Amid growing restrictions on clinic-based abortions, the online pill market functions as a haven of last resort for desperate women. “The women who come to us don’t have any other alternatives,” said Rebecca Gomperts, a Dutch physician and founder of Aid Access, which offers abortion pills online for about $90, with discounts for patients in financial straits. “They don’t have funds, or they are six hours away from the clinic, or they don’t have transport, they have small kids, they live in cars, there are situations of domestic violence — it’s just really bad situations.” In 2018, Gomperts prescribed the drug online to 2,581 patients.

But the pills aren’t just a way to evade today’s restrictions on abortion. Some activists argue that they can also remake tomorrow’s politics surrounding abortion — that the very presence of the underground market could force the authorities to loosen restrictions on abortion pills, eventually paving the way for an alternative vision for terminating a pregnancy in the United States: the inexpensive, safe, very early, private, at-home, picket-line-free, self-managed medical abortion.

“Did you feel a little rush when your pills arrived?” Elisa Wells, a director of the pill-advocacy group Plan C, asked me during a recent phone call. “It’s like, wow — it’s amazing that this really works.”