Inside the Online Market for Abortion Pills

A few times each month, a 10” x 15” padded FedEx envelope arrives in Mark’s mailbox in eastern Florida. He doesn’t know when the packages will arrive, only that each shipment usually contains about a dozen individual mifepristone pills and several 10-packs of misoprostol, the two drugs used in a medication abortion.

He repackages the pills — one mifepristone and four misoprostol each — and then prints a one-page sheet of instructions before shipping the medication to U.S. customers who have placed orders from, a website based in Kazakhstan that sells abortion pills exclusively.

A selection of abortion pill kits available online from overseas sellers.

Mark is one link in a supply chain for abortion pills sold outside of the formal U.S. health care system — a market that has expanded significantly in the last year and that includes both overseas manufacturers and ad hoc distribution networks in the United States.

“I’m not the dealer, I’m just forwarding the mail for someone,” Mark told me in February. (Because distributing medication from overseas is illegal, many people interviewed for this article asked to be identified by first name or first initial only.) “I’m not for abortion but I’m not entirely against it,” he added. “On some level, it’s none of my business.”

Cody, wearing a shirt printed with sunflowers and looking out into the distance.

Cody, a 19-year-old student in Wooster, Ohio, had been waiting for months to order abortion pills online, but most of what was available was out of their price range. When they saw a seller offering pills for just $100 in early February, they immediately placed an order.

Maddie McGarvey for The New York Times

A hand of Cody, showing the blister pack of abortion pills they ordered online.

Maddie McGarvey for The New York Times

Websites selling pills offer a convenient — though legally dubious — route for people looking for a way around state-level abortion bans. These sellers stand only to gain from efforts to restrict medication abortion, experts told me, including a federal appeals court’s decision to reimpose restrictions on abortion pills nationwide that the Food and Drug Administration had eased in recent years.

That decision came after a federal judge in a lower court ruled to invalidate the agency’s approval of mifepristone entirely. On Friday, the U.S. Supreme Court temporarily stayed the ruling.

“Patients are either going to be forced to use a less effective regimen, or it could potentially push people into unregulated informal networks,” said Greer Donley, a law professor at the University of Pittsburgh who focuses on abortion. “Those are the two consequences. It’s not going to stop people from obtaining abortions.”

Tens of thousands of patients seeking to terminate a pregnancy have already gone online in search of pills in the nine months since the Supreme Court’s Dobbs decision overturning Roe v. Wade. Often, it is the only option for those unable to travel for clinic-based care.

For years, the advocacy group Aid Access has provided pills to U.S. patients at little or no cost. But people have increasingly turned to other groups and to for-profit sellers like Mark’s employer for faster delivery.

In the span of two weeks in February, one online seller distributed more than 300 abortion pill orders, primarily to people in Southeastern states where access is restricted.

A map showing where more than 300 abortion pill orders were delivered from one online seller in February.

Telehealth medication abortions restricted

Telehealth medication abortions restricted

Telehealth medication abortions restricted

In interviews over the past few months, sellers, shippers and patients described how the online market for abortion pills is operating — and how it has grown since the Dobbs decision.

Overseas suppliers appear on track to provide abortion pills to around 100,000 people in the United States in the year after the decision, or enough pills to cover about 10 percent of the country’s annual abortions.

If prosecutors wanted to crack down on pills by mail, it is unclear how they would do so. The federal government is responsible for both the postal service and customs enforcement — rooting out individual shipments of illicit abortion pills among the millions of packages a day processed at the country’s international mail facilities is unlikely to be a priority, experts said.

Even anti-abortion groups say that it will be difficult to control this market. “It’s very amorphous,” said Sue Liebel, the director of state affairs at Susan B. Anthony Pro-Life America. “States are looking at ways to determine how they can keep these sellers out of their state, just as they would brick-and-mortar clinics. But it’s harder to regulate if it’s online.”

An influx of orders

Twenty-five states and Washington, D.C., allowed abortion pills to be prescribed via telehealth and sent through the mail legally under F.D.A. guidelines issued during the pandemic and made permanent last year.

But patients seeking pills by mail in other states have had few choices but to look online to overseas providers for access to the drugs. Abortion pills are typically used for patients who are less than 12 weeks into pregnancy.

A table of the overseas providers of abortion pills, in which the cost of the pills ranges from $0 to $470 and the time of delivery from three days to three weeks.



Clinician support

Pills from

Aid Access

$105 or less

2-3 weeks


Las Libres


1-2 weeks

Mexico, India

Online sellers

$115 – $470

3-7 days

India, Vietnam, others

The most established and sought-after option for online pills is Aid Access, a service run by Dr. Rebecca Gomperts, a Dutch physician and activist. It has provided Americans with pills since 2018. The second is Las Libres, a Mexican activist group that works with U.S. volunteers who distribute pills free of charge.

For many patients, figuring out how to get pills begins with Plan C, an advocacy group that acts as a clearinghouse for online pill providers. Today, Plan C lists 23 for-profit sellers, largely based in India, with about two dozen more waiting to be verified and listed.

A chart of the estimated number of abortion pills provided outside the U.S. health care system from July through December 2022.

Estimated abortion pills provided by sources outside the

U.S. health care system, July-Dec. 2022

Each square represents 100 orders

Estimated abortion pills provided by sources outside the

U.S. health care system, July-Dec. 2022

Each square


100 orders

Sources: Las Libres; online pill sellers; Abigail Aiken at the University of Texas at Austin

Note: Aid Access figures reflect that 50 to 60 percent of requests typically result in shipments.

Even though Plan C has boosted the online sellers’ visibility and legitimacy, they remain a relatively small piece of the landscape.

Through February, Aid Access was receiving an average of 254 requests a day from people in the United States, up from 83 requests from before the Dobbs decision. Las Libres said it had received around 100 daily requests through the end of March, down from around 200 per day in December. (Not all requests will end in shipments.)

The online sellers I spoke with, by comparison, said they were each receiving anywhere from five to 45 orders per day.

Where the advocacy groups see injustice, the online sellers see a lucrative market. A medical termination of pregnancy kit, or “M.T.P. kit,” retails for as little as $5 in India but can be resold in the U.S. for more than 50 times as much.

D., shown from behind so that her face is obscured, looking out over a balcony.

“I was kind of concerned, because their website does look and feel kind of sketchy,” said D., 25, who went to an Ohio abortion clinic and was given a flier advertising

Maddie McGarvey for The New York Times

To better understand how the sellers operate, I placed orders with four sites listed on Plan C, identifying myself as a reporter for The New York Times. Through one, I connected with Mahiwal, who said he answers customer queries over WhatsApp from Punjab for more than 80 websites that sell pills.

Mahiwal asked if I would like to become a shipper myself — for $2,000 he would send me 10 abortion pill kits, which could be resold for $350 each. He would handle the customer orders, and I would mail the packages and keep the profit. “U can buy Tesla with us,” he messaged me, assuring me of the easy money.

A Cleveland, Miss., man who goes by Guru is one shipper who took Mahiwal up on his offer. Guru said he got connected with through a relative in India who knew he was looking for work.

He ships 10 to 12 packages each day, for a total commission of about $40. “I thought, ‘This seems easy,’ I can do it from home. All I need is a printer,” he said.

Dr. Gomperts, of Aid Access, sees little problem with merchants selling pills purely for profit. “I have the medical background, I have the scientific background, and it is a better service because of that,” she said. “But to be honest, as long as the medication they’re sending is real, who cares?”

Weighing the options

The U.S.-based shipper network has been crucial to growing the business of the overseas sellers, who win customers by offering quick or even overnight delivery of the pills.

For most patients, the cost of the service remains the most important factor in deciding where to get pills online.

A chart showing the minimum, average and maximum cost of abortion pills from overseas providers: Aid Access, Las Libres and for-profit online sellers.

But shipping speed has become a priority too.

A chart showing the minimum, average and maximum delivery speeds of abortion pills from overseas providers: Aid Access, Las Libres and for-profit online sellers.

Sources: Plan C; online pill sellers

“I did consider Aid Access, but I was afraid by the time I got it I would be too far along. I didn’t want to take any chances,” said J., a 31-year-old mother of three from Indiana.

J. ended up choosing a seller called “It said fairly fast shipping, and it was one of the cheaper options. So I took a shot with them,” she said. She paid $310 and got a USPS tracking number via email. The pills arrived in four days.

A major difference in ordering from online sellers, compared with telehealth or in-clinic abortions, is that there is no physician oversight. Instead, many patients turn to resources like the Miscarriage and Abortion Hotline or lengthy Reddit threads with advice on how to self-manage an abortion with pills: when to take them, what to do for pain, how long to expect bleeding, cramping and other possible side effects.

While opponents of abortion argue that self-managing with pills is dangerous — and self-managing with pills from an unregulated overseas supplier even more so — there have been no publicly reported instances of serious complications for patients who took pills bought online.

Overall, abortion pills are exceptionally safe and effective, though some experts raised concerns about the possibility of patients receiving ineffective or damaged pills from overseas, especially misoprostol, which is susceptible to degradation in heat or moisture. Even the F.D.A.-approved regimen has a 3 to 5 percent chance of resulting in an unsuccessful termination in the first trimester.

And while abortion-rights groups are concerned about efforts to further restrict the availability of legal pills, the outcome of the F.D.A. lawsuit could ultimately drive interest in extralegal options.

“With each outrageous act of a court or legislature, that provides us with another opportunity to tell people about this robust alternate supply network that exists in the U.S.,” said Elisa Wells, the co-founder of Plan C.

Sidestepping the regulators

Most online providers, including Aid Access and to a lesser extent Las Libres, source abortion pills from India, the world’s largest manufacturer of generic drugs.

India counts the most abortion pill manufacturers among the countries that make mifepristone or M.T.P. kits.

A chart showing the number of abortion pill manufacturers by country. India has the highest number of manufacturers by far.

Abortion pills technically require a prescription in India, but they can be purchased over the counter at local pharmacies and online marketplaces like IndiaMart and MedPlusMart.

“The system that governs how prescription drugs are dispensed is very leaky,” said Dinesh Thakur, a drug-safety advocate and former executive at the Indian drugmaker Ranbaxy Laboratories.

One supplier working for MedPlusMart, Ishan, told me he ships around 5,000 M.T.P. kits a month to the United States on behalf of, a seller listed on Plan C.

Indian pharmaceutical companies are producing the kits for the home market — there are an estimated 12 million medication abortions outside of health facilities each year in India — and they take little interest in how their products end up overseas.

Synokem Pharmaceuticals, a New Delhi-based manufacturer, said it was not “directly or indirectly” exporting its products to the United States. “We are not F.D.A.-approved, so no person can supply our products to the U.S. Not even an online pharmacy,” said Manmohan Juyal, the company’s senior manager for international business.

But at least two M.T.P. kits that Synokem manufactures — A-Kare and Killpreg — are sold by sites listed on Plan C. Ms. Wells estimated that Plan C has received about a quarter of the available global brands of M.T.P. kits through its own orders.

A close-up of a white mifepristone tablet still in its silver packaging.

Mifepristone pills manufactured by Ba Dinh Pharma in Vietnam are resold on

Tony Cenicola/The New York Times

In most circumstances, importing drugs into the United States for personal use is illegal — but the F.D.A. does make exceptions, including in situations when “the drug is for use for a serious condition for which effective treatment is not available in the United States.” The F.D.A. declined to comment on whether mifepristone would meet this requirement.

Patients in states where abortion is banned may get away with ordering pills online for personal use, though they could face other charges. A woman in Texas last year was charged with murder for self-managing an abortion before the district attorney eventually dropped the case.

There is less ambiguity for the distributors — they are acting illegally. In 2020, the Justice Department prosecuted and a judge sentenced a New York woman to two years of probation and fined her $10,000 for supplying abortion pills from India to U.S. customers.

But enforcement remains rare. Over the years, the occasional Aid Access package has been confiscated by customs agents, but the service has remained largely untouched. Experts say a federal crackdown on patients ordering abortion pills — even those arriving from overseas — is unlikely.

“In this climate, it’s almost certain the F.D.A. is not going to go after people who are doing this,” Ms. Donley, the abortion law expert, said.