Guttmacher admits mail-order abortion is cause of spike in abortion total

Buried in a recent study published by researchers with the Guttmacher Institute (Planned Parenthood's former research arm and "special affiliate") is the real reason why reports indicate a huge spike in abortions since the end of Roe v. Wade in June of 2022: mail-order abortion.

Key Takeaways:

• The Guttmacher Institute notes that telehealth abortion with the ability to mail abortion pills to abortion seekers has contributed to the increased abortion numbers since the end of Roe v. Wade.

• In 2023 and 2024, Guttmacher and #WeCount reported increased abortion numbers overall, with the abortion pill comprising about 63% of those. The numbers are staggering.

• Federal laws already exist that ban sending drugs through the mail with intent to use them for an abortion. These laws are simply not being enforced at this time.

The Details:

Guttmacher's study acknowledges that "it is likely that the increased availability of telehealth medical abortion has contributed to the overall increase in abortions in the US." And yet, there are unenforced federal laws that already prohibit the mailing of abortion-inducing drugs in the United States: the Comstock Act.

Telehealth abortions led to increase in abortions overall

The study, entitled "Effects of the Dobbs decision on abortion and related service provision among sexual and reproductive health clinics in the United States: results from a qualitative study" was published in September of 2025 in Sexual and Reproductive Health Matters (SRHM).

The Dobbs decision from the U.S. Supreme Court overturned Roe and enabled individual states to decide their own abortion laws.

Authors reportedly sought to "better understand the impact that the growing number of abortion restrictions is having on the provision of and access to abortion services in the United States (US)" by conducting interviews with "clinic managers, and other administrators at publicly funded [sexual and reproductive health] SRH clinics around the US" between November 2023 and February 2024.

In the study, Guttmacher authors noted that "out-of-state travel for abortions has increased since Dobbs" but also admitted (emphasis added):

Our findings indicate that [sexual and reproductive health] SRH clinics are trying to continue to provide high-quality care to meet patient needs and ensure reproductive autonomy even as regulations complicate their ability to do so.

We found that clinics in less restrictive/protective states are responding to an increased demand for abortion by expanding access to medical abortion and telehealth services. This finding is consistent with research that has found an increase in overall abortion provision over the last several years.

It is likely that the increased availability of telehealth medical abortion has contributed to the overall increase in abortions in the US, as telehealth may have improved access for people in rural areas or those who may not have been able to travel to seek services.

The report went on to say:

Restrictions on telehealth for medical abortion have also been implemented; eleven states require at least one trip to the clinic to access medical abortion as of November 2024.

In contrast, shield laws have been adopted in several states, which can protect providers who prescribe and mail medical abortion pills across state lines, while federal protections for mifepristone’s approval and availability ensure that it can continue to be prescribed and mailed.

In this bifurcated policy context, we have found that providers in less restrictive/protective states are stepping up their efforts to increase abortion access for all patients, regardless of the abortion policy in their state of residence. Continuing education for providers located in shield law states about the extent of legal protections afforded to them by the law may help to expand access further.

After years of decline, abortion numbers are climbing again

In 2017, U.S. abortion numbers began to tick upward after a long-term decline. By 2020, abortions had increased nearly 8% — in just three years.

Then, in 2021, the Biden FDA began removing the guardrails on the abortion pill:

• April 2021: Under the guise of the COVID-19 pandemic, the Biden FDA temporarily enabled abortion pill distribution and expanded FDA's REMS safety regulations to limited mail-order pharmacy distribution. 

• December 2021: Biden FDA further weakened the REMS by eliminating the in-person dispensing requirement and enabling the abortion pill to be permanently shipped by mail.

• January 2023: Biden FDA announced it would allow retail pharmacies to dispense the drug. 

Unsurprisingly, after all of this, the 2023 data — released in 2024 and 2025 — revealed a sharp increase in chemical abortions along with abortions overall.

Guttmacher

Guttmacher’s estimated abortion data analysis for 2023 (released in February 2025) revealed a whopping 648,500 abortion pill abortions for that year, translating to 54,042 chemical abortions monthly, 1,777 daily, 74 hourly, and one abortion by pill every 49 seconds. But in October 2025, it revised its total abortion numbers (to 1,037,950 for 2023 and 1,053,470 for 2024), revealing a total abortion increase of more than 13% from 2020.

The abortion pill regimen is conservatively estimated to comprise 63% of all abortions; using this figure to calculate abortions done by pill in 2024 shows this type of abortion was quite likely in excess of 664,000 for just that year.

As Guttmacher's abortion numbers are only an "estimation," and it "does not collect data on self-managed abortions" which "are not provided by a US clinician,” the numbers are almost certainly higher. Guttmacher's estimates also do not “currently include medication abortions provided under the protection of shield laws to a patient in a state where abortion is completely banned."

#WeCount

#WeCount is a project of the pro-abortion Society of Family Planning (SFP), which is funded by the David and Lucile Packard Foundation and the Susan Thompson Buffett Foundation (Warren Buffett), both of whom are investors in abortion pill manufacturer Danco Laboratories.

A report published last year by #WeCount stated that it observed a 155% increase in telehealth abortions "from 22,430 in the second quarter of 2023 to 57,150 in the second quarter of 2024."

Interestingly,  #WeCount also recently claimed that “nearly half of the telehealth abortions that took place in 2024 were administered by physicians in states with shield laws” which protect abortion providers who illegally mail these drugs to more restrictive states (emphasis added).

Why It Matters:

As Guttmacher pointed out, abortion providers in multiple states have admitted to shipping abortion pills “unlawfully” into states that prohibit the drugs or restrict telehealth dispensing.

Yet, the federal Comstock Act (U.S.C. §§ 1461–62) prohibits the shipment or mailing of drugs intended to be used for abortion — but it is not currently being enforced to prevent the laws of pro-life states from being broken by abortionists in pro-abortion states that shield them from consequences.

During oral arguments in the Alliance for Hippocratic Medicine (AHM) v. FDA lawsuit, two U.S. Supreme Court Justices hinted that the federal Comstock Act could become relevant to this situation.

As Live Action News previously documented, according to its website, the U.S. Postal Service (USPS) is supposed to:

• “prevent the flow of illicit drugs and contraband through the mail stream”

• “eliminate the mailing of opioids and other illicit drugs"

• "work[] closely with other law enforcement agencies, including U.S. Customs and Border Protection, to share intelligence, coordinate cases and conduct joint enforcement operations”

Since “the Postal Inspection Service enforces over 200 federal statutes related to crimes that involve the postal system, its employees, and its customers” (emphasis added), then it stands to reason that the USPS should enforce the Federal Comstock Act — which is also a federal statute.

According to a report published by Americans United for Life (AUL) and Live Action, “A key focus of the Act was a national prohibition on the sale and shipment of abortion drugs and devices through the U.S. Mail.”

Multiple states have filed lawsuits (State of Missouri v. FDA) challenging the FDA's expansion of the abortion pill, mifepristone (200mg), and asking the Courts to enforce the Comstock Act. They claim that the FDA’s decision to allow mail-order abortions has resulted in “dangerous drugs… flooding states like Missouri and Idaho and sending women in these States to the emergency room.”

The states of Louisiana, Florida, and Texas have more recently also sought to intervene. Florida and Texas allege in their lawsuit:

• "States have the sovereign power to enact and enforce regulations on abortion."

• "The FDA’s actions seek to enable the violation of state laws restricting abortion."

• Telehealth was a "boon for sex traffickers" and mailing abortion pills to men has "facilitated the death[s] of multiple preborn children."

• States "have been forced to divert resources to address the explosion of abortion drugs mailed to their residents by abortionists operating under...'shield laws.'"

• "... The FDA’s actions have inflicted concrete economic injury on states as the payers and insurers of residents’ medical expenses."

• Abortion drugs harm women and girls and risks have been “undercounted.” 

• The 2000 approval did not comply with the federal Comstock Act. 

The Bottom Line:

The admission from Guttmacher comes as at a time when lawmakers are pressuring the Food and Drug Administration (FDA) to review the safety and expansion of the abortion pill mifepristone (200mg). According to FDA data, 36 deaths have been associated with the drug; the FDA's caveat explains that “The adverse events cannot with certainty be causally attributed to mifepristone….” 

The most recently published report by the Food and Drug Administration (FDA) reveals that between 2000 (when the abortion pill was approved) and December 31, 2024, approximately 7.5 million women have used the abortion pill to end their babies’ lives in the U.S. alone.