Facing potential FDA rollbacks, this overseas telehealth provider pledges uninterrupted access to abortion pills for Americans.
In the wake of Roe’s fall and a wave of state abortion bans, reproductive health advocates abroad have launched international telehealth abortion services that mail abortion pills directly to people’s homes in all 50 states. As Trump’s FDA threatens to block U.S.-based medical providers from offering telehealth abortion, one international telehealth provider—Abortion Pills in Private—has vowed to continue providing mifepristone and misoprostol to U.S.-based patients, no matter what.
Their commitment is clear: “We will continue to send mifepristone, even if the FDA takes it off the market inside the U.S.,” said a representative of the service.
Their service and determination grew directly out of the post-Roe crisis. The Supreme Court’s 2022 decision to overturn Roe v. Wade and end constitutional abortion rights spurred the formation of Abortion Pills in Private, which began serving people in the U.S. in March 2024.
As one cofounder put it, their project emerged as a direct extension of their global abortion work. “Of the small group of us who set it up, a couple of us were actually working on abortion access in other countries for all of our careers. When Roe v. Wade fell, we came together with U.S.-based advocates to set up something for the U.S. because we thought that there would be further restrictions coming into play, and it would be really important to have something outside of the U.S.”
Since March 2024, they have served almost 3,500 patients in the U.S., most of them living in the hardest-hit states—those with abortion bans and severe restrictions. “They are from all over, but they are very much from banned states. Texas is always number one. Then Florida, Georgia. Even Ohio and Pennsylvania. There are some blue states too.”
Abortion Pills in Private uses a simple, doctor-supervised telehealth model designed for easy access and confidentiality, serving patients through 11 weeks of pregnancy.
First, patients complete an online medical history form, which a doctor reviews within 24 hours. Eligible patients must be at least 16 years old, though no identification is required.
If a patient is approved to receive the medications, the doctor sends a prescription to a pharmacy in India, which mails the pills directly to the patient in a plain envelope. Packages arrive within three to six days, and contain one mifepristone and 12 misoprostol pills. The service costs $95, which patients pay with a credit card through a payment link, and they then receive a tracking number for their package.
Each package comes with instructions, and Abortion Pills in Private’s website provides more detailed guidance and a video on how to use the medication.
Not only do they provide medical guidance, they also offer emotional and navigation support through their partnership with Aya Contigo. This digital companion service provides patients with up-to-date information in an app, support from peer counselors in the app chat or WhatsApp, and referrals to trusted local resources and services.
Abortion Pills in Private reports their patients’ successful abortion experience show the powerful impact of safe, telehealth abortion care. Last year, they partnered with Guttmacher Institute, which conducted research on patient experience with several online platforms. “For us, there were no major complications. There were a couple of healthcare visits, but there was no need for treatment. They went there out of concern, for reassurance, especially around the amount of bleeding, which can be more than expected.”
Alongside strong outcomes, the service also emphasizes privacy and security. To protect patients’ privacy, Abortion Pills in Private uses an end-to-end encrypted telehealth platform hosted outside of the United States and deletes patient information after three months.
Thank you, truly, for your support and words. Even though I went through this alone, I will never forget that, even without knowing who you are, you were here for me.
– Aya user from Georgia
People find Abortion Pills in Private through the Plan C website. “We’re not trying to have big volumes. We’re very happy to see the U.S. shield providers do well. We are a backup service so if mifepristone is further restricted, if the shield laws fall, and more people have to find pills this way, then we will be here to help whoever we can help. We are able to scale up if we suddenly have a lot more people ordering.”
Although Abortion Pills in Private does not offer discounts, they actively support community networks where lawmakers have imposed bans and restrictions, mailing free abortion pills to people who would otherwise go without care.
Whereas another international abortion pill service, Women on Web, has demedicalized its model because abortion pills are so safe and easy to use, Abortion Pills in Private have chosen to keep doctors writing prescriptions for their patients. “You don’t need to have a doctor, but if you’re seeking an abortion, you might feel reassured that there is a doctor reviewing your prescription. I think it’s good that there are different options.”
Both Women on Web’s demedicalized model and Abortion Pills in Private’s doctor-supervised model rest on a large body of evidence that abortion pills are extremely safe.
- Medication abortion successfully terminates first-trimester pregnancies 99.6 percent of the time, with only a 0.4 percent risk of major complications and an associated mortality rate of less than 0.001 percent (0.00064 percent)—lower than many common over-the-counter medications.
- Since the FDA approved mifepristone in 2000, over 7.5 million women have used abortion pill.
- Over 100 peer-reviewed studies have proven that abortion pills are safe and very effective.
Despite this outstanding safety record, Health and Human Services Department Secretary Robert Kennedy Jr. announced in September that the FDA would be conducting a “safety review” of mifepristone, based on a methodologically-flawed, six-page report produced by an antiabortion organization and not peer-reviewed. Abortion opponents, Republican state attorneys general and Republican members of Congress are now demanding that the FDA prohibit telehealth abortion.
A representative from Abortion Pills in Private worries that the so-called ‘safety review’ will be used to roll back telehealth access, and is already planning for that possibility.
“I think it’s likely that the FDA says we have to go back to in-person dispensing, in which case you are going to have so many more people who need to get pills delivered to them by the various services, so we need to have a robust system, which is why we’ve given grants to community providers,” she said. “Plus, we want to see several strong online platforms because if there’s no shield protection, there’s going to be a growing number of people who will depend on online services from abroad.”
She expressed frustration and disbelief that the United States is now falling behind the rest of the world in abortion rights. “We’ve spent our whole careers working in these other countries on expanding abortion access. And then to see this happen in my own country. … Now it’s harder to get an abortion in half of America than it is in so many African countries that we’ve worked in, where they’re going in the other direction.”
She noted that abortion pills are available over the counter in India and are inexpensive.
“We want to make this service easy, the best experience that it can be, with dignity. You can just go online, and it’s easy, and there’s no judgment. If you need this, we are here for you. Here are your pills. Here’s the support service that you need. You can do this from home. Whatever the reason is, we want to have that service there for you to be able to do that, no matter where you live.”
Abortion Pills in Private urges supporters to donate to Plan C and Vitala Global Foundation, which powers Aya Contigo.
