Huddled around a small conference table in Greater Boston, fewer than a dozen volunteers form an ad hoc assembly line to slip hundreds of pills into padded envelopes.
It’s not an illegal drug operation, at least not here in Massachusetts. But, the volunteers’ work to fill online prescription requests could risk criminal or civil charges in states where abortion is banned.
The Massachusetts Medication Abortion Access Project, or The MAP, is the group that runs the website offering these medications by mail to people living in states that restrict abortion. It’s one of several organizations around the U.S. conducting these missions. And in their view, they are fulfilling a basic health care need amid a fierce national debate and legal uncertainty.
“I couldn’t care less what the law says. This is the right thing to do,” said Sunny, the only man at the eight-person gathering. WBUR agreed not to use the full names of volunteers due to their potential legal risks.
At the head of the line, Tori and her 14-year-old daughter stuff bottles of pills into white priority mail packages. Each contains the medications for an abortion: Mifepristone stops a pregnancy. Misoprostol causes cramps and bleeding to empty the uterus.
Abortion opponents are pressing multiple challenges that could shut down this work. A federal lawsuit that could reduce access to mifepristone is pending. Some anti-abortion groups are urging the Trump administration to stop allowing pill delivery through the mail. Louisiana calls the two pills “controlled dangerous substances,” putting them in the same legal category as medications like Percocet or Xanax.
Tori and her daughter pause to unwrap another case of pills. The group will tackle roughly 350 medication requests this evening.
“It feels really important to just sit around a table and put together a package that provides basic health care to a woman who wouldn’t otherwise have it,” Tori said. “It’s an antidote to the hopelessness that has set in.”
A woman in her 70s, whom WBUR agreed to identify by the initial I., adds a sheet of detailed instructions about when to take the pills, what to expect and how to call physicians at The MAP with questions or concerns. She heard about the organization from a friend.
“I knew people back in the day who had botched abortions,” I. said. “We worked for years to change the law of the land, and now we’re going backwards. So I want to support women who need these pills.”
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More people seek medication abortions
Demand for the packages these volunteers prepare has risen dramatically since The MAP launched in September 2023, a year after the U.S. Supreme Court overturned Roe v. Wade and with it, a national right to abortion. At the time, abortion bans were taking effect across the country.
This month alone, the group expects to mail 2,500 packages of abortion pills, with just over half going to Texas, Georgia and Florida. The MAP is seeing another spike since last fall when the group dropped the minimum price for pills, and President Trump was re-elected.
Clients seeking pills from The MAP answer questions online about their medical history and the timing of their pregnancy. The MAP cannot ship pills to anyone under age 16, or whose last period started more than 11 weeks ago. A doctor reviews each request, asks for more information if needed, and lets the patient know if the request is approved.
Patients pay as little as $5, more if they choose. Donations cover the balance. Medical staff are available if patients have questions, or problems after taking the pills. The MAP follows up with patients to see how they are doing, but in most cases, the patient and the doctor never speak.
“This would definitely be criminal activity under Texas policies right now,” said John Seago, president of the nonprofit Texas Right to Life. “And we’re working on a bill that is a big tool box of more ways the state of Texas could go after those that are breaking Texas law in this space.”
That bill would let private citizens file wrongful death lawsuits against abortion pill providers and would make financial and other abortion assistance a felony. Internet providers that host sites like The MAP could be forced to stop. Seago said Texas is responding to the “bold innovative tactics” of projects like The MAP.
Temple Law School Dean Rachel Rebouché, who studies and writes about reproductive issues, said the stakes for both sides of the abortion debate keep rising.
“This is a conflict we might have expected to find ourselves in,” she said, “because the abortion rate is higher now than before the Supreme Court overturned Roe.”
Easier access to abortion pills helps explain that increase. The Guttmacher Institute, an abortion rights research group, estimates 63% of abortions were induced with medications in 2023, up from 53% in 2020. The numbers are even higher in states where The MAP routinely ships packages: 83% in Georgia, 76% in Iowa, 74% in South Carolina.
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Taking precautions
The MAP co-founder, Dr. Angel Foster, said she, her staff and volunteers take many precautions to avoid prosecution. Foster said she doesn’t drive outside Massachusetts or take flights with layovers in states where mailing abortion pills might be considered illegal. The MAP uses a pill delivery model that Foster said is designed to “distribute the risk” of prosecution or civil lawsuits for everyone involved.
“Very intentionally, the person who orders the pills is different from the person who prescribes the pills, is different from the person who packages the pills, is different from the person who brings the pills to the post office, is different from the person who processes the payments,” she said.
In addition, The MAP’s pill bottles don’t show the doctor’s name, which could make charging an individual physician difficult. Foster said she’d like to raise the public profile of The MAP on social media and other places, so that scared clients know the group is legitimate and not a scam. But doing so could also make The MAP more of a target.
“This is such a politically fraught space,” she said. “It’s a constant balance.”
Massachusetts enacted a law designed to protect abortion providers from lawsuits filed in other states. It says care from Massachusetts is legal as long as providers follow the state’s own laws.
Some other states have adopted similar “shield” laws. They have not been tested in court, but civil and criminal charges filed against a physician in New York who fills online prescriptions for abortion pills may provide that test. New York is not cooperating with efforts to penalize the doctor.
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‘We are here for you’
The MAP hosts what staff call “pill packing parties” twice a week. Volunteers also sign up for shifts where they sort, label and mail the packages.
“It’s very competitive to volunteer,” said Molly, who’s been participating for several months. “When they send out the email you have to get your name in within five minutes or it’s filled up.”
At the conference table, another volunteer, Tricia, slides a fact sheet about ectopic pregnancies, which the pills won’t abort, into each envelope.
The MAP providers had a dozen reports of these rare and dangerous pregnancies last year, out of nearly 11,000 orders. Abortion opponents say such serious concerns could be prevented if patients were required to have an ultrasound before taking abortion pills.
The MAP is aware of an additional 20 patients who needed either a blood transfusion after heavy bleeding — or a surgical procedure to finish the abortion. The MAP helps patients find medical care; although it can be challenging in states that ban abortion. Overall, the group said just 2% of patients called or emailed, worried about whether their bleeding was normal. The vast majority of recipients did not report any problems.
Tricia pauses to let her hands rest on a package, giving it a little pat.
“I’m thinking about the person this is going to be delivered to,” Tricia said. “You don’t have to worry, it’s on its way. We are here for you.”
A woman in Florida, hearing a description of that moment, weeps.
“Thank you a million times, with all my heart,” said the woman, whom WBUR agreed to identify by the initial N. “I wish I had better words.”
N., who is 27, has one child. She was hospitalized with complications after the delivery, so she and her husband decided they didn’t want any more children. Her husband had a vasectomy. But it failed. N. had recently returned to work when she got pregnant. Both of her parents were battling cancer at the time.
“The thought of going through another pregnancy — financially, emotionally — I couldn’t handle it,” N. said.
Another client, Maria, is 32 and has two children. She went back to college after her kids started school and had just landed her first job in a hospital when she learned she was pregnant again.
Maria lives in a Midwestern state with a near total abortion ban. She remembers shaking with terror as she filled out questionnaires on The MAP’s website.
The pills arrived two days after a clinician at The MAP approved Maria’s application. The package included a hand-written note that said: “We hope the best for you.” Maria kept it.
“I had my oldest daughter when I was very young. I gave up a lot and was severely depressed,” Maria said. The MAP “took away the anxiety of having to do that again, anxiety about losing my career. They made me feel safe.”
The cards are the last stop on the pill packing assembly line. Sunny adds one and passes the envelope to his partner, Sarah. She checks the contents, seals the bag and drops it in a long plastic bin. Sarah and Sunny have written checks and gone to protests to support abortion rights in the past, but Sunny said they wanted to do more.
“So much is out of your control,” said Sunny. “With this, we walk out of the evening and we know that 400 women will get what they need. It’s just instant. That sort of impact is hard to replicate.”
Abortion opponents have their own teams of volunteers. Dr. Catherine Stark, an OBGYN in southeastern Michigan, is one of about 1,000 physicians and nurses who volunteer with the Abortion Pill Reversal network.
Stark takes calls from women who’ve taken the first of the two abortion pills, and changed their minds. She said she gets about one a week. If the woman hasn’t started bleeding heavily or cramping, Stark prescribes a high dose of progesterone to try to counter the effects of that first abortion pill.
The American College of Obstetricians and Gynecologists does not recommend this practice, called “abortion reversal,” but Stark said it can work. A 2018 study, led by the founder of the Abortion Pill Reversal program, found 48% of patients who called the group’s hotline and received the medication maintained a pregnancy.
“I believe in this,” Stark said. “I’ve used it with several patients who went on to have healthy babies.”
Stark said staff at projects like The MAP, who never see the patients they treat, “are mixing up access with what’s in the best interest of women.”
A MAP client from Louisiana disagrees.
“They made such a difference in my life, but I can’t tell people here because [abortion’s] illegal,“ said the woman, C., who was entering her final semester of law school when she got pregnant. She already had one child. “I don’t know if I would have been able to graduate. What they’re doing is so important.”
This article was originally published on WBUR.org.
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