58. Fifteen Minutes of Feminism: Everything You Need to Know About Getting an At-Home Abortion (with Dr. Julie Amaon)

With Guests:

  • Dr. Julie Amaon, a family medicine doctor working for Just the Pill, a nonprofit telemedicine abortion provider based in the Twin Cities and serving people in Minnesota, Montana and Wyoming, as well as people coming from surrounding states.

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In this Episode:

The future of abortion care is here: A safe, legal abortion in the comfort of your own home—accessed via mail and telehealth, delivered right to your door.

So, what do you need to know about abortion pills? How do they work? How long has medication abortion been available? Is it safe? (The answer’s yes!) Is it legal? (Yes!) Is it effective? (Extremely.)

Have a topic you’d like us to delve into, a guest recommendationor just want to say hi? Drop us a line at [email protected]

Background Reading:

Transcript:

00:00:00 Michele Goodwin: 

Welcome to Fifteen Minutes of Feminism, part of our “On the Issues with Michele Goodwin” platform at Ms. Magazine. 

You know what we do. We report, rebel, and we tell it just like it is, and on this show, too, we center your concerns about rebuilding our nation and advancing the promise of equality. So, so happy that you’re joining me as we tackle the most compelling issues of our times. History matters to us. We examine the past as we think about the future. 

On today’s show, we’re talking about abortion access by mail and telehealth. 

So, what do you need to know? We begin to tackle that question by looking through one important lens of this. That is through telehealth. How long have medication abortions been available? How safe is medication abortion?

And joining me for this episode to help break it all down is Dr. Julie Amaon. She’s a family medicine doctor working for Just the Pill, a nonprofit telemedicine abortion provider based in the Twin Cities and serving people in Minnesota, Montana, and Wyoming as well as people coming from surrounding states. 

00:00:01 Michele Goodwin: 

So, Dr. Amaon…and you’ve given me permission to call you Julie. Thank you so much. You’re the medical director of Just the Pill as my audience has just heard. Can you tell us a bit about the organization and why you started it?

00:00:17 Dr. Julie Amaon:  

Sure. Yes. So, Just the Pill is a nonprofit sexual and reproductive health telehealth startup, and we started in, let’s see, April of 2020 is when our executive director…

00:00:30 Michele Goodwin:

Right after the pandemic launched.

00:00:32 Dr. Julie Amaon: 

Yes. This was a pandemic project. I tell people some people had sourdough projects. Our executive director was solving rural abortion access during the pandemic. That was her pandemic project. And I came on pretty soon after that in July, June or July of 2020, right when I was graduating from residency, and our executive director’s original idea was to provide medication abortion and contraception to rural areas in Minnesota, via a mobile clinic because most of our clinics are in the urban settings on the eastern side of our state, so Duluth, the Twin Cities, and Rochester, and there’s a whole of state left that had a long drive, and so that was her original idea, but in July of 2020, a federal district court in Maryland allowed everybody to mail the medication abortion due to the pandemic. Right? We don’t want to expose anybody to coronavirus if we don’t have to, so we quickly pivoted and started mailing medications as of October 2020. 

00:01:38 Michele Goodwin: 

Okay. Oh, all right. So, you began mailing them as of October 2020, and this began as a bit of a COVID project, but in reality, you were meeting a long-standing need, as the Guttmacher Institute so importantly shows us, that over the years we’ve seen a decline in the availability of clinics that are nearby to people that need them. Can you explain just a little bit more about that because the need was already there?

00:02:11 Dr. Julie Amaon: 

Sure. Yes. Exactly. So, I think the pandemic really just opened up possibilities. Right? It made telemedicine more of a reality, and you’re exactly right. You know, it’s always, you know, once Roe passed many…’73, a long time ago. It has slowly been kind of eroded, and it has always really mattered what your ZIP code is, what your income is, and how readily available you can access abortion care.

So, over the last I want to say 10 to 15 years, the regulations that states have passed have just put roadblock after roadblock for patients, and they’ve shut down some clinics because of that. So, yes. So, it’s really been, you know, dire straits, and so that was…it was a pandemic project, but it was also filling a need, as you said, that was already there before the pandemic started. 

00:03:05 Michele Goodwin:

And this need is significant when you think about it. The rural areas that you were trying to reach, and that’s just Minnesota. Right? But when you begin to think about all across the country, the rural areas…and then even if you happen to be in urban areas, it’s not a guarantee that you have access, or can afford to have access, to the types of services that one needs. So, let’s break this down a little bit more for people who are still curious. 

What exactly is telehealth and telemedicine for people who have no idea. Do you have to be their doctor? Do they have to have some formal relationship with you in order for telemedicine and telehealth to work?

00:03:45 Dr. Julie Amaon: 

Yes. That’s a good question. So, that is really state-specific. So, most states it is where the patient is located, not where the doctor is located. That establishes where the telehealth conversation can happen. Some states have more strict rules as far as, you know, does the patient have to have a relationship with the physician. You know, in Wyoming, for instance, we expanded to Montana and Wyoming after Minnesota. 

For Wyoming, we need to do a video visit. That’s considered a telehealth visit. We can’t just do it over the phone. In Minnesota and Montana, a telehealth visit is considered a phone visit. You can do it over video, but for patients that are living in rural areas, sometimes broadband internet is not as accessible, but most people have a cell phone. 

So, yes. So, it’s where the patient is located. And like I said, state-specific as far as, you know, what it’s considered, but it can be audio. It can be video, or sometimes it can even be text, as well, so that’s where we do a lot of our patient education. 

00:04:46 Michele Goodwin:

So, this is very helpful, and I have a couple of questions to just follow up on that thread because, where video conferencing is required, it also makes me think about the safety and security of individuals. It’s one thing to take a call and to be able to convey a message during a phone call, but even internet and WiFi systems aside and the potential failures there, where’s the safe place for you to be able to have this important conversation, and if it’s on video, perhaps you can’t have the most confidential type of conversation that keeps you safe. 

00:05:27 Dr. Julie Amaon: 

Yes. That’s exactly right, and that’s something that I ask every patient, you know, kind of before we start. Are you in a comfortable and confidential space? I see a lot of patients in their cars. Right? They’re on their lunch break or taking a break. You know, family’s in the house, and they’re taking a break from childcare issues. And if they’re not, then we really try to reschedule their appointment so that they do have a confidential place because you’re exactly right. The video makes it just a little bit harder to be confidential, so we really try to make sure people are safe.

00:05:57 Michele Goodwin:

And there are people who also wonder, I’m sure, well, how long does this take? How many phone conversations or video conversations do I need to have because one of the backdrops that we see in terms of the politicization, and the fracturing of reproductive liberties, is this notion that somehow people who become pregnant don’t know what they want. They need many, many days and months to think it over. They’re so in the end grief that they’re not clearheaded, and it’s interesting because it’s really primarily only around this particular area of healthcare. Otherwise, we presume that people know what they want and what’s going to keep them safe and allow them to be healthy.

So, getting to this point of conversations, how many does it require if a patient wants to be able to terminate a pregnancy?

00:06:54 Dr. Julie Amaon: 

Yes. That’s a good question, and you are exactly right. This is the only area of healthcare where we just don’t trust our patients. Right? It’s ridiculous, really.

And so, I really try to be as trusting as I can. Right? I’m having a telehealth conversation. I trust that they know their last menstrual period. I trust that they have regular periods and that they’re going to take the medications. Pregnant patients and my patients know exactly what they want. I don’t do options counseling. Most people know exactly what they want when they get here. I’m not trying to, you know, patronize them and you know, act like they don’t already know their options. Right? They can continue their pregnancy and adopt, or they can continue their pregnancy and continue parenting or abortion. You’re exactly right. Our patients know exactly what they need. 

And so, with us, it is state-to-state specific, but for Minnesota, we require one 15-minute telehealth appointment, and we do that mostly via phone. The same for Montana, and then I talked about Wyoming being video, and then we do two follow-ups, but I do the follow-ups how the patients like them. If they would rather a text versus an email versus a phone call, whatever’s convenient for them. So, we do a seven-day…seven to 14-day follow-up just to make sure the process is complete. Make sure they feel like they passed the pregnancy. They bled as expected. Symptoms are gone. Bleeding is better. 

And then we also do a pregnancy test, just a urine home pregnancy test in four weeks just to make sure, and so I try to make it…you know, there are some, you know, laws and rules that we have to follow, but I really try to meet the patients where they’re at and try to do, you know, their follow up as easy as is possible for them.

00:08:34 Michele Goodwin:

So, for people who are wondering how safe is this, it’s a good question because there’s been so much fear that has purposefully been designed around abortion, and so I want to just take a moment and then lead our conversation in just a…not a slightly different direction but just expand it. Right? 

So, Roe v. Wade 1973, as you mentioned, a seven to two opinion. Five of those justices were Republican appointed. We saw the dramatic decline of medical wards having to be devoted to people dying from botched abortions, with people having attempted abortions themselves in bathtubs, in motel rooms, on dining room tables, and the World Health Organization has long said that a legal abortion is as safe as a penicillin shot. A person is 14 times more likely to die by carrying a pregnancy to term than by terminating it. Right? 

So, just as level setting, we’re talking about something safe. Are those kinds of questions that you have to answer from your patients? Do they wonder, well, how safe is this? And can you explain to the audience here how safe are medication abortions?

Medication abortion uses two types of pills: mifepristone, which interrupts the flow of the hormone progesterone that sustains the pregnancy; and misoprostol, which causes contractions to expel the contents of the uterus. (VAlaSiurua / Wikimedia Commons)

00:09:52 Dr. Julie Amaon: 

Sure. Yes. So, this is a very safe process. It’s been around for over 20 years now, the medication abortion pills, actually, 40 years, if we’re talking about in Europe, when it was first developed, just 20 years in the United States, so we have an amazing safety profile and data, and a lot, actually, during the pandemic when people were allowed to mail to know that this is safe to continue to do this at home and not having to go back to doing this in-person. 

So, it’s 98% effective. Right? So, 2% failure rate, which is very low, and the rates of, you know, safety issues of heavy bleeding, of infection, are also very low. I will say that I don’t have to answer that many times to patients because they’ve done their research, and they know, you know, that this is a safe process. That’s why they’re choosing this at home. They’d like to either not have to go into a clinic or, you know, go through protesters, or they just want to be in the comfort of their own home. Right?

So, yes. So, this is a very safe method that I think is a game-changer, like you said, talking about the unsafe abortions that happened pre-Roe. Whatever happens with the Supreme Court coming up this summer I think we’re in a different boat, right, just because we have these safe options for pregnant people, which is great. 

00:11:07 Michele Goodwin:

Well, and Justice Breyer in Whole Woman’s Health v. Hellerstedt broke down at just comparatively how safe it is to have an abortion in the United States. I mean, it’s safer than a colonoscopy in the state of Minnesota. A person’s more likely to die due to domestic violence than a person is by terminating a pregnancy.

But you also mentioned something, too, which is about being able to do this in the safety of one’s own home and avoiding sometimes the harassment, the spitting, the shoving, the threats that take place when one has to go to a clinic. I mean, what shouldn’t occur anyway, and again, when one thinks about it, is the only area of healthcare where one is subjected to threats, abuse, and real terror as one goes to get a medical procedure. 

00:12:01 Dr. Julie Amaon: 

That’s exactly right. It is, I mean, frankly ridiculous. It’s the only…like you said…the only medical procedure, and this is one in four people in their reproductive health years choose this. This is very common. It’s very safe, and I don’t think until you have to go through this process yourself that you really realize how hard it is for people to get these services and to get this general reproductive healthcare that they need. The hoops are kind of ridiculous. 

00:12:28 Michele Goodwin:

So, then the next question that I want to turn to before we begin the wrap up of our 15 Minutes of Feminism, and I’m so grateful that you’ve joined me because this is really such important work that you’re doing, and I know there’s an audience that is so hungry to learn more and to understand exactly what their options are given the backdrop of these political times in our country. 

What about the cost? So, we’ve talked about the safety of this and the availability and how telemedicine and telehealth work when it comes to receiving medication abortion, and pills in the mail, but what about the cost because still, it turns out that for people who are most economically vulnerable, abortion services can still be out of reach, so how is that addressed within this area?

00:13:19 Dr. Julie Amaon: 

Yes. That is true. So, you know, right soon after Roe v. Wade was passed in ’73, the Hyde Amendment was passed in ’76, and that was just devastating right then. It took away the ability for Medicaid, and like you said, our most economically marginalized patients are not able to use that service. Thankfully, some states have allowed Medicaid coverage. Minnesota is one of those to do that, but still, the hoops are great. We’ve been struggling for a year at Just the Pill trying to get qualified for Medicaid. It just shouldn’t be that hard.

Also, with the telehealth, the switchover to telehealth and whether you’re doing it via video versus telephone, sometimes Medicaid doesn’t reimburse as well or other insurances as well. And then, as far as just kind of out of pocket paying, if you don’t have insurance or their insurance won’t cover it, it can run anywhere between 200 and let’s see, for first trimester up to, you know, 800 dollars, which is not something that most people have just lying around.

00:14:22 Michele Goodwin:

No. That’s rent, mortgage, clothes for the kids, lunch money, cellphone bills. Right? I mean, that’s…

00:14:28 Dr. Julie Amaon: 

Exactly. Yes. Thankfully, we have…at least, at Just the Pill we are working with close to 13 or 14 different individual funds just to depending on where you live that will help cover the cost of the abortion, cover the cost of childcare, travel, hotels if you need a safe place to have the medication abortion, so we really work with all of those funds to really not turn anybody away regardless of your ability to pay, but that’s not everywhere. Right? So, it’s just…yes.

00:14:56 Michele Goodwin:

That’s right. And one last question before we get to our silver lining, which is what we ask all of our guests what we see as the kind of bright future coming ahead, and that is a question with regard to other organizations that are working in similar spaces to Just the Pill. I mean, you’re not alone. Right? 

So, for our listeners who listen all around the country, all around the world, they might think, oh, my gosh. But I don’t live in Minnesota. I don’t live in Montana. Do they have access to medication abortion even if they don’t happen to live in Minnesota or Montana or other places where you work?

00:15:36 Dr. Julie Amaon: 

They do. They do. Yes. So, there are two other organizations that are similar to ours that opened to different states. 

Hey Jane is one of them, and they are working in Washington state, New York state, and I think they just expanded to Illinois, but don’t quote me on that, and then Choix, which is Choix, started in California, and they are also in Illinois, Colorado as well and expanding, so there’s other telehealth medication abortion options.

And then plancpills.org is another organization that has done amazing work and has looked at all of the online providers, whether they’re international or local, and you know, they can tell you exactly how much it costs. They’ve ordered the pills, checked the mailing time. They checked the legitimacy of the pills, so they actually work. They’re the same medications that we use in the United States, and that is also a great resource for people, so yes. There is hope. There are lots of resources out there for people. 

00:16:33 Michele Goodwin:

Yes. So, listeners, pay close attention to what it is that you’ve just heard because resources are available even if you happen to live in states that are hostile to abortion, contraception, sex education, and more because when we really get down to it, Dr. Amaon, the truth of it is, is that we’ve seen all across the country not just the rolling back of Roe v. Wade but everything that we’ve seen is fundamental to a democracy concerning the human body. 

All right. So…

00:17:04 Dr. Julie Amaon:

Exactly right.

00:17:05 Michele Goodwin:

We are at that time where we look at silver linings. What do you see at a time in which it looks like the Supreme Court may be poised to dismantle Roe in part or in whole? For so many people, they are very deeply worried, and that’s rightfully so, but there are silver linings, and I’m wondering what’s a silver lining for you going forward.

00:17:27 Dr. Julie Amaon:   

Yes. Definitely. So, I agree. I think this is a very scary time, and Roe could be completely dismantled, but I think the thing that keeps me going every day is knowing that you know, Just the Pill, and when we move out with our mobile clinics, we’re going to be called Abortion Delivered, so we are truly trying to expand to the states that we’re considering safe havens, so they either have constitutional state protection or other protection, and we’re going to drive the borders of the states that people don’t have access.

And I feel like this is also going to be…besides the expansion and you know, continuing to fight for people’s access…I think if Roe v. Wade is overturned, people are going to…I think it will be a mobilization period. Right? 

So, this has been in effect since ’73, and people have just gone about their business and had this right, even though it’s really a skeleton right, to be honest, and I’m hoping that this mobilizes people, that people are outraged, right, because this is…like you said, this is a fundamental human right, reproductive justice for everyone, so we need to go beyond what we have.

00:18:39 Michele Goodwin:

Well, I want to thank you, Dr. Julie Amaon, for being with me today, for the important work that you do, and what an exceptional COVID project this has been, transformative in the lives of so many people. Thank you so much for joining me. 

00:18:54 Dr. Julie Amaon:  

Yes. Thank you, and a pleasure to be here. 

00:00:00 Michele Goodwin:

Guests and listeners, that’s it for today’s episode of Fifteen Minutes of Feminism with Michele Goodwin. I want to thank my guest, Dr. Julie Amaon, for joining us in being part of this critical and insightful conversation, and to you, our listeners. You know I love you. I thank you for tuning in for the full story. 

We hope you’ll join us again for our next episode where we will be reporting, rebelling and you know, telling it just like it is, as usual, and it will be an episode you will not want to miss.

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This has been your host Michele Goodwin reporting, rebelling, and telling it just like it is. “On the Issues with Michele Goodwin” is a Ms. magazine joint production. Kathy Spillar and Michele Goodwin are our executive producers. Our producers for this episode are 

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