Telehealth Overtakes Travel in States With Total Abortion Bans

Telehealth provision under shield laws surpassed out-of-state travel for in-person abortion care among residents of states with total bans in 2025, according to a research letter published October 22, 2026, in JAMA Network Open.¹ A separate study in the same issue suggests telehealth and in-clinic medication abortion serve distinct patient populations.²

Telehealth Surpassed Travel by 2025

Researchers used the Guttmacher Institute’s Monthly Abortion Provision Study to estimate abortions provided by US clinicians to residents of the 13 states with total bans from 2023 to 2025.¹ Shield laws, which began protecting clinicians who mail abortion medications in July 2023, have been implemented in 8 states.

In 2023, an estimated 89,620 abortions involved residents of ban states traveling for in-person care, more than 3 times the 24,460 provided through telehealth. By 2025, telehealth accounted for 90,460 abortions, compared with 64,590 among residents who traveled. The shift was clear in Alabama, Arkansas, Louisiana, Mississippi, Oklahoma, and Texas, where most abortions were provided through shield laws even after accounting for uncertainty, though the shift was not clear in the other 7 states.

From 2024 to 2025, the rise in telehealth provision exceeded the decline in travel, and the authors said it is possible shield laws allowed people who could not travel to obtain wanted abortions. Still, more than 60,000 residents of ban states traveled for care in 2025, indicating continued demand for abortion funding and practical support.

The authors noted that mailed medications do not necessarily represent abortions, as some people may have obtained them from multiple clinicians or not used them. Travel counts could be underestimated if patients did not disclose a ban-state residence. Counts include only care from US clinicians, excluding community networks and websites selling pills without prescriptions. Data for 25% of online-only clinic months in 2025 were missing and modeled, with higher missingness among clinics serving ban states.

Telehealth and Clinic Patients Differ

A retrospective cross-sectional study compared 12,823 patients who received telehealth medication abortion care with 725 who received in-clinic care at a Kansas clinic, all residents of Kansas or Texas, from February to June 2024.² Patients younger than 18 years were excluded, and percentages exclude patients with missing data.

In unadjusted comparisons, telehealth patients were more likely to be at less than 6 weeks’ gestation (Texas: 61% vs 27%; Kansas: 59% vs 33%), and the association held after adjustment in Texas. Telehealth patients were also more likely to have no children (Texas: 44% vs 15%; Kansas: 51% vs 8%), though child data were missing for more than half of in-clinic patients. Among patients with ethnicity data, 3% of Texas clinic patients were identified as Hispanic or Latine, compared with 32% of telehealth patients. In Kansas, the figures were 7% and 18%. The Texas difference persisted after adjustment (adjusted OR [AOR], 12.18; 95% CI, 4.78-31.06) compared with White patients, while the Kansas difference was borderline and not significant after adjustment.

Distance and Rural Residence Linked to Telehealth Use

Nearly all Texas patients (12,947 of 13,139) lived more than 200 miles from an abortion facility, by county-level estimates. In-clinic patients were concentrated at 200 to 399 miles (61%, vs 33% of telehealth patients), while 66% of telehealth patients lived 400 or more miles away, vs 39% of in-clinic patients. Each additional 50 miles was associated with a 0.3 percentage point higher probability of telehealth use on average (average marginal effect, 0.003; 95% CI, 0.002-0.004), though the association reversed at shorter distances, where more miles slightly lowered telehealth probability. Texas patients in nonmetropolitan counties were more likely to receive telehealth than those in large metropolitan counties (AOR, 2.29; 95% CI, 1.04-5.04).

Study Limitations and Takeaways

The data came from one telehealth service and one Kansas clinic, so results may not represent all patients, and county-level measures may not reflect individual circumstances. The authors called for research on patient preferences and experiences to guide patient-centered services.

“In this cross-sectional study of patients who used medication abortion, teleMAB patients more often had no children, were living farther from an abortion facility, and represented populations facing structural racism and long-documented barriers to abortion care compared with in-clinic patients, particularly in abortion-restrictive states,” the authors concluded. “A higher number of patients at lower gestational age received telehealth than in-clinic services, suggesting more convenient and timely care.”

References

1. Jones RK, Aiken ARA, Maddow-Zimet I. Telehealth provision and travel for abortion care in states with total bans. JAMA Netw Open. 2026;9(10):e2640018. doi:10.1001/jamanetworkopen.2026.40018

2. Fiastro AE, Thayer EK, Fredman SN, et al. Telehealth vs in-clinic medication abortion provision. JAMA Netw Open. 2026;9(10):e2640034. doi:10.1001/jamanetworkopen.2026.40034