A report released by the Restoration of America Foundation (ROAF) claims that nearly 330,000 abortion pills have been shipped from out-of-state providers to states with abortion restrictions between July 2023 and December 2025. The report, citing data from the Society of Family Planning's #WeCount project, asserts that these shipments were enabled by "blue state shield laws," which protect providers in states with less restrictive abortion access from prosecution by states with bans.
According to ROAF CEO Doug Truax, monthly shipments of chemical abortion pills into these states nearly tripled during the period studied, increasing from approximately 5,400 pills in July 2023 to 14,870 in December 2025. This escalation, the report argues, has led to abortion numbers in some conservative states remaining at or above pre-Roe v. Wade levels.
Truax stated that the Biden administration eased safety standards for abortion medication, allowing pills to be prescribed via telehealth and mailed, while "pro-death" Democrats in blue states enacted shield laws. "The second thing was the pro-death blue states started implementing the shield laws, which is the focus of the paper that we've got out now, which are basically the laws that prevent people in red states from going after the people in the blue states that are sending the abortion pills into the red states," Truax said.
The report identifies 22 states and Washington, D.C. as having adopted some form of abortion shield law, with eight states specifically protecting providers who prescribe medication abortion through telehealth to patients in states with abortion restrictions. The ROAF contends that this situation undermines state-level abortion bans and creates a "constitutional disorder."
ROAF is urging the Trump administration to reverse the Biden-era FDA regulatory changes that permit mail-order abortion pills and to enforce existing federal laws concerning the mailing of abortion drugs. The report suggests that reversing these policies could significantly reduce the flow of abortion pills into states with restrictions. Truax warned that without such changes, Donald Trump, who has positioned himself as the most pro-life president, could be perceived as the "most pro-death president" due to the rising number of abortions facilitated by current policies.