Battling the abortion pill black market

In July, a woman in her 20s came to Radiance Women’s Center outside of Austin, Texas, needing an ultrasound—but not because she wanted to meet her unborn baby. As center director Brittany Green explained, the woman wanted to find out how developed the baby was so she could know how many abortion pills to take. She already had one child and was pregnant again because of a one-night stand.

Green found out the woman had already ordered abortion pills from the website Aid Access. The European-based group began sending abortion pills to U.S. women in 2018, continuing even after the U.S. Food and Drug Administration under the Trump administration sent a cease and desist letter in 2019. Green said the woman showed her an email from Aid Access on her phone that outlined instructions on how to take the abortion pills at home.

For Green, this kind of visit is rare but not unheard of. Just last week, she said, a woman in her 30s who had already received pills from an online company also came in for an ultrasound.

Texas is one of 15 states that protects most babies from abortion throughout pregnancy. It’s also one of several states with laws that specifically prohibit people from sending abortive drugs through the mail. But in a July press release, Aid Access boldly claimed it had sent abortion pills to more than 3,500 people in pro-life states in less than a month—and it’s just one of many online abortion pill providers. As pregnancy centers encounter women who are still accessing abortion pills despite state protections for unborn babies, pro-life lobbyists and lawmakers are struggling to find ways to shut down this black market.

Green’s experience isn’t unique. Staff at a mobile ultrasound unit in East Texas and another pregnancy help organization based in Mississippi shared similar stories with WORLD. The national pregnancy center organization Heartbeat International also said in an email that its Abortion Pill Rescue Network has seen “a ten-fold increase in clients obtaining the abortion pill through a website or from a friend” in the past three years. Heartbeat listed Aid Access among the most common online providers they’ve heard about from clients but noted there are “70+ independent websites that sell the abortion pill to anyone with a credit card.”

Rebecca Weaver, the legislative director at Texas Right to Life, said her group advises pregnancy center staff who reach out with stories like this to inform their local district attorneys. She said they can do so without violating the confidentiality of the women who come to them.

“At least if they bring these things to their attention, those law enforcement individuals can see what they can do—like, what actions they can take—to try to stop this as much as possible,” Weaver said. Texas law exempts women who have abortions from punishment, meaning that any attempt to enforce the law would target the pill provider, not the woman who obtained or took the pills.

But after her encounters with her clients, Green said she didn’t do anything to notify authorities because she didn’t know of any systems in the state that allow residents to report abortion pills. And, based in the Austin area, she’s skeptical that authorities will do anything to punish pill providers. Travis County District Attorney José Garza is one of five Texas prosecutors who, along with dozens of elected prosecutors from other states, have signed an open letter refusing to enforce pro-life state laws.

In the July press release, Aid Access credited pro-abortion shield laws in some states for allowing U.S. abortionists to participate in prescribing and sending the pills. Some of these laws—passed in 2022 and 2023 in states including New York and Massachusetts—protect abortionists from facing prosecution for breaking another state’s prohibitions on remotely prescribing and mailing abortion pills. They prohibit officials in the pro-abortion states from participating in any arrests or investigations related to activity that breaks another state’s pro-life laws. Technically, such laws violate a constitutional provision that requires states to honor other states’ laws. But pro-abortion governors and lawmakers supported the bills anyway.

“This is a whole new frontier, honestly, that we as the pro-life movement are having to face,” Weaver said.

Mississippi State Sen. Angela Hill authored that state’s 2013 law prohibiting mailing abortion pills. She said that before abortion facilities shut down in Mississippi, it was effective in stopping abortionists in the state from performing telemedicine abortions. But the law was always hard to enforce on abortionists outside of the state because of how difficult it is for state law enforcement agencies to track what’s in the mail. She said the federal government would be in a better position to enforce these kinds of laws and go after international groups like Aid Access. But under the pro-abortion Biden administration, any progress in that arena is unlikely.

In the meantime, some state lawmakers and lobbyists are looking for creative solutions. One Texas bill introduced in March would have prohibited the creation and maintenance of websites that help people obtain abortion pills. It also included a clause directing internet service providers in the state to block access to existing abortion pill websites, specifically naming Aid Access and five additional online providers. But the bill didn’t even get a committee hearing.

Weaver said she thinks there “just wasn’t an appetite in the Texas legislature this session” to prioritize abortion legislation. “I think there is a little bit of the misunderstanding that, well, we’ve prohibited abortion in our state, so we’re done,” she said. “And we’re not. There’s still a lot to do.”

In Mississippi, Jameson Taylor, director of policy and legislative affairs for AFA Action, says he’s seen a similar lack of enthusiasm from lawmakers in his state. He senses that the pro-life movement as a whole doesn’t have solutions for the problem of abortion pills coming into pro-life states. “In fact, I’ve been sort of shocked by the lack of ideas,” he said.

Taylor also mentioned the possibility of targeting abortion pill platforms on the internet, as well as requiring pro-abortion states to pay for the medical complications resulting from unsupervised chemical abortions in pro-life states. Recent studies show that chemical abortions have a greater complication rate than surgical abortions.

Taylor said pro-life states could also “do what the left does, which is to sue everybody.” States could sue the federal government for not enforcing the Comstock Act, a federal law that prohibits mailing abortion drugs. They could sue the post office for aiding and abetting Comstock Act violations, the states that have violated the Constitution by disrespecting the laws of other states, and other countries that are shipping abortion pills into the United States.

State Sen. Hill said she’s motivated to work on legislative solutions but agreed that litigation might be the best way to bring attention to the issue and crack down on out-of-state providers.

“The question is, are we going to take our pro-life protections seriously and are we going to enforce our laws?” Taylor said. “It’s not a question of policy or legality. It comes down to what do we really believe? And what are we willing to sacrifice for?”