The Legal Fight Over Telehealth Clinics Helping Women Defy Abortion Bans

Introduction to the Debate

Every month, thousands of women thwart abortion bans in their home states by turning to telehealth clinics willing to prescribe pregnancy-ending drugs online and ship them anywhere in the country. Whether this is legal, though, is a matter of debate. Two legal cases involving a New York doctor could wind up testing the shield laws some states have passed to protect telehealth providers who ship abortion pills nationwide.

The Cases Against Dr. Margaret Carpenter

Dr. Margaret Carpenter faces a felony charge in Louisiana for supplying abortion medication through the mail to a pregnant teen in that state. The patient’s mother also faces criminal charges. A Texas judge fined the same physician $100,000 after the state accused her of prescribing abortion medication for a woman near Dallas.

Protection Under New York’s Shield Law

So far, the prosecution hasn’t progressed thanks to New York’s shield law, which has protected Carpenter from extradition to Louisiana. But other telehealth centers operating in states with similar legal protections for abortion providers are watching closely. “We have great legal counsel who have advised us that what we are doing is legal,” said Dr. Angel Foster, co-founder of The Massachusetts Medication Abortion Access Project, which is among a handful of telehealth providers that facilitate abortions from afar in states with bans.

A coordinator shows the medications and care kit, which will be sent out to clients at Massachusetts Medication Abortion Access Project, May 13, 2025, in Somerville, Mass. (AP Photo/Charles Krupa)

Legal Challenges and Debates

As more states consider enacting shield laws or expanding existing ones, whether one state can shield providers from liability for breaking another state’s laws around abortion is still an unsettled area of law. Erik Baptist, senior counsel for the Alliance Defending Freedom, which opposes abortion, said shield laws violate a constitutional requirement that states respect the laws and legal judgments of other states. “What these shield law states are doing are undermining the prerogative of these pro-life states to implement and enforce pro-life laws,” said Baptist, director of the group’s Center for Life. ”And so I think the Supreme Court ultimately will want to take this.”

The Mechanism of Telehealth Abortions

Decades ago, the FDA approved the use of two prescription medicines — mifepristone and misoprostol — to terminate pregnancies. But it wasn’t until 2023 that telehealth abortions across states became more popular, after the U.S. Supreme Court overturned Roe v. Wade in 2022. The Society of Family Planning, which supports abortion rights, said that between April and June 2024 there were an average of 7,700 telehealth abortions performed each month in states that either ban abortion totally or after six weeks of pregnancy.

How Telehealth Clinics Operate

The prescribing process at telehealth clinics varies by provider, but usually takes place entirely online, with the patient answering a series of health-related questions and consent forms. At some telehealth clinics, medical providers don’t come face-to-face with patients, even via videoconferencing, and patients don’t necessarily know the prescriber’s name unless requested. For instance, when Foster’s clinic, also known as The MAP, puts pills in the mail, only the name of the practice appears on the label, as allowed under the Massachusetts shield law. If patients have follow-up questions, they can talk or text the doctor working that day, but may not know that doctor’s name either. Pills can arrive in less than a week.

States with Shield Laws

Twenty-three states and Washington, D.C., currently have shield laws protecting abortion providers. Of those, eight have specific provisions protecting them from criminal prosecution or civil lawsuits even if the patient is in another state, according to the nonprofit research organization KFF. They include California, Colorado, Maine, Massachusetts, New York, Rhode Island, Vermont, and Washington. Louisiana’s request to extradite Carpenter hit a roadblock when New York Gov. Kathy Hochul rejected it, citing the state’s shield law.

Clinics’ Resolve to Continue Operations

Julie Kay, the executive director of the Abortion Coalition for Telemedicine, the nationwide organization co-founded by Carpenter, said providers won’t be “bullied and intimidated” into ceasing operations. Other telehealth abortion providers said they also won’t be deterred by legal threats. “I have been working in this field for 25 years and this is part of the work,” said Dr. Rebecca Gomperts, founder and director of Aid Access, an abortion pill supplier. ”It’s something that we all anticipated would happen,” she said of the legal challenges.

Conclusion

The legal fight over telehealth clinics helping women defy abortion bans is complex and multifaceted, involving issues of state sovereignty, constitutional law, and the provision of healthcare services across state lines. As the debate continues, it is essential to consider the perspectives of all stakeholders, including patients, providers, and policymakers, to ensure that women have access to safe and legal abortion services.

FAQs

• Q: What are shield laws, and how do they protect abortion providers?
  A: Shield laws are state laws that protect abortion providers from liability for breaking another state’s laws around abortion. They can prevent extradition and protect providers from criminal prosecution or civil lawsuits.
• Q: How do telehealth clinics operate, and what is the process for prescribing abortion medication?
  A: Telehealth clinics operate by providing online consultations and prescribing medication based on patient-provided health information and consent forms. The process varies by provider but often does not involve face-to-face interactions, even via videoconferencing.
• Q: What is the current legal status of telehealth abortions, and are they available in all states?
  A: The legal status of telehealth abortions is unsettled and varies by state. While some states have laws protecting telehealth providers, others have laws banning or restricting abortion, including telehealth services. Availability depends on the state’s laws and the provider’s willingness to operate within those legal frameworks.