Abortion providers in shield law states say they are undeterred by legal threats

The brewing interstate legal fights over telemedicine abortion have had a consequence that was perhaps unintended by the authorities in Louisiana and Texas who have taken legal action against a doctor in New York.

The attention is spotlighting how people in the U.S. can get pills for first-trimester abortions directly from doctors on the internet, even if they live in states with near-total abortion bans, and sometimes for as little as $5. These services have proliferated with the emergence of shield laws that provide some legal protections to patients and providers.

A few of the small but growing number of doctors currently mailing abortion-inducing medications to patients in ban states told States Newsroom their patient volume has in recent months continued to climb, with more people preparing for a possible unplanned or unviable pregnancy.

“Ironically, with more media attention being paid to the Texas and the Louisiana lawsuits, it actually gets the word out to more people in Texas and Louisiana that there are providers out there who will provide you abortion care through the mail,” said Dr. Angel Foster, who in 2023 co-founded the Massachusetts Medication Abortion Access Project (MAP). “I think we’re going to continue to see an increase in demand.”

Rising availability of mail-order abortion pills

The telemedicine abortion industry has steadily grown since the U.S. Supreme Court overturned federal abortion rights with the Dobbs v. Jackson Women’s Health Organization decision in June 2022. One year later, more than a dozen states had banned all or most pregnancy terminations. Yet, total abortions nationally were the highest in a decade, with medication abortion representing more than 63% of all clinician-provided terminations, according to the Guttmacher Institute.

Self-managed abortions are also on the rise, facilitated by community networks and online vendors selling abortion pills directly to people and the expansion of shield laws. Massachusetts passed the first in July 2022, which gives legal safeguards to providers and protects patients’ medical information. Similar laws have passed in California, Colorado, Maine, New York, Rhode Island, Vermont and Washington.

Shield law providers told States Newsroom their patient volume has increased since Donald Trump was elected president, with many people worried abortion access will become even more scarce.

MAP is a project of the nonprofit Cambridge Reproductive Health Consultants, which Foster co-founded in 2014 and is one of a handful of providers that send pills to all 50 states and territories. It is modeled after the Massachusetts law protecting clinicians, helpers and funders that provide legally-protected reproductive or gender-affirming health care.

These providers typically offer asynchronous abortion care, a telehealth service that allows patients to communicate through secure messaging rather than in real time. The providers States Newsroom spoke with said they offer direct phone and text lines to communicate with patients who have questions or concerns before or after taking the medication.

MAP has four prescribing physicians and adding a fifth. Foster, who is not one of them, said the practice served more than 10,000 patients in 2024 and is on pace to serve about 30,000 in 2025, seeing between 2,500 and 3,000 patients a month. More than half of their patients are from Texas, Georgia and Florida, she said.

Foster credits the increase in patient volume to increased restrictions and uncertainty around abortion but also to their lower prices, which is possible due to increased grants. Patients are asked to pay $75 to cover the cost of the package and can pay $150 to get the medication expressed, but they are also invited to pay $5, or nothing. About one-third of their patients pay $5 or less, she said, while payments overall average $55.

“We probably waive a payment every day,” Foster said. “A patient that I made the payment for either today or yesterday explained that she was homeless. She was living in a shelter and was unemployed and didn’t have $5, and of course, we waived the payment.”

Based in California and founded last summer, A Safe Choice Network provides telemedicine abortion services to all 50 states and territories. Unlike other abortion-pill vendors that offer a sliding scale rate, A Safe Choice has a $150 flat rate but also offers free telehealth consultations for everybody.

Aid Access, founded in 2018 by Dutch physician Dr. Rebecca Gomperts, is one of the longest-running telehealth providers and sends abortion pills to all 50 states for $150, with a sliding scale for people with lower incomes. Gomperts told States Newsroom that their patient volume has increased significantly since the election but the organization has been able to keep up with the demand, replying to women within hours and shipping within a day. She said Aid Access is prepared to continue providing the service despite ongoing legal uncertainties.

“It doesn’t make sense to worry; we just have to do what’s right,” Gomperts said. “That means that we continue providing abortion care to the people that need it.”

Restrictive states test strength of shield laws

Texas and Louisiana are the first states to test the strength of shield laws — starting with New York’s — arguing that abortion-access shield laws conflict with their state abortion restrictions.

Texas Attorney General Ken Paxton brought civil charges last year against Dr. Margaret Carpenter of New York, after learning that the Abortion Coalition for Telemedicine co-founder had prescribed medication to a Texas woman. This month a county judge ordered Carpenter to stop prescribing abortion pills for Texans and to pay $100,000 plus about $13,000 in legal fees.

Louisiana brought criminal charges against Carpenter and a Louisiana mother, who were indicted by a grand jury in January, and last week, Republican Gov. Jeff Landry signed Attorney General Liz Murrill’s request to extradite the doctor to Louisiana to face prosecution.

Murrill has claimed that the mother who purchased the pills from Carpenter gave her minor daughter the abortion against her will. However, the complaint cites a 2022 law that makes it illegal to mail, receive, or administer abortion drugs in Louisiana and does not cite the state’s controlled substances law, which addresses coercion when “means of fraud” are involved. Louisiana adopted a new law last year treating abortion-inducing mifepristone and misoprostol as controlled substances, even though they have a high safety record and are used to treat a wide range of conditions, including miscarriages, some cancers, and depression. Texas is considering a similar law.

Democratic New York Gov. Kathy Hochul refused the extradition request, and has signed a law allowing doctors to leave their names off prescriptions for abortion pills.

Both Texas and Louisiana cases are each expected to lead to court battles that could eventually reach the U.S. Supreme Court.

Preparing for more pill crackdowns with advanced provision

Providers told States Newsroom they feel confident in their state shield laws but acknowledge that it’s an ever-shifting landscape.

“We are continuing to provide care apace,” Foster said. “We are a legally compliant practice and part of the formal health care system in Massachusetts, and we continue to trust that the shield laws will protect us from any lawsuits that come from other states.”

And there remain other possible state and federal regulatory actions and legal cases that could hinder the flow of medication abortion, among them an ongoing federal lawsuit over the U.S. Food and Drug Administration’s approval of medication abortion, brought by the attorneys general of Idaho, Kansas and Missouri.

The Trump administration, which has signaled its support for the anti-abortion movement, has been mostly quiet about its planned policy on medication abortion. But recently Attorney General Pam Bondi said she would “love to work with” Louisiana prosecutors to stop shield-law-supported health care. And during his confirmation hearing, Health and Human Services Secretary Robert F. Kennedy Jr. said Trump had asked him to study the safety of mifepristone, something which has been rigorously studied for decades and found to be safer than some over-the-counter medications. Researchers from the University of California San Francisco published data last year showing low rates of complications for telemedicine abortion.

As the legal situation around abortion and miscarriage care evolves at the state and federal level, providers are suggesting people of reproductive age stock up on abortion pills through a practice known as advance provision, which has growing national support, according to a recent study published in the Journal of the American Medical Association. Several states led by Democratic governors, including California, Massachusetts, New York, Oregon and Washington, have started stockpiling abortion drugs. Providers told States Newsroom that mifepristone has a shelf life between three and five years and misoprostol between one and two years, depending on how the medications are stored.

“In the wake of the election on November 6, we started to see peak demand of advance provision,” Foster said, noting that the number of MAP’s patients requesting pills for future use grew from less than 1% to 5% since last October.