As the landscape of abortion access in the United States continues to shift dramatically, a transnational struggle is unfolding—one that pits innovative telehealth providers against increasingly restrictive state laws. On December 8, 2025, Texas enacted the Woman and Child Protection Act, the nation's most aggressive law targeting mail-order abortion pills. At the same time, international telehealth services like Abortion Pills in Private are vowing to maintain access to medication abortions for Americans, regardless of what comes next from regulators or state lawmakers.
This collision of legal and medical realities has left patients, advocates, and lawmakers locked in a tense standoff, with each side determined to shape the future of reproductive health in the U.S.
Abortion Pills in Private, an overseas telehealth provider, emerged in March 2024 in direct response to the Supreme Court's 2022 decision to overturn Roe v. Wade. That landmark ruling ended constitutional abortion rights and paved the way for a patchwork of state-level bans and severe restrictions. According to the service, their mission was clear from the outset: to step in where domestic options were vanishing. "Of the small group of us who set it up, a couple of us were actually working on abortion access in other countries for all of our careers. When Roe v. Wade fell, we came together with U.S.-based advocates to set up something for the U.S. because we thought that there would be further restrictions coming into play, and it would be really important to have something outside of the U.S.," a cofounder explained, as reported by Abortion Pills in Private.
Since launching, the service has provided nearly 3,500 Americans with access to abortion pills, focusing especially on those living in states with the harshest restrictions. Texas, Florida, and Georgia top the list, but patients from Ohio, Pennsylvania, and even some blue states have also sought help. The provider uses a doctor-supervised telehealth model: patients fill out an online form, a doctor reviews the information within 24 hours, and—if approved—a prescription is sent to a pharmacy in India. The pharmacy ships a package containing one mifepristone and twelve misoprostol pills directly to the patient in a plain envelope, typically arriving within three to six days. The cost is $95, paid by credit card, and each shipment includes clear instructions and access to further guidance online.
Privacy and security are paramount, especially given the legal risks patients may face in states with bans. Abortion Pills in Private utilizes an encrypted telehealth platform hosted outside the U.S. and deletes patient records after three months. They also partner with Aya Contigo, a digital companion service, to offer emotional support, up-to-date information, and referrals to local resources. As one grateful patient from Georgia shared, "Thank you, truly, for your support and words. Even though I went through this alone, I will never forget that, even without knowing who you are, you were here for me."
The efficacy and safety of medication abortion are well established. According to the Guttmacher Institute, which partnered with Abortion Pills in Private to research patient experiences, medication abortion successfully terminates first-trimester pregnancies 99.6% of the time, with a major complication risk of just 0.4% and a mortality rate of less than 0.001%. Over 7.5 million women have used abortion pills since the FDA approved mifepristone in 2000, and more than 100 peer-reviewed studies have confirmed their safety and effectiveness. Despite this, the U.S. Health and Human Services Department, led by Secretary Robert Kennedy Jr., announced in September that the FDA would conduct a "safety review" of mifepristone. This review is based on a six-page report from an antiabortion organization, a document criticized as methodologically flawed and not peer-reviewed.
Abortion opponents, including Republican state attorneys general and members of Congress, are now pushing for the FDA to prohibit telehealth abortion. The possibility of new federal restrictions looms large. A representative from Abortion Pills in Private voiced concern: "I think it’s likely that the FDA says we have to go back to in-person dispensing, in which case you are going to have so many more people who need to get pills delivered to them by the various services, so we need to have a robust system, which is why we’ve given grants to community providers." She added, "Plus, we want to see several strong online platforms because if there’s no shield protection, there’s going to be a growing number of people who will depend on online services from abroad."
The urgency of these preparations became even more apparent with the enactment of Texas's Woman and Child Protection Act. As reported by Texas Right to Life, the law allows citizens to sue companies and activists who provide abortion pills illegally—even if those providers are based in states with more permissive laws. The law sets a penalty of $100,000 per violation, aiming to "shut down companies that illegally sell abortion pills," "let women harmed by illegal abortions sue traffickers," and "help Pro-Lifers stop abortion activists who are hiding in liberal states." Notably, the law does not punish pregnant women and includes exemptions for legitimate medical care, such as treatment for ectopic pregnancies, miscarriages, and life-threatening emergencies.
Before the law took effect, activists were estimated to have trafficked at least 19,000 orders of abortion drugs into Texas each year. The new law represents, according to its supporters, "the nation's boldest, most expansive effort to target the underground abortion industry." Texas Right to Life has made clear its intention to promote this legislative model nationwide, aiming to "rescue babies, help mothers, and end the abortion industry's criminal network."
Abortion Pills in Private, for its part, is not backing down. The provider has pledged to continue mailing mifepristone and misoprostol to U.S. patients even if the FDA removes the drugs from the U.S. market. "We will continue to send mifepristone, even if the FDA takes it off the market inside the U.S.," a representative stated. The service is designed to be scalable, ready to respond if shield laws fall or if more people turn to international options in the face of new restrictions. While they do not offer discounts, they support community networks in banned states by mailing free abortion pills to those who cannot otherwise access care.
Some international providers, like Women on Web, have moved toward a demedicalized model, reflecting the safety and simplicity of abortion pills. Abortion Pills in Private, however, has chosen to retain a doctor-supervised process. "You don’t need to have a doctor, but if you’re seeking an abortion, you might feel reassured that there is a doctor reviewing your prescription. I think it’s good that there are different options," a representative said. Both approaches are grounded in a large body of evidence supporting the safety of medication abortion.
The contrast between the U.S. and other countries is stark. As one cofounder of Abortion Pills in Private lamented, "Now it’s harder to get an abortion in half of America than it is in so many African countries that we’ve worked in, where they’re going in the other direction." In India, for example, abortion pills are available over the counter and are inexpensive. The goal, the provider says, is to make the process "easy, the best experience that it can be, with dignity. You can just go online, and it’s easy, and there’s no judgment. If you need this, we are here for you. Here are your pills. Here’s the support service that you need. You can do this from home. Whatever the reason is, we want to have that service there for you to be able to do that, no matter where you live."
As the legal and political battles intensify, one thing is certain: the demand for abortion access—and the determination of those providing it—shows no sign of waning, even as the rules of the game are rewritten.