohibits mailing materials “designed, adapted, or intended for producing abortion.” It has not been enforced for this purpose in over a century. Whether it applies to mifepristone is now the central legal question in abortion access.
The Supreme Court Stepped In. The Fight Is Not Over.
Louisiana sued the FDA in October 2025, arguing that FDA rules allowing remote prescribing and mail delivery violate Comstock. The Fifth Circuit granted the request in May 2026, ruling that mifepristone could only be dispensed in person.
The Supreme Court blocked that ruling 7-2 on May 14, preserving mail delivery and telehealth prescribing while litigation continues. Thomas and Alito dissented. Thomas’s dissent explicitly called for prosecution of anyone mailing mifepristone under the Comstock Act.
The Biden DOJ issued a 2022 memo concluding Comstock does not prohibit mailing mifepristone when the sender lacks intent for unlawful use. The Bondi DOJ has not rescinded that memo and has continued opposing enforcement. But the memo is guidance, not law. A future AG could reverse it.
22 States Protect Access. 9 States Want to Criminalize It.
Twenty-two states plus D.C. have shield laws protecting reproductive healthcare providers. Seven states specifically protect telehealth prescriptions to patients in ban states. California signed AB 260 allowing anonymous prescriptions.
On the other side, legislators in 9 states introduced 23 bills in 2025 to criminalize medication abortion distribution. Texas obtained a $100,000 default judgment against a New York doctor for mailing pills into Texas. New York’s shield law blocked enforcement.
What you can do now
- Tell your senators to pass the STOP Comstock Act. The bill would clarify that the 1873 law cannot be used to ban medication abortion. Text RESIST to 50409 or use Resist Bot.
- Know your state’s shield law status. 22 states plus D.C. protect reproductive healthcare providers. If yours does not, push your state legislature to pass one. Check your state.
- Support abortion funds. Organizations like the National Abortion Federation help patients in ban states access medication and travel. Demand is rising as legal uncertainty grows.
- Watch the Supreme Court docket. Louisiana v. FDA is the next major case. The outcome could determine whether 63% of abortions via medication remain legal nationwide.