Three Republican-led states are taking a new legal approach to enforcing abortion restrictions, arguing that out-of-state providers who mail abortion pills across state lines are creating a “public nuisance.”

Louisiana, Alabama and Arkansas filed two lawsuits last week targeting the interstate distribution of abortion drugs. One lawsuit was filed directly with the U.S. Supreme Court and challenges shield laws adopted by New York, California and Massachusetts, while the other was filed in federal court in Louisiana and names nearly 30 medical providers and organizations as defendants.

The states argue that shield laws, which protect abortion providers from prosecution and civil liability stemming from other states, allow medical providers to circumvent abortion restrictions adopted by states where the patients live.

The legal strategy relies on public nuisance law, which has traditionally been used in cases involving environmental pollution and other threats to public health and safety. In recent decades, states have also used the doctrine in lawsuits involving tobacco, opioids, climate change, vaping and social media.

The Republican-led states contend that abortion-pill shipments fit within that framework because they undermine laws enacted to restrict abortion within their borders. In their Supreme Court filing, the states compared the alleged conduct to scenarios involving dangerous substances being intentionally sent across state lines.

The lawsuits come as telehealth has expanded access to medication abortion in states with strict abortion laws. About 91,000 abortions were provided through telehealth in 2025 to patients living in states with total abortion bans, up from approximately 74,000 in 2024, according to the Guttmacher Institute.

New York Attorney General Letitia James and Massachusetts Attorney General Andrea Joy Campbell, both Democrats, defended their states’ shield laws and accused the Republican-led states of attempting to impose their abortion policies beyond their borders. California Attorney General Rob Bonta’s office did not immediately comment.

The dispute stems from the broader legal battle over abortion access following the Supreme Court’s 2022 decision overturning Roe v. Wade. Since then, nearly half of the states have banned or severely restricted abortion, while women in those states have increasingly relied on travel, telehealth, and mailed abortion medication.

Medication abortion generally uses mifepristone followed by misoprostol and is used to terminate pregnancies during the early stages. The FDA and major medical organizations have maintained that mifepristone is safe and effective when used as directed.

Republican-led states have separately challenged federal policies governing mifepristone and telehealth prescribing. The Supreme Court in May declined Louisiana’s request to halt telehealth prescribing and nationwide mail delivery of the drug while that litigation continues.

The new public nuisance lawsuits face significant legal hurdles. Critics argue the cases are unusual because they concern federally approved medication and focus primarily on states’ ability to enforce their own abortion laws rather than preventing a conventional public health nuisance.

The Supreme Court could also decline to hear the lawsuit between the states, as it routinely rejects disputes brought directly under its original jurisdiction.

The cases represent another front in the increasingly complex battle between states with abortion restrictions and states that have enacted laws designed to protect providers who assist patients from other states.