It’s Time For States to Get Serious About Protecting Abortion Access

Here are five ways they can do this in 2022.

Will Roe v. Wade make it to 50? On the eve of the landmark Supreme Court decision’s 49th — and possibly final — anniversary this Saturday, January 22, the outlook for abortion access is looking increasingly bleak.

We entered 2022 with a record number of abortion restrictions at the state level (leading the Guttmacher Institute to call 2021 “the worst year for abortion rights in almost half a century”) and a Supreme Court that has strongly indicated that it plans to overturn Roe v. Wade when it finally issues a decision on Dobbs v. Jackson Women’s Health Organization.

But we are not sitting ducks. As the CEO and co-founder of Hey Jane, a telemedicine abortion provider that offers treatment on people’s own terms, I’ve seen firsthand the impact that technology can have on access. Our patients don’t have to wait 8 days (the average time to get an in-clinic appointment), find the funds to pay for gas, a bus ticket, or even a flight, arrange for child care while they’re gone, or worry about taking time off from work; instead, with Hey Jane they quickly connect with our clinical team, and can text, phone, or video chat us at any time. That’s why at-home abortion care through a provider like Hey Jane means expanded access.

Telemedicine abortion is one of the few bright spots in the reproductive care landscape — this incredibly safe treatment will be a crucial part of the foundation of a post-Roe future.

In fact, telemedicine abortion is one of the few bright spots in the reproductive care landscape: With the FDA’s December 2021 decision to permanently remove the in-person dispensing requirement around mifepristone (the first of two medicines used in what is commonly called “the abortion pill”), this incredibly safe treatment will be a crucial part of a post-Roe future.

But the barriers to care are complex, and abortion providers — both in-person and virtual — cannot find the solutions on their own. Which is why we need our elected officials to step up. It’s not enough to say you support abortion; you must actually take action to expand access, remove barriers, protect providers, and ensure that anyone who needs an abortion can get the care they need.

And so, I’m calling on leaders in supportive states to do the following before January 22, 2023:

1. Enshrine the right to an abortion — at every level of government.

With Roe on the rocks, we can no longer rely on this court precedent to protect care. For one thing, it was never adequate to begin with: From the Hyde Amendment to hostile state laws, the “right to choose” has not been consistently afforded since the 1973 decision and has often excluded BIPOC, immigrants, young people, and economically disadvantaged people. But also, it leaves access at the whims of nine unelected judges. Legislators must prioritize policy that enshrines — and expands — not just a vague concept of “choice”, but true access to abortion for all.

Other states can take proactive steps to expand what the right to an abortion means in 2022—now is not the time to be passive.

While at the federal level, it’s crucial that the Senate passes the Women’s Health Protection Act, there are also state-level measures that would strengthen post-Roe protections. In Arizona, Michigan, West Virginia, and Wisconsin, for example, their pre-Roe abortion bans are still on the books — an issue that must be urgently addressed to ensure access, regardless of any future Supreme Court decisions. Other states can take proactive steps to expand what the right to an abortion means in 2022 — which is exactly what Colorado is doing with the Reproductive Health Equity Act. Now is not the time to be passive.

2. Address access by funding abortion care and practical support.

One of the biggest barriers to care is cost — and abortion funds do incredible work to bridge the gap. In 2021, for example, Hey Jane (and our phenomenal network of supporters) raised over $25,000 to fund care for patients in need. But crowdfunding isn’t a long-term solution, especially as the costs associated with obtaining an abortion spike for people who live in areas with restrictions. Case in point: The organization Access Reproductive Justice estimates that someone traveling from Texas to California for care would need at least $2,216 in support.

Crowdfunding isn’t a long-term solution, especially as the costs associated with obtaining an abortion spike for people who live in areas with restrictions.

That’s why I’m urging leaders in cities and states across the country to include abortion-related funding in their budgets. This isn’t a pipe dream; already, places like New York City and Austin have allocated money to abortion funds. We need more cities to step up, and a larger percentage of budgets dedicated to this. Even better? Let’s have states themselves create abortion funds, similar to what has been proposed for all of New York.

3. Support the bodily autonomy of students.

Nearly 30% of people who get abortions are in their early 20s — and more than 40% of them have attended some college. For many college students, access to abortion is critical for continuing their education — but unnecessary barriers place heavy burdens on those seeking care. From covering costs to finding transportation, or navigating rigid school and work schedules, these concerns must be considered.

For many college students, access to abortion health is critical for continuing their education — but unnecessary barriers place heavy burdens on those seeking care.

Telemedicine abortion providers like Hey Jane address many of these barriers, but there is more that can be done to give students the support they need to thrive. It’s time for states to pass legislation that would provide public university students access to medication abortion at their on-campus student health centers. California did just that in 2019, but similar bills in states like Massachusetts and New York have stalled. Given a 2018 study that estimated around 500 California public university students alone seek medication abortions each month, it’s time to make this a priority.

4. Invest in the next generation of abortion providers.

Care is critical — but also impossible if there aren’t clinicians to connect with patients. At Hey Jane, we hear it time and time again: Our attentive clinical team members are difference-makers. That’s why I’m urging states to broaden the definition of “abortion provider” to include advanced practice clinicians (such as nurse practitioners, certified nurse-midwives, and physician assistants). Not only have studies shown that they can just as safely and effectively provide care as physicians, but expanding the pool of providers means more access in more places. States like New York, Virginia, and Maine have already done this, and Maryland will be introducing similar legislation this year.

And with an eye towards the future, we need to train the next generation of medical providers who are not only talented, but also prepared to navigate the virtual telemedicine abortion landscape. (Hey Jane partnered with the University of California, San Francisco on a study that found 75% of patients chose virtual care over a clinic because they’d be more comfortable at home — so there’s a growing need for webside manner, not just bedside manner.)

With an eye towards the future, we need to train the next generation of medical providers who are not only talented, but also prepared to navigate the virtual telemedicine abortion landscape.

And, even more importantly, we must ensure that this cohort is as diverse as the people they’re treating. To do that, there needs to be increased opportunities — and support — for BIPOC providers and others who have historically been excluded from health care professions. Our leaders can take a step towards addressing this by covering loan repayments for health care workers who commit to providing abortion care. California’s governor Gavin Newsom announced that the state budget includes $20 million for this very purpose; more elected officials should follow his lead.

5. Protect those seeking — and providing — care.

If Texas’ SB8 is any indicator, abortion restrictions will only get more extreme — and targeted. We need to see states enact legal protections from civil and criminal liability for clinicians that provide abortions. These frivolous lawsuits not only drive up costs and divert valuable resources, but they are also a tool of harassment.

State laws must be amended so that it is explicit: You will not be prosecuted for pregnancy loss.

States must also protect patients. Already, at least 21 people across the US have been arrested for self-managing an abortion or helping someone who self-managed an abortion, and hundreds more have been arrested for experiencing miscarriages. It is Black, brown, and Indigenous people who are disproportionately criminalized. State laws must be amended so that it is explicit: You will not be prosecuted for pregnancy loss.

While there are many things in the abortion landscape that are out of our control — including a Supreme Court and a smattering of state legislatures that are hostile towards reproductive care — I’m not without hope. For one thing, telemedicine abortion has the ability to literally put the power in people’s hands. (Hey Jane’s patients constantly tell us how supported and empowered they feel from it.)

And I know that there are so many passionate people out there who are willing to stand up for what’s right. But we can’t do this alone — and there are many tangible steps that our leaders can take to protect and expand abortion access. I hope they can rise to the level this moment requires.