As U.S. abortion laws tighten, more Americans are looking overseas for access. Here's what's happening.

Amsterdam — As oral arguments resume Wednesday in a landmark federal court case over the Food and Drug Administration's decades-old approval of the abortion pill mifepristone, some Americans are circumventing their state and local laws and looking overseas to Europe to get medications to terminate early pregnancies.

"People with unwanted pregnancies, they can follow an online questionnaire, and this is reviewed by doctors and their assistants, and then the medicines are sent to their home address and they can do the abortion at home," Dr. Rebecca Gomperts, who is based between the Netherlands and Austria, told CBS News.

Gomperts founded the organization Aid Access in 2018, headquartered in Europe, to provide reasonably priced telehealth abortion pill services to people living in the U.S.

"Abortion is controversial in the United States because it's politicized, and it's not being treated with the scientific evidence and the human rights arguments that it should be," Gomperts said. "In other countries, it's not controversial, and abortion is recognized as a human right."

Gomperts has worked for nearly 20 years to provide access to abortions for women in countries where it is restricted or banned, through the organizations Women on Waves and the Women on Web. She created Aid Access in 2018 specifically to service Americans, despite abortion rights in the U.S. still being protected under the now-overturned Roe v. Wade Supreme Court ruling at the time.

"We started looking into the countries where abortion is legal and should be available there, where we started getting a lot of help requests," she said. "One of these countries was the United States." 

Gomperts said more and more people in the U.S. were reaching out asking for help getting abortion pills, despite having the right to an abortion at home, because they "couldn't afford the local abortion care that was available or distance that they had to travel."

She says demand has skyrocketed since Roe v. Wade was overturned in June 2022.

"We have seen an enormous increase in requests, and especially, of course, from the states where there's restrictions, but also from the other states," Gomperts told CBS News. "I think at this moment we are seeing between 1,000 and 1,500 requests per day."

What is medication abortion?

Medication abortion, or abortion done with pills, is now the most common type of abortion in the United States. The FDA-approved regimen uses two drugs, mifepristone and misoprostol, taken about 24 hours apart.

The FDA says the regimen is safe, and notes medication abortion with mifepristone is approved in more than 80 other countries.

Medication abortion is even more common elsewhere than it is in the United States: 87% of all abortions in the U.K. in 2021, for example, were done with mifepristone and misoprostol, official data show. In the U.S., 53% percent of abortions in 2020 were medication abortions, according to the The Guttmacher Institute, a reproductive health rights research and policy organization.

How does Aid Access work?

Someone who wants an abortion in the United States can go to Aid Access' website and fill out an online form, which assesses where they are in their pregnancy and other relevant details.

Depending on what state they're in and what the local laws are, their case may be reviewed by a clinician in the U.S. working for Aid Access, or by Gomperts herself in Europe.

If the person is a candidate for a medication abortion and in a state with abortion restrictions that limit the ability of American clinicians to help, Gomperts will write a prescription for mifepristone and misoprostol, which will be mailed directly to the pregnant person from a pharmacy in India.

When the drugs are mailed internationally, they can take a couple of weeks to arrive. For people who can be helped by clinicians within the U.S., the pills can be sent more quickly.

Is it legal to get abortion pills from overseas?

In states with abortion restrictions or bans, "the actors that are certainly doing conduct that the state would consider to be illegal are the international pharmacies and international providers that are helping people in their states access these drugs," Greer Donley, a law professor at the University of Pittsburgh who specializes in abortion law, told CBS News. "The problem is that those states don't have the jurisdiction to enforce their statutes against people who live outside of the country."

Donley says Aid Access appears to be operating within the laws of the jurisdiction where the organization is based.

"I don't think there's anything under the laws in which Aid Access is operating where their conduct is illegal. It might be illegal under certain state law here in the U.S.," Donley said. "I think Aid Access would feel very confident saying that they are following the laws of their home country and their home territories."

Donley says the legal situation is unclear for Americans who order pills from overseas, but they may fall under an exemption the FDA provides for the importation of medications for personal use, and most states have exemptions that exclude pregnant people from criminal punishment for violating abortion laws.

But Donley warned that "even though people who are buying these pills should be exempt, there are risks. ... You've seen states that have tried to use creative statutes to kind of get around those exceptions."

In 2019 the FDA sent Aid Access a warning letter, instructing it to cease its operations. Gomperts sued in response, and the regulatory agency took no further enforcement action.

The FDA declined an interview and did not respond to CBS News' request for comment on this story.

"Acting in accordance with my medical professional oath"

Elisa Wells founded Plan C, a website that lists various ways Americans can get abortions in different states. 

"Aid Access appears to be the main provider in restricted states," Wells told CBS News, adding that other international providers of abortion pills are also gaining traction. "I think it's fantastic that Dr. Gomperts has stepped up to address a human rights issue in the United States that's created by our laws and policies and by anti-choice extremists. … If we can't do it ourselves, we are fortunate to have somebody who can help people access this service and have safe abortion in their homes."

As far as Gomperts is concerned, she's just doing her job.

"I'm acting in accordance with my medical professional oath, that I am supposed to make sure that people that need medical care, that they will get it. That's what I do. And that is my laws, and my conscience, that I obey." 

In:
• Abortion Pill
• Abortion

Haley Ott

Haley Ott is an international reporter for CBS News based in London.

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