After Roe v. Wade, Abortion Still Accessible in All 50 States

Think abortion is inaccessible in your state? Think again.

Aid Access, a nonprofit organization founded in 2018 and run by Dutch physician Rebecca Gomperts, prescribes the abortion pill (technically two medications: mifepristone and misoprostol) to women in all 50 states—including those where abortion is heavily restricted.

The organization receives more than 4,000 requests for abortion pills daily. Orders from pro-life states have increased significantly since Roe v. Wade was overturned. Requests from Texas have tripled since Roe fell and Texas’s pro-life laws went into effect (under which abortion is illegal unless the life of the mother is at stake).

State Abortion Laws

In less restrictive states and the District of Columbia, a U.S. medical provider fills the abortion pill prescriptions. In more restrictive states, such as Texas and Louisiana, Gomperts and other foreign physicians prescribe abortion pills using their non-U.S. medical licenses. Prescriptions are then filled in India and mailed to the United States.

In 19 states, it is a crime to prescribe abortion pills remotely, and in Oklahoma, South Carolina, and Nevada, it is illegal to self-manage an abortion. It is also illegal to bring prescription drugs into the United States from another country for personal use. Despite this, Aid Access sends abortion pills to women in these states.

In other words, Aid Access is flagrantly breaking state laws.

Even when Aid Access has been targeted for its lawbreaking, it has largely escaped unscathed. The organization is shielded from restrictions or prosecution because it is based in Austria. Case in point, in 2019 the Food and Drug Administration (FDA) sent Aid Access a cease-and-desist letter because the organization was distributing unapproved drugs to consumers in the United States. Gomperts denied any legal wrongdoing, sued the FDA for seizing packages containing abortion pills, and maintained that the FDA had no legal jurisdiction over her or Aid Access. The FDA then declined to take any further action.

Because Aid Access is based in a foreign country, it also avoids the financial disclosures that the United States requires of its nonprofit organizations. This allows its financial structure to remain private and donors to remain anonymous.

Despite operating outside the law, Aid Access and Gomperts are promoted by U.S.-based organizations such as Shout your Abortion, Abortion on Our Own Terms and Planned Parenthood, who refer to Gomperts as a “heroic abortion rights advocate.”

No Jurisdiction

State governments can do little to stop Aid Access and organizations like it. They have little influence outside of their states, and countries such as Austria, where Gomperts holds her medical license, will not cooperate with state prosecutors. Harry Nelson, a health care law attorney, stated that because mail delivery is a federal responsibility, there is “no practical way to prevent the ongoing flow of these medications into abortion-hostile states.”

Allowing foreign nonprofit organizations to operate outside of state and federal laws and regulations within the U.S. sets a dangerous precedent. Allowing foreign organizations to pick and choose which laws to follow further undermines the rule of law.