As the number of abortions nationwide continues to grow, pregnant people in states with restrictions and bans are accessing pills from out-of-state providers. Some say they’re breaking the law.
ARI SHAPIRO, HOST:
More than half of all abortions in the U.S. are done by taking medication. Prescription pills are widely available in the mail through telehealth providers. Some providers even send pills to states where abortion is illegal. These practices are a response to the Supreme Court’s ruling in Dobbs, and opponents of abortion want to see these providers prosecuted. NPR’s Elissa Nadworny takes us inside a medical practice sending abortion pills to states where they’re banned.
ELISSA NADWORNY, BYLINE: I’m standing in a small but crowded room outside Boston.
(SOUNDBITE OF DOOR CLICKING)
ANGEL FOSTER: This is our office.
NADWORNY: Angel Foster, who has an MD and a Ph.D., is my tour guide. She motions to the walls which are piled high with boxes the size of a hardcover book.
(SOUNDBITE OF BOXES BEING MOVED)
FOSTER: These are all kind of prepackaged and ready to go…
NADWORNY: Yeah.
FOSTER: …To those…
NADWORNY: You look – honestly, this looks kind of like an Etsy store.
FOSTER: It really does.
NADWORNY: Even the postal service workers down the street are convinced Foster sells jewelry.
FOSTER: And they just think we are, like, on fire as a jewelry business (laughter) ’cause we are pushing a lot of this stuff out the door.
NADWORNY: But inside, it’s not earrings or bracelets. Instead, there’s a small white bottle of misoprostol and a small box containing mifepristone – the two drugs used in a medication abortion – plus instructions, resources and a handwritten note.
FOSTER: You know, this is what our service looks like (laughter). Welcome to modern abortion care.
NADWORNY: This is the headquarters of the Massachusetts Medication Abortion Access Project. To be more discreet, they call it The MAP. Pregnant patients fill out an online form, connect with one of four OB-GYNs via email or text and, if approved, receive the pills within a week, no matter which state they live in.
FOSTER: This is a legitimate service. These are legitimate docs. These are real pills.
NADWORNY: The MAP is one of just four groups in the U.S. sending pills to people who live in states that ban or restrict abortion. They can do this because they are in states that have passed shield laws that protect them legally. Eight states have such laws. Medication sent by shield law providers now accounts for about 10% of abortions nationwide – as many as 12,000 a month.
FOSTER: Let’s see.
NADWORNY: Foster pulls up the list of today’s patients.
FOSTER: Right now, there’s 13 patients that are going to get pills from our service.
NADWORNY: It’s still early in the day, but so far, the practice’s OB-GYNs have signed off on prescriptions for women in Texas…
FOSTER: Tennessee, Georgia, Alabama, Oklahoma and South Carolina.
NADWORNY: Most of the states they send to have near total abortion bans. The MAP serves people who are up to 11 weeks pregnant and who are 16 or older. Today…
FOSTER: We’ve got one patient that’s over nine weeks, and the rest are around six.
NADWORNY: Many of their patients already have kids. On the online form patients fill out, there’s a blank spot to add any additional thoughts.
FOSTER: This is just from today.
NADWORNY: Foster reads a few.
FOSTER: (Reading) I’m a single mom of four. My youngest is only 10 months, and I’m not mentally or financially ready for another baby right now.
We don’t ask them to tell us this information, but they do.
(Reading) I’m a single mom of a kid under 2. I have no job, and I will lose everything if I am pregnant. I can’t afford a baby. I can’t even afford this abortion.
NADWORNY: It costs $250 to get the pills in the mail, but patients can pay as little as $5 on a sliding scale. Since many patients don’t pay the full price, The MAP gets money from abortion funds, individual donations and philanthropic gifts. When I ask Foster about the legality of what they’re doing – sending about 500 pills a month to states with bans – she tells me many lawyers were involved in putting this together.
FOSTER: Our belief is that we are a fully legally compliant practice, and as such, the commonwealth has our back.
NADWORNY: Shield laws, like the one in Massachusetts, give abortion providers some protection from criminal prosecution, civil claims and extradition, among other threats. But the laws have yet to be tested in court, and they certainly haven’t gone unnoticed by lawmakers and groups looking to limit abortion.
JOHN SIGO: They are aiding and abetting crimes in Texas.
NADWORNY: That’s John Sigo, president of Texas Right to Life. His group helped pass abortion bans in Texas because they believe life begins at fertilization. The way he sees it, providers like doctors at The MAP…
SIGO: They’re actually committing a crime that began in another jurisdiction but ended in Texas.
NADWORNY: His organization has been looking for the right person or circumstance to challenge shield laws directly in court. And he’s been frustrated that many conservative prosecutors have been hesitant to take action, likely because it’s an election year.
SIGO: We want to use, you know, all the tools available to really, you know, fight against this new trend of abortion pills by mail.
NADWORNY: The potential personal risks aren’t lost on providers. Many of the folks who work at shield law practices – people like Angel Foster – have changed their lifestyles just in case.
FOSTER: My mom and stepdad live in South Carolina, and I can’t visit them anymore because I won’t travel to or through ban or restricted states.
NADWORNY: That includes avoiding airport layovers in places like Dallas or Atlanta, where they could be subpoenaed, served legal papers or even be arrested if there’s a warrant.
FOSTER: Yeah. Let’s see.
NADWORNY: By the afternoon in The MAP’s offices near Boston, more patients have been added to the list of packages being sent out, taking today’s final tally up to 21.
FOSTER: We’ve got somebody who we’re getting pills out, and they filled out their questionnaire three hours ago.
NADWORNY: Where are they from?
FOSTER: This person’s from Alabama.
NADWORNY: She’s a single mom, about six weeks pregnant, living in a state where abortion is banned with very limited exceptions. Her address, along with 20 others, gets printed out, stuck on a box and taken to the post office. The packages will be at apartments and houses across the U.S. by the week’s end.
Elissa Nadworny, NPR News.
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