Abortions to move underground in half the US: Here's how it might work

Before the Supreme Court released its ruling Friday upending abortion rights in the U.S., Elisa Wells was thinking of virtual mailboxes.

For people who move or travel a lot, a virtual mailbox is a way to check their mail online. If an item is critical, they forward it to their current location.

For Wells, founder of the online abortion site Plan C, which tells women how to find the abortion pill, it’s a potential workaround to state laws restricting access.

Using dried garbanzo beans and old pill bottles, Wells tested whether a virtual mailbox set up in a state like California or New York -- which allow abortion pills to be prescribed through a telehealth appointment -- could make its way to a woman in a state like Texas or Oklahoma that restrict access.

The answer was yes.

“We want all the information we provide on our website to be as helpful as possible,” Wells told ABC’s "20/20."

“We know that people looking for abortion care, especially in restricted states are in a really stressful situation. And we don't want them to have to guess about what to do and which services to use,” she added.

As 26 states are expected to eventually ban or severely restrict abortion in the wake of Dobbs v. Jackson, a grassroots resistance movement is on the rise that looks notably different than it did in the 1960s.

Unlike before the 1973 Roe v. Wade ruling on abortion, about half of the U.S. will already offer abortion access, and several online-based state funds are providing patients with flights, child care, gas cards and access to food delivery services like Grubhub and DoorDash if they need to travel far. The National Abortion Federation is expanding a nationwide hotline -- established in 1978 -- to connect abortion seekers to those funds.

“It is just really important that people understand that there is an infrastructure in place right now to help people move across the country and to help provide support," said Melissa Fowler, chief program officer at NAF.

It's possible anti-abortion rights states will try to brand such efforts as illegal, paving the way for more court challenges.

The other major difference is federal approval 22 years ago of the drug mifepristone. Used in combination with another drug, misoprostol – commonly prescribed for stomach ulcers -- the Food and Drug Administration says the pills can be used to induce an abortion so long as a woman is within 10 weeks of pregnancy.

The FDA also says those drugs can be prescribed through a telehealth appointment and mailed to the person’s home, although anti-abortion states have restricted access. A group called Just the Pill and Abortion Delivered said Friday that it's now launching new mobile clinics in Colorado -- one that will offer surgical abortion for patients over 11 weeks, and another equipped entirely for telehealth appointments for medication abortion.

Another group, called Unite for Reproductive and Gender Equality, is training local activists on how to "self-manage" an abortion, including when and how to take mifepristone and misoprostol. Several anti-abortion rights lawmakers and activists say this could potentially violate state laws that prohibit "aiding and abetting" abortion.

Kimberly Inez McGuire, head of URGE, said she believes their work will be protected as free speech.

"Before Roe (v Wade), we did not have safe and effective abortion pills like we do now. We didn't have the internet. And so it really is a different circumstance," she said.

This grassroots movement also is looking overseas. Among the options the website Plan C points people towards is Aid Access, an international organization that prescribes the abortion pill to women in the U.S. even if their state law prohibits it.

Dr. Rebecca Gomperts, founder of the organization, told ABC that she will personally conduct a telehealth appointment online with American patients and prescribe the pills to them for 95 euros; the pills are then filled from a pharmacy in India and mailed to the US address. Gomperts said she believes state laws only apply to residents of that state, whereas she works out of Amsterdam and Austria.

The FDA though warns getting medications overseas from sites not regulated by the US could be dangerous. Under federal rules, the abortion pill can only be prescribed by certified clinicians and provided from FDA-inspected manufacturers.

Another drawback: The medication can take as long as three weeks to arrive – posing a risk that patients may take the medication too late in their pregnancy.

Gomperts said she is confident in the quality of the product and will continue to offer the service. She predicted other doctors in the U.S. and around the world will follow suit as states ban abortion.

“What will happen (in the U.S.) is what happens everywhere in the world and that is that there will be huge underground markets,” she told ABC’s “Nightline.”

ABC News’ Erin Murtha contributed to this report.