Last week, a Texas judge ordered Dr. Margaret Carpenter — a New York abortion doctor — to pay at least $100,000 in penalties for failing to appear in court. Carpenter has found herself at the center of two major abortion lawsuits: In December, she became the target of the first-ever civil suit against an out-of-state abortion provider, and officials in Louisiana are now also seeking her extradition, with newly appointed US Attorney General Pam Bondi signaling that she’d “love” to get involved.
The mounting legal battles center on whether states with abortion bans can block their constituents from receiving FDA-approved abortion pills from doctors in states with no such restrictions. The cases represent the latest salvo in the fast-evolving fight over reproductive rights in America.
The attacks on Carpenter coincide with new federal threats to abortion medication: Robert F. Kennedy Jr., now at the helm of the Department of Health and Human Services (HHS), recently said he was open to reviewing and potentially reinstating stricter safety requirements on the abortion drug mifepristone — despite it being incredibly safe, as affirmed by decades of patient data from around the world.
Abortion pills have become the most common method for ending pregnancies in the United States, partly due to their safety record, their lower cost, and diminished access to in-person care. While states have ramped up abortion restrictions since Roe v. Wade was overturned in 2022, access to abortion pills has actually significantly expanded since then, helping to explain why there were more US abortions in 2023 than in any year since 2011.
Reimposing federal restrictions on the drugs could effectively end telemedicine abortion access, in which patients consult with abortion providers remotely, and which thousands of people in states with bans rely on each month for care.
A potent strategy is emerging: Revert back to older Food and Drug Administration (FDA) restrictions on mifepristone under the guise of women’s health and safety, while simultaneously supporting states’ attempts to block out-of-state abortion providers. If it works, the anti-abortion movement could achieve many of the same ends as a federal ban without the political backlash.
Maggie Carpenter’s charges underscore an emboldened anti-abortion movement
Carpenter, a family medicine physician from New Paltz, New York, has become a focal point in the ongoing war over abortion access.
In 2022 she co-founded the Abortion Coalition for Telemedicine Access (ACT) to help enact shield laws in blue states to support providers dispensing abortion pills to patients in red ones. Shield laws protections can include barring state agencies from helping another state’s criminal investigation, and ensuring that an abortion provider does not lose their professional license or face malpractice insurance penalties as a result of an out-of-state complaint. To date, 18 states, including New York, have passed such laws, though Carpenter’s case represents the first real legal test of this shield strategy.
The Texas civil suit filed by Attorney General Ken Paxton alleges that Carpenter violated a state law that bans the mailing or online prescribing of abortion pills to people in Texas. The case was initiated by a report filed with Paxton’s office by a man who claims to be the father of the pregnancy allegedly affected by the abortion pills. The Washington Post reported that the anti-abortion movement plans to launch a campaign encouraging male partners of women who’ve had abortions in Texas to come forward and sue.
The Louisiana criminal case centers on Carpenter prescribing medication to the mother of a pregnant minor. Abortion pills are banned in the state and Carpenter, her medical practice, and the girl’s mother, who turned herself into the police, were all charged with felonies. The Louisiana law carries penalties of one to five years in jail and fines ranging between $5,000 and $50,000.
In an interview with Talk Louisiana, the district attorney who filed the criminal charges, Tony Clayton, said doctors “can’t hide behind the borders of New York and ship pills down here,” but acknowledged New York’s shield law “prevents me” from going there to issue his arrest warrant. Clayton will be prosecuting with state Attorney General Liz Murrill, who warned that Carpenter could face arrest if she leaves New York, as most states honor each other’s warrants through reciprocal agreements.
Julie Kay, Carpenter’s colleague and ACT co-founder, described this as a “watershed moment.”
“This has crossed a line that’s never been crossed in this country and is not what people want,” she told Vox. “Nor is it smart because we have an incredibly high rate of maternal mortality and this pushes people away from licensed practitioners.”
New York has responded aggressively so far to protect Carpenter. Gov. Kathy Hochul explicitly stated she would “never, under any circumstances” extradite the physician, while the state’s attorney general, Letitia James, denounced the prosecution as a “cowardly attempt” to weaponize the law. Days after Louisiana’s indictment, Hochul also signed new legislation that allows physicians prescribing abortion pills to keep their names off the drug packaging. This new shield protection, which took immediate effect, lets doctors put their medical practice’s name on the packaging instead.
Mifepristone and Misoprostol pills are pictured Wednesday, Oct. 3, 2018, in Skokie, Illinois. (Erin Hooley/Chicago Tribune/Tribune News Service via Getty Images)
These shield laws set the stage for new kinds of legal battles between red and blue states. “If Illinois refuses to extradite an abortion provider to Georgia, will Georgia retaliate and refuse to extradite a gun dealer to Illinois?” Greer Donley of University of Pittsburgh, David Cohen of Drexel University, and Rachel Rebouché of Temple University wrote in a 2022 paper that was cited directly in the Dobbs v. Jackson Women’s Health Organization dissent.
A broader backdoor strategy
The lawsuits against Carpenter are part of a broader legal offensive that seeks to exploit the post-Roe landscape.
Louisiana has emerged as a key battleground, in 2024 becoming the first state to classify mifepristone as “a controlled dangerous substance” — putting it in a class of highly regulated drugs that include fentanyl and methamphetamine. According to legislative tracking from the Guttmacher Institute, four more states — Indiana, Mississippi, Oklahoma and Texas — have all introduced or pre-filed bills this year that would do the same thing.
Meanwhile Republican attorneys general from Idaho, Kansas, and Missouri are mounting a new federal challenge to mifepristone that represents a more legally sophisticated approach than previous attempts. Unlike the 2024 Supreme Court case brought by anti-abortion advocates that was ultimately dismissed for lack of standing, these attorneys general argue they have standing because their states incur costs for emergency medical care, and say they have an interest in enforcing their state abortion bans.
The states’ rights strategy will likely appeal to Trump, who campaigned for reelection by insisting the Supreme Court had made abortion a states’ issue going forward. Trump also claimed he would avoid signing any federal abortion ban if elected. His flip-flopping on abortion worked: Most voters believed that Trump would not be a threat to abortion rights and that he would not prioritize the issue. As Vox reported last month, anti-abortion activists have signaled they’re willing to accommodate compromises with the White House that allow Trump to say he’s kept his campaign pledge, even as they push other restrictions and promote “fetal personhood” language in policy wherever possible. (Trump’s recent executive orders have already begun incorporating language about “sex at conception” — a win for the fetal personhood movement.)
State Rep. Mandie Landry, a Democrat from Louisiana, told Vox that her state was already deeply hostile to abortion, even before the charges against Carpenter. The way forward, according to Landry, will be to build more political power state by state, not file more lawsuits or push more federal bills. “The way to dig out of the hole we’re in with reproductive rights and LGBTQ rights is to do the grunt work that takes a long time through the state legislatures,” she said.
The anti-abortion movement’s embrace of states’ rights arguments might seem to conflict with their ultimate goal of ending abortion nationwide. But experts say this strategy could actually advance their broader aim of establishing the national standard of fetal personhood. If the Supreme Court accepts red states’ argument that they can block their residents from getting abortion care from blue states, it would help establish precedent for state authority to “protect unborn life” — precedent that could later support arguments for fetal rights more broadly.
Kirsten Moore, the director of the Expanding Medication Abortion Access Project, says the red state charges against Carpenter reveal the anti-abortion movement’s hypocritical logic. “They’re saying you blue states don’t get to do what you want, and we red states get to do what we want,” she said.
Can red states preempt the federal government?
Over the objections of groups like the American Congress of Obstetricians and Gynecologists, the FDA long has long had mifepristone on its Risk Evaluation and Mitigation Strategies (REMS) list, a designation used when the government determines that increased restrictions are necessary for a drug’s benefit to outweigh its risks. As a result, until relatively recently, patients had to visit doctors in person to receive the medication, meaning telehealth was off limits, and patients couldn’t just fill a prescription at their local pharmacy
In 2017, the ACLU sued the FDA, arguing its mifepristone restrictions were not medically justified, and during the pandemic the FDA temporarily lifted its requirement that mifepristone be dispensed in person at a clinic or a hospital. In December 2021, the FDA announced it would permanently lift the in-person requirement, leading to the robust abortion telemedicine abortion industry that exists today.
But many leaders in the anti-abortion movement cast these actions as proof that lawmakers had “lowered medical standards.” They pushed a number of baseless and misleading arguments about protecting women’s safety which Vox examined in 2023. It’s widely expected that anti-abortion lobbyists will try to push the FDA to reinstate the national restrictions that the Biden administration eased.
Moore, of the Expanding Medication Abortion Access project, emphasizes that this would take time, and almost certainly face legal challenges from drug companies that have invested millions into the FDA drug approval process already. Another option though, could be for an official at HHS to write a memo on behalf of Kennedy claiming mifepristone represents an “imminent harm.” Under federal law, that could empower the HHS Secretary to pull the drug from the market. Moore suspects, however, that a less politically conspicuous states’ rights strategy would be more attractive to Trump.
The fight over whether states can restrict FDA-approved medication isn’t new. In 2022, the manufacturer of generic mifepristone sued Mississippi over its restrictions on the abortion pill, arguing that federal approval should preempt state regulations under the supremacy clause of the Constitution. While that case was ultimately deemed moot after Roe was overturned, the same fundamental tension now animates the Republican attorneys general lawsuit and the prosecution of Carpenter.
Legal scholars see a “strong, though legally uncertain” argument that federal authority should prevail when state and federal law directly conflict. But anti-abortion forces are betting that the current Supreme Court, which emphasized state authority in overturning Roe, will be receptive to arguments for state power to restrict abortion pills — even if that means overriding federal drug approvals.
For providers like Carpenter, these federal developments add another layer of uncertainty to an already precarious and shifting landscape. Even if she and her colleagues successfully fight off state-level prosecution, FDA rule changes could effectively limit their ability to provide telehealth abortion care to patients in restricted states.
The legal challenges to Carpenter will likely take months, if not years, to play out. A spokesperson for ACT declined to comment on the new Texas penalties.
For now, advocates emphasize that abortion remains accessible and affordable to people in all fifty states. Should that change — be it through new FDA restrictions, new aggressive enforcement of the Comstock Act, or other developing tactics — even the backup option of international providers like Aid Access might not be enough to prevent a significant increase in people forced to carry unwanted pregnancies.
Still, a broader aim of the anti-abortion movement is to deter providers like Carpenter from choosing to offer care at all. While the immediate battles center on medication abortion and the provision of care to red states, the long-term goal for the anti-abortion movement is to end access in all states, with fetal personhood established nationwide.
When asked how other providers have been reacting to the charges, Kay, the ACT co-founder, said the new attacks follow a long history of violence, harassment and intimidation against people who offer this care. “Nobody becomes an abortion provider lightly,” she said. “They do it because they’re mission-driven and because they recognize that one in four women in America will have an abortion, with more than half of those already mothers.”
