The antiabortion movement is desperately doing everything it can to block access to abortion pills. In the nearly three years without the protections of Roe v. Wade, the number of abortions in the United States has increased. The wide availability of medication abortion and the rise of telehealth providers who see patients virtually and send pills across the country have completely transformed the landscape of reproductive health care. You can imagine how frustrated antiabortion leaders are with this development; just when they achieved the long-awaited dream of overturning Roe, changes in Food and Drug Administration (FDA) requirements for medication abortion, along with the dedication of abortion providers and activists, have opened new avenues for care in states with abortion bans and restrictions.

Medication abortion now constitutes 63 percent of all abortions in the country. Telehealth abortion care rose from 4 percent of all abortions in April 2022 to 19 percent in March 2024. This surge in telehealth care began during the pandemic, when the FDA lifted some restrictions on mifepristone, the first medication used in a typical two-pill regimen to terminate a pregnancy up to ten weeks gestation. In 2021, the FDA eliminated the in-person dispensing requirement for mifepristone, allowing providers to use telehealth to support patients who could not or chose not to travel to clinics for in-person care. Clinicians conduct remote consultations, typically via video call appointments but also through secure text messaging, relying on the patient’s self-reported medical history and calculating gestational age based on the patient’s reported last menstrual cycle. Recent research on medication abortion provided through telehealth demonstrated the same high rates of safety and efficacy as in-person medication abortion care.

As the demand for abortion care surged in states where it remained legal after 2022 — particularly in states like Illinois, Colorado, and Kansas, which saw an influx of patients from surrounding states with bans — telehealth became essential in reducing appointment waiting times and meeting the heightened demand. Immediately after Roe was overturned, advocates in abortion-friendly states started exploring ways to protect providers from lawsuits for treating patients from banned states. Interstate shield laws, designed to protect abortion providers, supporters, and patient medical records from civil and criminal consequences related to reproductive health care provided to out-of-state residents, are now on the books in eighteen states. Since July 2023, eight states have also implemented shield laws specifically to protect telehealth abortion providers who consult with patients virtually and ship pills to states with abortion bans or telehealth abortion restrictions. Clinicians working under the protections of state shield laws provide up to twelve thousand telehealth abortions each month.

Antiabortion leaders frustrated by these legal developments are using their significant resources to undermine access to medication abortion. Last month, Texas attorney general Ken Paxton sued a doctor based in New York for providing medication abortion pills to a twenty-year-old woman in Texas. The civil lawsuit accuses Dr Maggie Carpenter of violating Texas’s antiabortion law and practicing medicine without a Texas medical license, seeking civil penalties of “no less than $100,000 for each violation of the law.” Carpenter, cofounder of the Abortion Coalition for Telemedicine (ACT), which supports clinicians providing telemedicine abortion care to patients in states with bans, is one of the most prominent doctors offering telehealth care. By targeting Dr Carpenter, Paxton aims to intimidate providers and dissuade them from taking any legal risks to offer abortion care to patients in states with bans.

The first legal challenge to a telehealth shield law pits abortion-hostile Texas against abortion-friendly New York in a struggle over extending abortion laws beyond state borders. “The truce over interstate abortion fights is over,” Mary Ziegler, a prominent abortion historian and law professor at UC Davis, said on X/Twitter. Abortion supporters are rightly employing every tool available to expand access for patients in states with strict bans. To protect telehealth providers from prosecution, shield laws require these providers to adhere to the laws in the state where they are located, regardless of their patients’ locations. According to these laws, providers of telehealth abortion care do not need to possess medical licenses in all the states where their patients reside; they only need to hold a medical license and comply with the laws of their home state. Abortion care has long been treated as separate from other types of medical care, so it appears reasonable for the regulations surrounding telehealth abortion care to differ from those governing other forms of telehealth services.

So according to New York law, Dr Carpenter’s actions are entirely legal. As Drexel University law professor David Cohen says, “The New York shield law exists to prevent Texas from having any ability to get someone in New York who is following New York law into Texas court in any way.” According to Cohen, because New York’s telemedicine shield law “requires the state to refuse to order Carpenter to comply with Texas’ court orders,” Texas is effectively left without a defendant to bring this suit against.

Civil suits like the one against Dr Carpenter are entirely expected and exactly the situation the shield laws were designed to oppose. “Ken Paxton is prioritizing his anti-abortion agenda over the health and well-being of women by attempting to shut down telemedicine abortion nationwide,” the Abortion Coalition for Telemedicine said in a statement on the lawsuit. “By threatening access to safe and effective reproductive health care, he is putting women directly in harm’s way.”

Antiabortion leaders attempt to frame their abortion bans as important to protecting women’s health. In Paxton’s legal brief regarding the lawsuit, he asserts that the woman in Texas who received abortion pills ended up in the emergency room with serious complications, suggesting that medication abortion is inherently dangerous. As journalist Jessica Valenti has reported, there is no evidence that the patient suffered any harm. The fact that she visited the hospital for bleeding does not imply that she experienced complications from abortion pills or even required any medical intervention. With the increase of self-managed and telehealth abortions, hotlines like Miscarriage + Abortion are addressing the needs of patients by offering free support for questions concerning the safe amount of bleeding. The misleading brief issued by the Texas attorney general’s office is part of the broader antiabortion strategy that claims medication abortion is hazardous and anyone providing telehealth abortion care is endangering women’s health.

Texas antiabortion leaders have been actively seeking plaintiffs to challenge laws that protect access to medication abortion. The lawsuit filed by Paxton cited firsthand information from the unnamed partner of a woman who received abortion pills by mail. In fact, the entire case arose from a report that Paxton’s office received from the man and “emerged as part of a broader abortion law enforcement initiative quietly created by the attorney general, which includes searching for potential plaintiffs.” According to reporting by the Washington Post, next month Texas Right to Life plans to launch an “advertising campaign on Facebook and X to reach the husbands, boyfriends, and sex partners of women who have had abortions in the state — with the goal of recruiting them to file lawsuits against those who assisted the women in ending their pregnancies.”

John Seago, the president of Texas Right to Life, states that the organization plans to file several lawsuits of this nature in various appellate courts, aiming ultimately to bring one of them before the Texas Supreme Court. “The group’s employees have been reaching out to antiabortion pregnancy centers and ‘abortion recovery groups’ that support men. They are particularly focused on cases involving websites that send pills into states with bans, as well as those that compile abortion pill resources,” reports Caroline Kitchener in the Washington Post. This strategy underscores the challenges antiabortion groups encounter in finding legal ways to contest shield laws. Relying on aggrieved husbands and boyfriends — often the only other individuals aware of their partner’s private decision to use abortion pills — highlights that these lawsuits are fundamentally about patriarchal control rather than genuinely protecting women from harm.

Another recent challenge to telehealth abortion care arose in mid-January when conservative US judge Matthew Kacsmaryk of Amarillo, Texas, issued a ruling permitting the attorneys general of Idaho, Kansas, and Missouri to continue litigating the Alliance for Hippocratic Medicine v. FDA case. In June 2024, the Supreme Court ruled that the antiabortion organizations that initiated the original case lacked legal standing to sue. The attorneys general of Idaho, Kansas, and Missouri are expected to ask the court for a nationwide order to restrict access to mifepristone by prohibiting telehealth provision and requiring three in-person doctor’s appointments. The suit also notes that the three state attorneys general will seek to revoke the FDA’s approval of the generic version of mifepristone, restrict its use by minors, and limit the pill’s use to the first seven weeks of pregnancy rather than the current limit of ten weeks.

The attacks on telehealth medication abortion care are coming from all directions. Conservatives, frustrated that their bans haven’t stopped people from obtaining abortions, are employing every legislative and legal means available to undermine access to abortion pills. However, abortion advocates are keeping up the fight. Even if one legal path is blocked, the prevalence of abortion pills makes it nearly impossible to restrict access, even in the states with the strictest bans. The robust network of activists, providers, and legal advocates continues to discover new ways to support individuals despite the many challenges they face.