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How a network of abortion pill providers works together in the wake of new threats

By 37ci3 Apr7,2024

When the U.S. Supreme Court heard oral arguments on limiting access to the abortion drug mifepristone in March, Plan C co-founder and co-founder Elisa Wells was on hand.

Plan C, an information resource that connects women with abortion pill providers, saw an almost immediate spike in drug searches.

The Florida Supreme Court is leading the way for the state six-week abortion banWells says he expects more search activity and more creative thinking from providers.

“When these terrible decisions happen, the first thing they do is hurt,” he says. “And the second thing that happens is people get organized and crazy and take action.”

since In the 2022 Dobbs decision, the Supreme Court ruled in Roe v. He overruled WadeIn the United States, a network of abortion providers began to expand access to abortion, and although the procedure was effective, it wove an abortion safety net across the country. Banned in 15 states.

Providers such as Aid Access, Hey Jane and Just the Pill operate both inside and outside the established health care system – including sending abortion pills to women in states where it is banned, setting up mobile clinics and offering financial assistance – often in close contact with they keep else.

abortion pills tablet bottles
Bottles of misoprostol tablets.NBC News

Many of these efforts include access to abortion pills by mail The Food and Drug Administration was completely legalized As new abortion restrictions come into place in 2021, it will create a kind of “traveling pill sisterhood” that keeps the groups together.

Wells says Plan C convened various providers for a meeting on how best to navigate the changing abortion landscape.

“We’ve had meetings where we introduce providers to each other,” he said. “All these groups that are usually competing with each other to come together and discuss, you know, how can we make a difference? How can we collectively solve this problem?”

One such group is Aid Access, an online-only service based in the Netherlands. Originally a resource for U.S. women to purchase abortion pills from abroad, the organization’s providers now ship the pills from within the U.S. under telemedicine protection laws. Shield laws have been passed in six states: California, Colorado, Massachusetts, New York, Vermont and Washington. The laws protect providers who prescribe and ship abortion pills to patients who live in states where abortion is prohibited or severely restricted.

“Before our shield law, we were shipping pills to blue states and only [pills from] can be shipped overseas to restricted states,” said Dr. Linda Prine said.

After New York’s shield law was passed, “the first month we shipped about 4,000 pills to restricted counties, now we’re about 10,000 pills a month,” Prine said.

In a basement in upstate New York, another Aid Access provider, who asked not to be identified for security reasons, stressed the importance of sending these pills from the United States, not overseas.

“Sometimes they get stuck in customs,” explained the provider, as more than 100 prescriptions are packed around them and prepared to be shipped to states with bans.

“When you have a medical abortion, the sooner you can get those medications, the better,” the provider said in an interview. “It’s easier, less bleeding, less cramping, and not to mention the anxiety these women go through waiting for those drugs to arrive in the mail.”

abortion pills
Pill boxes will be packed in envelopes for domestic shipping.Callan Griffiths/NBC News

Aid Access providers say they send pills to some of the most desperate — people who are willing to risk going outside the established health care system to access abortion services. The organization is exploring contingency plans in the event of a disruption in access to abortion pills by mail.

“We have a lot of patients who are harassed and can’t travel,” the provider said. “That’s why we have to find other ways. I would say that the last resort is to import these drugs again.”

Although the shield laws have not yet been challenged in the courts, anti-abortion groups have drawn attention.

“The fact is, just because you’re in California doesn’t mean you’re not violating the laws of Florida, Texas and 30 other states,” Katie Daniel, director of public policy for the anti-abortion group Susan B. Anthony Pro-Life America, told NBC News. “So I think there’s a false sense of security about it.”

In the six months after Dobbs, researchers saw an increase in the number of women receiving abortion drugs outside of the traditional health care system, with more than 27,000 additional cases. A recent study in the journal JAMA.

“These are groups like Las Libres, WeSaveUs, Arkansas Together,” said Wells, who co-authored the study. “They serve a significant number of people for an all-volunteer-led effort.”

Even in the traditional health care system, medical abortions are on the rise. Medication abortions accounted for 63% of all abortions in 2023, up 10% from the previous year, according to a study by the Reproductive Rights Think Tank. Guttmacher Institutethis is the most common way to terminate a pregnancy.

abortion pill envelopes
Envelopes filled with abortion pills.Callan Griffiths/NBC News

New York-based Hey Jane has seen this demand firsthand. Founder Kiki Freedman, an early Uber employee, launched the telemedicine-only abortion provider in 2018 after seeing other startups deliver drugs and savings to customers through online-only prescription services. Hey Jane took off after the FDA eased restrictions on mifepristone prescriptions during the pandemic, allowing women to buy the abortion pill by mail. According to the statement, the company sent abortion pills to at least 50,000 patients.

“We have the added benefit of that kind of geographic fluidity, where a doctor in New York can serve a patient in Illinois or a New Mexico doctor or New Mexico provider if they’re busy,” Freedman said. “The other part is financial access and access to expanding ways to do that, particularly through insurance.”

Hey Jane only prescribes and ships abortion drugs to states where they are legal, marking a difference from advocacy providers and organizations like Aid Access.

Access to medication abortions helps patients avoid travel and waiting times at private clinics and allows them to take the pill individually at home. While providers that ship to states with bans have struggled with traditional payment platforms, Hey Jane’s focus is on maintaining access covered by insurance.

“Still, 75% of abortions happen in the 20 states where we’re located. The vast majority of care is still here,” Freedman said. “It’s not like access to these states has been seamless so far, is it? Even there, it’s always been difficult, especially Post-Dobbs, the wait times and things like that have really gone up in those states.

abortion pill container bottles
Empty pill bottles in the basement of a New York City law enforcement agency will be filled with abortion pills. Abigail Brooks/NBC News

Just Pill provides abortion access to women in states with bans using discreet mobile clinics set up outside the states.

The group has bulletproof vans in Colorado, Minnesota and Montana and a brick-and-mortar location in Wyoming. Appointments are made via telemedicine, making backstop laws unnecessary in a state where abortion has always been legal, the Just the Pill provider says, because the backstop is intentional so care won’t be interrupted if the shield is available. laws are challenged.

“I fully support what these other organizations are doing,” he said, asking not to be named for security reasons. “I welcome them from afar, but I want to make sure they don’t interfere with our service.”

Just Pill works with abortion funds that provide financial assistance to patients seeking the procedure to help them travel across state lines for their appointments. After a telemedicine visit, the pills are prescribed and patients can pick them up within the borders of the state where the procedure is legal. Because Just the Pill’s clinics are mobile, they can travel across the borders of banning states and get as close as possible to women traveling from rural areas or long distances for care.

Meanwhile, Plan C is working with more international pill providers to access telehealth prescribing in the U.S. if telehealth visits for mifepristone are affected here, Wells said.

“We know we live in an era where anything can happen,” Wells said. “We want to have as many alternative routes and exits as possible. Many eggs and many baskets.’

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