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The day after Texas Attorney General Ken Paxton ordered two women’s health clinics and an individual to stop providing abortion pills through the mail to women, threatening $100,000 fines, one of those clinics was deluged by requests from women seeking medication abortions.

“We surpassed 250 [requests] by 8 o’clock in the morning,” said Debra Lynch, nurse practitioner and founder of Her Safe Harbor, one of the clinics that received the cease-and-desist order from Paxton on August 20.

Most of the requests were from women who wanted the pills on hand in case of a future unwanted pregnancy. These “just in case” requests usually account for about 15% of calls to Her Safe Harbor, Lynch said. The organization fills orders for future use if patients agree to call the service for medical counseling before actually taking the medication.

In many ways, it’s easier to get an abortion in the US today than it was before the Dobbs v. Jackson Women’s Health Organization Supreme Court decision that overturned the constitutional right to abortion in 2022. That’s true even in states that ban almost all abortions.

People who work for services providing medication abortions say that ongoing legal threats can invoke fear in women seeking abortions, but they won’t stop the widespread availability of medication abortions by mail.

According to data published this summer by the Society of Family Planning, there were 1.14 million abortions in 2024, up from 1.05 million abortions in 2023. In Texas, there were approximately 900 more abortions in December of 2024 than in April of 2022, 2 months before the Dobbs v. Jackson Women’s Health Organization decision.

Experts attribute the increase to greater awareness about the availability and safety of abortion pills, the growth of telemedicine, and volunteer-driven networks that assist women in obtaining an abortion, especially in the 19 states that restrict the procedure.

Twelve states ban abortion in almost all circumstances,  while seven ban abortions after 6 or 12 weeks. “Abortion is always under threat, but there’s also always innovation and will on the part of providers ,” said David Cohen, law professor at Drexel University in Philadelphia and coauthor of After Dobbs: How the Supreme Court Ended Roe but Not Abortion.

Mail-Based Abortion Services Are Filling a Void, Carefully

Her Safe Harbor protects clients by using paper-based medical records and requiring patients to request abortion pills over the phone, so there’s no digital trail. The phone call is also an opportunity to offer medical counseling and make sure that medication abortion is appropriate, Lynch explains. (Medication abortion is contraindicated for those with ectopic pregnancy, certain bleeding disorders, and other rare conditions, and it may not be effective for those on long-term steroids.)

For $150, Her Safe Harbor will mail the abortion kit; the service also provides zero-cost or subsidized kits to those who need them. Her Safe Harbor offers clients 24/7 access to clinicians by phone if they have questions or complication concerns, Lynch explains.

Plan C is an organization that provides a searchable database of options to get abortion pills by mail, detailed instructions on how to take medical abortion pills, and tips to protect health privacy and avoid legal trouble. For example, the website recommends people use encrypted email and chat services when ordering abortion pills. For Louisiana, the website lists 20 different abortion pill purveyors; for Texas, 19. Both states have near-total bans on abortions, with no exceptions for sexual assault or incest.

Volunteers for TexasAccess, a community network, send abortion pills to patients for free. They send generic abortion pills sourced from India and don’t require a doctor’s prescription, so any potential Supreme Court ruling against shield laws wouldn’t affect them. Plus, their service wouldn’t be affected by FDA regulation limiting abortion pill prescriptions in the US.

Legal Efforts Not Expected to Stop Medication Abortions

In addition to Paxton’s cease-and-desist order, several legal efforts are underway that threaten mail-order abortions. In December 2024, Texas filed a lawsuit against Maggie Carpenter, MD, a New York physician who prescribed an abortion pill to a pregnant teenager in Louisiana.

New York won’t extradite that doctor. It is one of eight states that have shield laws that prohibit the use of state resources to punish medical care that’s lawful in their state, even if that care is provided to a patient out of state. The case could land in the Supreme Court, which could deem certain aspects of shield laws unconstitutional.

Earlier this summer, a Texas woman filed a wrongful death suit against medication abortion provider Aid Access and its founder, Rebecca Gomperts, MD, MPP, PhD, a Netherlands-based physician. The man who impregnated the woman allegedly drugged her with abortion pills he’d accessed through the organization.

While no state has prosecuted anyone for taking abortion pills (instead, states target those who facilitate these abortions), women face risks. In 2022, authorities in Texas charged a 26-year-old woman for murder after she had a medication abortion at 19 weeks of pregnancy. Those charges were dropped within days, after swift public outcry — state law in Texas bans the prosecution of women who have abortions. In Louisiana, where abortion pills were recently designated a controlled substance, women who order abortion pills could face charges for possession.

Republican lawmakers have also attempted to make the abortion pill less available by challenging the FDA’s approval of mifepristone, as well as the FDA’s removal of an in-person requirement to access a mifepristone prescription.

But Lynch and Gomperts say they’re continuing their work, despite the legal threats. “We don’t fear fines or jail time at all,” said Lynch. 

“Abortion at home is one of the safest medical procedures,” said a volunteer with TexasAccess. “These legal threats generate fear and misinformation. But they don’t affect our day-to-day.”

Lynch and Gomperts founded organizations that provide medical abortion pills by mail.

No other commenters had financial conflicts of interest.