Angel Foster only enters the US via Canada, where she’s a professor. She doesn’t drive a car outside Massachusetts. And she doesn’t visit Florida, South Carolina, or other states that ban or restrict abortion.
These are the precautions this MD takes as founder of the Massachusetts Abortion Access Project (the MAP). It’s a service that prescribes and ships abortion medication via telehealth under Massachusetts’s shield law, which protects those physically present in Massachusetts from out-of-state penalties for accessing or assisting with abortion care.
Legal challenges to providing abortions via shield law have popped up over the last few months, but Foster and others aren’t backing down. Foster envisions a future with even more providers working similarly from other states that have comprehensive shield laws.
“We have been trying to identify folks in those states who are willing to provide [this care], and then work with them to build out a practice so that they don’t have to reinvent the wheel,” Foster said. “They can piggyback on a lot of the things that we’ve learned.”
The deets. Twenty-two other states and Washington, DC, currently have shield laws, according to the University of California, Los Angeles School of Law. Eight of those—California, Colorado, Maine, Massachusetts, New York, Rhode Island, Vermont, and Washington—specifically protect telehealth abortion even if the recipient is located in a state where it’s illegal for them to get care.
The Supreme Court struck down constitutional protections for abortion in 2022. The MAP was founded in September 2023. It serves 2,000 to 2,500 patients a month, 95% of whom are from states with bans and restrictions, Foster said. In 2024, about 10,000 abortions in the US were provided under shield laws each month, according to the nonprofit research organization the Society of Family Planning’s #WeCount tracker.
Navigate the healthcare industry
Healthcare Brew covers pharmaceutical developments, health startups, the latest tech, and how it impacts hospitals and providers to keep administrators and providers informed.
Though not a prescriber herself, Foster still faces a risk of prosecution if she leaves the state of Massachusetts. The MAP’s five prescribers know the risks, too. “I think we all went into working in the shield law space with the expectation that there would be a lawsuit at some point,” Foster said.
Beyond Foster’s practice, telehealth abortions are growing rapidly, making up to 25% of all abortions by the end of 2024, compared to 19% at the end of 2023 and 7% at the end of 2022, according to #WeCount.
A 2024 analysis in Nature Medicine found that this form of treatment is just as safe and effective as in-person abortion.
The risk. No one has been jailed for providing a telehealth abortion to someone in a state where the procedure is banned.
Recently, however, 15 attorneys general from banned states signed a letter pushing Congress to put a stop to shield laws altogether.
“These laws are blatant attempts to interfere with states’ ability to enforce criminal laws within their borders and disrupt our constitutional structure,” they wrote.
In January, Louisiana filed criminal charges against a New York doctor who allegedly prescribed pills to a minor in the state. So far, New York’s governor has held strong and refused to turn the doctor over for prosecution. This, and the MAP’s close working relationship with the Massachusetts government, gives Foster hope.
“We’re feeling very confident about the ability of the Massachusetts shield law to protect us,” she said.