Though living in a state with a near-total abortion ban, Texans can be prescribed and mailed mifepristone and misoprostol pills by out-of-state medical providers, making at-home medicated abortions possible. Last summer, Texas lawmakers tried to close off that access to abortion medication for good when they passed House Bill 7.
As of Dec. 4, HB 7 is in effect, allowing private citizens to sue any individual who makes, distributes, mails, or prescribes abortion pills to a Texan patient. Rather than incriminating the patient themselves, the law targets those helping the patient access the pills – whether that be the parent of a pregnant teenager, a spouse, or their medical provider.
But post-HB 7, the reality is that Texans are still accessing abortion pills due to the reproductive care shield laws in states like Massachusetts, New York, California, and Colorado that legally protect their medical providers’ rights to serve patients over telehealth, regardless of where the patient lives. At the end of October, New York’s shield law held up against Texas Attorney General Ken Paxton’s attempt to enforce a civil decision from Texas against a New York doctor.
One out-of-state group serving Texans is the Massachusetts Medication Abortion Access Project, whose five clinicians prescribe and mail abortion medication to pregnant individuals in their first trimester for a suggested fee of $5. Two-thirds of patients requesting abortion medication cannot afford the full $75 cost of the care, according to MAP.
MAP also offers abortion medication in advance as “period pills” for higher fees, a practice where the pills are taken by someone who thinks they might be pregnant but didn’t take a test. “For some patients, not knowing is something that they value,” Angel Foster, a leader at MAP and medical provider, told the Chronicle. “They know they don’t want to be pregnant, but they don’t want to know if the pills caused an abortion or not.”
Since HB 7 took effect in Texas, “We haven’t changed anything about our practice,” Foster said, adding that, in December, the same month HB 7 became law, MAP saw its largest monthly patient volume yet – over 3,000 patients. About a third of the organization’s patients reside in Texas.
Nonetheless, HB 7 could still have an isolating effect on Texas patients. Foster said that MAP is often contacted by a parent on behalf of their pregnant child, or an English-speaker on behalf of their non-English-speaking partner or family member – acts that could be prosecuted under HB 7. As before the law, MAP insists on working with the patient directly.
“I fear … abortion seekers in Texas will feel less comfortable reaching out to their support networks for fear that those people could get sued,” Foster said.
Moreover, complications from abortion medication are rare within the first 10 weeks, but cases of excessive bleeding, ectopic pregnancy, or incomplete abortion would require further care, Foster emphasized. In states like Texas with near-total bans that can delay even miscarriage treatment, Foster said patients have reported not receiving needed treatment at their local clinic. “The thing that keeps me up at night is that somebody presents at an emergency department, and then doesn’t get treated,” Foster continued.
Additionally, when many individuals are using the internet to look up out-of-state abortion pill providers like MAP, data privacy can be a concern for those in unsafe relationships or home situations. Over the past year, patients have increasingly contacted MAP via secure or temporary emails, like Proton Mail, Foster said.
Attorney General Ken Paxton continues to challenge abortion pill access, suing the U.S. Food and Drug Administration alongside Florida on Dec. 9 after the agency’s approval of a new generic version of mifepristone, accusing the agency of enacting changes “untethered to any medical research evaluating the safety and effectiveness of mail-order abortion drugs.”
Foster says Paxton’s claims that abortion pills prescribed by out-of-state providers are mailed out without discretion and additional medical care are not based in reality. “In terms of what our medical practice looks like and the kind of care that we provide to patients, it just couldn’t be further from the truth,” Foster said. “They’re painting a picture of how we’re providing care that is just inaccurate.”
While the legal challenges continue, MAP and similar providers plan to continue to serve Texans. “Our message to them is that we’re here for them. We’re going to continue to provide care, and we can provide support as well,” Foster said.
Editor’s note: This story has been updated since publication to clarify legal language around HB 7 and AG Ken Paxton’s challenge to New York’s shield law.
This article appears in January 16 • 2026.