An innovative research initiative on online abortion access in the United States
Project Overview
Building on Guttmacher’s decades of experience measuring abortion incidence in the United States and around the world, the Online Medication Abortion Study (OMAS) estimates the number of abortions in the United States obtained from online providers and generates data on the characteristics and experiences of people seeking medication abortion online.
In 2023, Guttmacher launched the OMAS pilot study, collecting data from 522 residents of Florida, Indiana and Louisiana who accessed medication abortion via online sources. After successfully implementing the OMAS pilot, the research team fielded a national survey from November 2025 through April 2026, collecting data from 2,559 eligible respondents across all US states.
As data from Guttmacher's Monthly Abortion Provision Study show, people in the United States are increasingly accessing medication abortion online from providers operating under the protection of state shield laws. Accordingly, studying the experiences of people who rely on this and other forms of online care provision is critical to understanding the current US abortion landscape. OMAS is the first study to collect national data on the experiences of people accessing care through multiple modes of online abortion service provision, including international and US online clinics, community support networks and websites that sell pills.
OMAS collects data on a wide range of factors related to online medication abortion, including user characteristics, user experience and preferences, care-seeking behaviors and health outcomes. OMAS will also be integrated with other signature Guttmacher research initiatives, including the Monthly Abortion Provision Study and the Abortion Patient Survey, to provide the most comprehensive picture of abortion provision in the United States post-Dobbs. These forthcoming findings will be published in peer-reviewed journals and in Guttmacher policy analyses and will be added to this page upon publication.
Types of Online Providers Included in OMAS
Online clinics with US-licensed providers
These clinics offer telemedicine abortion care provided by US-based clinicians operating under their licensed scope of practice. Care may be available synchronously or asynchronously, by sliding payment scale or at a fixed price.
OMAS includes patients of online clinics with US-licensed shield law providers, serving residents of states with total or telemedicine abortion bans, in addition to residents of states without such bans. OMAS does not include patients of online clinics that limit their provision to states without abortion bans (either telemedicine or total bans).
International online clinics
International online clinics offer telemedicine abortion care by clinicians outside of the United States. Care is available asynchronously, by sliding payment scale or at a fixed price. International online clinics serve all US states. OMAS includes patients of international online clinics.
Community networks
Community support networks are non-medical organizations run by trained, volunteer community members who mail abortion pills for free to US residents, most often but not exclusively to those who live in states with abortion bans and other restrictions. Community support networks typically offer accompaniment support throughout the abortion process, and are modeled on the feminist acompañate groups common in Latin America. OMAS includes clients of community support networks.
Websites that sell abortion pills
These websites, which exclusively provide medication abortion, offer abortion pills by mail at a range of price points, without clinician or peer support. OMAS includes clients of websites that sell abortion pills.
Wraparound Care for Medication Abortion
- Seeking in-person follow-up care, if desired, is a common and normal part of the medication abortion process, most of which typically takes place outside of clinical settings. Whether patients receive the medications in-person or in the mail, they are typically taking the pills at home or in an environment of their choosing—a feature of medication abortion that many patients prefer for the privacy and flexibility it affords them. Like miscarriage management and many interventions for common conditions such as urinary tract infections and kidney stones, medication abortion is a process that is primarily managed by the patient, followed by optional remote or in-person care to address symptoms, rule-out complications and confirm resolution.
- Decades of research have established the safety and efficacy of medication abortion care. This includes both the use of the combined mifepristone‒misoprostol regimen and the use of misoprostol alone. Evidence also shows that telehealth provision of medication abortion—where patients receive abortion pills by mail after a remote consultation with a US-based clinician—is similarly safe and effective, with 29% of US abortions being obtained via telehealth by the end of 2025.
- Serious adverse events—such as those requiring a transfusion or hospitalization—are exceptionally rare in medication abortion care, typically well below 1% of cases. (While all medical interventions are unique, the mifepristone‒misoprostol regimen’s safety profile is comparable to that of ibuprofen, and represents lower risks than those posed by penicillin and Viagra.) To rule out these rare complications, providers often advise everyone experiencing a specific set of symptoms (such as prolonged heavy bleeding) to consult a clinician, even though most of them will not, in fact, be experiencing a serious adverse event.
- In the small number of cases (3‒5%) in which medication abortion is unsuccessful and the patient remains pregnant, the abortion can be safely and effectively completed with additional rounds of misoprostol or a procedural abortion. (These additional follow-up interventions are the same ones typically used to treat a miscarriage or early pregnancy loss.)
- Since home pregnancy tests can show “false positive” results up to five weeks after a successful abortion, in-person visits can offer a way for people to confirm they are no longer pregnant. While remote or in-person follow-up is not routinely required after medication abortion, it can be an important way for patients to get advice on how to address their symptoms and to monitor their hormone levels if there are concerns about incomplete abortion.
- Most people who have a medication abortion will experience symptoms such as bleeding and cramping, and seeking in-person care is one way that they can confirm that these symptoms are normal and expected. Other reasons that people sometimes seek care after medication abortion include consultations for contraception and to confirm that any continuing symptoms (such as intermittent bleeding or fever) are normal and not a cause for concern.
- Since the Dobbs decision overturning a constitutional right to abortion, many people who would have sought an in-person consultation before a medication abortion are now prevented from doing so, due to abortion restrictions or the threat of criminalization.
- Care-seeking behavior is also impacted by a US context in which many people are uninsured or underinsured and have no access to a regular health care provider. This means that many people are forced to visit emergency departments to address a broad range of non-emergency conditions and concerns. Since abortion care is highly stigmatized and banned in many states, patients may have genuine fears about their legal safety. In this context, emergency departments may often be the most accessible and anonymous way to get information and resolve concerns.
- Mis- and disinformation about medication abortion has proliferated in recent decades, in part because medication abortion—and especially its online provision—has become critically important to abortion access across the United States. (In 2023, medication abortion accounted for 64% of clinician-provided abortions in the United States.)
- Attacks on mifepristone, in particular, frequently take the form of biased and ideologically driven research papers, riddled with serious methodological flaws, which have subsequently been discredited by researchers and retracted by peer-reviewed journals. Common errors include characterizing incomplete abortion and unrelated conditions as serious adverse events, presenting expected rates of complications as new information, and categorizing all ER visits, for any reason, as serious adverse events. These attacks also frequently categorize normal symptoms as serious adverse events that do not meet the FDA’s criteria for such events.
- Information about care-seeking is also complicated by abortion bans and peoples’ legitimate fears about criminalization for a broad range of pregnancy outcomes including miscarriage or stillbirth. Particularly in states with restrictive abortion laws, seeking follow-up care after an abortion can put individuals at risk of criminalization; health care providers are often the ones reporting abortion patients to police, despite the fact that no state laws currently require such reporting to law enforcement. These factors make data collection in traditional medical settings far more complex and potentially inadequate.
- As misinformation about abortion care proliferates, understanding people’s actual experiences with medication abortion and care-seeking is more important than ever. The data generated by the Online Medication Abortion Study provide a nuanced and detailed picture of the medication abortion process from the perspective of the patient and explores the various reasons that patients might seek in-person care before, during or after that process. While the science is clear on the safety and efficacy of medication abortion, we hope this research will inform best practices, help identify potential gaps in support and counseling, and drive patient-centered innovations in care provision and health policy.
Methodology
OMAS has two primary research objectives:
1. To estimate the incidence of abortions obtained through online medication abortion services
2. To understand the characteristics, experiences, preferences and health care needs of people using online medication abortionOMAS will estimate the incidence of abortions occurring through online medication abortion services by adapting an indirect estimation method (known as AICM) that Guttmacher scientists have developed and applied for decades in countries where abortion is legally restricted. OMAS will apply this method for the first time in the United States and will combine estimates with the Monthly Abortion Provision Study to present the most complete estimate of abortion incidence in the United States post-Dobbs.
OMAS will describe who uses online medication abortion services and what they experience. Combing our data with the upcoming round of Guttmacher's Abortion Patient Survey, we will present the fullest picture to date of who obtains abortion care in the United States.
The OMAS pilot and national surveys employed similar methodologies to recruit participants. Guttmacher researchers recruited survey participants via partnerships with online providers, including: online clinics with US-licensed providers serving both states with telemedicine abortion bans and those without such bans; international online clinics; community networks; and websites that sell pills.
We identified and connected with online medication abortion providers through Plan C, an online resource which provides information about accessing abortion pills by mail in every US state. Participating providers agreed to reach out to every patient or client in our target geographies and time periods with a message about the study. Messages included a brief description of the study, a link to the survey, and a unique, one-time access code. Instructions indicated that respondents would become eligible to complete the online survey five weeks or more after taking their abortion pills.
The survey asked respondents about their abortion experiences, care-seeking behaviors, care needs, abortion preferences, demographics and other topics. It was administered through Qualtrics in English and Spanish. The survey did not collect any identifying information about participants. We offered eligible respondents who completed the survey a $50 gift card. This study was approved by the Guttmacher Institute’s Institutional Review Board.
Acknowledgments
The OMAS team is sincerely grateful to the individuals who took the time to share their abortion experiences with us. We also thank Plan C, Aid Access, and the online medication abortion providers who supported recruitment for our survey, including Abortion Pills in Private, Life Easy on Pills, The Massachusetts Medication Abortion Project, and others who wish to remain anonymous.
Project Staff
Research:
Principal Investigator – Elizabeth Sully
Primary Contact: Isabel DoCampo
Sidney Cech
Margaret Giorgio
Rachel Jones
Samira Sackietey
Policy:
Anna Bernstein
Amy Friedrich-Karnik
Communications:
Joerg Dreweke
Ian Lague
Emma Stoskopf-Ehrlich