The anti-abortion movement in the United States has set its sights on a new target: doctors sending pills across state lines to help women end unwanted pregnancies.

Since the US Supreme Court's decision to overturn the federal protection of the right to an abortion, states like Texas and Louisiana have adopted tough anti-abortion laws.

Women seeking to end pregnancies, even victims of rape or incest, are now obliged to travel long distances or to seek the delivery of abortion pills from other jurisdictions.

And that measure is now under attack.

Texas and Louisiana are launching a legal case against a doctor in New York, a state which in turn has passed a "shield law" to protect its physicians from outside prosecutions.  

"These are the first kind of cross-border fights that we've seen since Roe was overturned," said California legal scholar Mary Ziegler, referring to the 2022 Supreme Court decision.

"And those are just, I think in some ways, the tip of the iceberg. We're likely to see a lot more of these cross-border fights. From Texas or Louisiana's standpoint, they're saying: 'Why is this doctor mailing pills into our state?'" explained Ziegler, a professor at the law school at the University of California, Davis.

"And from New York's standpoint, they're saying: 'Our doctor wasn't doing anything wrong. Why are you trying to prosecute her?'"

'Chilling effect'

In Texas, Attorney General Ken Paxton declared that "out-of-state doctors may not illegally and dangerously prescribe abortion-inducing drugs to Texas residents."

Margaret Carpenter, a New York doctor and a co-founder of the Abortion Coalition for Telemedicine, was ordered to stop sending pills to Texas and fined $100,000.  

In Louisiana, she faces criminal charges and the state has demanded her extradition, to which New York Governor Kathy Hochul responded. "Not now, not ever."

Hochul said the state's shield law was designed to "anticipate this very situation."

According to #WeCount, an initiative that collates abortion statistics nationwide, 10 percent of abortions in the second quarter of 2024 were conducted under the protection of shield laws.

This accounts for approximately 10,000 women each month. 

In Louisiana, this was the solution chosen by 60 percent of women — about 2,500 — to terminate pregnancies in the second half of 2023, #WeCount estimates.

Now, abortion rights activists fear that individual doctors will be targeted.

"The tactic of going after providers, patients and helpers through the courts is definitely something that we are going to see them try more of," Amy Friedrich-Karnik, of the Guttmacher Institute, told AFP.

"And I think the goal is both to, you know, scare those individuals... and there's a chilling effect from that," said Friedrich-Karnik, a policy director at the pro-abortion rights think tank.

The legal battles will be long, and the results are far from certain. Some cases may get to the Supreme Court, and it is not clear whether President Donald Trump's administration will attempt to intervene. 

"This is a long-lasting debate, even if it goes to the Supreme Court," Ziegler said.

"Because then what would happen is the next case that comes along will be different enough that whatever the Supreme Court has to say about these cases won't give us the answer necessarily," she said. 

"There's not... going to be one clean solution that the Supreme Court reaches that resolves this once and for all."

Procedure rejected

Meanwhile, the attorneys general of Idaho, Kansas and Missouri have demanded that the federal Food and Drug Administration (FDA) end prescriptions of the pill via online medical visits — effectively restricting access nationwide.

A similar request was nevertheless rejected by the Supreme Court in 2024.

"There's uncertainty about what Trump is going to do. There's uncertainty about what power states have to project power outside of state lines. There's uncertainty about what the FDA is going to do," Ziegler said. 

"Simply not knowing can impact patients and doctors. But that's the scenario right now — there's a big question mark around a lot of it."