Abortions increased post Roe. A clash over mail-order pills helps explain why

Lauren Pearle

Tue, January 20, 2026 at 11:00 AM UTC

5 min read

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After the Supreme Court's 2022 decision in Dobbs v. Jackson Women's Health Organization ended the constitutional right to abortion, national abortion numbers were expected to plunge. Instead, they rose.

At the center of this counterintuitive trend are abortion pills and telemedicine. Opponents of abortion have targeted both on multiple fronts. In a new escalation, states with abortion bans are reaching across state lines to investigate, sue and even prosecute out-of-state providers.

That escalation came into sharper focus this month when California Gov. Gavin Newsom blocked an effort by Louisiana Gov. Jeff Landry to extradite a California-based doctor accused of mailing abortion pills into Louisiana, where abortion is mostly banned.

The standoff illustrates why the end of Roe did not reshape abortion access as dramatically as some expected - and how the ongoing legal battles could raise the stakes yet again.

How abortion pills and telehealth reshaped the post-Dobbs landscape

Nationwide, monthly abortion numbers have increased by roughly 10 to 20% since Roe was overturned, according to the Society of Family Planning, a nonprofit association of health care professionals.

Researchers attribute part of that increase to the expanded use of the abortion pills mifepristone and misoprostol, which have been approved by the U.S. Food and Drug Administration. This method now accounts for roughly 63% of all abortions, up from 53% in 2020, according to the Guttmacher Institute, a national research and policy organization.

Telemedicine has also expanded since Dobbs. Patients in states with near-total abortion bans can meet with out-of-state providers online and obtain abortion pills in the mail - no office visit required. That is how almost all patients in these states access the medications, according to the Society of Family Planning.

By contrast, in New York and California, where abortion remains legal, roughly 10% of patients use telehealth exclusively for abortion services; the rest see a medical professional in person, their data shows.

Abortion-rights advocates argue that abortion pills and telehealth have been helpful in expanding access. Opponents say they often provide an illegal workaround to evade state laws.

Why did California refuse to extradite a doctor indicted in Louisiana?

Earlier this month, Louisiana Attorney General Liz Murrill announced the indictment of California physician Rémy Coeytaux on a felony charge of "criminal abortion by means of abortion-inducing drugs."

Prosecutors allege Coeytaux prescribed mifepristone and misoprostol to a pregnant woman in St. Tammany Parish, Louisiana, where abortion is mostly banned and these drugs are tightly regulated. According to court filings, the woman contacted an Austria-based telehealth group, Aid Access, completed a form and paid $150 over Venmo. She allegedly received the pills by mail without ever consulting with a medical practitioner, even online.

"This is not health care; it's drug dealing," Murrill said in a statement.

Murrill told a Senate committee last week that abortions in Louisiana have increased since Dobbs despite the state's ban, an outcome she attributed to mail-order abortion pills flooding in from other states.

Neither Coeytaux nor Aid Access responded to a request for comment from Straight Arrow News.

This case is now at an impasse after Newsom rejected Landry's extradition request, arguing that Coeytaux did not commit a crime under California law. He invoked California's abortion shield law, which protects abortion providers from out-of-state investigations and prosecutions.

Twenty-two states and Washington, D.C., now have shield laws, though the protections vary.

Newsom's defiance echoes a similar stance by New York Gov. Kathy Hochul last year. In February 2025, Hochul invoked New York's shield law and said she would not approve Louisiana's extradition request for a doctor in her state - "not now, not ever."

To date, that doctor has not faced prosecution.

Is it legal to mail abortion pills into states with bans?

Under current FDA rules, mifepristone can be prescribed via telehealth and dispensed by mail in states whose laws allow it. However, the Trump administration has indicated it might revisit and tighten these regulations.

It remains contested whether telehealth providers can legally send abortion pills into states with abortion bans, narrow telemedicine laws or tighter controls on these medications.

"Louisiana absolutely has the right to indict Dr. Coeytaux and try to prove he violated Louisiana law, but they have an enforcement problem," said David S. Cohen, a law professor at Drexel University and co-author of "After Dobbs: How the Supreme Court Ended Roe But Not Abortion."

Newsom can refuse to turn over the indicted doctor because of a quirk in extradition law, Cohen told SAN. If the defendant was not physically present in Louisiana while allegedly committing the crime, extradition is discretionary - not mandatory.

Erica Bayles Inzina, policy director of Louisiana Right to Life, called the law "dated" and ripe for Supreme Court review.

"This precedent predates the internet and the plethora of crimes that can, and are, committed virtually," Inzina told SAN.

What comes next?

Anti-abortion activists are pursuing multiple strategies at once: Pressing for tighter FDA rules, lobbying for state and federal legislation, suing providers, challenging shield laws and now, attempting to criminally prosecute out-of-state doctors.

Legal experts said the Coeytaux case is unlikely to see a quick resolution. "Ultimately, I expect it will remain at an impasse until it makes its way to the Supreme Court," Inzina said.

Cohen agreed, but said it is far from certain the court will agree to hear it.

Regardless of the outcome, Cohen said the case underscores a central reality.

"The fact that abortion providers are mailing pills from shield states to states where abortion is banned is a hugely important part of the post-Dobbs landscape," he said. "It's a major reason why abortion numbers have increased instead of decreased."

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Abortions increased post Roe. A clash over mail-order pills helps explain why