Seated around a circular table in a nondescript office building just outsideBoston, the volunteers pack theabortionpills into envelopes with practiced efficiency.
Each of the volunteers – five women and one man – have a unique role in the assembly line. One volunteer drops slim, orange boxes of mifepristone, the first drug typically used in a medication abortion, into the envelopes, while another volunteer adds green-capped bottles of the second drug, misoprostol. A few volunteers add brochures on topics such as how to use abortion pills or what to do if a woman suspects she has an ectopic pregnancy. Finally, one volunteer drops small purple cards into each envelope. They all bear the same handwritten message: “We wish you the best.” The cards are signed with a swooping heart and a nondescript name: “the Map”, or theMassachusettsMedication Abortion Access Project.
By the end of the day, dozens of these envelopes will have been dropped off at a US Postal Service office – many on their way to people who live in states that have banned abortion.
The Map is one of a handful of organizations operating under a controversial legal innovation known as a“shield law”. Enacted by eight states in the years since the US supreme court overturnedRoe v Wade, shield laws are designed to protect abortion providers from red-state prosecutions and legal actions, even if the providers’ patients are located instates that ban abortion.
Providers in shield law states routinely ship abortion pills across state lines: in spring 2024, they facilitated more than 7,700 monthly abortions in states with total or six-week abortion bans, according to #WeCount, a research project by the Society of Family Planning.
But shield laws are now being put to the test. In December,Texas suedDr Margaret Carpenter, a New York doctor, over allegations that she violated Texas’s abortion bans by mailing abortion pills to a Texas woman. Then, in January,a Louisiana grand jurycriminally indicted Carpenter.
The New York governor, Kathy Hochul, hasrefused to sign an extradition orderfor Carpenter. Citing the state’s shield law, a New York county clerk has also refused to enforce a $113,000 fine, levied by a Texas court, against her. Now, Texas is expected to sue New York over the shield law – a move that could ultimately land the case in front of the supreme court, dominated 6-3 by conservatives, and tip the balance of power between states that protect abortion rights and those that do not.
“No one wanted this, but it’s not unexpected,” said Dr Angel Foster, the Map’s co-founder, of the state-on-state fight. “I think we were prepared for this to happen, and we’re waiting for the next shoe to drop.”
The legal battle has not slowed down demand at the Map. Before dropping their prices last year, the Map was mailing pills to about 500 patients a month. Now, it provides pills to roughly 2,500 per month.
“Since the election, it’s felt even more urgent to have a tangible and literally hands-on impact. A package is going to somebody who needs it, in a place where they are being denied their rights,” one Map volunteer said as she sealed envelopes. She spread her palm out on a package as if she were placing a hand on a Bible. “It’s going to a real person.”
To order pills from the Map, a patient must be within their first trimester of pregnancy and at least 16, the age of consent for an abortion underMassachusettslaw. After they fill out an online intake form, a licensed clinician reviews their chart; if a patient has questions, someone from Map will take their call. Because the organization operates on a sliding scale, patients can receive pills for as little as $5.
On one recent Tuesday morning, Cheryl, a retired OB-GYN, sat in the Map’s tiny, dimly lit office and quietly clicked through patients’ charts, evaluating the answers to questions about the date of their last period and their past pregnancies. Patients shared why they wanted abortions, but Cheryl rarely lingered over their answers. One, however, struck her: a 25-year-old single mom who felt like another pregnancy would endanger her ability to take care of her child. It reminded Cheryl of the five years she spent providing abortions at Mississippi’s last abortion clinic,which shutteredshortly after the supreme court’s2022decisionin Dobbs v Jackson Women’s Health Organization paved the way for state abortion bans to unfurl acrossthe US.
“That was a really common refrain: ‘I just want to do right by the kids I have,’” Cheryl recalled. About half of the Map’s patients, she said, already have children. They are also predominantly under 35 and people of color – similar to abortion patients writ large, at least before Roe fell.
After Roe’s collapse forced the Mississippi clinic to close, Cheryl started providing abortions in North Carolina – until that state banned the procedure after 12 weeks and the clinic where she worked no longer needed her services. “I was sitting at home, being sad and useless and doing local advocacy stuff,” Cheryl said. She also grew increasingly angry and frustrated with what she saw as masscomplacency with the post-Roe reality.
That’s when someone told her: “I have just the group for you.”
Working with the Map means assuming a certain level of risk. There is no way to guarantee that a staffer or volunteer won’t get drawn into a lawsuit – or worse.
To diffuse risk, the Map never mails anything that includes clinicians’ names. Foster no longer travels to or through states with abortion bans, and does not drive outside of Massachusetts; she doesn’t want to run the risk of getting pulled over for speeding and learning that another state has put out a warrant out for her arrest. This is also, in part, why the Map relies on an assembly line to put its packages together: there is no single person to point a finger at.
“I’m feeling like the people that have the power to protect us really aren’t, so we just have to keep moving along and doing what we think is right,” Cheryl said. “It’s terrifying, but the whole world is terrifying. I feel like just walking down the street these days is terrifying. Someone’s going to whisk you off and accuse you ofwriting an op-edor something.”
She asked to be identified only by her first name to protect her ability to travel in the US, although Cheryl has no plans to enter a state with an abortion ban.
As Cheryl worked, a US map dotted with silver stars glimmered on the wall above her head. Each star represented the location of a patient served in October 2023, the Map’s first month of operation. Although sky-blue areas like the coast of Oregon glinted with stars, most were clustered in the south-eastern US, which is now blanketed in abortion bans. Today, a third of the Map’s patients come fromTexas, which outlaws virtually all abortions, while another third hail from Florida and Georgia, which both prohibit abortion past six weeks of pregnancy.
The map’s constellations illuminate a paradox of the post-Roe US: even though 26 million women of reproductive age live under a total or six-week abortion ban, many are still receiving abortion pills in the mail or crossing state lines to visit a brick-and-mortar clinic. In 2023 and 2024, the US saw more than 1m abortions – some of the highest numbers in a decade,according to the Guttmacher Institute.
The question is whether this paradox is sustainable.Anti-abortion activists consider this kind of interstate networking an existential threat. While Texas and Louisiana have gone after Carpenter, a number of states have attempted to criminalize people who help others cross state lines for abortions. Courts have frozen many of those efforts, but these legal battles are far from over.
With different US states now home to fundamentally contradictory reproductive regimes, both sides – whether they seek to punish out-of-state travel or offer banned healthcare – are scrambling traditional codes of conduct between states, creatingnew questions about whatthe constitution allows.Thesequestions are sure to end up before the supreme court.
“There isn’t really much of a precedent for anything like shield laws, and the courts are very conservative,” warned Mary Ziegler, a University of California, Davis School of Law professor who studies the legal history of reproduction.
The US constitution protects people’s right to travel, but also mandates that states honor court rulings from other states – such as the fine that Texas won against Carpenter (becauseshe and her lawyer did not show up to a court date in the state). In addition, the constitution specifies that, if an individual commits a crime in one state and “shall flee from justice” to another state, that individual must be “delivered up” – or extradited – back to the scene of the crime.
Yet there’s no evidence that Carpenter and other shield law providers did “flee from justice”; rather, they’re practicing within and obeying the law of their own home states.
“New York is going to say: ‘She’s not a fugitive. This is not the kind of scenario where a court should get involved,’” Ziegler said.“Precedent would say they don’t have to extradite her, and the question would become whether Louisiana can find a way around that.”
Ziegler also questioned whether Texas could convince a court to force New York to collectits $113,00 fine. The constitution, she said, forces states to recognize fines levied in lawsuits between individuals – not necessarily fines that result from a lawsuit by a state against an individual.
ButSteven Aden, the chief legal officer and general counsel at the powerful anti-abortion group Americans United for Life, isbullish about Texas’s chances.
“You can’t go to Reno and incur a gambling debt in a casino and then go back home and raise a defense in court, when the casino comes after you for that gambling debt, by saying: ‘We don’t have gambling in our state,’” Aden said.
Ziegler and Aden did agree on one thing, though: not only is the supreme court all but certain to take up Carpenter’s case in one form or another, but the high court will likely see a deluge of similar cases over the next several years.
“These are the first shots fired in what we like to call – what we reluctantly, I guess, call – a coming war between the states,” Aden said.
Expertshave notedthat the closest parallels are the pre-civil war battlesover how to treat enslaved people who had escaped southern states (which permitted slavery) and fled to northern states (which did not). When these disputes reached the US supreme court, as in the case of Dred Scott v Sandford, the court repeatedly sided with enslavers and lent power to the federal government to enforce pro-slavery laws.
The modern-day dispute between states over abortionis dramatically different from the 19th-centuryinterstate battle over slavery–butAbraham Lincoln’s famous warning still seems to resonate: “A house divided cannot stand.”
Other threats to abortion pills could soon imperil shield-law providers, too. The attorneys general of Idaho, Kansas and Missouri are nowpursuing a lawsuitthat could roll back providers’ ability to prescribe the pills through the mail. Anti-abortion activists are alsotrying tocajoletheTrump administrationto enforce the Comstock Act, a 19th-century anti-vice law that bans the mailing of abortion-related materials but went dormant under Roe.
The Map would close if the law no longer protected its work, Foster said. But that doesn’t necessarily mean she would give up.
“We might, as a group of people, decide to pivot and do something that’s around civil disobedience, and create a different kind of entity doing different work,” she said.
Even if anti-abortion forces prevail in court, there is likely no way to keep abortion pills out of US hands.The US Postal Service already fails, frequently, to detect the illicit drugs that swim through it. In addition to shield law abortion providers, there is a thriving online market for abortion pills that are sent straight from overseas pharmacies, allowing women to end their pregnancies without involvingthe formal UShealthcare system. (Medical experts widely agree that it is safe to end your own pregnancy using pills in the first trimester of pregnancy.)
For now,the Map has no shortage of volunteers. As the volunteers stuffed abortion pills into envelopes, a woman working in another part of the office building, who had no connection to thegroup, walked by the conference room and asked Foster: “Can I volunteer?” Another bystandertold them: “Thank you guys for what you’re doing.”
It took less than two hours for the volunteers to package some 200 envelopes. Soon after they departed, another pair of volunteers arrived to add shipping labels and drop off the packages, discretely packed into a bin, at a nearby post office. In January, the Map was mailing roughly 150 packages a day – in part, Map project manager Andrea suspects, due to fears surroundingDonald Trump’s inauguration – but that volume has slowed, to about 65 to 85 packages a day. (Andrea asked to be identified by her first name only.)
A woman working at the post office once asked Andrea if she was running a jewelry business, given the number of shipments and the rattling sounds each package made. She had mistaken the pills for beads.
Andrea smiled. She did not confirm or deny.