Since the 2022 Dobbs decision overturned Roe v. Wade, abortion access has shifted dramatically from state to state, leaving many people unsure of what care is available where they live. These changes have also created challenges and health risks for people seeking timely reproductive healthcare.
Recent data from the Gender Equity Policy Institute shows that maternal mortality rates (1) are nearly twice as high in states that have banned abortion. News outlets have also reported heartbreaking stories, including that of Texas resident Josseli Barnica, who died during a miscarriage when her doctor feared that providing care could violate state law.
Amid this landscape, many people are turning to telehealth as a reliable way to access reproductive care without unnecessary delays. The Society of Family Planning (2) reports that by 2024, about 25% of abortions in the U.S. were provided through telehealth—up from just 5% in 2022 before the Dobbs ruling.
Receiving abortion pills by mail has become an important option for expanding abortion access to people who want timely, medically supported care in a setting that feels safe and private for them.
The State of Abortion Laws
Nearly half of all states have abortion bans or restrictions prior to viability. Currently, 12 states are considered to have total abortion bans, albeit with some narrow exceptions; six others have early gestational limits of between six and 12 weeks; and four states have gestational limits of between 18 and 22 weeks, according to KFF (3). Nine states plus Washington, D.C., have no gestational limits, while the remaining 19 only have limits at or near fetal viability (4).
Yet these broad laws only tell a small portion of the story on access to reproductive care. As an unprecedented number of people travel out of state to receive care, they have to worry about shield laws, which protect patients and doctors from legal consequences from other states where that same care may not be legal.
For example, 22 states and D.C. have protections against out-of-state investigations and prosecutions, and 16 states plus D.C. have protections against civil liability, according to the UCLA Center for Reproductive Health, Law, and Policy (5) and a KFF analysis (6).
Interstate travel for abortion care more than doubled since the Dobbs decision from 81,000 in 2020 to 169,000 in 2023, before declining slightly last year to 155,000, according to the Guttmacher Institute (7).
Part of that travel decline is likely due to the rise in telehealth and the ability to receive abortion pills by mail. The record 25% as of Q4 2024 is up from just 5% in Q2 2022 and 16% in Q3 2023, which was the quarter following when shield law protections began and when the #WeCount initiative from the Society of Family Planning expanded data collection to help track these sorts of changes (8).
Eight states now offer broad legal protections for telehealth abortion care, according to Guttmacher (9). These protections allow providers in states like California, Colorado, Massachusetts, Maine, New York, Rhode Island, Vermont, and Washington to offer virtual abortion care and mail medication to clients living or traveling from elsewhere—potentially even in states with total abortion bans. While some organizations have begun using this model, carafem only mails abortion pills within states where it is legal to provide care.
Because these telehealth shield laws are still new, the legal landscape continues to shift, and the level of protection for both patients and providers can vary based on individual circumstances.
Recently, for example, a judge in New York tossed a lawsuit from the Texas Attorney General against a county clerk in New York (10), due to the clerk not enforcing a Texas judgment against a New York doctor for allegedly prescribing and mailing abortion pills to a woman in Texas (11). The New York judge dismissed the suit due to the state's shield law, protecting against these types of out-of-state enforcement attempts.
Still, it's possible that this type of issue could be ruled differently by different courts, including if this or a similar case makes its way up to the Supreme Court.
Telehealth and the ability to receive abortion pills by mail have become important components of reproductive healthcare for many people nationwide. Some organizations state that they can mail abortion medication to clients in all or nearly all states.
At the same time, other providers offer a more comprehensive model that goes beyond simple mail delivery by including clinician-approved prescriptions, detailed medical instructions, and ongoing support throughout the process. This type of structured, medically supported care—such as the model provided by carafem—offers a more guided experience for people who prefer additional clinical oversight and personalized follow-up.
To help U.S. residents better understand which states provide the top environments for digital access to abortion pills, carafem ranked the top 10 states based on six metrics, spread across the categories of legality, accessibility, and demand.
The six metrics include the legality of medication abortion, the prevalence of state shield laws, the number of online abortion pill providers available, the proportion of abortions provided via medication in states without total abortion bans, the proportion of abortions provided by online-only clinics in states without total abortion bans, and visits per capita to carafem's website.
Please find the complete methodology at the bottom of the article.
Key Findings
Maine is the top state for abortion pill digital access: Maine has some of the most progressive abortion protections, with the state tying for first place in legality rankings. Maine also ranks highly across other analyzed dimensions, including No. 4 for accessibility based on the number of online abortion pill providers, and No. 10 for demand, indicating that state laws set the base for access and usage.
Majority of the top 10 states extend shield laws to telehealth: While this was only one aspect that went into ranking states based on their shield laws, there's a natural correlation between states that have telehealth protections and also being states where abortion pill access and demand are relatively high. However, Washington and Rhode Island did not make the top 10, despite having telehealth shield laws, due to factors such as not having quite as many online abortion pill providers available in these states as most of the top states.
Demand for abortion medication is high in several states with relatively restrictive laws: Wyoming ranks as the top state based on demand. While the state's current abortion limit is based on fetal viability (the point to which Roe v. Wade protected), that is potentially temporary; the state legislature passed an abortion ban, including banning medication abortion, but that has been overturned in state court and remains an ongoing dispute (12). Georgia—which has one of the more restrictive abortion bans at approximately six weeks—ranks second for demand for digital access to abortion pills. These types of findings indicate that telehealth is an important avenue for care in states that potentially make it riskier or more difficult for individuals to seek in-person care.
Top States
The top states for abortion pill digital access largely rank above the median across legality, accessibility, and demand. Maine ranks first, given factors such as its strong shield laws (tied for No. 1 rank), the number of online abortion pill providers available in the state (No. 4), and demand for telehealth/abortion medication (No. 10).
Colorado takes the No. 2 spot, tying Maine for No. 1 on legality and only ranking slightly behind on accessibility via online abortion pill providers (No. 7). Yet demand is even higher in Colorado than in Maine (No. 7).
New York, which has been in the news for shield laws, ranks No. 3 overall while being tied for No. 1 on legality, and also being No. 1 for accessibility. The only reason it didn't rank quite as high overall is because of relatively low demand (No. 27). For example, only an estimated 58% of abortions in the state are provided via medication, vs. 70% in Maine and 95% in Wyoming (13). While that could be a result of factors like legal protections and a history of offering procedural abortions at in-person clinics, lower demand could still potentially coincide with not having quite as much accessibility as some other states in the future.
New Mexico also stands out as one of the top states (No. 6), but it ranks a bit lower on legality (tied for No. 14). The state does have several shield laws, but not specifically for telehealth or for protections related to professional liability, insurance, and health plans. Still, the state is tied for No. 1 for accessibility, with 33 online abortion pill providers available in the state (14).
Legality
This category considered whether medication abortion is legal in a given state, as well as state shield laws across seven subcategories. Because this category was based on a binary "yes/no" of whether a state has certain legal protections, there was a six-way tie for the top spot. These six states all have shield laws in each of the seven measured areas:
Protections for reproductive care
Protections against out-of-state investigations and prosecutions
Protections from professional discipline
Protections against civil liability
Protections related to professional liability, insurance, and health plans
Protections of medical information and other data related to reproductive and gender-affirming care
Broad protections extended to telehealth provision
Accessibility
This category measures the number of online abortion pill providers accessible in a state, based on Plan C data. The top 10 states for accessibility closely align with overall rankings, with just slight movements among the states. The only top 10 state overall that did not rank in the top 10 here is Vermont (No. 13 for accessibility), while Minnesota (No. 12 overall) cracked the top 10 here (No. 9).
Still, all states have a double-digit number of providers available, indicating broad accessibility for abortion medication online. Given this broad access, these rankings were not adjusted for population so as not to skew toward low-population states. Relatedly, population is generally not much of a barrier for online providers who are simply mailing from one state to another, compared with the population barriers related to setting up in-person clinics.
Demand
This category accounted for the proportion of abortions provided via medication and the proportion provided via online-only clinics in states without total abortion bans; this data was combined with proprietary carafem data measuring site traffic per capita from March 2022-September 2025.
The data showed a mix of states—some with restrictive and some with progressive legality—having high demand for abortion pills. In states such as Wyoming (No. 1 for demand), Georgia (No. 2 for demand), Iowa (No. 6 for demand) and Nebraska (No. 9 for demand), abortion legality is typically limited or under pressure amidst ongoing litigation. As such, medication, particularly from telehealth providers, could potentially be an easier, more secure way for patients in these states to obtain care. Granted, patients should consider the legality pertaining to their situation.
Still, some states with strong legal protections rank highly for demand, such as Colorado (No. 7) and Maine (No. 10). That could potentially relate to issues like geography, as Colorado and Maine have relatively low population densities, and people in rural areas may find that telehealth is more accessible than in-person clinics.
Conclusion
The top states for abortion pill digital access are often rooted in strong legal protections for medication abortion and shield laws that protect providers and patients. That often sets up the conditions for more providers to operate in that state, making online abortion pill access more available.
However, that does not always correlate with higher demand for abortion medication, potentially due to factors like strong legal protections also making in-person procedural abortions more accessible. Yet medication abortion, particularly via telehealth, is growing (15). For individuals in states with restrictive abortion policies, those where accessing an in-person clinic is difficult, or those trying to preserve privacy, online abortion pill access is very important.
Methodology
We used the most recent data for six metrics across three categories to determine the top states for abortion pill digital access. We used a Z-score distribution to scale each metric relative to the mean across all 50 states and Washington, D.C., and capped outliers at +/-3. A state’s overall ranking was calculated using its average Z-score across the six metrics, with a weighting of 40% for legality, 30% for accessibility, and 30% for demand. In states where data was unavailable for certain metrics, their overall scores were created using the remaining metrics. Here’s a closer look at the data we used:
Legality
Legality of medication abortion, July 2025 (KFF analysis of state policies and court decisions)
State shield laws, July 2025 (UCLA Center for Reproductive Health, Law, and Policy and KFF analysis of state laws and regulations) and Oct. 20, 2025 (Guttmacher Institute)
Accessibility
Number of online abortion pill providers that mail to a given state, Oct. 31, 2025 (Plan C)
Demand
Proportion of abortions provided via medication in states without total abortion bans, 2023 Guttmacher Institute)
Proportion of abortions provided via online-only clinics in states without total abortion bans, 2023 (Guttmacher Institute)
carafem site visits, Mar. 2022-Sept. 2025 (carafem)
Sources & References
Gender Equity Policy Institute, "Maternal Mortality in the United States After Abortion Bans." Apr. 2025
Society of Family Planning, "#WeCount report, April 2022 to December 2024." June 23, 2025
KFF, "Abortion in the United States Dashboard." Sept. 02, 2025
KFF, "Abortion in the United States Dashboard." Sept. 02, 2025
UCLA, "Shield Laws for Reproductive and Gender-Affirming Health Care: A State Law Guide." Oct. 2025
KFF, "State Shield Laws: Protections for Abortion and Gender-Affirming Care Providers." July 2025
Guttmacher Institute, "Guttmacher Institute Releases Full-Year US Abortion Data for 2024." Apr. 15, 2025
Society of Family Planning, "#WeCount report, April 2022 to December 2024." June 23, 2025
Guttmacher Institute, "Shield Laws Related to Sexual and Reproductive Health Care." Oct. 20, 2025
The Hill, "New York judge tosses Texas lawsuit over abortion pills shield law." Nov. 01, 2025
The Hill, "Texas Attorney General Paxton sues New York county clerk over abortion ruling." July 28, 2025
State Court Report, "Wyoming Supreme Court Set to Decide Whether Abortion Is Health Care." Apr. 30, 2025
Guttmacher Institute, "Medication Abortion Remains Critical to State Abortion Provision as Attacks on Access Persist."
Plan C, "Abortion pill providers in New Mexico." Oct. 31, 2025
Guttmacher Institute, "Medication Abortion Accounted for 63% of All US Abortions in 2023—An Increase from 53% in 2020." Mar. 2024