Under new shield laws, providers can send abortion medication to patients in all 50 states

Thanks to shield laws passed recently in a number of states, Aid Access, a group that offers telemedicine medication abortion services, announced in July that its team of seven abortion providers, consisting of midwives and nurse practitioners, can now safely send abortion medication to patients in all 50 states.

So far, about 3,500 patients across the United States have received abortion medication from Aid Access clinicians.

Interstate shield laws protect clinicians who offer telemedicine abortion services to patients in states with restrictive abortion bans. Laws enacted in the last year in five states — Massachusetts, New York, Washington, Vermont, and Illinois — protect licensed providers from being criminally prosecuted for providing abortion medication to out-of-state patients.

Lauren Jacobson is a women’s health nurse practitioner who holds a master’s degree in international health and specializes in sexual and reproductive health and rights. She’s a co-founder of RAISE Global Health, a consultancy collective focusing on international projects in global health around gender and reproductive justice. Jacobson is also one of the telehealth abortion providers partnering with Aid Access.

Jacobson tells the American Independent Foundation she learned about Aid Access through Women on Web, an international abortion medication mail service founded by Dutch physician Rebecca Gomperts in 2005.

Gomperts skirted Food and Drug Administration regulations that, at the time, did not allow doctors in the U.S. to mail mifepristone, the abortion medication used in conjunction with misoprostol to end a pregnancy. Using her website, Gomperts began by writing prescriptions for abortion-seekers in Europe and having the medications shipped to users’ homes from pharmacies in India.

Gomperts had launched the Aid Access telemedicine website in 2018.

“Rebecca emailed me immediately and then we started talking and she was like, Oh, it’s interesting, you’re in a shield state. Let’s talk about how to get you involved … And that was when she told me about Aid Access’ plan to become U.S. provider-led by providers working in shield states, and I was fully on board,” Jacobson says.

In 2020, because of COVID-19, the FDA began allowing the drug to be dispensed via the mail, and Aid Access began working with American providers. But the pills were still being sent from India. Today, that’s changed because of the shield laws.

“I essentially get assigned a certain number of users that I can see every day and communicate directly with them via email,” Jacobson says:

Anyone in any state can access these pills up to 13 weeks [of pregnancy]. They’re safe, they’re effective. Research with the World Health Organization has shown this. And all the pills are coming from within the U.S. and U.S. manufacturers. So shipping time is two to five days from U.S. providers, and we have a sliding scale. So if people can’t afford it, we do have the ability to donate in some cases. I think just putting as much information out there about the safety and efficacy and accessibility of these medications is really important, because of course people who are in restrictive states are probably getting pummeled with the opposite message. And it can be so hard, looking at the news, to know what to believe.

Prescriptions from Aid Access cost $150; an in-person visit to a clinic can cost roughly $500 for a medication abortion.

Jacobson notes that users who self-manage abortion are not being charged with crimes at this time in the United States: “I think that there is a lot of intimidation from the anti-abortion movement to try and keep people from accessing these services by making these threats. But even in Texas’ health and safety code it specifically says that people who have an abortion cannot be criminally or civilly charged.”

As for the legal risk to providers, Jacobson says that those working with Aid Access understand the risk, but they also know the shield laws.

“Massachusetts put this law up for a reason, right? I think that it’s there to protect the human rights that are being violated by states with restrictive abortion laws, and it’s there to ensure that I can provide the care that I’m responsible for providing,” Jacobson says.

David Cohen, a Drexel University law professor who focuses on abortion legislation, told the American Independent Foundation: “This isn’t a solution for everyone, but for those who can use pills and get care from these providers, it’s a game-changing shift in our post-Roe environment. If the preliminary numbers are any indication, we could see almost 50,000 people in ban states get care this way each year. The abortion providers mailing pills understand the risks and are willing to take them because of the urgent necessity of getting care to people who need it.”

Published with permission of The American Independent Foundation.