Trends in medication abortion service delivery in the U.S., 2020-2025

Objective: Since 2020, medication abortion provision in the U.S. has been reshaped by changing abortion policies and expanded telehealth access, yet little is known about how medication abortion service delivery has evolved. We examined national trends in service delivery from 2020 to 2025, including changes in abortion facility types, telehealth provision, and gestational limits. Study Design: Using ANSIRHs Abortion Facility Database, a national census of publicly advertising abortion facilities (2020 to 2025), we analyzed trends in medication abortion service delivery. Systematic web searches and mystery shopper calls gathered data on facility types, telehealth provision, and gestational limits. Data analysis included frequencies and comparisons across regions and states. Results: Medication abortion-only facilities increased nationally, from 35% of facilities in 2020 to 65% in 2025, with substantial growth in abortion-restrictive regions such as the Midwest and South. By 2025, 99% of facilities provided medication abortion. Telehealth provision expanded from 7 facilities in 2020 to 606 facilities by 2025, driven by growth in both brick-and-mortar facilities offering telehealth care and new virtual clinics. Overall, 46% of all facilities offered medication abortion by telehealth in 2025. Gestational limits for medication abortion increased nationally, from <1% of facilities offering medication abortion after 11 weeks in 2020 to 38% in 2025. Conclusions: Medication abortion service delivery has adapted to legal and logistical challenges by increasing telehealth options and expanding gestational limits. These changes improve access for abortion seekers, especially those living in restrictive environments. Sustaining abortion access will require ongoing provider adaptation and supportive policy environments.