By Melinda Young
State Shield Laws, which protect providers and patients from criminal and civil investigations initiated in abortion-ban states, are successfully improving access to medication abortion, new research shows.1 The study looks at what happened after Massachusetts passed the 2022 Massachusetts Shield Law, including the start of the Massachusetts Medication Abortion Access Project (The MAP).1
“The MAP has been in operation for over a year, and the study is of its first six months,” says Angel M. Foster, DPhil, MD, AM, a professor with the faculty of health sciences at the University of Ottawa in Ottawa, Ontario, Canada. Foster also is a co-founder of The MAP. The access project addresses cost barriers that affect many abortion patients. In its first year, the payment model was for people to pay as much as they could afford. Nearly two-thirds of the people enrolled in the study required a subsidy. And 29% paid $25 or less. Among the 35% who paid the full $250 price, 3% paid extra, instructing The MAP to use the funds to help subsidize other patients’ care.1
“Within the reproductive field, we use the words ‘trust women,’” Foster says. “Trust them on the kind of abortion they want and what’s right for their families, and trust them with money, to pay as much as they can.”
There is no means testing. People seeking abortion care are told what it costs to provide that care and asked to pay whatever they can afford. If they can afford more than the actual cost, the money can be used for people who cannot afford more than a very small amount for their pills, she explains.
After the Massachusetts legislature passed the Shield Law, a group of abortion rights providers and advocates got together to think about how this law could help them improve abortion access. “We wanted to provide high-quality abortion care to those most impacted by Dobbs,” she says. “In the first six months, we provided care in 45 states and Washington DC.”1 The MAP also sent pills to people with military addresses. More than eight in 10 patients received pills in the Southeast or the Gulf Coast regions.1
Massachusetts was the first state to pass a shield law and one of only eight states with comprehensive shield laws, Foster says. “The Massachusetts Shield Law protects clinicians, funders, and prescribers,” she explains. “It is very comprehensive in [protecting from] civil and criminal policies, and there is a specific statement about the protection of patients who travel to Massachusetts and protection of patient records.”
When someone works with a Massachusetts provider to obtain abortion care, they are considered a resident of Massachusetts for that purpose, so all of the state’s providers follow Massachusetts laws regarding abortion services, including following the state’s parental involvement law that says they can only provide care to a person who is age 16 years or older, Foster notes. “We do not check driver’s licenses; we base our practice on what patients report to us,” she adds.
The state’s shield law also provides for an alliance between the state government, attorney general, and department of public health to provide abortion access.
“We knew the folks who created the shield law did it very thoughtfully and with intent,” Foster says. “We have four prescribing clinicians who work by day, doing shifts 365 days a year [collectively].” The MAP’s work has grown from about 2,000 patients in its first six months to between 1,500 to 2,000 patients a month now.1
The physicians who provide abortion care through the program receive rewarding comments from the patients they help, such as the patient from an abortion-restricted state, who said, “This was the result of assault. I am currently unemployed and make all my income from helping my cousin clean houses and other odd jobs when I can. I have an 18-month-old and can’t afford the medication. But this is my worst nightmare, and I just really need some help.”1
Another parent to two children wrote, “I have a special needs autistic nonverbal globally delayed 4-year-old who requires $800 a month in therapies (speech, occupational) and a 16-month-old — I can’t imagine adding another while surviving on one income as I cannot find trusted childcare for my 4-year-old. Thanks so much for offering this service.”1
The physicians, two of whom are retired from office or clinic practice, love the work, Foster says. “Our medical director talks about how this is one of the most rewarding things she’s done in her medical career, and she’s 75 years old,” Foster says. “All of us feel so privileged to do this work when there’s such incredible need because of Dobbs. It’s been an honor to do this.”
Reference
- Foster AM, Mark A, Drouillard KJ, et al. “Trust women:” Characteristics of and learnings from patients of a Shield Law medication abortion practice in the United States. Perspect Sex Reprod Health. 2024; Sept 30. doi: 10.1111/psrh.1228. [Online ahead of print].
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
