The Post-Ro Abortion Pill: How Doctors Are Helping Women Abort

Linda Prine is a family physician and co-founder of the Abortion and Abortion Hotline, which advises women who want to use medication to self-manage their abortions. For women in states where the procedure is banned in whole or in part, the drugs, mifepristone and misoprostol, are often their best chance of obtaining abortion care, especially if they are unable to 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. Although the FDA recently allowed pharmacies to carry the pill, and for patients to receive the drug by mail, online pharmacies in the United States still won’t sell or ship to states where self-administered abortions are illegal — meaning patients often rely on overseas suppliers, which take weeks. can take

At the hotline, Prine and other volunteers talk women through the abortion self-management process, offer advice on medical and privacy concerns, and help provide resources to women seeking to order the pill (the hotline itself does not provide the pills). Prine and physicians like her are at the forefront of efforts to preserve women’s rights to abortion care—an effort that will have important legal and political implications for years to come. Vox spoke with Dr. Prine about how her work 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 he thinks will be needed in the coming weeks and months to protect states’ jobs to provide telemedicine with restrictions.

This interview has been edited for length and clarity.

What made you decide to start the hotline?

We actually started this during the Trump years, when we were frustrated with all the state restrictions and little did we know how bad it would get. Initially there was a team of only 12 of us, and we staffed about 12 hours a day and each of us took a few shifts a month. It was abundant in the beginning. And then it gets busy.

Do you remember where you were when the Supreme Court verdict was overturned? Ro?

I was actually in a car, traveling to go on vacation, and my phone blew up. It was a call from the practice I was attending in New Mexico, because several clinics in Texas had given us phone numbers because they were canceling people’s appointments. I think I talked to 60 people that day, just nonstop, trying to help care for them wherever we could. It was a really painful day for those people. They really called us crying and upset and upset and incredulous.

What has changed since its fall Ro? How has it changed your work?

Well, the hotline is getting more calls, and the difference now is that many of our callers are later in their pregnancy, because they’re getting their pills from overseas. They are ordering pills from online pharmacies, and they sometimes come with no instructions. So they called us about that. But also, they’re further along in the pregnancy and they’re scaring us, because they’ve passed a small but recognizable embryo, and they’re scared and they didn’t expect it. And it’s frankly traumatizing, what people are going through, because they had no advance guidance that this was going to happen, and people who have had abortions before on the pill didn’t go through anything that they could see.

The pills are approved for up to 10 weeks by the FDA and up to 12 by the World Health Organization Although most of the time, our country has used under eight weeks; 75 percent to 80 percent of people who use the pills stop using them before eight weeks.Dobbs. But now, they are using them whenever they can get them And sometimes that is quite a bit later. Sometimes it’s 14 weeks, 18 weeks. And so we get calls from people who are completely distraught, crying, crying. I think for us, trauma and its horror Dobbs The conclusion is that people have to go through something they shouldn’t have to experience.

Do you think these delays compound trauma for people that they wouldn’t otherwise have to go through, if they had access to the pills early?

Yes, absolutely. People did not use these pills late in pregnancy, before-Dobbs. This is a huge change. There is no research to support it [that] yet. This is exactly what we are seeing on the ground.

You mentioned that your staffing needs at the hotline are different now, post-Dobbs.

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

Are there other types of concerns that you hear from patients who call in?

People are afraid to go to the emergency room if they think they need it, and most of the time they don’t, so we talk to them from that end and explain what they need to do to take care of themselves. But we also tell them, if they decide to go, how they can protect themselves by explaining what is happening to them. In other words, they’re having an abortion, they’re not having an abortion, and it’s impossible for someone in the emergency room to know they’ve used the pill. There is no blood test for this. There is no test to show this. So letting them know how to protect their privacy in the medical system, when it becomes a potentially dangerous place, was really important.

Now, it’s not really true that any medical staff has any duty to report the patient. In fact, they are not supposed to because it would be a HIPAA violation. And it’s not illegal for people to buy and use pills from the Internet. What is illegal, most of these states have passed laws, is for doctors to dispense pills. So the doctors, if they supply the pills, would be breaking the law, not the patients. But that doesn’t mean there isn’t an atmosphere of fear. It’s not made clear to the general public, I don’t think people are breaking any laws by using abortion pills.

What other challenges are patients facing?

The thing that’s hitting us the most is difficulty accessing care and then late access to care. And that’s why so many of us have been involved in this movement to pass SHIELD legislation in blue states so that we can serve people with FDA-approved drugs that we can mail faster through the U.S. Postal Service to those red states, so that people have two to three weeks rather than one. Can get what is needed during the day.

How do you think about your personal risk when doing this type of work? Because it’s zero risk for you as the provider.

I live in New York City, so I feel very safe there. If it comes to passing a shield law and we send pills to a red state and some bigot in Texas or Louisiana or Alabama wants to try to arrest me, I feel confident that the law we passed in New York state, and the lawyers who will give us a pro bono offer. Surrounded, they will take care of me. And really, the optics of arresting doctors for providing humanitarian care in these states that are limiting care, I don’t think that’s going to win many votes for Republicans. So I’m willing to be there and let them see how it goes.

Without shield laws, can state lawmakers and abortion rights advocates help make your job easier?

Yes, there is new legislation proposed by New York State Assemblywoman Amy Paulin that would allow pharmacy standing orders for abortion pills. So just as you can go to a pharmacy and get a vaccine without a specific doctor ordering it for you, you can go to a pharmacy and get your abortion pills without a specific doctor ordering it for you. That’s brilliant. And if he needs a doctor for a standing order, sign me up.

Let’s continue to get creative like this. And frankly, you don’t need a doctor to prescribe you an abortion pill. You’re swallowing them at home, wherever you get them… it’s not really rocket science. And people are fully capable of deciding whether they need it at that point in their lives. So I support all initiatives that make access to these pills easier.

The safety and effectiveness of these drugs is what people, and especially lawmakers, need to understand, so that they can ease access and make it possible for us to perform telemedicine abortions across state lines. People can pick them up at the pharmacy, and get rid of FDA regulations that make it difficult to prescribe this drug.

Another thing we’re seeing an increase in is people ordering pills just in case. It is called advance provision. And those of us who work on Aid Access get a lot of requests for advance provisions — people who aren’t pregnant at all, but want to keep these pills in their medicine cabinets. Especially if they’re in a red state where it can take three or four weeks to get your pills, it’s a really good idea to have them on hand.

Is this something you’ve seen a lot before, people asking for pills just in case?

no Since its collapse it has gone completely through the roof DobbsEspecially in the first few weeks. People were overwhelmed with requests for advance arrangements.

That’s the big problem I’m hearing, from my OB-GYN colleagues in this red state, with normal obstetric care, terrible. I don’t know what the solution is other than having referendums in as many states as possible to legalize abortion.

Feel free to tell us some things you’ve heard from your own colleagues about maternity care?

I hear they are trying to take their own patients to other states for the care they need, which is crazy. If you have someone who has a premature rupture of the membranes of a pre-eclamptic fetus, and they have to remove that fetus for their own well-being and safety, and it’s never going to live—not being able to do that procedure in your own state, but bleeding. At risk, to have to transfer someone who is at risk of infection, is madness. It’s a crazy thing that’s happening in healthcare. People are literally trying to take care of their patients on signal chat. So, yeah, that’s what I’m hearing. This is devastating news from many of these states.

What else should we remember?

Now is the time to get active. In that November election, voters told us: We want access to abortion. So we have to go and see how we can get people access. Enough to be afraid of our shadow, or we’re going to be guilty of this, that or the other thing. Let’s move on and see what we can do to make abortion available by every creative [method]: Legal, underground, beyond borders, whatever it takes. I think we won. Voters told us they want access to abortion, and the American people want it. So let’s get it for them without worrying about our own criminalization.