The Underground Abortion Pill Network Is Booming

At least 20,000 packets of abortion pills were shipped to people in the United States in the six months after the Supreme Court overturned Roe v. Wade, two sources with knowledge of the situation told VICE News. 

The suppliers of these estimated 20,000 packets are neither abortion clinics nor abortion telehealth organizations, but instead operate outside of the U.S. legal health care system. The demand for their pills, as well as their success at shipping them out undetected, are evidence of the thriving underground abortion network that has sprung up since Roe’s demise devastated access to abortion clinics. 

Meant to be used by people who want to induce their own abortions, these pills—and the people who supply them—are in a legal grey area. Self-managing an abortion is only banned in a few states, but experts have long warned that if a prosecutor is determined to press charges for it, they’ll find a way.

“People have always self-managed abortions and will always self-manage abortion. We'll have to continue to fight back against all of the bans and restrictions that are being implemented on people,” said Christie Pitney, a licensed nurse practitioner, a midwife with Forward Midfwery, and co-founder of Abortion Freedom Fund, a fund for telehealth abortions. Referring to self-managed abortion, she added, “it’s just going to grow more and more.”

Pitney works with both Aid Access, an organization that mails abortion pills to states where abortion is legal, through providers like Pitney, and to states where it is not, through a doctor who is based overseas. When she started working at Aid Access, where she legally provides abortion pills to people in two states, Pitney estimated that she used to help roughly 60 people get access to abortion pills each month. Now, she said she helps “hundreds” per month.

“Those are specifically for myself, not even the whole organization,” said Pitney, who confirmed to VICE News that at least an estimated  20,000 abortion pills were shipped between the June 2022 Roe decision and December 2022. 

Aid Access is not one of the suppliers included in the 20,000 estimate, suggesting that the true number of abortion pills that have been mailed out through covert channels since the end of Roe is even higher. A recent study of Aid Access also found that the organization received almost three times as many requests for help after Roe was overturned, compared to before a draft of the Supreme Court decision overturning Roe leaked in May 2022. The biggest increases in requests came from people in states that have banned abortion.

Since Roe’s demise, at least 13 states have enacted near-total abortion bans. Data from the Society of Family Planning found last year that, in the two months following Roe’s demise, there were 10,000 fewer in-clinic abortions in the U.S. 

However, just because an estimated 20,000 abortion pills were mailed out does not necessarily mean that 20,000 abortions have already occurred off the grid. Some of these pills may have been requested by people who were looking to stock up in case of a future unwanted pregnancy.

The estimate comes as abortion rights advocates brace for a potential nationwide ban on mifepristone, one of the two drugs typically used in a medication abortion in the United States. Anti-abortion activists filed a federal lawsuit in Texas asking to overturn the Food and Drug Administration’s 2000 approval of mifepristone; the judge overseeing the lawsuit, appointed by former President Donald Trump, has a history of conservative views on issues like abortion as well as a demonstrated willingness to wade into national policy fights.

If it’s successful, this lawsuit would yank mifepristone off the market everywhere—even in blue states that have abortion protections on the books.

Several abortion providers have said they plan to start performing misoprostol-only abortions if mifepristone is banned. But while legal mifepristone might disappear, people will still be able to find it on their own.

“The reality is that mifepristone is flowing into this country,” said Elisa Wells, a co-founder of Plan C, a website that provides information about how to get abortion pills. The suppliers who sent out the estimated 20,000 pills are listed on Plan C, and Wells also confirmed that at least 20,000 pills had been distributed. “There’s a robust pipeline of misoprostol and mifepristone coming in.”

Experts widely agree that it is safe to use these pills to self-manage your own abortion, at least during the first trimester of pregnancy. The World Health Organization has a recommended protocol for self-managing an abortion using both mifepristone and misoprostol, as well as a protocol for doing so using only misoprostol. 

There are, however, legal risks. Between 2000 and 2020, at least 61 people were criminalized for allegedly self-managing an abortion or helping someone else do so, according to research by the legal advocacy organization If/When/How.

Women who have been turned away from abortion clinics and ended up giving birth lacked  money to cover basic living expenses like housing, food, and transportation years later, according to the landmark Turnaway Study, which followed women for years after they attempted to get abortions or succeeded in doing so. Women denied abortions were also more likely to have serious health complications from giving birth, to stay with a violent partner, and to end up raising a child alone.

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