Three of every four abortions in Hawaii are now done with pills instead of surgery.
Planned Parenthood calls it personal choice and mails those pills to islands without a single abortion facility.
But the abortion chain left out one number every woman swallowing those pills deserves to hear.
Hawaii Abortion Data Shows Abortion Pill Use Tripled in a Decade
The Honolulu Civil Beat dug into Hawaii Department of Health records in September 2026.
In the most recent year of data, the state recorded 2,012 abortions, and more than three out of four were chemical.
Pills overtook surgery in 2021, at 56 percent, and have led every year since.
Pill use has tripled over the past decade, while surgical abortions fell to their lowest point in more than ten years.
Hawaii allows abortion for virtually any reason through about 24 weeks, yet only three facilities in the state perform surgical abortions – all on Oahu and Maui, two of them run by Planned Parenthood.
So for a young woman on Kauai, Molokai, Lanai, or the Big Island, the abortion comes in the mail.
Then there's the calendar.
The FDA approved mifepristone for pregnancies up to 10 weeks.
Hawaii providers, Planned Parenthood included, hand it out up to 12 weeks.
Dr. Colleen McNicholas, a top officer at the Planned Parenthood affiliate covering Hawaii, Alaska, Indiana, Kentucky, and the Northwest, told the Civil Beat the trend proves the need for telehealth abortion.
"The decision to end a pregnancy is really personal, and that extends into how they choose to end that pregnancy," she said.
Not one word about what happens to women after they swallow the pills.
Mifepristone Side Effects Hit One in Ten Women in Largest Abortion Pill Study
In April 2025, the Ethics and Public Policy Center released the largest real-world study of the abortion pill ever done.
Jamie Bryan Hall and Ryan T. Anderson examined insurance claims for 865,727 mifepristone abortions from 2017 to 2023.
They found 10.93 percent of women suffered sepsis, infection, hemorrhaging, or another serious or life-threatening event.
The FDA label puts serious adverse reactions under half a percent – roughly 22 times lower.
Apply the EPPC rate to Hawaii's roughly 1,500 pill abortions, and you get about 165 women a year facing a serious complication.
For women on the neighbor islands, the facility that sold them the pills is an airplane ride away.
Joe Biden's FDA built this system.
In 2021, it let the pills go out by mail, and in 2023 it permanently scrapped the rule requiring women to pick them up in person.
Louisiana v. FDA Puts Mail-Order Abortion Pills on Trial
Rosalie Markezich knows exactly where that leads.
In October 2023, she told her boyfriend she was pregnant, and she wanted to keep the baby.
He didn't.
He used her email and address to order abortion pills online from a California doctor who never talked to her at all.
The pills came in the mail.
He pressured her until she took them in a hospital parking lot, telling her his life would be ruined if she kept the baby.
She bled for about a week, lying in the bathroom "bleeding and crying for the loss of my child."
In October 2025, Rosalie joined Louisiana Attorney General Liz Murrill in suing the FDA to restore in-person dispensing.
On May 1, 2026, the Fifth Circuit sided with them and put a nationwide hold on the mail-order rule.
On May 14, the Supreme Court set that order aside, and the pills kept shipping while the case goes on.
Murrill's office was back before the Fifth Circuit in September, arguing an in-person requirement would help curb mail-order abortions and protect women.
FDA Mifepristone Safety Review Still Has No Results
Health and Human Services Secretary Robert F. Kennedy Jr. told Republican attorneys general in September 2025 that the FDA was reviewing the drug's safety.
By February 2026, Sen. Josh Hawley said the agency was "nowhere on it."
FDA Commissioner Marty Makary resigned in May 2026 under fire from pro-life leaders and congressional Republicans over the delays.
In June, the FDA confirmed it was moving ahead with a safety study, but as of September, it still hasn't announced any results or a completion date.
In August, a Senate Health Committee report found the three companies that make mifepristone had never decertified a single prescriber.
Hawaii Shows Where Mail-Order Abortion Pills Are Taking America
Hawaii isn't an outlier.
It's a preview.
When abortion facilities thin out, the abortion industry doesn't close shop – it opens a mailroom.
The baby dies either way.
The difference is that the mother now goes through it alone at home, with a Planned Parenthood executive assuring her it's all "really personal."
Some people in Hawaii are offering women something better.
A Place for Women in Waipio, a life-affirming pregnancy center on Oahu, gives free ultrasounds, diapers, and baby supplies, and even offers abortion pill reversal for women who change their minds after the first pill.
That's real choice.
Every week the FDA sits on its review, more packages land in island mailboxes, and more women like Rosalie pay the price.
Sources:
- Cassy Cooke, "Use of the abortion pill has tripled in Hawaii," Live Action, September 2026.
- Hikari Mae Hida, "Abortion Pill Use Has Tripled in Hawaiʻi Over Past Decade," Honolulu Civil Beat, September 16, 2026.
- Jamie Bryan Hall and Ryan T. Anderson, "Largest-Ever Study of Abortion Pill Reveals Shocking Number of Adverse Events," Ethics and Public Policy Center, April 28, 2025.
- Alliance Defending Freedom, "Rosalie Markezich's Story," ADF, November 5, 2025.
- Nolan Mckendry, "Louisiana presses abortion-pill challenge before Fifth Circuit," The Hayride, September 10, 2026.
- Rachel del Guidice, "Hawley demands congressional oversight of abortion pill after FDA fails to complete promised safety study," Fox News, February 12, 2026.
- Michael Kaplan, "FDA moves ahead with safety study of abortion pill mifepristone," CBS News, June 5, 2026.
- Dorothy Brooks, "The Federal Mifepristone Safety Review Is Still Unfinished While Senators Press Its Three Approved Manufacturers on Oversight," Medical Daily, September 9, 2026.
