U.S. Clinicians Can Now Mail Abortion Pills to States Banning Abortion, Thanks to Shield Laws in Five States

Telemedicine abortion provider shield laws have led to quicker shipping times for abortion pills for people living in restrictive states—from several weeks to several days.

Abortion rights activists rally outside the U.S. Supreme Court on April 14, 2023, after the Court temporarily preserved access to mifepristone, a widely used abortion pill, in an 11th-hour ruling preventing lower court restrictions on the drug from coming into force. (Probal Rashid / LightRocket via Getty Images)

In June, New York enacted a shield law to protect clinicians offering telemedicine abortion services to patients in states banning abortion. The law shields licensed clinicians from criminal and civil litigation, as well as loss of a medical license and malpractice insurance relating to any legally protected healthcare activity in the state, including prescribing and sending abortion pills to patients living anywhere in the United States. 

As soon as New York Gov. Kathy Hochul (D) signed the new law in mid-June, telemedicine abortion provider, Aid Access, began serving patients living in states banning abortion.

“It’s nice to be playing offense, not defense,” said a New York physician working with Aid Access, which was founded by Dr. Rebecca Gomperts and is based in Austria.

Massachusetts was the first state to pass a telemedicine provider shield law, later followed by Washington, Colorado, Vermont and most recently New York. Between mid-June and mid-July, seven Aid Access clinicians located across these five states mailed pills to 3,500 people located in states banning abortion.

“Seeing the number—3,500 patients—treated since the New York shield law took effect surprises even those who are experienced in doing this work. It shows what people want,” said Julie F. Kay, co-founder of the Abortion Coalition for Telemedicine Access, which works to expand the number of states with telemedicine abortion provider shield laws.

California is currently considering such a law.

“Having access to licensed medical providers and FDA-certified medications is so important,” said Kay. “If that’s not available, somebody is going to ship them pills, and if there aren’t instructions or if there isn’t access to follow-up care, we as a movement are not providing the best possible care to people in those particular situations.”

Rebecca Gomperts, second from right, leads supporters at a rally on May 31, 2018, in Londonderry, Northern Ireland. The group ROSA—Reproductive Rights Against Oppression, Sexism and Austerity—had earlier risked arrest after distributing abortion pills from a touring bus. (Charles McQuillan / Getty Images)

Aid Access formed in March 2018 in response to an increasing number of requests for help to Women on Web, an international organization that serves people in countries where abortion is banned. Aid Access served people in all 50 states, but since telemedicine abortion was not allowed in the United States at the time, clinicians had prescriptions filled through a pharmacy in India, which could take several weeks.

When the FDA finally allowed telemedicine abortion for the first time during the COVID-19 pandemic, Aid Access partnered with U.S.-based clinicians to serve patients in states allowing telemedicine abortion. But for patients living in restrictive states, Aid Access had to ship them abortion pills from outside of the country. Telemedicine abortion provider shield laws have led to significantly quicker shipping times for people living in restrictive states—from several weeks to several days—which is critical for this time-sensitive medical care.

To receive care, Aid Access patients fill out an online form, which is reviewed by a clinician to determine whether the patient is eligible to use abortion pills. Patients pay $150, with a sliding scale for people who can’t afford to pay the full amount. The abortion pills arrive in two to five days. During the abortion process, patients can call the Aid Access help desk and email with a clinician if they have questions or need help.

Aid Access serves women who are up to 13 weeks pregnant and applies the law of the state in which the providers are located. New York, for example, does not have a parental consent law, so clinicians there can serve people of any age.

In addition to supporting the passage of shield laws, Abortion Coalition for Telemedicine Access works to implement these laws.

“We help medical providers get up and running, such as getting medical malpractice insurance, setting up electronic medical records and explaining how to ship pills,” said Kay, who is an attorney. “Telemedicine shield laws are excellent, but there is still some legal risk for providers, so Abortion Coalition for Telemedicine Access advises them on how to minimize that risk.”

The new telemedicine provider shield laws stand on very firm constitutional and legal grounds, said Kay. “They don’t conflict with constitutional law or interstate law. They’ve been very well researched and carefully crafted by law professors and reproductive rights attorneys and legal counsel of the state governments. The amount of kicking the tires and looking under the hood that went on in New York alone has been significant, and certainly way more than a lot of other legislation that has been passed.”

Abortion Coalition for Telemedicine Access also works to decrease stigma. “The stigmatization is magnified because it’s abortion, because it’s medication abortion, because it’s telemedicine, and because it’s across state lines,” said Kay. “We’ve gotten a lot of resistance, even from providers and practitioners that support abortion politically but who are not fans of the model of telemedicine abortion.

“The medical profession tends to be conservative with a small ‘c,’ but these medications have been proven safe and effective for decades,” she continued. “So part of our work is educating providers and the general public.”

Kay said they also experience resistance from lawyers in the reproductive rights movement. “Lawyers are trained to be super-double-cautious. Globally, in places where abortion has been banned or severely restricted, you have to work within that context. One year after Dobbs, we’re still having a really hard time adjusting to that the United States. It’s a luxury that we may have as activists, but certainly people who are seeking abortion services in ban states don’t have. Our mission is to provide reproductive healthcare as a human right. If we’re not taking a risk, we are shifting the risk onto the people who are the most vulnerable.”

Abortion Coalition for Telemedicine Access was the key engine behind passage of the New York telemedicine provider shield law, along with the New York State Academy of Family Physicians.

“Aid Access is mission driven first and foremost. I see that in the risk that the abortion providers are taking. They are putting themselves and their families at risk because they feel that it is important to provide these services,” said Kay. “It is such an abomination to see what has happened in this country post-Dobbs and even pre-Dobbs. Abortion is a human right. It’s not subject to state boundaries.”

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Carrie N. Baker, J.D., Ph.D., is the Sylvia Dlugasch Bauman professor of American Studies and the chair of the Program for the Study of Women and Gender at Smith College. She is a contributing editor at Ms. magazine. You can contact Dr. Baker at cbaker@msmagazine.com or follow her on Twitter @CarrieNBaker.