Nearly two out of every three abortions in America today use pills.
These “chemical abortions,” as they are often called, are especially popular in states that prohibit abortion clinics. Last month the Guttmacher Institute released survey results showing that in 2025, women in states with abortion bans were more likely to obtain abortions by ordering abortion pills through telehealth providers than by traveling out of state to obtain either a chemical or surgical abortion.
These numbers are why contemporary pro-life activists have made stemming the flood of abortion pills into pro-life states one of their chief causes. One of the most significant pro-life legislative campaigns this spring, for instance, which has the support of Students for Life Action, is to get conservative state legislatures to pass laws restricting the distribution of abortion pills.
This proposal, which has been introduced in multiple conservative states, targets abortion providers by allowing the state attorney general to take legal action against those who unlawfully send abortion-inducing drugs into the state. One variation of the proposed bill would also allow women who use abortion pills, as well as their family members, to also bring lawsuits against the abortion pill prescribers.
The proposed legislation specifically exempts women who obtain abortions through drugs from being prosecuted, so activists have marketed it as a mainstream pro-life effort—rather than an “abortion abolitionist” approach—that will save unborn lives and protect women from telehealth abortion providers who cannot assist their patients in emergencies or other serious health complications from the drugs.
But even in strongly Republican, heavily pro-life states, the proposed legislation has faced substantial obstacles. Last year, Republican senate leaders in Oklahoma refused to bring one such bill to a floor vote even after it passed in the state house of representatives by a vote of 77–9. Students for Life Action blamed this defeat partly on the actions of one abortion abolitionist state senator who tried unsuccessfully to amend the bill to allow women who obtained abortions to be criminally prosecuted, a politically unpopular measure that divides pro-life Republicans.
This year, the mainstream of the pro-life movement—which advocates for legal protection for the unborn that penalizes abortion providers, but not women who obtain abortions—has been better prepared.
In March, the governor of South Dakota signed into law a measure making it a felony to market or distribute abortion pills in the state. And this month, the Mississippi state legislature passed a bill (which the governor is expected to sign into law) that would allow those who prescribe or provide abortion pills to be sentenced to up to ten years in prison.
Because abortion is already illegal (and unavailable) in both South Dakota and Mississippi, observers expect these bills to be used primarily against out-of-state telehealth providers. But some legal scholars say it’s unlikely that out-of-state abortion providers can be successfully prosecuted under these laws.
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“I think lawmakers are imagining this will be primarily used against doctors or drug manufacturers in blue states,” Mary Ziegler, a scholar of abortion policy at the University of California Davis School of Law, told ABC News. “But it will be much harder for prosecutors to actually get those people into court than it will be for them to get someone whose partner has these drugs.”
Eight states (California, Colorado, Maine, Massachusetts, New York, Rhode Island, Vermont, and Washington) have “shield laws” in place that specifically protect medical providers of reproductive and abortion services from being extradited to another state, and other ten states have similar laws that generically protect medical personnel without specifically mentioning abortion. Telehealth abortion providers from one of those states who faced lawsuits in Mississippi or South Dakota could simply refuse to show up in court and rely on their own state to protect them from further prosecution.
The federal government could override these varying and competing legal situations by making telehealth prescriptions of abortion pills illegal. The government legalized this practice only in 2021, during the Biden administration, and the Trump administration has continued that policy.
The federal government could also restrict the sale of abortion pills more broadly. But that seems unlikely in the near term, as the Trump administration’s Food and Drug Administration expanded these sales by approving a new version of the abortion drug mifepristone last October.
For now, in the absence of federal regulation, these state governments are trying to restrict abortion pills on their own—but whether their efforts will be enough to overcome the legal challenges of prosecuting out-of-state providers is far from certain.
Daniel K. Williams is an associate professor of history at Ashland University and the author of Abortion and America’s Churches.
