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On Friday, May 1, Chicago Abortion Fund executive director Megan Jeyifo was getting ready for a fundraising event when she heard the breaking news about a court decision that severely curtailed nationwide access to the abortion pill mifepristone. She immediately sent a staff-wide message on Slack.
“Mifepristone by telehealth is no longer accessible for anyone seeking abortion care in the country,” she wrote. “We’re working to understand what this will mean for our grantees who are receiving telehealth now and in the short term. We know how critical telehealth abortion care is, and this is a very difficult thing to digest.”
Across the reproductive health landscape, similar messages were sent to staff as providers everywhere grappled with the sudden unanimous decision from the Fifth Circuit Court of Appeals. As my colleague Nina Martin reported earlier this month, their move “granted Louisiana’s request for an injunction against FDA rule changes from 2023 that have allowed blue-state telehealth providers to send mifepristone to thousands of patients every month in states where abortion is banned.” More than a quarter of abortions in the US occur via telemedicine. By Monday, the US Supreme Court temporarily reinstated access to mifepristone, which, with misoprostol, is prescribed to induce an abortion or aid in a miscarriage.
Now, the Supreme Court is expected to make a decision in the case as early as Thursday. Meanwhile, abortion providers as well as the directors of some of the country’s largest abortion funds and support hotlines told me this week that they are prepared to address patients’ needs even if further restrictions on mifepristone are created. Many anticipate offering patients just misoprostol for their abortions. As Nina reported last week, a misoprostol-only protocol can work just as effectively—though it may cause more side effects. “Telehealth providers aren’t going away,” said April Lockley, medical director of the Miscarriage + Abortion Hotline. “Through all the confusion and potential legal changes, we’re all here to stay and support abortion seekers.” Abortions with mifepristone will also still be available for in-person treatment at clinics.
Since the May 1 ruling, many providers have noted increased orders for this medication. “Getting pills in advance of the need for them is a strategy that we have proposed and advocated for for years now,” said Elisa Wells, co-founder of Plan C, an online campaign on abortion pill access. Their website traffic has also increased since the Louisiana ruling.
“Any challenge to abortion access in the United States by the anti-choice movement is designed to instill fear, confusion, and chaos.”
“Any challenge to abortion access in the United States by the anti-choice movement is designed to instill fear, confusion, and chaos,” Wells added. “These court cases are no different.”
It’s a concern I heard from other providers and abortion funds as well, with many pointing to news headlines about the mifepristone case that seemed to imply that all medication abortion was now banned. “I think letting people know abortion is still legal is just really important,” Jeyifo, with the Chicago Abortion Fund, told me. “You hear a soundbite on TikTok or Instagram or like a headline, and a lot of people assume that abortion is illegal in totality.”
Other providers told me they fear that further restrictions on abortion pills would fuel the growing criminalization of self-managed abortions. At the Abortion Freedom Fund, which exclusively funds telehealth abortions, co-executive director Carly Kol said she received a few messages after the Fifth Circuit ruling from patients who already had mifepristone and were unsure if they should take it, fearing that doing so would be considered illegal. “We live in a very punitive society,” she said. “I think folks are really scared.”
Abortion funds are also prioritizing fundraising to help get patients who want to use the mifepristone-misoprostal combination to terminate pregnancies to in-person appointments. The Women’s Reproductive Rights Assistance Project is a national abortion fund that works with hundreds of clinics, doctors, and hospitals nationwide. Sixty-four percent of abortion seekers who come to them choose medication abortion.
Last year, the organization, known as WRRAP, helped 17,000 patients, with 42 percent needing to travel due to abortion restrictions in their states. Executive director Sylvia Ghazarian said her organization expects to spend more if mifepristone is restricted because a patient who chooses the two-pill, gold standard combination of mifepristone and misoprostol will need to travel to a clinic. “I am worried about the donations,” she told me. “That is primary right now, trying to see what we can do to get as much funding as possible to be able to support whatever these outcomes are long term.”
When news of the Fifth Circuit decision broke, staff at Whole Woman’s Health, one of the largest independent abortion providers in the country, was ready. The organization, which runs clinics in four states and also offers telehealth services, immediately switched to a misoprostol-only protocol. They posted information about the court ruling on Facebook to keep patients up to date. For CEO Amy Hagstrom Miller, who was concerned that abortion seekers would think that all abortion medication was now banned, messaging was important. Court rulings can often be confusing as information filters through social media and vague news headlines.
On Monday, Hagstrom Miller told me her staff was ready for whatever the US Supreme Court decided. If they restricted mifepristone, Whole Woman’s Health would offer a misoprostol-only regimen to patients. Mifepristone would continue to be available in person at their clinics. “We basically have everything lined up,” she said. “There shouldn’t be any disruption at all.”
While it’s true that patients will still have access to misoprostol, restricting mifepristone further reduces the already limited options for abortion care in much of the US, Hagstrom Miller said. “Stop taking away our options,” she said. “Yes, we can still provide abortions with misoprostol, but, like, what’s next?”
Nina Martin contributed reporting to this story.
