A new era in abortion services may be over before it ever really began

This past week, Republicans dialed up the anti-abortion pressure campaign on the Trump Food and Drug Administration when virtually every Republican senator signed a letter to Health Secretary Robert F. Kennedy Jr. asking the FDA to impose new restrictions on mifepristone, a drug currently used in the majority of abortions nationwide.

The letter (which only Sens. Lisa Murkowski and Susan Collins declined to sign) was inspired by GOP outrage over the FDA’s approval of a second generic version of mifepristone last week.

The senators ask the FDA to suspend further generic approvals, prohibit telehealth access to mifepristone, and immediately stop mifepristone distribution altogether by declaring the drug to be an “imminent hazard” under federal law.

This pressure from Republicans on the Trump administration makes sense, given the fundamental shift in the nature of abortion we’re seeing in America. We seem to be entering Abortion 3.0, an era defined by access to pills and telehealth, even in states where abortion is banned. That’s precisely what Republicans are trying to stop.

This new era looks to be markedly different than what came before. Abortion appeared to be common when states criminalized the procedure throughout pregnancy in the 19th century. Newspapers marketed remedies claiming to end or prevent pregnancies. Midwives and so-called female physicians — abortion providers, often women, who specialized in reproductive treatments — offered services alongside regular doctors.

The new state criminal laws allowed physicians to intervene to protect the life of the mother — a term that was understood by courts for decades to give doctors (but not other providers) considerable discretion. That consensus began unraveling in the mid-20th century, when prosecutors cracked down on what they called abortion rackets. Fewer physicians were willing to add abortion to their practices, and hospitals created committees to shield themselves and their employees from liability.

That was the world that Roe v. Wade transformed, a first era of defining abortion rights, when abortion services were primarily provided in hospitals. Hospital care made abortion appear to be like any other medical procedure. In 1970, when anti-abortion protesters forced their way into the George Washington University Hospital, they were interrupting treatment at a place where patients went for everything from childbirth to appendectomies. But patients relying on hospitals struggled to get abortions. Hospitals still worried about liability, and immediately after Roe, only one-fourth of all hospitals offered the procedure at all.

That led to a second era, one in which abortion-rights advocates pushed for the creation of freestanding clinics that could offer abortion and other reproductive health services. There were feminist health centers, primary care doctors and other clinics that made abortion more available. At the same time, the clinics created new opportunities for abortion opponents, who could physically and symbolically isolate abortion from other medical services. Protesters could mount massive blockades to stop patients from even entering a clinic. Anti-abortion leaders could argue that it was only “abortionists,” not ordinary doctors, who offered the procedure.

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Enter the current era, where most abortion access is defined by telehealth. Data from the Guttmacher Institute found a modest increase in the number of abortions performed thus far in 2025, combined with a more marked decrease in abortion-related travel. More of the procedures, the data suggested, involved pills sent by mail. The FDA removed an in-person dispensing requirement, a change made permanent in 2023. And after the Supreme Court overturned Roe, progressive states began passing shield laws to protect their residents from civil or criminal consequences under state bans. A network of so-called shield doctors has grown up around these laws to mail pills to patients in ban states.

The telehealth model could have a transformative impact on how Americans experience abortion — and not just in ban states. Telehealth can make abortion more readily available to people, especially those in rural areas with no ready access to a clinic. Unlike clinic procedures, telehealth abortions take place in private, away from protesters and even providers who sometimes report to law enforcement, and can resemble a miscarriage, which a significant number of women experience over the course of their reproductive lives. In the era of telehealth, abortion may more often resemble other procedures managed at home, and won’t as often expose patients to threats or protest.

But the new telehealth model has grown up in the shadow of tremendous legal uncertainty. Shield state leaders know that it is only a matter of time before clashes about their laws land before the Supreme Court. The Trump administration has undertaken a study of mifepristone, which abortion opponents believe will lead to the restoration of pre-2016 restrictions that disallowed telehealth.

Republican lawmakers, like the signatories of the Senate letter, have pushed the Trump administration to act. And there is more than lawmaker pressure that might force Trump’s hand.

A major suit to limit access to mifepristone launched by the Republican attorneys general of Missouri, Idaho and Kansas is ongoing before the Eastern District of Missouri. Louisiana’s Republican attorney general has filed her own lawsuit against the FDA. Louisiana and Texas have also taken aim at shield laws in separate suits arguing that such statutes violate constitutional provisions requiring comity between the states. Individuals are also suing. All of them hope the Supreme Court will declare that conservative states can target those in places where abortion is protected, or that the FDA had no authority to approve mifepristone or permit telehealth access to it.

Suits also seek to establish that the Comstock Act, a 19th-century obscenity law, operates as a de facto abortion ban. Even if Republicans have sound political reasons for avoiding any discussion of abortion, the courts may leave Trump no choice but to respond.

What will happen if the Republicans succeed? Will doctors continue to make abortion medication available off-label, or will patients simply turn to other drugs that can terminate a pregnancy? Will more Americans go back to traveling to brick-and-mortar clinics, or will a lack of resources — or the pressure created by the “big, beautiful bill” and its state equivalents — mean that it’s no longer an option for many?

It’s too early to say, but one thing is clear: Depending on which way the conservative federal courts lean, a new era in abortion services may be over before it ever really began.