By Chuck Donovan

A new report from the Guttmacher Institute from its Monthly Abortion Provision Study estimates a total of 99,470 abortions for January 2026. The estimate follows a Guttmacher calculation of 1,126,470 abortions for all of 2025, or an average of 93,872 abortions per month for that year. The Guttmacher figures are indeed estimates, given the number of abortions taking place at home via the mail, with limited data regarding what proportion of pills mailed are actually consumed by the recipient, saved for later use, discarded, or even prevented by abortion pill reversal medication. However imprecise the data are, they are disturbing numbers that should trouble the conscience of a nation.

Abortion has, by its advocates’ own admission, been made extraordinarily easy to obtain. A vast marketplace exists on the internet. Actions by the Food and Drug Administration (FDA) have eliminated medical oversight and made the pills available later in pregnancy. The Trump FDA has approved a second generic version of the drug, declined to act on federal law criminalizing the shipment of abortion drugs across state lines, and fought with states seeking to enforce their laws against such shipments into their territory.

On May 14, the Supreme Court agreed with pill manufacturers that Louisiana was not entitled to a suspension of the FDA’s pill-by-mail policy while the case proceeds in the Fifth Circuit. Much of the media portrayed Louisiana’s stance as a national ban when in fact the state was asking to reinstate a basic requirement of in-person administration of the drug — a practice created under President Clinton when the drug was first approved and stood throughout the Obama administration.

The mantra is now that the abortion drug (chemical name “mifepristone”) is “safer than Tylenol.” Pro-life organizations and researchers question such an easy assertion, and did so a decade ago when they reviewed a study of abortion-pills-in-the-mail whose authors dismissed measurable concerns about dosage, damage to pills in transit and other issues. For its part, the FDA, including under the Trump administration, has made analysis more difficult by dropping the requirement for any non-lethal injuries to be reported to the agency.

Public policy on mifepristone is now at its liberal apex and is driving in the dark, with information from a variety of studies — but delay and difficulty in garnering more information. Moreover, as part of the staff retrenchment at the U.S. Centers for Disease Control (CDC), we are a half-year past the typical release date of the CDC’s abortion surveillance report, a flawed but still useful alternative to the pro-choice Guttmacher’s calculations. The last report from the CDC was published in November 2024 and covered state abortion data from calendar year 2022, when Dobbs v. Jackson Women’s Health was decided. The developments in abortion policy since then have been profound, with analysis of trends hampered not only by policy but by the nature of mifepristone administration in a demedicalized and, as we will see, often dissembling context.

An exhaustive new paper by Mia Steupert, a research associate at Charlotte Lozier Institute, takes a comprehensive look at something we can measure: the practices of the growing number of distributors of mifepristone in an unregulated national and international environment. Steupert strove to identify as many current purveyors of the pills as possible, focusing on a website called PlanC.org. The site plays off the popular name Plan B, the so-called “morning-after pill” which has been on the market under various legal regimens since 1999. Plan B is a synthetic hormone now available over the counter. It acts to inhibit ovulation, and its advocates downplay the key concern registered by the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) that it can also act as an abortifacient, blocking implantation of an already fertilized ovum, a new human life.

Plan C’s website is functionally an online directory for the United States for a drug designed to destroy an existing pregnancy and, in combination with the prostaglandin misoprostol, expel the developing child.

Steupert’s research involved an exhaustive examination of these sources and how they address problems attendant upon what masquerades as “telehealth,” a system where no confirmation of the identity of the actual patient is obtained, where an in-person medical exam is attenuated or foregone completely, where the stage of pregnancy is not ascertained and may exceed the FDA’s approved limit, and where access to follow-up care in the event of complications is difficult or non-existent. Plan C’s site does note the existence of legal risks where the providers of the pill are shipping the drugs into the states that currently bar or limit the administration of abortion pills. These latter instances are the focus of the litigation occurring in Louisiana and several other states that seek to protect women and the unborn.

The findings describe an array of questionable practices that violate the law and compromise basic medical practice. First, eight online organizations are violating state laws by shipping mifepristone in defiance of those states’ pro-life laws. Of the 79 sources identified in the study that are part of the formal U.S. health care system, only 15 observe the FDA’s policy limiting use of the abortion pill regimen to 10 weeks of gestation or earlier. Fully 81% — or 64 sellers — will mail the pills out of compliance with the FDA’s 70-day rule. Of the 18 foreign-based websites, none require women to supply an ID before they ship the drugs, making procurement by a disgruntled family member, boyfriend, or trafficker a relatively simple matter.

These are just a few of the serious problems the study identified. A new video released separately by AAPLOG offers dramatic evidence of the dire condition of the “health care” offered by mifepristone merchants. AAPLOG President Dr. Christina Francis, an obstetrician-gynecologist, accessed one of the most prominent international pill websites as a resident of Indiana, a state that has banned abortion, and ordered pills while offering the supplier an array of medical conditions that should have resulted in her being denied the pills and referred to a physician for examination before proceeding. No such recommendation came. As Dr. Francis commented, “This site allows women to assume the risk on themselves if they have life-threatening complications that can occur if they have an IUD, are on blood thinners, or have anemia. A minor can order them, as well as abusers, who can order these drugs and cover up their crimes.”

Keep in mind that the legal issue before the U.S. Supreme Court was the judgment of the Fifth Circuit Court of Appeals panel that the FDA decision to suspend physician involvement was unsupported. The appeals panel would have reinstated the FDA’s own requirement for medical involvement — on the belief, which the Steupert study definitively shows, that mail-order abortion introduces a level of irresponsibility and risk that policymakers before the Biden administration recognized and incorporated in the drug’s approval.

Add to that the fact that the FDA ended the mandatory tracking of injuries to women in the last year of the Obama administration (acting late in presidential terms is a hallmark of abortion pill policy) and it is more than arguable that the FDA’s removal of the in-person visit requirement, instituted as a temporary measure during the COVID era in 2021 and made permanent in 2023, was arbitrary and capricious.

The FDA has taken steps recently to reassure pro-life leaders that it is indeed reviewing the whole question of mifepristone safety and distribution. In light of the overall weaknesses in abortion reporting at both the CDC and the FDA, the challenges facing this review are considerable, albeit peer-reviewed studies are available that underscore the problems that existed even before the FDA ended mandatory medical screening and limits on use of the drug at lower gestational age.

There would appear to be nothing to prevent the FDA from acting now to restore mandatory data collection and sharing with the FDA wherever possible. The same holds true for the CDC whose silence only augments the sense that on the question of the leading form of abortion in the nation, we are driving blind.

Chuck Donovan served in the Reagan White House as a senior writer and as Deputy Director of Presidential Correspondence until early 1989. He was executive vice president of Family Research Council, a senior fellow at The Heritage Foundation, and founder/president of Charlotte Lozier Institute from 2011 to 2024. He is now co-president of the Science Alliance for Life and Technology (SALT). He has written and spoken extensively on issues in life and family policy.

This piece originally appeared here.