Abortion pills post-Roe: How doctors are helping women have abortions

Linda Prine is a family physician and co-founder of the Miscarriage and Abortion Hotline, which advises women who want to use medication to manage an abortion. For women who need an abortion in countries where the procedure is completely or partially banned, the drugs, mifepristone and misoprostol, are often the best chance to receive abortion care, especially if they cannot travel.

In 2020, the last year for which complete data is available, medication abortions accounted for more than half of all abortions in the United States. While the FDA recently authorized pharmacies to carry the pill, and patients receive the drug by mail, online pharmacies in the US still won’t sell or ship to countries where self-administered abortions aren’t illegal – meaning patients often rely on overseas providers. , which can take weeks.

At the hotline, Prine and other volunteers talk to women about the abortion process themselves, advise on various medical and privacy issues, and help provide resources for women who want to order the pill (the line does not provide the pill itself). . Prine and doctors like her are at the forefront of efforts to ensure women retain their right to abortion care — efforts that will have important legal and political implications in the years to come. Vox spoke with Dr. Prine about how it works has changed since the fall Roe v. Wade (The number of calls to the hotline, he said, has tripled since the Supreme Court Dobbs v. Jackson Women’s Health decision last June), and what they think will be needed to protect jobs that provide telemedicine in countries with restrictions in the coming weeks and months.

This interview has been edited for length and clarity.

What made you decide to start a hotline?

We actually started during the Trump years, when we were just frustrated with all the state restrictions, and we didn’t realize how bad it was. At first there was only a group of 12 of us, and we were staffed for about 12 hours a day, and we each took a couple of shifts a month. That’s a lot at first. Then it got noisy.

Do you remember where you were when the Supreme Court decision came down Roe?

I was actually in the car, traveling for the holidays, and my phone just blew up. This is a call from a practice I’m involved in, in New Mexico, because some clinics on the Texas side have given out their phone numbers because they’re canceling people’s appointments. I think I talked to 60 people that day, just not stopping, trying to help them get treated somewhere. It was a really traumatic day for everyone. They really call us sobbing and freaked out and upset and incredulous.

What has changed since the fall of Roe? How has it changed your work?

Well, the hotline has increased, and the difference now is that many people call us later in pregnancy, because they are taking pills from abroad. They are ordering pills from an online pharmacy, and sometimes there is no direction. So he called us about it. But also, they are more advanced in pregnancy and we are called afraid, because they have passed the small but recognizable fetus, and they are afraid and do not hope. And frankly traumatized, what people experience, because they do not have anticipatory guidance that can happen, and people who have had abortions before using the pill do not go through anything that they can see.

The pill is approved by the FDA for up to 10 weeks and by the World Health Organization for up to 12. Most often, they have been used in our country for less than eight weeks; an estimated 75 percent to 80 percent of people who use the pill used the drug less than eight weeks ago.Dobbs. But now, they use it whenever they can get it. And sometimes it’s a little later. Sometimes 14 weeks, 18 weeks. So we got a call from a very scared, crying, crying person. I am for us, trauma and horror from Dobbs the decision is that people should experience things they shouldn’t experience.

Do you feel that this delay adds trauma to people that they would not have gone through, had they had access to the pill in the first place?

Yes, indeed. People do not use this pill at the end of pregnancy,Dobbs. This is a big change. There is no research to support it [that] not yet. This is all we see on the ground.

You mentioned that the staffing needs of the hotline are different now, after allDobbs.

We are now up to 60 volunteers. We went from 12 to 20 to 40. And then, yes, with Dobbs we need to extend the hours and shorten the shift. You just can’t be on the phone for eight or 12 hours straight. So now we’re doing six-hour shifts, and I’m getting stronger. You’re receiving text messages and phone calls at the same time and trying to talk to as many people as you need, and it’s a little bit tired by the time six hours are up.

Are there other problems you hear from patients who call?

People are afraid to go to the emergency room if they think they need it, and usually they don’t, so we talk about it and explain what they need to do to take care of themselves. But we also tell them, if they decide to go, how to protect themselves in terms of how to explain what happened. In other words, she was miscarrying, not having an abortion, and no one in the emergency room knew she was on the pill. There is no blood test for that. There is no exam to show that this is the case. Knowing how to maintain privacy in a medical setting, when it can be a dangerous place, is very important.

Currently, it is not true that the medical officer has a duty to report the patient. In fact, they shouldn’t do this because it would violate HIPAA. And it is not illegal for people to buy pills from the internet and use them. What is illegal, in most of these countries that have enacted laws, is for doctors to provide these pills. So the doctor, if he provides the pill, is breaking the law, not the patient. But that doesn’t mean there isn’t fear out there. It hasn’t been explained to the general public, I don’t think people who use abortion pills are breaking the law.

What other challenges do patients face?

The hardest thing for us is the difficulty in accessing treatment and then the delay in accessing treatment. And that’s why a lot of people are involved in this movement to get shield laws passed in blue states so that they can serve people who have FDA-approved drugs to be shipped quickly through the US Postal Service to those red states, so that people can get what they need in two to three days instead of over a week.

How do you think about the personal risk involved in doing that kind of work? Because it is zero risk for you as a provider.

I live in New York City, so I feel very safe there. If it comes to passing the shield law and we mail pills to a red state and some zealot from Texas or Louisiana or Alabama wants to try to arrest me, I believe that our law passed in the state of New York, and the lawyers who have surrounded us with pro-bono offers, will take care of me. And really, the optics of arresting doctors for providing humanitarian care in these states that limit that care, I don’t think it’s going to get many votes for the Republicans. So I’m willing to go out and let them see how it goes.

In addition to protective legislation, is there anything that state and local lawmakers who protect abortion rights can do to help make your job easier?

Yes, there is a new law proposed by Assemblywoman Amy Paulin in New York state that would allow standing orders to pharmacies for abortion pills. So just like you can go to a pharmacy and get a vaccine without a special doctor’s order for you, you can go to a pharmacy and get an abortion pill without a special doctor’s order for you. That’s brilliant. And if they need a doctor to do a standing order, sign me up.

We must continue to be creative like this. And honestly, you don’t need a doctor to get you an abortion pill. You’re swallowing them up front, no matter where you get them… It’s really not rocket science. And people are perfectly competent to decide what they need at that time in their lives. So I all support all initiatives that make access to these pills easier.

The safety and efficacy of these drugs is something that people, especially legislators, need to understand so that they can be more comfortable with easy access and make it possible for us to perform telemedicine abortions across state lines. people to pick up in the pharmacy, and get rid of FDA regulations that make it hard to prescribe this medication.

Another thing we’re seeing an increase in is people ordering the pill if they have one. This is called an advance provision. And those of us who work for Aid Access get a lot of requests for advance provision – people are not pregnant, but they want to have the pill in their medicine cabinet just in case. Especially if they live in a red state where it can take three or four weeks to get a pill, having someone on hand is a good idea.

Did you see a lot before this, people want pills just in case?

Not. This has been done through the roof since it fell off Dobbs, especially in the first couple of weeks. People were overwhelmed with requests for advance arrangements.

A bigger problem I’ve heard, from my OB-GYN friends in these red states, that with normal maternity care, it’s terrible. I don’t know what the solution is for that other than really having a referendum in as many countries as possible to make abortion legal.

Would you like to share some of the things you hear from your colleagues about maternity care?

I’ve heard of them trying to bring their own patients to other countries for the treatment they need, which is crazy. If you have a person who has premature rupture of the membrane with a pre-viable fetus, and they must have the fetus removed for their own well-being and safety, and it will not be a living being – it is not possible. to do the procedure in your own country, but to have to transfer someone with the risk of bleeding, with the risk of infection, is crazy. It’s a crazy thing that’s happening in health care. People are literally in the Signal chat trying to find treatment for their patients. So, yeah, that’s what I heard. It’s devastating news from many of these countries.

What else is there to remember?

Now is the time to be proactive. That November election, the voters told us: We want access to abortion. So we have to go ahead and see how we can get people access. Just fear his shadow, or that we will be punished criminally for this, that, or the other. Let’s move and see what we can do to make abortion available to every creative [method]: legislative, weak, border crossing, whatever. I have won. Voters have told us they want abortion access, and the American people want it. So let’s look out for them instead of worrying about our own criminalization.