New data from the Guttmacher Institute shows that more people are turning to virtual abortion care—and while that tidbit might sound like a silver lining in our post-Roe world, it can be dangerously misleading if we’re not careful.
Telehealth is, without a doubt, an essential tool. My organization was one of the first abortion providers in the country to offer telemedicine back in 2009. And since the FDA allowed abortion pills to be delivered by mail in 2021, we have worked tirelessly to expand our virtual abortion care into 10 states to reach as many patients as possible. But let’s be clear: virtual care alone isn’t a silver bullet. And it’s not a stand-in for truly accessible care.
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The best abortion care is about the both/and, eschewing the tyranny of either/or. True access looks like real options for abortion seekers, whether that’s in our clinic or the comfort of their own space. We need both. After all, abortions after 12 weeks are provided in clinics, so focusing only on pills and telemedicine neglects patients who are further into their pregnancies or who require a larger range of pain-management options.
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The increase in online-only abortion provision speaks to the critical role that virtual providers play in a time of escalating bans and shrinking access. Where it’s available, telehealth can lower barriers by reducing travel time, cutting costs, and lessening the stigma people can feel when pushing through protesters to seek abortion care in person. But this is only part of the story.
The reality is, the Guttmacher numbers showed the majority of abortions last year still took place in brick-and-mortar clinics. That’s a crucial detail because despite the headlines and hope around telemedicine, most people still rely on in-person care. And for those living in the 16 states with total or near-total abortion bans, virtual care isn’t always attainable, as they still need to leave the state entirely. Accessing virtual abortion care also isn’t as simple as clicking a link. You need a device, an internet connection, a credit card, and—critically—a safe place to receive the pills. For someone experiencing domestic violence, housing insecurity, or financial instability, those requirements can be just as insurmountable as making it to a clinic.
Every day, our in-clinic clinicians and virtual-care providers work closely with patients navigating an increasingly fractured and costly system. And too often, those hit hardest are Black and Latina women, young people, and people working hourly-wage jobs without paid leave. Based on Guttmacher data and our own patients’ experience, we see a clear preference for in-person care among our patients of color, while our virtual care skews more white and Asian. That alone should challenge assumptions that telemedicine is an option for everyone.
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Fewer and fewer travelers can afford to make it to abortion care in other states. More are having to delay care, or forgo it entirely. And yet none of the recent reporting on abortion access, including the Guttmacher data and the viral New York Times maps, has factored in the impact of funding.
For example, immediately after the Dobbs decision overturning Roe, The Abortion Access Fund (TAF) operated by Resources for Abortion Delivery (RAD) stepped in to cover the full cost of abortion care for people traveling from ban states to access points like Illinois, Colorado, Florida, North Carolina, and New Mexico. Support like that was a game changer. It provided no-cost procedures and freed up grassroots and local abortion funds to focus on covering travel, lodging, and other practical support.
But that support ended in September 2024, and this followed large cuts from the National Abortion Federation Justice Fund that went from funding our patients in poverty at 50% down to 30% in July of the same year. The effects of these cuts have been immediate. While existing abortion funds still do incredible work, they’re under immense strain. And without that extra layer of funding, far fewer patients can travel or get the full scope of care they need. For many, the question of whether they can access abortion at all—let alone where or how—now comes down to what they can afford. We simply cannot ignore how the economic landscape has shifted with the devastating loss of that additional support.
Let’s not forget: people should be able to use their insurance or Medicaid to pay for abortion care, not solely rely on donations or emergency grants. Donation dollars should not be used for care that Medicaid and insurance could easily cover. It’s why we navigate the sticky red tape to accept insurance and Medicaid for patients in as many states as possible, but ultimately, reimbursement systems are patchy, and far too many people live in places where public or private coverage can’t be used for abortion care at all.
As independent abortion providers, we are doing everything we can. We have dedicated staff whose only job is to help patients access every dollar of funding available. On any given day, we’re coordinating between $5,000 and $10,000 in financial support for our patients. That’s six days a week, 52 weeks a year. But with national abortion funds unable to provide as much money and local grassroots funds stretched to their limits, it’s just never enough.
When people talk about telemedicine as the solution, they often overlook these financial realities. They also underestimate the practical support required to make access real. Even if funding were magically available to cover 100% of a patient’s abortion procedure, that means little if they can’t afford a tank of gas to leave their state, find a hotel room, or arrange childcare for their kids back home. These are the underfunded infrastructures we urgently need.
To build a future where abortion is truly accessible, we must prioritize economic justice, invest in the infrastructure that supports patients on the move, and center the people most impacted by bans and barriers. That means investing in in-clinic care and virtual care. It means Medicaid and mutual aid. Anything less risks reinforcing the very inequities we’re trying to dismantle.