It Just Got Easier to Get a Medication Abortion (Some Exceptions May Apply)

When the Food and Drug Administration (FDA) approved mifepristone--the first of two drugs used in a medication abortion-- in 2000, the approval process came with a myriad of restrictions. Kirsten Moore, creator and director of the Expanding Medication Abortion Access (EMAA) Project, sits down to talk with us about the evolution of restrictions on medication abortion over the past 22 years, as well as the future of medication abortion access.

In the mid-2000s, these restrictions were folded into an FDA program called Risk Evaluation and Mitigation Strategies (REMS). These restrictions included a certification process for the clinician, requires that the medication be dispensed in person in the clinic, hospital, or medical office, and patients must fill out a consent form. During the pandemic, the FDA issued guidance for medications subject to REMS, easing restrictions on providers and patients—but medications requiring in-person dispersal was not included. The American College of Obstetricians and Gynecologists (ACOG) sued the FDA, leading to a short period of time in 2020 when providers were able to consult with patients and prescribe medication abortion care through telemedicine and the mail. In January of 2021, the Supreme Court shut these abilities down. Still, in spring of 2021, the FDA announced that they would re-consider the current REMS restrictions. In December of 2021, the FDA announced the removal of the in-person distribution requirement for mifepristone and allowing in-person and mail-order pharmacy distribution.

Unfortunately, expanded medication abortion access will, like many reproductive health services, be dependent on where you live. At this moment, 19 states prohibit the use of telehealth for abortion care (the number of states may rise to 26 depending on the future of Roe v. Wade). Many patients who are seeking an abortion are already facing structural, financial, and logistical barriers that make accessing this care extremely difficult to begin with. Even so, the FDA’s lifting of unnecessary restrictions on medication abortion dismantles one less barrier to care for many.

Links from this episode

The EMAA Project on Facebook
The EMAA Project on Twitter
Blog post- Supporting a Friend’s Abortion At Home
A Tale of Two Medication Abortions Youtube Video

Transcript

Jennie: Welcome to rePROs Fight Back, a podcast where we explore all things reproductive health, rights and justice. I'm your host, Jennie Wetter, and I'll be helping you stay informed around issues like birth control, abortion, sex education and LGBTQ issues and much, much more-- giving you the tools you need to take action and fight back. Okay, let's dive in.

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Jennie: Welcome to this week's episode of rePROs Fight Back. I'm your host, Jennie Wetter, and my pronouns are she/her. So this weekend was an important one, it was the 49th anniversary of the Supreme Court decision on Roe V. Wade, which guaranteed a legal right to access abortion in the United States. Now we know from the very beginning that while it guaranteed legal right to abortion, it did not actually ensure everybody had access to abortion. The hardest hit were especially people of color who were struggling to make ends meet. And so you've seen after Roe was decided decades of abortion restrictions were put in place to deny people access to abortion. And again, those hit the most marginalized among us, everything from the Hyde amendment to SB8 in Texas to TRAP laws across the country. So many restrictions that have blocked people from accessing abortion care. So while we've had 49 years of a legal right, for so many people that has been a right in name only, and this year, as we're sitting here thinking about this 49th anniversary, that automatically leads you to think about next year and the 50th, but what are we gonna see at the 50th anniversary? I'm really worried. Y'all like, is Roe gonna make it to see 50? I don't know. It's already not a place in Texas, right? With SB8, like saying that you can't get an abortion after six weeks. That means that Roe does not exist in Texas. And according to the Guttmacher Institute, because of that, that means 1 in 10 women in the United States live somewhere without access to Roe. And I said women because that's what the data is. Not that women are the only people who can get pregnant. That's 1 in 10 women. That is a lot of people y'all like, and that's just one state. It seems likely, and that the Supreme Court is gonna say in the Dobbs decision that we're expecting this summer, that a 15-week abortion ban is okay. That's basically overturning the holding at the heart of Roe. It is gutting Roe. What is that gonna mean? According to Guttmacher, that means that probably 26 states are likely to ban abortion. That is wild y’all. A lot of them have trigger laws already in place. So as soon that it happens, you would see Roe cease to exist in so many places.

Jennie: What is that gonna mean for people accessing care they need, it's gonna force people to carry an unwanted pregnancy to term. And again, then this is not gonna fall equally on everyone. Some people are gonna be able to travel to go and get abortion care where they need it and travel out of state. But so many people aren't gonna be able to travel. And when you're talking 26 states, they may have to travel a long way. It's gonna be a lot of money. So again, the need, it's gonna disproportionately on people of color, struggling to make ends meet. We really need to be planning for this post- Roe world and what we need to do to ensure that everybody is getting access to the abortion care they need. And I just, you know, this 49th anniversary, like, we should be celebrating that people have access to the care they need. They don't. And I think by Roe’s 50th anniversary is it even gonna exist? Like, what is, what is abortion access gonna look like this time next year? I don't know, but I do know the fight is not over. And even if Roe falls, people are gonna keep fighting to ensure that everyone has access to the abortion care that you need. So, you know, it's disheartening and y'all, I would be lying if I said there weren't days that I got really down and thinking about Roe not making it to its 50th anniversary is one of those times. and I may need to pause and like sit back and stop for a minute because I need to take a break, cuz I'm tired. That doesn't mean I'm ready to stop fighting. Right? We're gonna keep on in this fight to ensure that everybody has access to the abortion care they need. So I guess, well, thinking of the 50th anniversary makes me sad. It also makes me really determined to fight. And I'm in this fight for the long haul. So I guess with 49 years, we're ready to keep fighting for it to get to 50. But even if it doesn't, we're still in this fight to ensure that everybody gets access to the care they need. And sorry, y'all for the blanket intro. I know things are kind of dark right now, but there is good news, right? What?! No you're telling me there's good abortion news?! I know, there is good abortion news. And so I'm super excited that today we're gonna talk about it-- in December, the Biden administration and the FDA changed their restrictions around medication abortion, and it is gonna expand access to for people and make it easier for them to get access to medication abortion. Now, unfortunately, this isn't gonna impact everybody. There are states that have restrictions that so [in those states] this won't apply, but it is good news for a lot of people and it is gonna make abortion care, easier to access. So today we're gonna talk all about it and I can think of a better person to have on then Kirsten Moore with the Expanding Medication Abortion Access Project, or the EMAA Project, on here to talk all about it. So with that, let's turn to my conversation with Kirsten. Hi Kirsten. Thank you so much for being here today.

Kirsten: Thank you for the invitation Jennie, looking forward to the conversation.

Jennie: So before we into the conversation, do you want to introduce yourself and include pronouns?

Kirsten: Sure. My name is Kirsten Moore. She/her. And I created the EMAA Project, and EMAA stands for Expanding Medication Abortion Access.

Jennie: So I'm so excited to have you here because we've actually had some good abortion news and that is kind of rare these days. But before we get to the good news, maybe we should do a little bit of like scene setting and talk about what things look like. So what did accessing medication abortion look like before all these changes? And like before the pandemic, cuz there was a change then too.

Kirsten: That's right. So when FDA approved Mifepristone, which is the first of two drugs that are used in the medication abortion care regimen, it puts some restrictions on how mife could be prescribed and dispensed. And those restrictions ended up getting folded into an FDA program called the Risk Evaluation Mitigation Strategies, or REMS. In the mid 2000s, Congress gave FDA the authority to set up kind of a standardized program to restrict use of some drugs. And so the initial restrictions were folded into the REMS and, and what we were dealing with in the REMS, the restrictions had three, what FDA calls, elements to assure safe use. And so the first element says that only certified prescribers can write a prescription and the certification isn't that onerous it's, uh, licensed healthcare professional in states that allow licensed healthcare professionals, some states as, you know, only allow physicians to prescribe or provide abortion. But anyway, the certification process is basically checking off three boxes on a piece of paper. And the first says, “yes, I know how to detect an ectopic pregnancy,” which is actually kind of tricky to do early in pregnancy. All you're doing is asking mostly family history. “Yes. I know how to date a pregnancy.” And that of course is something that most women can do because they can tell you the date of their last menstrual period. And then “yes, I can refer for treatment for complications or backup care as needed.” Again, that's a standard-- if you were a licensed healthcare professional, you know how to refer for treatment or backup care. So you're just signing your, you know, name to those three things, but it means putting your name on a list of abortion providers and that's a disincentive for some people. That's the first element. The second element to assure safe use is one that says that that certified prescriber has to be both doctor and pharmacist, meaning they had to prepurchase and stock the pills in their clinic or hospital or doctor's office and dispense the pills directly to a patient. And then the third element to assure safe use is a patient consent form. Basically again, the patient signing a piece of paper that says, “yes, I know I'm taking a drug that will cause an abortion.” So those three elements were in place since 2000. During the pandemic, the FDA issued guidance for drugs that are subject to REMS and said, “you know, hey, we get it. This is a time where people are trying to limit exposure to the virus. So we're gonna give you healthcare providers more latitude to consult with patients, you know, use telehealth appointments, for example, you know, we're, we're not gonna make you adhere to the REMS in this public health emergency,” but they had a footnote that said this doesn't apply to drugs that are subject to in person distribution. So that meant mife was subject to the, the same restrictions for comparison. Most of the other drugs or all the other drugs that fall into that category are cancer treatment drugs. So those are drugs that really do have to be administered in a clinic because they have to be titrated individually and they have to be monitored while the patient is taking the medication. Mifepristone is a drug that you pick up in the clinic, but you can go home and start your abortion process at your, at the timing of your choice. So that kind of didn't make sense. The healthcare provider community, a combination of folks, you know, wrote into FDA and said, “Hey, wait, come on. Can't you carve out an exception here?” The FDA was nonresponsive. Of course, this was under the Trump administration and then the ACLUE on behalf of ACOG, the American College of OBGYNs, sued FDA and said, you know, this… holding this drug hostage to this restriction in the public health emergency doesn't make sense. Courts agreed with ACOG and ACLU and for a period of time in 2020, certified healthcare providers in states that can use telehealth would consult virtually with patients and then they were FedExing or UPSing or mailing the medication to patients. So we started to get this system up and running and we started to collect data about how that system was working. The Supreme Court shut that down in January of 2021, but you know, we didn't give up, there was a new administration. We were going back in and asking FDA to reconsider. There was also this preexisting litigation that ACLU had brought on behalf of someone named [inaudible] who practices in Hawaii about the REMS writ large and said they were, you know, unconstitutional. They were unnecessary, burdensome in the context of that legal back and forth, FDA volunteered to revisit the REMS. This was in April or May of 2021. So when we knew that FDA was gonna revisit the REMS, we worked with other healthcare providers and researchers to get as much data into the record as possible that the FDA could consider all of that. And then in December of last year, of 2021, FDA announced that it was removing the in-person distribution requirement and is going to allow pharmacy distribution, meaning both mail order and brick and mortar, but they're gonna require that those pharmacies be certified. So we're now in a period of time where there's gonna be some back and forth between the drug makers, the drug sponsors, and FDA to figure out how this program is gonna work in practice.

Jennie: Yeah. So many questions. And there's so many like things that, that makes me think of. So maybe we'll start at the beginning and, and I think you kind of started to address this, but like there's no real reason I would need to like go and get mife from an abortion provider. Like I don't need to actually see them in person in their building to be able to safely take this.

Kirsten: So it is an incredibly safe, medication abortion, that is true. And again, you know, people who are taking this drug are you know, know they are pregnant, know they don't wanna be pregnant. And you know, really like the idea of having an option, a non-invasive option for ending an early pregnancy. Mife and miso are used up to 10 weeks of pregnancy. So the medication itself, isn't the isn't really an issue, but it is true that, you know, the process of ending the pregnancy, right? The, the bleeding that happens, the mife shuts down the hormones that are necessary to sustain a pregnancy. And then the second drug misoprostol is what causes cramping and bleeding so the pregnancy can pass. There's one, a provider called CARAFEM, that has a few brick and mortar clinics, and also does some virtual stuff. And they've developed an AI bot called Cara. And what we've seen with that, that patients who use mife, you know, they're bleeding, they're bleeding in their own home. They've been warned, they've been told this is what's happening, but they just seek some reassurance as one provider has called it, but their body is doing what it's supposed to be doing. And so, you know, it, it, it, it's not that you need special training to offer prescribed mife, but it is true. It requires a little bit of, I would say kind of backend support for patients who just wanna be reassured that everything is going according to plan. But that being said, you know, there is the certificaiton that I described, you know, doesn't help do all of that. So, you know, and, and I think, you know, there are any number of patients who would prefer to go to their own healthcare professional and get a prescription, and then be able to get that prescription filled in a way that makes sense for them.

Jennie: Yeah. And I guess that leads me to the next thing like this new arrangement makes me think of, is it adds in this whole other layer, like at least when you were going to abortion providers, you know, they would give it to you. If I go to a pharmacy, I mean, people sometimes have a hard time getting birth control, uh, for religious refusal reasons or various reasons. And like in cities, that might not be a huge problem. But if you live in a rural area, there might only be one pharmacy. It, it just like raises this whole level of concern of like certified pharmacies. What is that actually gonna mean in terms of access?

Kirsten: So that's all, those are all really good questions, legitimate concerns, frankly, concerns I shared. Um, uh, when we thought about EMAA and kind of what we thought we could try to get from FDA in my head, I, I thought a good solution was a system that was, that had players who are opting in voluntarily… you know, to ensure precisely your point that patients would get the medication when they wanted it. So as a result of the pandemic, right, we now have two mail order pharmacies that are up and running that are doing this, that are delivering the meds to patients, usually within, you know, a couple of days of a telehealth appointment, the FDA change, while it says, you know, patients no longer have to come into a clinic to pick up a pill in states that don't allow telehealth, they can still come into the clinic, that clinic can still dispense the medication to them directly. And then hopefully, and this is what the drug sponsors and providers and advocates are really thinking through right now is, you know, okay…yes, there are 80,000 and retail pharmacy outlets in the United States. How do we create a system that ensures confidentiality and ensures the delivery of the medication? And there's just a lot of unknowns at this point, but again, we hope that we're gonna be working with somewhere down the road, like major pharmacy chains that have a policy. We provide this medication for our patients. We might have a policy that allows a pharmacist to step away as if under a conscience clause, but that patient can't be not denied care. Like there has to be somebody else who's there to fill the prescription. So there are a lot of unknowns and I share your concern about, you know, we, on the one hand, we don't like the idea of abortion exceptionalism. On the other hand, right, it is exceptional in our healthcare system and we can't wave a magic wand and make and reconcile those two things.

Jennie: Yeah, you're right. Like, this is good news just immediately in my head, you know, having to sit in other repro spaces and having to fight these like religious refusal battles in so many areas like this is like the first thing that like popped in my mind when I start hearing that, like you can go to a pharmacy to get, it is just a, all of the hurdles we've run to in other areas of, with like birth control and stuff of accessing that. And, you know, the idea that there would be like certified pharmacies. So maybe when you have your telehealth appointment, you'll get like, “here, here, here,” will make it easier. Yeah. But like still, if you have to like go and find a pharmacy, depending on where you live, it could still be complicated.

Kirsten: Absolutely agree. Yeah. And, and as I said, kind of all of us who are working in this space are, you know, really committed to what makes the most sense from a patient perspective, you know, what is a streamlined model here that, that will work, and that is viable from a business perspective, you know, we're having to get real about this. Right? Yeah.

Jennie: So, yeah. The other thing that listening to you made me think about is this isn't gonna be true in every state, right? Like this is great for the states that allow it, but there are a number of states that aren't gonna allow this. So I think that's also a really important point to talk about. So maybe, can you talk a little bit about, what is this gonna look like? How is this gonna impact people depending on where they live?

Kirsten: No, the fact is that right now, upwards of 20 states, I think 19 states, prohibit the use of telehealth for abortion care. And that can be, you know, a pre-consult meeting. It can be the actual visit, “okay, I've described your options. You've just, you've said, you, you want [a medication abortion], I can write you a prescription and mail it to you.” Like that's not allowed, people have to go in person into a clinic. And in some cases, see if, as I said before, see a physician, not just, you know, a nurse midwife for another licensed healthcare provider who, and can counsel women about what to expect. So the FDA change won't have a dramatic impact in those states, but hopefully, you know, and this is just the conversation that, that folks are starting to think out loud about is, you know, if the use of telehealth and mailing of medications or, or, or brick and mortar pharmacies, you know, creates some more flexibility in the abortion care ecosystem, you know, the states where the telehealth model is offered, might be able to create some space, to provide services to people who are in other states where abortion is increasingly restricted, you know, like women from Texas having to go to other cities to get the care they need. So we, you know, again, still kind of waiting to see how this is gonna play out in real terms. The other question that some of us are really looking into is, you know, it’s bonkers to me, that women in, again, upwards of 19 or 26 states, depending on what the court does with Roe, wouldn't have access to an FDA approved drug, right? That is not okay. That doesn't exist any where else in the healthcare system. So there is, you know, the idea that there might be a legal challenge out here around the topic of preemption, like, you know, state laws can't preempt a federally approved drug, or can't preempt the use of, or access to a federally approved drug. So, you know, very much TBD.

Jennie: Yeah. And I think, you know, this is all, it's so great to see it expanding. And I, but I think it is really important to also then mention that like, those states that are blocking it and like requiring you to go in person to get it are states where there are so many other abortion restrictions. And you're seeing clinics that have closed. There may be one clinic in the state, or like Texas, and you have to travel, you know, you can get a medication abortion up to 10 weeks, but Texas has like a six-week ban. So, you know, it, it still is very hard to access medication abortion in those states for are those reasons of having to jump through all of these hurdles. That's something I try to raise a lot when we talk on the podcast is we're not talking about individual restrictions, right? Like, yes, it is important that there is this in-person requirement, but it is also living in this world with all of these other restrictions that are impeding access to care, including TRAP laws, which are forcing clinics to close. So it's making it harder and harder to be able to access care in those states

Kirsten: A hundred percent. And I, you've probably talked about this on the podcast with other guests, or maybe even had her as a guest, but you know, huge, I'm a huge fan of Diana Green Foster or Diana Foster Green's work. The Turnaway Study.

Jennie: Yes, I had her on, she was wonderful, but yes, reiterate it, it’s important.

Kirsten: The, the reality that the majority of patients who seek abortion care today are, are already mothers. They already have children and they are mothers who are struggling to make ends meet. And, you know, when you look at outcomes, five years down the road of women who got to a clinic right before their cutoff date, you know, her, her pregnancy and their ability to provide care who got the care they needed, versus women who got to the clinic and were just at, you know, a couple of days too late and were turned away. And you look at the outcomes between those two patient groups, both mothers and children, you see that women who got the care that they needed and their children are doing better. And again, it's just, you know, especially in light of the recent Supreme Court arguments, it's just so offensive to me that, that this assumption that like, oh, we can just wave pregnancy away. We can just wave the cost of motherhood away. We're, you know, the crisis pregnancy centers are there to give you a bag of diapers. It'll I'll be okay. Yeah.

Jennie: Well, yeah. And even, you know, something that Dr. Green Foster talked about was what she found shocking in the Turnaway Study was like, we know there is the risk you were talking about with abortion. Isn't the risk of having the abortion or not having the abortion, it's having the abortion versus having the child and, and, and being pregnant and having childbirth. And the maternal mortality rate in this country is high, especially for Black women, for people of color. And that the study showed, like they had two of the people or maybe three. They had a couple people in their, in the study die because of maternal mortality. And this is a very real risk. And so these need to be simultaneous conversations that we're having. We're not just talking about having an abortion, just to not be pregnant. It is actually life and death. It can have real consequences to have economic consequences. It can have mortality related consequences. These are very real decisions that people have thought through. And I think that's one of the things that you often is missing from a lot of these abortion cases, right? Or these laws. It's like, let's give the lady a little more time to think about her decision, cuz she doesn't know what she wants. And oh, so infuriating that they know what they want. They know what the risks are and they have made these decisions and we need to get outta people's way so that they can access the care that they need and want.

Kirsten: Yeah. I mean, I've, I spent some time earlier in my career thinking about how to talk about abortion, especially with people who feel conflicted about it, the majority of people do. And you know, I was like, okay. So if I had a bumper sticker, what would it be? And for me it was like, you know, it happens. Kids are too important, that is a lifetime commitment. If you feel, you know, that you are not a able to do that or you're trying to live up to your existing commitments, who am I to second guess that?

Jennie: Yeah. Okay. So we have these new, the in-person requirement is going away. It's not gonna be gone in all states. What's next?

Kirsten: Yeah. I mean, the changes that FDA is gonna make are, you know, they are not a panacea, but they are a real sign of progress. FDA doesn't often rethink things. And the fact that a big giant bureaucracy took the time to look at all of this data and make a decision to move forward and make some changes is a big deal. It's important. And part of the real world importance is evidenced by FDA on December 16, when they sent the letter to the drug sponsors and said, you know, we wanna update the REMS and work with you to figure out what this distribution certification process will look like. Um, and sent a letter to the plaintiffs in the lawsuit to say, we're gonna do this. They also, uh, issued a response to the American Association of Pro-Life OB GYN’s citizen petition. They had filed a citizen petition actually back in the day in like 2003 or something, a couple of years after FDA first approved mife and said, “you've got it all wrong. You should never have approved this drug. You shouldn't do anything else.” When FDA updated the label in 2016 and made some changes to say, okay, we've looked at the data. Our original label said you had to use, you know, I forget what it was… 400 milligrams of mife. Now we know you only need 200, so we're gonna update the label there. We initially said, you could only use it for 49 days. Now we see the data and see, you can use it up to 70 days safely. We initially said only physicians could prescribe it. We've looked at the data and we see now licensed healthcare professionals. We used to require you to take the pill in the clinic. Now we see that is not necessary. You just still have to come into the clinic and pick it up and take it at home anyway. So when FDA updated the label in 2016, they wrote back and said, your petition is denied. [Inaudible] they submitted another citizen petition to FDA saying, “you know, we disagree with the changes you made in 2016. And we don't think you can make any other changes going forward. You know, and here's why,” and frankly, as one of our colleagues says, you know, this is the, it's not the pro-life organization, it's the pro-lies organization. And just, you know, submit a lot of in, I, I, I can't even call it data, you know, just submit a lot of fluff and misrepresent things. So FDA took the time, this time around to write a 40 page response. And so they went through all of the, you know, claims that were being made and said, “we look at the data and we disagree. You know, we look at the data, this is not accurate. We look at the data you're misinterpreting.” So that's a pretty heavy rebuttal and, you know, shores up the kind of, again, evidence base of the decision. This wasn't a political whim. This was nope, we really have facts behind us here. The other telling piece to me about how, again, even though it, the changes are not a panacea, the real world implications are kind of big is the Susan B. Anthony List, which is a major pro lies organization. Um, they did an op-ed in the Hill, like maybe a week later after FDA announced their decision on the mife REMS and said, this is our worst nightmare. and they're totally freaking out right now because they know that, you know, once we're mailing medications, people are gonna find ways to keep mailing the medication.

Jennie: Yeah, for sure. I agree. I right. Like the cat is out of the bag. The horse has left the barn, like there's medication abortion, you can get it easier. And a lot of places now, like there's no going back on that. And I think, you know, having worked in repro for so long, my instinct is always to focus on the like, oh, we still need to worry about this. And what about this? So maybe we should take a minute and really celebrate why this is such a big victory. Like how much this is gonna expand access. Like just thinking and people who live in states where you can access this via telehealth, like people in rural areas who aren't gonna have to travel as much people who can't take the time off of work to have to go to a clinic like this is game changing for them. And it is huge. And I, I let my instinct to like, look at all the things we do need to worry about, get in the way of like, for us taking that minute to be like, this is huge for people who are going to be able to use it.

Kirsten: Yeah. And when, when we were getting ready to kind of make the case that, you know, it's been 20 years since FDA first approved this drug and put these restrictions in place, been 20 years, it's time to revisit these restrictions. We did a lot of opinion research, again, talking to people who really kind of feel more conflicted about the issue of abortion. And, you know, when we talked about, when we first introduced the idea of mife, of course, everybody thinks we're talking about emergency contraception or plan B. So you explained no, those are different drugs-- plan B prevents pregnancy mife ends a pregnancy, but once you laid out a couple of facts for people and I'm talking, you know, we did male, female, African American, Latino, Asian American, tried to do some work in an indigenous community as well. Like really wanted to see across the board. And what it would say was a universal response. I mean, there was always some skepticism of like, wait a minute, how does this drug really work? But they heard, okay, FDA approved, been around for 20 years, and I didn't even know about it, but, oh, she has an option for ending a pregnancy and, and she could have a noninvasive option and she could, you know, like people thought that was generally speaking a good thing. So, you know, when I'm hoping this recent change does, is help normalize that as an option. And again, kind of just gets people a little bit, um, like scratching their heads of wait a minute, it's an FDA approved option. Why don't women in Texas have access to this? That can't be right. So, you know, it remains to be seen. The other, just concrete of expanding access, which I, I love, I don't know if you've heard of, or, or maybe again, you've talked with them already, but the folks who run Just the Pill in Minnesota.

Jennie: Oh, uh, we haven't had 'em one yet, but yes, I've heard of them.

Kirsten: Yeah. So started, you know, a virtual clinic, but then when FDA shut down the option of mailing the medication for that time period, they actually started a, a van and go into remote corners of Minnesota to bring medication abortion care to patients. And, you know, one of the stories that they told was somebody who you know, who was able to come in for a, a visit said, I'm so thankful you're here because my abusive partner never would've allowed me to travel, you know, a day to have to go to your clinic in Duluth or St. Paul and take a, you know, a full day driving to and fro. So again, not a panacea, but there are real, real world implications that are beneficial for people.

Jennie: I'm excited. I'm excited what this means for all the people who are gonna be able to use it. Like we have pointed out, there still are a lot of questions in a lot of ways that this isn't gonna be available to everybody, but it is a huge, really important step. So I always love to end the episodes with like, what actions can our audience take. So what can our audience do to make sure that we are increasing, keep continuing to expand that?

Kirsten: I mean, I think obviously the fight in the states to reduce the barriers is ongoing. So being a part of advocacy efforts with organizations that are doing that work Planned Parenthood NARAL et cetera, really important. Again, I think just getting the word out about this, being a safe option for folks and not the same thing as emergency contraception, like just talking about it with people. And what I like about one of the things that I particularly attracts me to medication abortion care is the idea that we, as individuals can be helpers to people who are seeking care. You know, if you're going into a clinic and having a procedure, that's just a slightly different setup. But if you know, you're helping somebody find a prescriber online and you know, then just going over their house, when they're ready to start the, you know, take the pills and just sit with them, you know, make 'em a pot of tea, bring them a cozy blanket, do you know, Netflix and chill, and just realizing that we can be a part of that experience with our friends, our loved ones and support people. So that's another way I think people can make a different,

Jennie: Well, Kirsten, thank you so much for being here today. I had so much fun talking to you.

Kirsten: Thank you very much. I, I enjoyed the conversation. I appreciate your interest.

Jennie. Okay. Everybody. I hope you enjoyed my conversation with Kirsten. It was so nice to be able to celebrate good news. Like I said, in my intro, things are little bleak right now. It doesn't mean we quit fighting and seeing victories like this and opportunities to expand access to care, they feel pretty good. So like I pointed out in the episode, there are challenges. Let's take this minute and celebrate the good part, right? For so many people, this is a huge expansion and access to abortion care. So let's sit with that and let's end there today, right? There's this huge expansion and access to medication abortion. And that feels like a good place to stop today.

Jennie: Thanks for listening everyone. And we'll see you on our next episode of RePROS Fight Back. For more information, including show notes from this episode and previous episodes, please visit our website at reprosfightback.com. You can also find us on Facebook and Twitter at RePROS Fight Back, or on Instagram at reprosfb. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.

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