6 wins in reproductive health care this year

When it comes to reproductive freedom, there seems to be an unending flow of frustrating and concerning headlines in the news. What we don’t always see or hear are the wins, big and small, happening as advocates across the country push for change and protections. As part of our Un-Whisper Network Conversations series, members of Hey Jane’s leadership team sat down to discuss the good news in reproductive health care in 2023. 

Setting the scene after Roe v. Wade fell

Since Roe fell in June 2022, abortion demand has surged in states where care remains legal. State-level restrictions on abortion have not curbed the total number of abortions happening in the US—when people need abortion care, many will find a way to get it. 

Investigations by publications like the New York Times have seen this at a national level, but at Hey Jane we’ve also seen these trends to be true with a 278% increase in patients since Roe fell. This means that patients are undergoing substantial obstacles to get care—from driving hundreds of miles to securing funds for accommodations and taking time off work. 

“In states where [abortion] care remains legal, access has become more difficult as well. We’ve seen wait times go up meaningfully across the board as a relatively fixed amount of infrastructure has been attempting to absorb a much greater patient load.” - Kiki Freedman, Co-founder & CEO of Hey Jane

Despite this, certain states have stood up to protect abortion access. These states have acted swiftly and aggressively to roll out some innovative regulations to protect patients, providers, and health care organizations.

While this increase is significant, we also understand that this increase was not seen equally across the country and does not mean that abortion care is accessible for people in states with abortion bans and restrictions.

2023 win: Nearly half of states have passed “shield laws”

These laws take a number of forms and vary state to state, but the overall principle is that shield laws protect providers and patients from prosecution, discrimination, and oftentimes cross-state investigation from hostile states.

“We require all of our team members to live in one of these shield states. We think it’s extremely important to protect the privacy of our patients and the safety of our team. We’ve seen some team members move in order to continue providing care. I think it really enforces how important this service is and the sacrifices that have needed to be made to continue providing it.” - Kiki Freedman, Co-founder & CEO of Hey Jane

2023 Win: Protections for cross-state care in select states

Certain states have enacted protections for out-of-state patients who are seeking abortion care. In particular, California has made sure that shield laws apply to tech companies that are incorporated in the state, so that they’re unable to share data regarding abortion with any out-of-state authorities.

2023 win: Approximately 1/5 of states enacted insurance coverage laws to to increase access

We’ve seen progress related to regulations for insurance coverage of abortion care. A number of states have implemented requirements for insurance payors to more broadly cover abortion services. This includes laws that limit co-pays and certain deductibles, which is important because abortion care is  time-sensitive, and patients may delay accessing care if they need to pay  up front. States leading the way to broaden insurance coverage include California, Colorado, Illinois, Maine, Maryland, Massachusetts, New Jersey, New York, Oregon, Vermont, and Washington.

At Hey Jane, we’re proud to be the first fully virtual abortion provider to accept insurance, and currently accept six major insurance plans (and are actively working on expanding our coverage). Learn more about what plans we accept here.

2023 win: Approval of the first over-the-counter birth control pill 

In July 2023, the FDA approved Opill, the first nonprescription daily oral contraceptive.

Allowing individuals to access birth control at their local pharmacy will eliminate some barriers, although there are still unknowns around cost and whether it will be covered by insurance without prescription.

Opill is expected to be on shelves in early 2024 and will be added to Hey Jane’s comprehensive offering of contraceptive options. Learn more about birth control with Hey Jane here.

2023 win: Despite sensational headlines, the Fifth Circuit mifepristone litigation is unlikely to restrict access

Name of the case: The Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration

End goal: A court case that completely disregards science and medicine in a political effort to restrict access to mifepristone – which has been used for decades to safely and effectively end an early stage pregnancy.

Current status: In December 2023, the Supreme Court agreed to review the Fifth Circuit’s order restricting access to mifepristone—a move we are glad to see, as it closes the door on the challenge to the initial FDA approval of mifepristone and opens the door to reverse the rest of this baseless ruling. From the moment this litigation was first filed, it was designed to cause confusion. It’s imperative the facts are repeated: Mifepristone is safe, mifepristone is effective, and mifepristone is still FDA-approved. And Hey Jane will continue to deliver evidence-based, compassionate medication abortion care to our patients.

“This has been an intentionally confusing case designed by anti-choice extremists to sow discord and doubt, but we think it is unlikely to have any lasting impact on access to mifepristone.” - Kiki Freedman, Co-founder & CEO of Hey Jane 

After a series of rulings, the case will now return to the Supreme Court, to review if the plaintiffs have standing and whether a preliminary injunction is appropriate.  We expect that the Supreme Court will continue to protect access during further litigation, and will ultimately find the plaintiffs do not have standing, and the case will ultimately be dismissed. 

We don’t expect a decision from the Supreme Court until June 2024, but until then Hey Jane will continue to deliver evidence-based, compassionate medication abortion care to our patients.

Flaws in the case

The case has a number of critical flaws, substantively and technically. Major issues include:

• Standing: The plaintiffs have extremely weak standing as they did not actually experience harm. They are concerned about the remote possibility of being asked to treat hypothetical future patients. They disregard that treating sick patients is an inherent part of their job,  that the serious adverse reaction rate for mifepristone is extremely low, and that going back to pre-2016 dosing would likely increase those reactions because it would triple the dosing of mifepristone above what is currently FDA-approved to be safe and effective.

• Agency Deference: The plaintiffs claim that the FDA’s regulation of mifepristone was “arbitrary and capricious,” despite a robust history of safety and effectiveness studies. Undermining the FDA in this way would be unprecedented and would threaten the pharmaceutical industry as a whole, disincentivizing research and development and opening the floodgates for all drugs to be questioned by virtually anyone.

• Traceability: The case challenges the 2016 REMS (aka Risk Evaluation and Mitigation Strategy). The 2016 REMS has since been replaced by 2023 REMS, which permanently authorized mail-order prescribing, and is not addressed in the case. Even if the 2016 REMS went away, the 2023 REMS would remain in place.

2023 Win: Abortion continues to win on the ballot

Following big election wins in 2022, abortion continued to dominate in the 2023 general election—with huge victories in Ohio, Kentucky, Virginia, Michigan, and Pennsylvania. 

People have seen what it means to live in a country where abortion access is not consistently available. It is terrifying and inequitable in so many ways, and American voters are seeing this and expressing their opinions when they have the chance to vote directly. Only 13% of Americans in recent polls believe abortion should be illegal in all circumstances, and 61% of Americans believe that overturning Roe was a “bad thing” (Gallup).

“Before I moved, I was part of the effort to collect signatures to get the abortion amendment on the ballot in Ohio. We know that when abortion is on the ballot, people vote for it because they know that they need it. People all over Ohio—nurses, physicians, even lay people— were collecting signatures. Despite the state’s best efforts to keep this off the ballot, it made it on and passed.” - Alyssa Wagner (DNP, RN, APRN, WHNP-BC), Medical Director at Hey Jane

What can I do to help change restrictive abortion laws in my state? 

“Talk to your state representatives. Give them a call, write to them, get others to write to them, and say you want to see a shield law to protect providers located in your state. Go vote! Gather your friends and family and go vote. Elections are tremendously important and what we’re seeing this year is that the power of democracy is reflecting what the people want.” - Adriana Benedict, General Counsel at Hey Jane

“Talk about abortion, share your stories, and stories that normalize that this is [essential] health care. We know that 1 in 4 people with a uterus will have an abortion in their lifetime, a statistic that tends to surprise people because they’re not hearing their communities talk about it.”  - Kiki Freedman, Co-founder & CEO of Hey Jane

2023 bonus win: Hey Jane continues to expand access across the country

We’ve made great progress this year and are live in 19 states plus Washington D.C.—more than double the number of states we started 2023 with. These states account for roughly 66% of national abortion volume based on where abortion access is concentrated now, and we will continue to expand access to more states in the near future.

We also think that it’s important to the ongoing stigmatization of abortion care to situate it within primary care. It is primary care, it is health care. We’ve now expanded into a number of services that wrap around the needs of our medication abortion patients. This includes birth control, emergency contraception, and treatment for common infections from UTIs and yeast infections to bacterial vaginosis (BV) and herpes.