This reporting was supported by the International Women's Media Foundation's Reproductive Rights Reporting Fund.
After the Supreme Court overturned Roe v. Wade, web traffic to Elisa Well’s online abortion medication locator jumped drastically.
The website she co-founded, Plan C, helps connect people to online pharmacies where abortion pills are sold.
“The day before the announcement we had 3,400 visitors to our website," Wells says. "The day of the announcement, we had 209,000."
As states similar to Missouri restrict or outright ban access to abortion, legal experts and pro-choice advocates say more people will turn to medication abortions. The pills cost less than traveling to states where abortion is legal and, location depending, can be fairly easy to access.
But though Missouri has banned abortion with only one exception (unspecified medical emergencies), Missourians can still access medication abortion online with some strategic maneuvering.
Abortion medication commonly refers to a two-pill regime that ends a pregnancy. Mifepristone prevents an embryo or fetus from growing. Misoprostol, taken a day or two after Mifepristone, empties the uterus. The federal Food and Drug Administration allows the medications for pregnancies up to 10 weeks.
“Abortion pills are safe and effective, even if you use them on your own without medical supervision,” Wells says. “They are available in all 50 states — even states that have regulations banning them. They are available through alternate routes of access.”
Buying pills online
Well’s website, Plan C, provides an extensive state-by-state search to help locate abortion pill providers. Wells and her team tested delivery from each provider that Plan C lists and then lab tested all the medication received, she says. The medication from each provider listed on Plan C’s website all offer legitimate and safe abortion medication.
Plan C directs Missouri residents to several online pharmacies and a website called Aid Access, an online-only service run by a team of European doctors who prescribe abortion medication pills to Americans. They primarily ship pills from a pharmacy in India.
To receive pills from online pharmacies and states that allow telehealth, some abortion seekers have used “virtual mailboxes,” Wells says.
Through websites such as iPostal1 and PostScan Mail, users can create virtual mailboxes in abortion-legal states. For example, abortion seekers can pay $15 a month to use PostScan Mail’s address in Swansea, Illinois. Once the pills arrive, PostScan Mail allows users to forward the content of their mailbox to any address.
This way, an abortion seeker can give telehealth providers an address where sending medication is legal and receive the medication without traveling. Virtual mailbox websites are common among travelers or small business owners who do not want to use their personal address. They typically cost less than $30 in monthly fees.
Traveling to haven states
Traveling to a state where abortion is legal remains the legally safest option for residents in trigger states, according to Farah Diaz-Tello, senior counsel and legal director for legal advocacy group If/When/How.
“People who have the ability to travel to another state are more insulated from legal risks than people who are self-managing,” Diaz-Tello says.
Telehealth abortion medication consultation is not legal in Missouri. Patients of Planned Parenthood in Fairview Heights, Illinois, must be in state at the time of their telehealth visit, and Planned Parenthood asks patients to confirm this.
Traveling out of state is the most financially burdensome option and often not possible for the most marginalized, but several Missouri organizations are providing resources to interested individuals.
The Missouri Abortion Fund has partnerships with St. Louis-area abortion clinics in Illinois to help cover the costs of abortions performed there.
Just the Pill, a medication abortion provider with clinics in four states, plans to set up mobile clinics near states with abortion bans. Each mobile clinic offers telehealth consultation and delivers medication.
The organization recently launched two mobile clinics in Colorado, and a spokesperson for Just the Pill tells the RFT it's working on bringing a clinic closer to Missouri.
“We are currently fundraising for our second fleet in Illinois,” Kathryn Mavengere says. “We have plans to expand and add more clinics year after year.”
State law doesn’t ban traveling across state lines to clinics such as these or Planned Parenthood, according to Diaz-Tello. However, she and other legal experts fear ambiguous abortion laws similar to Missouri’s could be used to target abortion seekers.
“Once a prosecutor decides they want to punish somebody for having an abortion, they'll find a way to do so in spite of what the law says,” Diaz-Tello says.
She continues: “The concern is that as the scrutiny on abortion intensifies, and abortion is seen as a criminal matter, whether or not the pregnant woman is the intended target of the law, they’re likely [going] to get swept into criminal prosecution.”
As it’s widely interpreted now, Missouri’s law does not punish individuals who receive abortions. Only those who “perform or induce” an abortion face the risk of a class B felony charge.
However, legal experts question whether those who take abortion medication and therefore induce their own abortions could face legal punishment.
“The trigger law says that a woman shall not be prosecuted for a ‘conspiracy’ related to an illegal abortion,” says Sidney Watson, a specialist in health law and professor at Saint Louis University. “However, there are other crimes, like accessory to an abortion.”
Last week, Missouri Attorney General Eric Schmitt clarified some ambiguity in Missouri’s abortion law. A spokesman for his office said the law does not prohibit the use or provision of Plan B or contraception, though there was no mention of abortion medication.
Missourians could wait and see how the law is interpreted, Watson says, or alternatively, “The attorney general could issue an opinion making it clear that women will not be prosecuted, which would be very helpful.”
Even before the near-total abortion ban in Missouri, the state has not allowed telemedicine abortion care.
During the pandemic, the FDA temporarily lifted its in-person requirement for mifepristone. The lifted restriction allowed providers to prescribe abortion pills remotely.
Yet Missouri and at least a dozen other states never followed suit. A state law enacted in 2013 required patients to be in the same room and “in the physical presence” of the physicians who provided the abortion medication.
Watson says prosecuting online abortion pill providers who continue to serve Missourians, such as Aid Access, would be difficult.
“That website is still up and running, partially because European doctors don’t feel like they are at particular legal risk of prosecution in the U.S.,” Watson says. “It’d be very, very difficult to prosecute physicians operating outside the U.S.”
Online pharmacies have been seemingly undeterred by legal risks. When asked if any online pharmacies have stopped serving restrictive states out of legal fears, Wells said she’s seen the opposite reaction.
“They see the need for this, and a lot of people want to help and get around this real injustice,” Wells says.
To navigate this legal landscape, Diaz-Tello’s website If/When/How offers a legal helpline, where attorneys answer abortion-related legal questions and provide legal representation if needed.
Abortion restrictions are meant to spark confusion, Diaz-Tello says. But she wants pregnant people who are seeking abortions to know they are not alone.
“This moment is intensely frightening for a lot of us, but there is help out there,” she adds. “People will continue to need abortion, and people will continue to support those who need abortions. I don’t want anybody who’s out there and pregnant and needing an abortion to feel like they’re alone because they’re not.”