Three Republican-led states — Louisiana, Alabama, and Arkansas — filed two lawsuits last week arguing that out-of-state medical providers are creating a "public nuisance" by mailing abortion pills across state lines. The suits also take direct aim at shield laws in New York, California, and Massachusetts, which protect abortion providers from out-of-state prosecution. Legal experts call this an unprecedented use of public nuisance law — a doctrine traditionally reserved for environmental pollution and similar public harms — to restrict access to a federally approved medication.

The lawsuits come as telehealth prescribing of abortion drugs continues to surge. Medication abortion now accounts for 65% of all US abortions, and roughly 91,000 abortions were provided via telehealth in 2025 to patients in total-ban states — up from 74,000 in 2024. The FDA, which has repeatedly affirmed mifepristone's safety, expects to complete an ongoing safety review by March 2027.

By the Numbers:

• 91,000 telehealth abortions in ban states in 2025 (up from 74,000 in 2024)
• 65% of all US abortions in 2023 were medication abortions
• ~30 individual medical practitioners and groups named as defendants in the Louisiana federal lawsuit

Why it matters: This legal strategy could reshape abortion access nationwide. If successful, it would set a precedent allowing abortion-ban states to effectively extend their restrictions beyond their borders — directly threatening the shield law protections that have become a critical lifeline for patients and providers alike.