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Tuesday, April 16, 2024

How a Telemedicine Abortion Provider Is Bracing for Post-Roe Life

When telehealth abortion provider Hey Jane launched in January 2021, people were actually celebrating policy changes in the world of reproductive health that made access to some types of abortion easier. Although the pandemic had created obstacles for people who needed to see doctors face-to-face, it also spurred US regulators to temporarily relax rules about telemedicine and abortion pills. Instead of physically traveling to a clinic, now people could simply make an appointment with an online provider and receive the pills by mail, opening up the door for Hey Jane and similar services. (In December 2021, the federal government made the rule change permanent.) It was a rare victory for reproductive rights in America—and many red states swiftly created restrictions to prevent telehealth abortion providers from legally operating within their borders. Because of these measures, Hey Jane currently operates in six states: California, Colorado, Illinois, New Mexico, New York, and Washington. On Monday, Politico leaked a draft opinion from the Supreme Court, later substantiated by Chief Justice John Roberts, indicating that the court had voted to overturn Roe v. Wade, a move that could reintroduce abortion bans in many states. The court's decision won't be official until June, and it could change, but it already has people like Hey Jane cofounder and CEO Kiki Freedman working on ways to continue providing access. WIRED talked to Freedman about Hey Jane's plans for a post-Roe v. Wade world, what people might not know about abortion pills, and the role telehealth providers might play in states they can’t legally serve.

This conversation has been edited for clarity and length.

WIRED: Can you briefly explain how Hey Jane works?

Kiki Freedman: Sure. So right now, patients come to our website, they'll do an intake, where we collect information about their medical history, potential contraindications. They can take that anytime, 24/7. Then, usually within 24 hours, one of our prescribers will follow up with them to answer any other questions, and, if medically appropriate, give them the prescription for a medication abortion treatment. This treatment will then arrive at their doorstep in a few days, and they can take the medication wherever is most comfortable for them. At any point throughout the service, they can chat with us for any form of support they might need, clinical or emotional. And we also offer an online community for patients to connect with one another if they want to. It's the first time that verified abortion patients can connect, going through the same thing at the same time, online.

In July 2020, a federal judge granted approval for pregnant people to obtain abortion medications without needing to see a doctor in real life. It seemed like a moment where abortion access might actually expand a bit. Now we’re in a very different moment. How is Hey Jane preparing for the likely overturn of Roe v. Wade?

I should start by saying that the overturn of Roe would be an incredible attack on individual liberty and equity. It’s really just increased our resoluteness to fight for high-quality abortion access for everyone. We see telemedicine fulfilling a specific role, and an important role, should the Supreme Court overturn Roe. We are live in six states right now, and we did select those states in part to cover the highest number of patients possible, but also to act as strategic anchor states. In a post-Roe world, people may need to travel across state lines to get care. In many cases, the telemedicine model will reduce the distance they need to travel. I think, especially as demand increases in these states—there’s data that says California is likely to experience a 3,000 percent increase in abortion patients post-Roe, and in Illinois, it’s 8,000 percent—just being able to provide an additional source of care for patients to go along with in-person clinics will remain critically important.

To expand on the anchor states thing—how does that work, logistically?

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People do need to be in the state during the consultation and to receive the medication. But it would allow them to get it at a location that would be more convenient, if there aren’t clinics close to the border. And in many cases, it’ll allow them to get care sooner if clinics have extended wait times due to the increase in demand.

Have you seen people doing this already, traveling to the border and staying with a friend, or maybe at an Airbnb, and then using telemedicine?

Yes, we have.

I read that you’re partnering with local abortion providers in various states to prepare for further abortion restrictions. Can you tell me about that?

We partner with some really great abortion funds to offer financial assistance for patients who can't afford the full cost of treatment. Our price now is $249, which tends to be less than the national average of $550. But of course, in many cases, that’s still burdensome, especially as patients may not be able to use insurance. And so the abortion funds, and practical support organizations, are also going to be really critical in supporting people who need to travel in order to get access to care.

Are there any particular abortion funds that you think people should know about?

I don't want to play favorites, but the National Network of Abortion Funds is a great resource that covers funds across the country.

Do you have any advice for people who need abortions but live in states that you aren't able to serve?

Check out Ineedana.com and Plan C. They have really great resources that anyone can use across the country.

What has the public response to Hey Jane been? Any issues with anti-choice protesters?

It’s been very positive, which I think reflects popular sentiment. Most people do believe that abortion is health care and have really shown a strong amount of support for efforts to increase access.

Are there any misconceptions about the abortion pill you’d like to clear up?

I think the biggest thing is that not enough people know about the abortion pill. We've seen some data where only one in five people even know that it exists as an option. So rather than going over misconceptions, I’d just go over some of the really important facts to know. It is incredibly safe. It's been around in the US, approved by the FDA, since 2000. There's a low adverse-reaction rate, 0.1 percent, which is lower than many common medications. There's a ton of data now supporting that it's just as safe when delivered via telemedicine. It’s very effective—data shows it's up to 98 percent effective at ending unintended pregnancies up to 10 weeks. And it’s very common. Now over 50 percent of abortions in the US are done through medication.

What are your biggest fears at this moment?

It’s just the reality that there are going to be millions of people who are unable to access care that they really need. And there are so many secondary effects to that. It’s just—it’s hard to even put into words.

What would you say to someone who opposes abortion?

One in four people with a uterus will have an abortion in their lifetime, including many people who say they oppose abortion. We really see patients across the political spectrum and ultimately just believe abortion care is health care. We think patients are best positioned to know what's best for them and their lives.

Are you hopeful about the future of reproductive rights in the US?

The reality is that overturning Roe, like many of the extraordinarily cruel bans that have already been put into place, will be really devastating to pregnant people, and particularly Black and brown people, low income people, and young people. But I do think a key difference for folks to remember is that unlike in the pre-Roe era, we do now have safe and effective tools that will put the power back in people's hands and technology to help connect people with that care. It's not to say that it's not a tremendous burden, but that does give me some hope.

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