AILSA CHANG, HOST:
Three years ago today, the Supreme Court overturned Roe v. Wade, ending the constitutional right to abortion. Since then, about 40% of U.S. states have increased restrictions on abortions, and now many women are having abortions without a doctor's oversight. And some doctors are OK with that. Here's reporter Abby Wendle.
ABBY WENDLE, BYLINE: For nearly four years, Maya Bass' commute included a monthly plane ride from Philadelphia to Oklahoma.
Do you like flying?
MAYA BASS: Oh, no. I get really motion sick. I'm really good at not vomiting, though, so...
WENDLE: Bass made that trip each month to fill a gap. Oklahoma had a shortage of abortion providers, and she's a family medicine doctor who provides abortion. One way was by prescribing abortion pills. Bass was trained to follow a strict protocol around the pills. It included multiple in-person appointments to get an ultrasound and blood work and to pick up the pills at the clinic. Bass believed many of these steps kept patients safe.
BASS: Of course I'm going to confirm exactly how big this pregnancy is. Of course I'm going to confirm that my patient has enough blood to handle this.
WENDLE: So Bass was concerned when she first heard about self-managed abortion - getting abortion pills without a prescription and taking them without a doctor's oversight.
BASS: Gosh, what if people are dropping like flies because they're taking meds that are actually rat poison and hurting themselves?
WENDLE: A lot of doctors had a similar reaction.
JEN KARLIN: People felt it was really unsafe.
WENDLE: This is Jen Karlin, a professor of family and community medicine at the University of California, San Francisco. In the late 2010s, she became interested in the debate about self-managed abortion.
KARLIN: I wanted to talk with clinicians about this to find out, are you really worried about the safety of this? And if you are, what aspect of the safety are you worried about?
WENDLE: In 2019, Karlin turned these questions into a study. First, she surveyed 40 abortion providers and asked what they thought about self-managed medication abortions. About half of them were ambivalent. Then Karlin gave them a fact sheet summarizing nearly two dozen peer-reviewed studies that showed self-managing with pills is safe and effective.
BASS: Like, wait, what? Like, seriously? I never knew about any of this.
WENDLE: Bass was one of the doctors in Karlin's study. The research on that fact sheet showed that the protocol Bass used - the multiple appointments, the ultrasound - wasn't always needed.
BASS: Realizing that I was unnecessarily putting people through hoops - that's hard. And then I felt also excited/maybe relieved. Like, this means that I can be less scared for people who are doing this.
WENDLE: The next year, 2020, far more doctors changed their minds because of the COVID-19 pandemic and the need for social distancing.
KARLIN: Now all of a sudden, the health care profession is saying, wait, wait, wait - does that person really need to come in to do that ultrasound? And lo and behold, there's all this evidence already out there that, no, they don't.
WENDLE: During the pandemic, the FDA stopped enforcing regulations on one of the abortion pills, mifepristone. Patients were no longer federally required to go to a clinic to get abortion pills. Doctors in many states began using telemedicine. Karlin went back to the doctors she had surveyed in 2019 to see what they thought about medication abortion with less medical oversight.
KARLIN: They're seeing it and they're saying, oh, everything I was reading about in those papers is right, and I'm seeing it from my own eyes, and now I'm even more convinced that it works.
WENDLE: Across the country, many doctors who provide abortions embraced a more demedicalized approach. As of 2024, 19% of all abortions happened with telehealth. But telehealth still requires a doctor to give a patient a prescription. Self-managed abortion goes a step further. People get the pills on their own, often by ordering them online. More women have done just that since Roe v. Wade was overturned in 2022. Since then, studies have shown that the rate of self-managed abortion has increased, and so have online abortion pill orders. And organizations that support people through self-managed abortions have seen an explosion in people reaching out. That's true for the Miscarriage and Abortion Hotline, which is run by clinicians. Bass, the family medicine doctor, joined the hotline after reading the research about self-managed abortion.
BASS: The vast majority of the calls I'm dealing with are people just being like, hey, can you tell me if it worked?
WENDLE: Bass knows self-managed abortions can't replace all abortions. Some people need medical intervention or just prefer to go to a clinic. But to her, the hotline and the immediate access it gives women to doctors without unnecessary tests feels innovative.
BASS: It feels like I'm just on the cutting edge of medicine. I'm practicing evidence-based medicine that is the leading edge of what reproductive health care might look like.
WENDLE: The broader mainstream medical community has been moving in this direction, too. In 2022, the World Health Organization declared self-managed abortion to be a safe and effective method in the first trimester. And in 2024, the American College of Obstetricians and Gynecologists put out a statement in support of it.
But there's been movement in the opposite direction, too. Last month, Secretary of Health and Human Services Robert F. Kennedy Jr. ordered the FDA to review regulations on mifepristone, which could restore the rules that require patients to get multiple tests and pick up the pills at a clinic. If abortion pills get harder to access through the formal health care system, even more women may look to self-managed abortion.
CHANG: That was Abby Wendle, reporter for Embedded, NPR's home for long-form documentaries. The podcast just came out with a new series about the history of self-managed abortions called The Network. It was produced with Futuro Media. Transcript provided by NPR, Copyright NPR.
NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.
