Three years ago, in Dobbs v. Jackson Women’s Health Organization, the Supreme Court’s conservative majority enabled states to severely restrict abortion or ban it outright. Since then, 17 states have enacted such limits; infant and maternal mortality have risen in many of them. But the impact of overturning Roe v. Wade extends far beyond medical catastrophes. It also appears in the quieter struggles—a myriad of small, compounding barriers that stand between individuals and their access to health care. Here are some of the stories of people who have stepped up to do what they can to provide care, and some of the women who found themselves trapped in a system increasingly difficult to navigate.
During college, I interned at a hospital in Cairo, where the labor and delivery floors were filled with women who had obtained unsafe abortions. I saw first-hand the repercussions of abortion bans. That, plus my mom’s difficult experience accessing abortion care before Roe v. Wade, made me passionate about helping people access safe care.
I went to medical school because I wanted to be an abortion-providing clinician but ultimately decided to work in research and policy. About 10 years ago, a legal colleague and I founded a nonprofit that developed strategies for delivering safe and effective medication abortion care in legally restricted and low-resource settings, like northern Thailand and rural Pakistan.
Then, in 2022, the US Supreme Court allowed states to ban abortion. The same year, Massachusetts enacted the first comprehensive Shield Law in the country: It effectively redefines the location of telemedicine abortion care. If the clinician is licensed and physically practicing in Massachusetts, then the telemedicine care is considered to be taking place in Massachusetts, regardless of the patient’s location. That legally protects Massachusetts clinicians, as well as helpers and funders, providing abortion care to patients physically located in other states.
We launched The Massachusetts Medication Abortion Access Project (The MAP) in September 2023. It’s an asynchronous telemedicine service that can be accessed through our website. We do a basic eligibility screen based on chronological age, gestational age and geography; most people are eligible based on those criteria, and they get an email with links to the medical questionnaire and consent forms. The clinician can then approve the patient for a shipment of pills or connect with them to talk through concerns. We ask abortion seekers to pay what they can afford—as little as $5.
There are patients that are not eligible for our service, either because of gestational age or because of underlying medical conditions. We work closely with them to try to find clinical care if that’s what they need.
We are very much a part of the formal healthcare system: We work with the state government and comply with all state laws. We provide abortion-seeking patients across the country with an alternative to traveling out of state for in-clinic care. More than half of our patients are from Texas, Florida, and Georgia, and 95 percent are from states with bans or very restrictive laws governing abortion access.
Complications from medication abortion are very, very rare, but we also provide information about what constitutes the need for clinical intervention, and how patients can safely seek follow-up care.
The biggest challenge we face is about our perceived legitimacy. When people learn there’s this group in Massachusetts that will send FDA-approved medications to your home for $5, it sounds absolutely bananas. People think this must be a scam, or that the pills are fake. It’s heartbreaking for us, because we’re real people. We’re a legitimate service. We’ve got highly trained clinicians who are doing this work. Some of our clinicians have been providing abortion care for decades.
—Dr. Angel Foster, DPhil, MD, AM, co-founder of The MAP
