Launched in 2023, The Massachusetts Medication Abortion Access Project (The MAP) is a telemedicine service that provides medication abortion care to patients in all U.S. states and territories. The procedure uses prescription pills, mifepristone and misoprostol, to end a pregnancy in its early stages.
The service can legally operate under Massachusetts’ comprehensive Shield Law, which “protects providers, helpers and funders from criminal, civil and licensure penalties when providing legally protected reproductive health and gender-affirming care,” says Foster, who holds the University Research Chair in Medication Abortion.
In short, if the clinician resides and is licensed to practise in Massachusetts, and prescribes abortion medication from that state, the care is considered to take place in Massachusetts. The patients’ location doesn’t matter, even if they live in a state that bans abortion.
“Right now, somewhere between 33 and 40 percent of American women of reproductive age live in a state where they have fewer rights to abortion care today than they did prior to Dobbs,” says Foster, referring to Dobbs v. Jackson Women’s Health Organization, the landmark ruling of the U.S. Supreme Court in 2022.
Demedicalizing abortion care
Foster leads The MAP’s research team, while the project’s five clinicians prescribe medication abortion drugs and provide virtual care and follow-up. A group of 100 volunteers package and mail the prescriptions to clients. Patients are asked to pay what they can for the service, with a minimum payment of five dollars. Cost shortfalls are covered through donations and fundraising.
The project’s team has witnessed first-hand one of the repercussions of the Supreme Court’s decision: a surge in demand for medication abortion via telemedicine. In a little over two years, The MAP has cared for more than 40,000 patients in the U.S.
“In our first year, we provided care to just shy of 5,000 patients,” says Foster. “A third of our patients were from Texas; 95% of our patients were from states with bans and restrictions on abortion.”
Foster and her team have undertaken a study to demonstrate that telemedicine medication abortion care through the Shield Law provision is as safe as in-clinic care. The previous community-based projects she conducted, in Pakistan, Jordan, Uganda and northern Thailand, all demonstrated that even when demedicalized abortion is conducted outside of formal health systems, it is effective and very safe.
The personal cost of action-oriented research
The professor describes her scientific approach as “implementation research,” which is “action- and intervention-oriented” and sometimes comes at a personal cost. Lawyers have advised her that due to her work on The MAP, Foster should not travel to or through American states with partial or total restrictions on abortion, which means she can’t visit her mother and stepfather, who live in South Carolina.
Foster’s interest in safe access to abortion care, and her subsequent research trajectory, are also deeply personal. Her mother became an advocate for reproductive health rights after she sought an abortion in Mexico while a college student in the 1960s, before abortion was legalized nationwide in the U.S. When she was 10 years old, Foster decided she wanted to become an abortion provider to make sure that no one would have to go through what her mother had experienced. Her resolve was further strengthened years later during an internship at a hospital in Cairo, Egypt, where she saw many women on the labour and delivery floor being treated for complications caused by unsafe abortions.
“That really reinforced to me the importance of working globally towards safe abortion care,” she says.
After her studies at Harvard Medical School, Foster opted to work on abortion policy research instead of clinical practice. Influencing policy continues to drive her research today and is central to her current role as University Research Chair in Medication Abortion.
Over a five-year term, Foster and her team will conduct a series of studies aiming to make medication abortion drugs available behind-the-counter in Canada, among other strategies to safely and effectively demedicalize abortion. She says Canada has the potential to become the first country in the Global North to expand medication abortion access within the health system, thus promoting more equitable care.
Foster is also putting the finishing touches on a forthcoming book she is co-editing, titled Abortion, politics, and the pill that promised to change everything: The global journey of mifepristone. It chronicles the more than 35-year history of the “abortion pill” that was first licensed for use in France in 1988 and has since been used by tens of millions of women worldwide. The book explores how mifepristone changed our understanding of abortion, and has simplified access to care, gradually moving it from the clinic into women’s hands.