Abortion pills are gaining ground as a method for ending pregnancies, and opponents are responding

As states that already ban abortion seek to further restrict access this year, much of the focus is on pills sent by out-of-state providers.

A survey released Tuesday helps explain this emphasis. That suggests more women in ban states obtained an abortion last year using the prescribed pills via telehealth rather than traveling to places where it’s legal.

Most states with the political will to impose broad bans have already done so in the four years since the U.S. Supreme Court overturned Roe v. Wade and opened the door to their application. So far this year, only one state has created a new one.

Here’s a look at the situation as many state legislatures wrap up or have finished their 2026 sessions.

South Dakota Gov. Larry Rhoden, a Republican, signed a bill last week that makes it a crime to advertise, distribute or sell abortion pills.

Similar measures were approved by both Mississippi legislative chambers this year. There, the House and Senate would have to iron out differences between their versions before they could send it to Republican Gov. Tate Reeves.

A survey of national abortion policies conducted by the Guttmacher Institute, which supports abortion rights, finds that at least three states — Florida, Oklahoma and Texas — already have laws that specifically prohibit providers from sending the pills to patients. Louisiana has classified one of these drugs, mifepristone, as a controlled dangerous substance.

Bills intended to prevent the use of the pills were approved this year by one chamber of the legislature in Arizona, Indiana and South Carolina. Republicans control the legislatures in all three states as well as the governor’s office in two of them. But in Arizona, any restrictions passed could be vetoed by Democratic Gov. Katie Hobbs.

A Guttmacher investigation released Tuesday sheds light on why abortion opponents might focus on the pills.

The report suggests that in 2025, for the first time, more women in the 13 states that ban abortion at all stages of pregnancy obtained pills through telehealth rather than traveling to other states to have an abortion.

The prescriptions come from providers in states with laws passed since the fall of Roe intended to protect those who prescribe abortion pills to patients in banned states.

The estimated increase in mail-in pills comes as Guttmacher’s estimates also suggest that fewer women are traveling to states like Colorado, Illinois, Kansas and New Mexico for abortions.

Guttmacher’s estimates are based on data from a monthly survey of a random sample of abortion providers in the United States, combined with historical data from each provider in the United States.

This follows a trend that has been documented in other surveys of abortion providers.

Several states have challenged in court federal rules allowing mifepristone, an abortion pill, to be prescribed via telehealth.

If they could require in-person prescriptions, that would at least reduce the ability of foreign providers to get pills to places where bans are in effect.

Louisiana has one such lawsuit in federal court; the attorneys general of Florida and Texas have one in Texas; those two states, along with Idaho, Kansas, and Missouri, are making the same arguments in a Missouri court.

Meanwhile, Texas has filed civil suits and criminal charges in Louisiana against providers accused of sending pills into their states.

The Food and Drug Administration approved a generic version of mifepristone last year, frustrating abortion opponents.

Wyoming is the only state to impose a new abortion ban this year.

Under a law signed in March by Republican Gov. Mark Gordon, it became the fifth state to ban abortion at about six weeks’ gestation — before many women realize they are pregnant. Like most other countries, Wyoming’s ban covers abortions once cardiac activity can be detected.

Courts have rejected Wyoming’s previous efforts to limit abortion.

The Wyoming Supreme Court in January overturned the ban on abortion at all stages of pregnancy.

No state has adopted a measure intended to allow criminal prosecution of women who have abortions.

Proposals in this direction continue to be made but fail at the start of the legislative process.

The farthest such a bill has reached was a hearing last year before a Senate subcommittee in South Carolina. One was scheduled for a subcommittee hearing in Tennessee this month, but it did not take place.

Pregnancy Justice, which advocates for the rights of pregnant women, says it has tracked new “abortion as homicide” measures introduced in six states in 2026, up from 13 states last year.

Major established anti-abortion groups oppose this approach. “Women need compassion and support,” said Ingrid Duran, state legislative director for National Right to Life. “No prosecution.”

Melissa Murray, a professor at New York University Law School, says introducing bills with sanctions against women can shatter the notion that such policies are forbidden.

“You keep pushing the limits, pushing the limits, and eventually you’ll get what you’re looking for,” Murray said. “It will no longer seem gimmicky or shocking.”

She also noted that women are already sometimes charged with crimes related to their pregnancy. This month, Georgia police charged a woman with murder after she allegedly used an abortion pill and oxycodone, an opioid painkiller.

The abortion questions will go before voters in at least three states in November.

Missouri lawmakers are asking voters to repeal the right to reproductive freedom they wrote into the state constitution in 2024.

Elsewhere, voters are being asked to add constitutional amendments that largely reflect current state abortion laws.

In Nevada, a constitutional amendment allowing abortion up to fetal viability — generally considered after 21 weeks of pregnancy — passed in 2024. But it requires voter approval a second time to take effect.

A Virginia ballot measure would guarantee the right to reproductive freedom, including access to contraception and abortion decisions during the first two trimesters of pregnancy.

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Associated Press reporter Amelia Thomson DeVeaux contributed to this article.