Conservative states press to limit access to abortion pills as telehealth use rises
Conservative-led states wrapped up or were nearing the end of their 2026 legislative sessions with a renewed focus on abortion pills and on the pathways providers use to deliver them across state lines. Much of the attention has centered on mifepristone and misoprostol prescribed through telehealth and then sent to patients in states with abortion bans.
The shift is reflected in state action that targets pill access more directly, not just clinic-based procedures. In South Dakota, Republican Gov. Larry Rhoden signed a bill last week that makes it a felony to advertise, distribute or sell abortion pills, and the state’s move followed similar legislation work elsewhere in the region.
Other states were also moving to restrict pills through criminal or licensing pressure. In Mississippi, measures cleared both chambers this year but required House and Senate negotiators to iron out differences before sending a bill to Republican Gov. Tate Reeves. In addition, policy tracking by the Guttmacher Institute, which supports abortion rights, found that at least three states already have laws that specifically ban providers from mailing pills to patients—Florida, Oklahoma and Texas—while Louisiana has classified mifepristone as a controlled dangerous substance.
The emphasis on pills is closely tied to how people access abortions after Roe v. Wade was overturned in 2022 and state bans began taking effect. Most states with the political will to impose broad abortion bans already have done so in the nearly four years since Roe fell, and the legal battles have increasingly centered on how pills are prescribed and delivered, including whether telehealth can be used.
A Guttmacher survey released Tuesday sought to explain why abortion opponents may be focusing on pills. The report suggests that in 2025, for the first time, more women in the 13 states that ban abortion at all stages obtained pills through telehealth than traveled to other states for abortion care.
Under the pill regimen described in the report, providers most often prescribe two drugs—mifepristone and misoprostol—approved for use in the first 10 weeks of pregnancy. Guttmacher’s estimates also suggested fewer women traveled to obtain abortions in states like Colorado, Illinois, Kansas and New Mexico, as pill access through prescriptions expanded.
Guttmacher said its estimates are based on a monthly survey of a random sample of U.S. abortion providers, combined with historical data from every provider in the country. The data were used to reflect a trend that the organization said has also appeared in other surveys of abortion providers.
While states have pressed new restrictions, court fights have continued on the federal rules that allow mifepristone to be prescribed via telehealth. Multiple states have challenged those rules, with Louisiana pursuing a lawsuit in federal court there, Florida and Texas pursuing cases in Texas, and Idaho, Kansas and Missouri making the same case in Missouri court. In parallel, Texas filed civil cases and Louisiana filed criminal cases against providers accused of sending pills into their states.
The legal landscape also includes federal regulatory developments that abortion opponents have said frustrated efforts to restrict pills. The Food and Drug Administration last year approved a generic version of mifepristone, a development that the report said frustrated abortion opponents and has sharpened the state-federal conflict over pill access.
Wyoming was described as the only state that imposed a new abortion ban this year, after Republican Gov. Mark Gordon signed a law in March that bans abortion at about six weeks of gestational age—before many women realize they are pregnant. The report said the ban, like other state bans, applies once cardiac activity can be detected, but it noted courts have rejected previous Wyoming efforts to limit abortion, and the Wyoming Supreme Court struck down an all-stages ban in January.
The report also said the idea of pursuing criminal prosecution of women who seek abortions is not gaining ground in 2026 so far. No state had adopted a measure intended to allow criminal prosecutions against women who have abortions, it said, and proposals aimed at that outcome were reported as stalling early in the legislative process in multiple places, including South Carolina and Tennessee.
Pregnancy Justice tracked what it described as “abortion-as-homicide” measures introduced in six states in 2026, down from 13 states last year, the report said. Ingrid Duran, state legislative director for National Right to Life, opposed those approaches, saying, “Women require compassion and support,” and adding, “Not prosecution.”
Legal scholars who study the issue have argued that introducing penalties aimed at women could shift what advocates see as the limits of what is politically and legally viable. Melissa Murray, a professor at New York University School of Law, said the strategy could change boundaries over time, adding, “You keep pushing the boundary, pushing the envelope, eventually you will get what you’re seeking,” and “It will no longer feel fanciful or shocking.”
Murray also noted that women can already sometimes face charges related to their pregnancies. This month, the report said, police in Georgia charged a woman with murder after allegedly using an abortion pill and the opioid painkiller oxycodone.
With the legislative sessions moving toward closure, abortion access is also set to re-emerge in electoral politics in November. The report said abortion questions will be on ballots in at least three states, including Missouri, where lawmakers seek to repeal a right to reproductive freedom added to the state constitution in 2024, and it said other states were considering constitutional amendments that broadly mirror current abortion laws.