The decision to overturn Roe v. Wade last summer sent shockwaves around the country. Today, at least 13 states completely ban abortion, and the number of states with bans is likely to jump up to 24 in the coming months.
At the same time, demand for abortion pills is on the rise, growing more and more urgent: Requests for pills that allow pregnant women to have their abortions at home increased 33 percent in the 30 most restrictive states.
But how do abortion pills work? Are they safe? And how are people getting them?
In a Ms. webinar on Wednesday, Jan. 18, two reproductive health advocates—Lauren Dubey, a nurse practitioner in Los Angeles and co-founder and chief nursing officer of Choix, a telehealth clinic with a vision of using technology to expand access to abortion care; and Melissa Madera, special projects consultant at Plan C Pills and host of the podcast The Abortion Diary—joined Ms. editor Carrie Baker, to break down everything you need to know about abortion pills.
Below, find a recording of the event, plus a transcript, lightly edited for clarity.
Carrie Baker:
In 2000, the U.S. Food and Drug Administration approved the abortion pill mifepristone to be used in combination with another medication misoprostol to end an early pregnancy. The Guttmacher Institute estimates that in 2020, 54 percent of all abortions occurred with abortion pills.
During the pandemic, telemedicine abortion with pills became widely available for the first time, leading to changes in FDA policy to permanently allow this practice. Over 20 states now have telemedicine abortion providers serving people in their states.
Just last week, the FDA issued procedures for pharmacies to become certified to distribute mifepristone for the first time, which Walgreens and CVS say they’ll do soon, making the medication much more widely available.
Now that the Supreme Court has overturned Roe v. Wade, increasing restrictions on abortion are making abortion pills more important than ever. Thirteen states now ban abortion, and 18 states ban telemedicine abortion. But post-Roe will not look like pre-Roe because of abortion pills, which are a game-changer.
Last week, the Department of Justice ruled that mailing abortion pills to people in red states does not violate the federal Comstock Law. People in red and blue states are now ordering pills online and using them in the privacy of their own homes without having to take time off work, travel long distances to clinics and pass through anti-abortion protesters to get the care they need. But are they safe? And how do they get them if they live in red states that ban abortion? This are some of the questions we’ll answer today.
Today, we’re joined by two amazing reproductive justice health advocates: Lauren Dubey of Choix and Melissa Madera of Plan C.
Lauren, can you tell me how abortion pills work?
Lauren Dubey:
Mifepristone and misoprostol are commonly known the abortion pill. It’s actually two medications that are taken together to end a pregnancy in the first 11 weeks or early in your first trimester.
The first medication, mifepristone, works by stopping the hormone that helps feed a pregnancy or helps it continue.
Misoprostol does two things. It dilates your cervix and it also can cause uterine contractions to help you pass the pregnancy. It induces bleeding and that’s how the abortion is done.
We at Choix also provide medications to support any side effects that you may experience, like pain or nausea.
Getting a telemedicine abortion is just as safe and effective as getting an abortion in a clinic, where you might have to wait, where you have to have potentially other invasive services done, where you might have to cross protesters.
Lauren Dubey
Carrie Baker:
Are abortion pills safe and effective?
Lauren Dubey:
They’re super safe and super effective. The regimen of mifepristone and misoprostol overall is about 95 to 98 percent effective. It sort of varies based on the route that you use it, because there are a couple different routes that you can administer misoprostol, that second medication. And also the effectiveness varies slightly based on how far along you are. But they’re really, really safe and effective overall.
Carrie Baker:
Is telemedicine abortion as safe as if you went into a clinic to meet with a doctor?
Lauren Dubey:
Yeah. One thing that’s been really exciting: The rise of telemedicine abortion services such as ours has helped illustrate how safe and effective this is. We know that getting a telemedicine abortion is just as safe and effective as getting an abortion in a clinic, where you might have to wait, where you have to have potentially other invasive services done, where you might have to cross protesters. So, we know about the safety and the effectiveness. Now it’s even sometimes more preferred.
Carrie Baker:
What’s the difference between emergency contraception and abortion pills?
Lauren Dubey:
Great question. So emergency contraception is commonly known as Plan B or the morning-after pill. That medication doesn’t do anything to an existing pregnancy. It can help prevent an unwanted pregnancy if you have unprotected sex at a time you forgot to use a condom or birth control failure. So that’s how that pill works.
The abortion pill is for an existing pregnancy. So, if you have an unwanted pregnancy, you don’t want to continue it, you take these two medications.
But emergency contraception will no do anything if you are already pregnant. It’s intended to prevent pregnancy.
Carrie Baker:
So why would someone choose telemedicine abortion with pills, as opposed to a procedural abortion in clinic?
Lauren Dubey:
So there’s:
- telemedicine abortions with pills,
- in-person or in-clinic abortion with pills, and
- in-clinic or hospital or surgical center procedural abortion—where instruments are used to remove the pregnancy from your uterus.
They all have their benefits.
If you have a hard time figuring out when you might have a day free from work or childcare, a telemedicine abortion can be done after hours on your phone in the privacy of your own home. Nobody else needs to know what you’re doing and you can submit a request, you can have an evaluation, you can receive your medications all without having to disrupt your regular schedule.
Whereas a procedural abortion maybe takes a little bit more time and requires an appointment and maybe it requires travel. It may require a couple different things. However, a procedural abortion can happen just in one day, where a medication abortion—whether you get your pills from a clinic or via telemedicine—happens over the course of a couple of days. So, it really is dependent on your situation, your lifestyle, your preferences.
Carrie Baker:
So how does Choix work? How does somebody get care from you and what’s the process?
Lauren Dubey:
Most people find us through the internet. They search for “how can I get abortion pills,” and they sign up. So you submit an initial medical questionnaire to our service at any time and then we review them on an ongoing basis during normal business hours.
If you’re approved to proceed with care, we’ll actually send you either text message or email links to proceed with next steps. All of our care at Choix is asynchronous—meaning it doesn’t happen in real time. We don’t require a video or a phone visit. We’ll send you links to proceed with signing consent forms and completing the final payment for our service. Then once we get that back from you, we’ll send your medications to our partner pharmacy. It’s a mail-order pharmacy based in Southern California. Once they receive the prescription, they’ll package up all your medications and they’ll ship them to your door.
Once medications are received, we ask that patients check in with us and say, “Hey, I got my medication and this is when I plan on taking it.” Once we know when you take your medications, we’ll then send you a follow-up link to make sure everything went as planned and that you didn’t have any sort of unexpected side effects or complications after taking the medication. If everything looks good, then we’ll schedule a four-week follow-up visit, where we’ll instruct you to take a pregnancy test at that particular time or you’ll follow up with us and say, “Hey, I got my first period after the abortion. I think it’s complete.”
Throughout the entire process, people have access to patient care coordinators and nurse practitioners or nurse midwives during our regular business hours, as well as supporting clinical physician staff. So, we have a team behind you every step of the way if you have any questions outside of those normal scheduled visits.
Carrie Baker:
How much does it cost? Does it cost the same as if you go into a clinic to get an abortion?
Lauren Dubey:
No, it doesn’t. At Choix, right now, the cost of care with us is $299. However, we do offer a sliding scale, so people can pay less if they’re not in a position to afford that cost, and they can pay more if they’re in a position to help offset the cost for someone else.
A medication abortion in person can often be way more expensive than that if your insurance doesn’t cover it or you don’t want to use your insurance. But also, in some places, insurance may cover the cost of an in-clinic medication abortion. So, it really varies. However, we know that even if people have insurance that may cover a medication abortion, they might choose us because they would have to wait two or three weeks for a medication abortion visit in the clinic, whereas with us they can submit a request and potentially have medications within two days.
Carrie Baker:
So you respond pretty quickly and then if somebody’s eligible, you mail the pills overnight or within a couple days?
Lauren Dubey:
Yeah. We have options.
You can choose to pay a little bit extra for an expedited shipping process through our mail order pharmacy.
Otherwise, people have generally received their medications with regular shipping in about three to five business days regardless of location. But you can choose next-day shipping and have them within the next day. So, it’s very possible that if you submit a request for pills on Monday, your pills could be in your hand by Wednesday.
Carrie Baker:
Do you work with local pharmacies? Could you call in a prescription to a local pharmacy? I mean as soon as that’s allowed…
Lauren Dubey:
Theoretically, yes. There are a couple different hoops that we’ll have to jump through as providers and pharmacies to make sure that there’s a good partnership there, but yeah, we could potentially prescribe these medications to be picked up at a local pharmacy.
There’s still a lot that we don’t know about this yet, and it’s going to unfold in these next couple of weeks ahead of us here. But it is an exciting prospect that someone could get them the same day as a consultation with us if we were to send it to a retail pharmacy, like CVS or Walgreens.
It’s very possible that if you submit a request for pills on Monday, your pills could be in your hand by Wednesday.
Lauren Dubey
Carrie Baker:
You mentioned that it was a sliding scale. Do you take insurance, or do telemedicine abortion companies take insurance?
Lauren Dubey:
At Choix we do not accept insurance right now, but it is definitely in the works for hopefully sometime later this year.
Carrie Baker:
Are abortion pills hard to use?
Lauren Dubey:
No … but I should be a little bit sensitive and reserve judgement—as long as you don’t have any problems swallowing pills.
The mifepristone pill—that first pill that you would take—is not a huge pill, and we’ve got lots of nifty tips and tricks for people who do have a hard time swallowing pills.
Then the misoprostol is also not that hard to take at all. It actually is a dissolving medication, so you either dissolve that one in your cheeks, in the pocket between your cheeks and your gums, or it can actually be inserted into the vagina and then the pills are tucked all the way back into your cervix. That method can sometimes be preferable for people who have a lot of nausea. Sometimes it can make people a little uncomfortable if they’re worried that they’re not putting the pills in far enough or something like that. But they’re otherwise pretty easy to use.
Carrie Baker:
What is the experience? What does it feel like to use abortion pills?
Lauren Dubey:
The experience really varies from person to person. It also varies a little bit based on if you’ve been pregnant before and had a delivery of a pregnancy. It may be dependent on your pain tolerance.
But the guidance that we tend to start with for patients is that it is probably going to be more painful than menstrual cramps. Then people have different opinions about if bleeding is gross or if bleeding is comfortable or uncomfortable, but it can be an uncomfortable process for a couple of hours, but we do our best to make sure that you have what you need in order to be the least amount of uncomfortable throughout the process.
Carrie Baker:
Can women under 18 get the pills through Choix?
Lauren Dubey:
In some states, yes. In some states, we do require either a parental notification or parental consent in some cases.
We find that it’s not evidence-based. A 16-year-old can have a safe abortion just as safely as a 26-year-old, but we do our best to make sure that we’re able to work with people no matter how old they are—although there are obviously state laws that we need to be able to abide by.
It can be an uncomfortable process for a couple of hours, but we do our best to make sure that you have what you need in order to be the least amount of uncomfortable throughout the process.
Lauren Dubey
Carrie Baker:
Could you use the pills Friday night and be ready to go to work on Monday? How many days do you have to take off?
Lauren Dubey:
Absolutely.
You have to space the medications apart a little bit. So the soonest you could take the mifepristone, let’s say Friday morning. That first medication, we don’t really anticipate it will cause any side effects at all. So it shouldn’t really cause cramping and bleeding. It might. We never say never, but we don’t expect it to cause very many symptoms at all.
Then six hours later, you could take misoprostol, the vaginal route, and there’s evidence showing that you can even take the medications closer together, but right now we recommend six hours apart. We give you up to 24 hours. We expect the onset of bleeding to occur within that first 24 hours after you take misoprostol. But most people start bleeding within a few hours after that. The heaviest bleeding should be within that first 24-hour period after the second medication. Then after that the bleeding and cramping should lighten up a little bit.
So yeah, if you were to take the medications and have bleeding Friday night, give yourself Saturday to complete that 24-hour period, recoup Sunday, you could be back at work on Monday.
Carrie Baker:
Does it always work? Is there sometimes it doesn’t work?
Lauren Dubey:
You’ll notice I didn’t say it’s 100 percent effective—it’s 95 to 98 percent effective. So there is that 2 percent chance that it might not work.
When we say it might not work, it might not work at all at ending the pregnancy, and that just sometimes happens. There’s other situations where it may partially work. Let’s say the pregnancy stops growing and doesn’t continue but your body doesn’t get rid of the contents of your uterus. That would be a situation in which maybe the medications didn’t work completely. But yeah, it’s not 100 percent effective.
Carrie Baker:
Then what do you do in that case?
Lauren Dubey:
It depends on whether it was we would call a failed medication abortion or an incomplete abortion.
We would usually refer people to one of our partner clinics in any of the states where we operate or back to their ob-gyn or primary care provider to manage them if that’s what they choose. Occasionally, people will get ultrasounds and come back to us and then we can manage them with a little bit more medication—misoprostol. But it really just depends on what the outcome is in that situation.
Carrie Baker:
Do you give people pills in advance if they just want to have them on hand in case?
Lauren Dubey:
Yeah. Choix has a really exciting thing that we do called advanced provision of abortion pills. So let’s say that you’re just a regular sexually active person who is pretty sure that they’d like to have some pills on hand in the event they became pregnant. We see it similar to having a Plan B just in case you have unprotected sex, you want to take it to prevent pregnancy. You have these pills on hand just in case you have an unwanted pregnancy in the future.
We do offer advanced provision—then in the event that you were to become pregnant, you could come back to us and say, “Hey, I am pregnant. I’d like to use these pills,” and you could have full clinical support with Choix throughout the process.
Carrie Baker:
What’s the shelf life of the pills?
Lauren Dubey:
About two years for mifepristone. So you’ve got a pretty long shelf life with it, if you should need to use it during that time period.
Misoprostol might be a little bit less of a shelf life but that’s also dependent on the lot and the pharmacy. Medications are always marked with the expiration date on it, so always be paying attention to those expiration dates.
Carrie Baker:
Can a regular doctor, like not an ob-gyn or reproductive health doctor, prescribe abortion pills? Or does it have to be someone like you who specializes in reproductive health?
Lauren Dubey:
As of right now, any provider who has an agreement with the manufacturers of mifepristone—so that’s GenBioPro or Danco—can prescribe them. You just have to have an agreement agreeing that you know how to prescribe and manage patients who use this medication. So, it can be a nurse practitioner.
I’m a family nurse practitioner, so my training is men, women and children across the lifespan. I can prescribe this medication. We work with primary care providers who can prescribe this medication. We work with nurse midwives.
It does not have to be an ob-gyn or a women’s health nurse practitioner or a reproductive health nurse practitioner. It can be anybody who is interested in prescribing and managing patients using these medications.
Carrie Baker:
What states do you serve?
Lauren Dubey:
California, Colorado, New Mexico, Illinois, Maine, Virginia.
Carrie Baker:
Melissa, how can people find abortion pills?
Melissa Madera:
There’s a variety of ways to access abortion pills. You talked about some already.
Of course, you can go to a brick-and-mortar clinic, where you would have an in-person visit with a clinician. You would get the pills, take them home and then you’d take them at home.
But of course, if you live in a state where abortion is banned or heavily restricted, you may not have access to a clinic and you may need to travel. Nowadays—very exciting as Lauren has talked about—there’s telehealth for abortion. That’s thanks to a lot of advocacy, evidence-based research, and actually the pandemic really sped things along in getting us there.
With a telehealth provider, you would have a consultation online with a clinician on your phone, on a computer—like Lauren says, at Choix they do texting. But sometimes a telehealth provider does video visits, some you do an online consultation and then they’ll mail you the pills and then you take them at home. There’ll be support through phone or text.
There are brick-and-mortar clinics that also provide telehealth as well. So, it’s kind of a hybrid system—like [Whole] Women’s Health or carafem—so you can get telehealth from them and some other in-person, some brick-and-mortar clinics as well.
Then of course there’s Aid Access, a telehealth clinic that provides abortion pills in all 50 states. They started providing care in 2018. They’re based outside of the U.S., so they’re kind of just like, “It doesn’t matter what the law is. We’re going to send those pills anyway.” So, they’ll send them to you, and there are physicians involved, right. So you do get care from a physician as well. All you have to do is go online, do an online consultation. If that goes well they’ll send the pills as well.
Another option is online pharmacies. Some of them are U.S.-based, and some of them are international, so they will sell abortion pills online without a prescription. There’s no medical screening and no medical advice. They’ll just put it in the mail and then you’ll get it at home and you can use them at home.
PlanCPills.org is a great resource because they have vetted online pharmacies and telehealth services. So if you go on their guides to online pills, you’re prompted to put what state you’re in. It’ll give you all the information on different ways to access pills, including these online pharmacies, and give you information on whether there is some sort of restriction in your state or anything to worry about in terms of laws as well.
Carrie Baker:
What if you can’t afford it and you need financial support? You mentioned Aid Access. Do you want to talk about their cost?
Melissa Madera:
Aid Access has a sliding scale. They actually ask for a donation, a little over $100. For some people who can’t afford it at all, they will send you the pills anyway, even if you can’t pay anything. So you can just go online and let them know, “I can’t afford it,” and they will still send the pills. Or you can say, “I can afford $40,” and send them $40. So, it is a true sliding scale and they will still send you the pills.
There are a few funds that are specific for online abortion providers for telehealth, so you can look out for those as well—the Abortion Freedom Fund and Reprocare, for example.
Carrie Baker:
I’ve also heard about mail forwarding. Some people use that if they’re in a red state and they’re trying to access pills from a U.S.-based provider.
Melissa Madera:
If you are in a state that has banned abortion or has heavy restrictions, you might not be able to get to a clinic. You might not be able to directly get abortion pills from a telehealth provider—because even before Dobbs there were states that had banned telehealth for abortion care.
Now if you live in a state that has a complete abortion ban like Texas, you cannot just order pills as easily as someone who’s in New York or California.
You could use Aid Access because they send them everywhere, but maybe you just want to get it through a U.S.-based provider. It’s also faster through a U.S.-based provider. So you could use creative ways like mail forwarding.
You can also, for example, mail it to a friend that lives in the state, then get that from your friend.
Also, because I don’t work for a telehealth provider I can say this, most telehealth providers are not checking IP addresses. There’s only one that I know of who does that. So, they only know what you tell them. So if you’re in Texas and you want to order from a telehealth provider that only can ship pills to certain states like California or Virginia, for example, then you can do the consultation in Texas—just not say that you’re in Texas. Then all you need is to provide a physical address in that state.
So, I think a lot of people put their foot in their mouths when they provide more information than necessary. If no one’s asking, don’t offer the information. So that’s another way—but you didn’t hear it from me.
A lot of people put their foot in their mouths when they provide more information than necessary. If no one’s asking, don’t offer the information.
Melissa Madera
Carrie Baker:
If someone’s self-managing an abortion, like they order pills from a pharmacy online, what if they need to talk to somebody? Are there resources to support people?
Melissa Madera:
Absolutely. If you have medical questions you can call or message the Miscarriage and Abortion Hotline, and they have clinicians on there that volunteer their time to provide this service for people who are managing their abortions.
Actually, it’s not just self-managed abortion. If you’re getting abortion pills outside of the formal healthcare setting, using these online pharmacies, or you might get it from a community network. You might get it by going to another country, because in Mexico you can just go to the pharmacy and get misoprostol, and you might bring it back and use it at home. So, yeah, there’s people who are self-managing. But even if you’re just having a medication abortion and have questions you might want to have this information as well. You might be getting it from a clinician and it might be really late at night and you just want someone to talk to.
So you could call the Miscarriage and Abortion Hotline. They will provide you with the care that you need and answer your questions.
Then if you have legal questions, you might want to go online and check If/When/How’s Repro Legal Helpline. You might have questions about your state. What are my risks? Is this legal? Should I do X, Y, Z? You can get all the information you need to make the decision that is right for you.
I think that is very important: for everybody to have all the information that they need and they themselves can decide how much risk they want to take and do what is right for them.
Carrie Baker:
What if you don’t have a credit card and you want to get pills online. How do you do it?
Melissa Madera:
That is such a great question. I’ve thought about this, and you know what, I don’t have a very good answer for that, because a lot of these places don’t accept something like Venmo. Even when I was doing research for Aid Access, there is a way that people have to pay and some people just couldn’t do it that way because they didn’t have access to a certain app or felt weird about using something that wasn’t PayPal. So, sometimes if you ask, you can use PayPal with Aid Access. But I think every different telehealth service has to figure out how they’re going to accept payment from people and what ways are going obviously make it easier. Because even if you’re a 16-year-old girl or person who’s pregnant, you’re not going to have a credit card or a debit card. So, it makes it really, really hard to get the care that you need.
For Aid Access you could just say, “D don’t have a way to pay,” and they will still send you the pills. But other telehealth providers may not do that. So that’s something to think about and talk about more: What are ways that we can help people access care who don’t have something like a credit card or even a bank account? That’s a really good question and is something we should talk about more.
Carrie Baker:
Somebody in the chat said gift credit cards can be used—so get a gift credit card and then use that is one way.i
In that rare circumstance where there are complications or you need to go to an in-person caregiver, can a health provider tell the difference between a spontaneous miscarriage and a medication abortion?
Melissa Madera:
No, they cannot. Again, don’t give people more information than you need to or they ask for.
Even if they ask for that, you can decide what kind of information you’re going to give them. No one can tell or a health provider cannot tell the difference between a miscarriage and whether you self-managed abortion with pills from an online pharmacy or whether you went to a clinic to get pills or a telehealth service. They cannot tell and there’s no exam. There’s no test that can tell whether you have used abortion pills. And one of the things I would also say is that if you are going to self-manage your own abortion using pills, then you should not put the pills in your vagina. So don’t dissolve them vaginally because it might leave remnants so that when you go to the clinic or to the hospital, then a provider might see that there are still pills in your vagina and then will know.
But if you use them orally, as Lauren had mentioned, then all you have to do is if they haven’t dissolved fully, you swallow them, there’s no evidence of anything at all. It’s gone. So, it’s really important for people to know that.
Carrie Baker:
For people in red states, is it a risk legally if they do this? Most of these laws prohibit doctors from doing abortions but not many states have laws against people having abortions, so is this legally risky?
Melissa Madera:
Well, I am not a lawyer, so with that caveat—as I said before, there are laws. Obviously, if people live in states where abortion is banned or if they leave in restrictive states, then they might need to worry a lot more about legalities, but we don’t know how these laws will be enforced. We do know that some people have been criminalized in the past for self-managing abortions. If/When/How said there’s been 61 cases since 2000. So we know that it happens.
But the truth is, the law is kind of gray and we don’t know how law enforcement will react or what they will do. So it’s just important to know your risks and then decide how you’re going to act or behave or what you’re going to do based on that.
We also know that risk has a lot to do with your own personal circumstances and who you are as a person, your identity—your gender identity, your immigration status, race. So those are important things that people are going to think about because some people are criminalized more than others.
The truth is that we can’t tell people what to do based on what might happen or what the risk is. Only people will know what they want to do or can do. So, that is very important. I think right now there’s only two states that even have self-managing abortion on the books as illegal: Nevada and South Carolina.
Carrie Baker:
Are there things you can do to search securely online for abortion pills if you’re worried about any sort of people finding out? Is there a way to do it where you don’t leave a digital trail that you could use?
Melissa Madera:
That’s so important to think about because we leave digital footprints everywhere in our lives. We are online all of the time. Most of the time, we’re not even thinking about it, so in many ways technology is great. It’s given us telemedicine. It’s given us a lot of things that have really opened up access. But in other ways it’s not so great because those digital footprints can be used by people and have evidence against folks.
I do know it’s not really even the digital footprint that is getting people in trouble—it’s who you’re telling. It’s the provider at a hospital who is reporting you, but it’s still important to think about that.
So, a secure option is make sure you delete your browser history when you’re going online looking for something. A great secure place to look, again, is Plan C Pills, right, on their website. But then don’t leave that digital trace behind when you’re searching.
Carrie Baker:
Digital Defense Fund is a great resource for this. Also Electronic Frontier Foundation. They have guides about how to search securely online.
Lauren, how late into pregnancy can you use abortion pills?
Lauren Dubey:
So the FDA has approved mifepristone up to 10 weeks of pregnancy and many providers use it up to 11 weeks of pregnancy.
Carrie Baker:
I know the World Health Organization has approved it through 12 weeks.
What happens if somebody does use them after 12 weeks? Is it dangerous or is it not effective? What are the risks of that?
Lauren Dubey:
It could be any one of those things.
It could just not work because what the World Health Organization, the regimen and the amount of medication, particularly the misoprostol that you would need in order to pass a pregnancy past a certain point is more than what we’re prescribing. So, if we calculate the gestational age where you’re actually farther along and you took the medications, more often than not, it just doesn’t work.
But it’s also possible that you fall into one of those categories I had kind of spoken about earlier of being an incomplete abortion. Now, at any point if we suspect that that happened or you went to a healthcare provider and it was found out that you either had a continuing pregnancy or an incomplete abortion, your options would be discussed with you at that time, which includes but is not limited to—potentially if it’s an ongoing pregnancy—continuing the pregnancy, a procedural abortion done by a healthcare provider in a clinic, or something of that nature.
Carrie Baker:
Can you take these pills if you’re on the pill or other birth control medication?
Lauren Dubey:
Well, we know people get pregnant while they’re on birth control—whether they missed a pill, they took one late, or just sometimes pills don’t work and it happens. Not to say you shouldn’t trust your birth control pills but just on occasion it does happen.
So, we generally recommend that people stop taking their pills because it’s not preventing you from getting pregnant if you’re already pregnant, and that you restart your pills after you take your misoprostol. You take your abortion pills, and then we counsel people that if they believe their medication abortion was successful they can start taking their birth control pills the day after misoprostol.
Carrie Baker:
How do you date a pregnancy, as far as the number of weeks? How do you know how far along you are?
Lauren Dubey:
So our intake questionnaire is really comprehensive at getting at people’s menstrual and sexual histories.
Sometimes it’s as easy as, “I get a period every 28 days,” and we can date it by their last menstrual period.
But sometimes it’s not that easy. We get really, really awesome information and feedback from people that choose to work with us in helping them figure out when they got pregnant and how far along they may be in pregnancy. So, while the quick answer is by dating using a last menstrual period. Not everybody has regular periods, some people were on birth control and only had sex one time, so we can use a date of possible conception, things like that.
Carrie Baker:
Is telehealth HIPAA compliant?
Lauren Dubey:
Our platform is. We actually give people the option to use a HIPAA compliant texting platform. We’re not texting people from our cell phones. So, we use a HIPAA compliant texting platform and we have an online EHR, electronic health record, and we use all of the stop gaps that we need in order to be HIPAA compliant, multifactor authentication, things of that nature.
We actually give people the option. You can opt into secure texting or regular text messages. We don’t just text people without their consent. We ask people when they sign up with us if you would like a regular text message—because if you leave your phone out on the table, anybody could potentially see that message. We do have the option for people to use secure messaging. The platform that we use to text people has a secure function so that requires a username and a login so that you can then download that app, log in and see it. But if you’re okay with getting those messages to your phone, we are HIPAA compliant on our end in sharing information with people.
You might not have money. You might not have time, but you can spread the word by … just generally talking about abortion. That also signals to people that you are someone they can ask for help or information if they need it in the future.
Melissa Madera
Carrie Baker:
A lot of people want to spread word and help other people get pills. If they do that in states like Texas that have these aiding and abetting laws, is it legally safe? Some other people are threatening to prohibit talking about abortion pills. Is it dangerous to share this information legally?
Melissa Madera:
The only way that we are actually going to give people the information that they need before they need it, the only way that we’re going to destigmatize abortion, is talking about it. So that’s one of the most important ways to help. You might not have money. You might not have time, but you can spread the word by just sharing it. So even if you’re just generally talking about abortion, that is something. That also signals to people that you are someone they can ask for help or information if they need it in the future.
Also, when you’re sharing information, you’re not giving advice, right. You’re not giving medical advice. You’re not telling people what to do. You’re saying, “Some people to do this,” or, “A way to get abortion pills is that.” So it is a way to provide information to people and that is a great way to get this information out into the world—even just saying, “I heard that people go on Plan C to find information about abortion pills or about how to access abortion.”
The legally risky is aiding and abetting. I don’t like to give too much credence to laws that are unjust or illegitimate. So I’m not going to give it that much weight in my life, because you give it weight and it becomes that. To me, our role is to give information when and if we can.
This is about you deciding how much risk you want to take. Everyone, all of us. My risk tolerance might be more than others, and so I’m going to continue to give all of the information that I can to everyone that I can give this information to.
Carrie Baker:
Plan C has these really handy dandy little stickers. You can order them from Plan C and put them inside bathroom walls or on bulletin boards. They have a number of them. You can go on their website and order them if you want to spread the word. Also, people spread the word on social media.
Melissa Madera:
Yeah. And bathroom stalls are a great place for stickers or just anywhere that you happen to be. Even a coffee shop. You just leave them and then that’s a way of spreading the word without saying a single word.
Carrie Baker:
People say that abortion pills are safer than Tylenol. Tylenol is obviously on the grocery shelf, the pharmacy shelf. Do you ever think that abortion pills will be on the shelf next to Tylenol, since they’re safer than Tylenol?
Melissa Madera:
Hopefully very, very soon.
Lauren Dubey:
Do we want them to be? or will they be? are two separate questions.
Carrie Baker:
Or should they be?
Lauren Dubey:
For safety and effectiveness, there’s very few scenarios in which taking them is truly unsafe and threatening to your health. We hear a lot of things thrown around and the anti-abortion movement loves to use those as reasons why it shouldn’t be more widely available, but we know that it’s so safe and so effective.
Honestly, I think that if it were more widely available, the biggest problem is that people would potentially be taking it inappropriately, thinking that it would end a pregnancy maybe farther along, or not knowing that they maybe need the two medications, or what have you.
I think that as long as abortion remains as stigmatized as it is in this country, as evidenced by recent affairs this past year, I don’t think that that’s going to happen anytime soon. The best we can do is, again, spread the word on the different ways to access pills and, as a telehealth provider, continue to expand into states where we can continue to do this within the framework of healthcare and supporting people in doing so.
Carrie Baker:
If I have the pills on hand and a friend gets pregnant, am I allowed to give them the pills to use?
Lauren Dubey:
As a healthcare provider, I’m going to say that when someone prescribes you medication to use, they are intended for your use, mainly just out of safety for that other person. You don’t know if they potentially have a health condition that might make it unsafe for them to take one of these medications. You don’t know if they have allergies to the medications.
If you want to be getting these pills for you to hang on to, so that you have them in case you need them, share with your friends how they can get pills to have on hand in case they also need them. And if they need a safe place to store them, maybe you can be that safe place for them to store their pills. But in general, we say it’s a better idea not to be giving these pills to other people.
Carrie Baker:
Misoprostol alone—can’t that be effective too? Could you talk a little bit about that?
Lauren Dubey:
Yeah. We know that there have been people all over the world that have been using misoprostol alone to induce abortions.
The reason why we don’t use it, and this is just a very medical answer, but if you could take 12 of these pills and they’re still less effective than five of these pills, we’re going to choose, within the healthcare setting, to give the medication that’s the most effective with the least amount of side effects.
Misoprostol as a solo regimen causes quite a bit of side effects for people inducing an abortion with just that medication. It can be really unpleasant. Again, we don’t want people carrying unwanted pregnancies to term or any further along than they need to be. We also want to provide the safest, most effective and as comfortable as possible regimen that we have available to us with all the research available to us. So, that’s why it’s not more widely used.
Carrie Baker:
Melissa, I know that misoprostol is just more accessible because it’s not so heavily restricted. You do research on self-managed abortion: Are people using misoprostol alone effectively in the U.S., now that abortion has been banned in some states?
Melissa Madera:
We did not interview people who only used miso. But there is some research being done on miso alone. It’s not, not effective at all. I think the last I heard was like 85 percent, and it actually might be higher in recent studies. So, it is effective, and for some people that’s all that they have available.
We know that people have been using it around the world for decades, and it began with people in Brazil noticing that this was something that could be used. So we know it works. We know people use it also later in pregnancy to the second trimester, too. So, I think that we need to really think more broadly about how we use abortion pills and how we offer abortion pills to people.
It’s also cheaper, right. This is important, and it’s also important if you do live in a restricted place and that’s all you have access to. Then what we need to do is provide enough information for people to be able to do it as safely as possible. Just like we do with medication abortion, self-management medication abortion with mife and miso. So we’re providing information and people can use it safely.
Carrie Baker:
In closing, the overturning of Roe v. Wade was a wakeup call and a reminder that we need to take charge of our own reproductive health. Abortion pills are a key way we’ll continue to access safe abortion, despite increasing barriers.
I want to give Lauren and Melissa a chance to close it out. Do you have any final thoughts?
Melissa Madera:
My final thought is always the same. Talk about abortion, share about abortion, share information and just frankly talk about abortion to destigmatize and also just like work towards making sure that people have the abortions that they need in the way that they want it, and respect everybody’s decisions around their own abortion experiences.
And go on PlanCPills.org and get information and get stickers. All you have to do is go online and order them.
Carrie Baker:
Stickers. Stickers. Stickers.
Lauren Dubey:
Very well-said, Melissa, as always. I think it’s important to know in places and in states where a healthcare provider is able to support you in your abortion process, whatever that one looks like for you. Just know that your providers are here for you. There are allies all around you that are here for you. Your abortion is yours. No one can take that from you either.
Carrie Baker:
I want to just make one last comment: The Department of Justice just issued an opinion saying that the United States Postal Service can deliver abortion pills by mail, even in states that ban abortion. So, they will continue to go through the mail if you need them.
I just want to thank Lauren and Melissa. You are a wealth of knowledge and thank you so much for being here tonight and sharing it. Thank you, everybody that came here tonight. It’s obviously a hard time, but if we stick together and keep fighting I know in the end people will get the care they need. So, thank you very much. Good evening.
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