‘Shield laws’ allowed medical providers to ship pills to over 40,000 people in states that forbid abortions in last five months of 2023

Over the last five months of 2023, medical providers shipped abortion pills to over 40,000 people living in states that forbid abortions, via new “shield laws” that protect providers who mail pills to people living under abortion restrictions.

Researchers from #WeCount, a project by the Society of Family Planning that studies the impact of abortion restrictions following the toppling of Roe v Wade, first started tracking abortions performed through shield laws in July 2023. In its Tuesday report, the researchers measured the impact of shield laws passed in five blue states – Colorado, Massachusetts, New York, Vermont and Washington state – that protect medical providers from legal repercussions if they ship abortion pills to people in defiance of state bans.

Between October and December 2023, an average of 5,800 monthly medication abortions in states with six-week or near-total abortion bans were facilitated under such shield laws, #WeCount found in the Tuesday report, which tracks abortion provision between April 2022, before Roe was overturned, and December 2023. States that permit in-person abortions but have in effect outlawed telehealth abortions, such as Arizona and North Carolina, meanwhile, saw a monthly average of almost 2,000 medication abortions provided through shield laws.

“That’s a huge number of people who are getting abortions in a way that didn’t exist just a few years ago,” Dr Ushma Upadhyay, a #WeCount co-chair, said of abortions through shield laws. Upadhyay is also a professor at University of California, San Francisco’s Advancing New Standards in Reproductive Health. “It’s unbelievable, and it’s a method of obtaining an abortion that most people in the US still don’t even know is available.”

Despite the fall of Roe, which led to abortion bans across much of the US south and midwest, the number of abortions performed within the US healthcare system rose, according to the report, whose findings are in line with previous analyses. Even excluding abortions offered under shield laws, providers performed almost 86,000 monthly abortions in 2023 in states that still allow the procedure, compared with nearly 82,000 monthly abortions in 2022.

“It leads to continued debate in our field. What’s happening here? How can this be happening?” Upadhyay said. “It is really interesting, but also so important to remember that there are many people living in states with bans that aren’t able to get their abortions.”

Telehealth abortions are especially on the rise. By December 2023, they accounted for 19% of all abortions nationwide.

In June, the US supreme court is expected to issue a decision on a case that could slash access to telehealth abortions. Anti-abortion activists have asked the court, which is dominated 6-3 by conservatives, to reverse measures by the Food and Drug Administration that allowed abortion patients to receive the common abortion pill mifepristone remotely, rather than forcing them to pick up pills in person.

The justices, who heard the case in March, appeared skeptical of the wide-ranging arguments made by the anti-abortion groups that brought the case. But if those groups prevail, clinics that offer telehealth will be affected. At least one virtual clinic told the Guardian it would probably shut down. Another may continue to provide abortions using a second abortion pill, misoprostol, which is still safe but can carry more complications.

“I don’t think they’re going away, and I think they will continue offering abortion care,” Upadhyay said of providers who offer telehealth abortions. “I do think maybe the numbers will go down because the model will change.

“It’ll rock the system tremendously,” she added.

Upadhyay is also bracing for another shock to the system: on 1 May 2024, Florida banned abortion past six weeks of pregnancy, which is before many people even know they are pregnant. Because Florida used to be the last south-eastern state that allowed abortion through the first trimester, people across the region often traveled there for abortions they couldn’t get in their home state. In the 18 months after Roe fell, Florida providers performed more than 17,000 more abortions than they would have if Roe had remained the law of the land, according to #WeCount.

“It remains to be seen whether the number of abortions provided under shield laws will increase as a result of Florida’s six-week ban,” Upadhyay said.