The Network: Pivoting as mifepristone access shifts

Summary

Podcast Summary: Embedded (NPR)

Episode: The Network: Pivoting as mifepristone access shifts

Release Date: May 7, 2026
Host: Kelly McEvers
Featured Reporters & Guests: Abby Wendle, Dr. Angel Foster, Elisa Wells, Destiny Spaeth

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Episode Overview

This episode of "Embedded" explores how medical providers, advocacy groups, and a robust underground network are responding to potential new restrictions around mifepristone access in the U.S., specifically following a pending Supreme Court decision that could block telehealth prescriptions of the drug. The episode highlights the strategies and resilient pivots of those working to ensure continued access to abortion medication, with a focus on switching to misoprostol-only regimens and relying on established grassroots distribution networks.

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Key Discussion Points and Insights

1. Medication Abortion Basics and Potential Regulatory Shift

• [01:05] The standard medication abortion involves two drugs: mifepristone and misoprostol.
• The Supreme Court may rule to restrict telehealth prescriptions for mifepristone, prompting providers to prepare alternative protocols.
• Quote (Dr. Angel Foster, 01:20):

  "If we have to, we will switch to a misoprostol only regiment."

2. Pivoting to Misoprostol-Only Regimen

• [01:24] Dr. Angel Foster, co-founder of the Massachusetts Medication Abortion Access Project, describes her group’s readiness to adapt.
• The organization mails abortion medication nationwide, circumventing restrictive state laws by operating under a "shield law."
• Decades of research: Misoprostol-only regimens are safe and effective, but may be more uncomfortable for patients.
• Quote (Dr. Angel Foster, 01:51):

  "The first is that this decision is terrible and we should be able to provide mifepristone and misoprostol via telemedicine. All of the evidence supports that, and I’m incredibly grateful that we have a high quality alternative in misoprostol alone that we can pivot to to continue to provide patient care."

3. Alternative Channels for Accessing Pills

• [02:12] Organizations like Planned Parenthood Direct signal their intent to continue providing access, even if restrictions increase.
• Mifepristone might still be obtained in person or through online sources outside of formal medical supervision.

4. The Global and National Abortion Pill Network

• [02:35] Dr. Foster highlights the resilience and scope of networks facilitating medication access:

  "There's an enormous network of people who are making access possible even now, despite these political restrictions that are happening."

• [02:44] Elisa Wells (co-founder, Plan C Pills) describes how their site connects people to trusted sources for abortion pills, both domestically and abroad.
  • They regularly test pills for efficacy and authenticity.
  • Traffic to their website doubled after a recent appellate court ruling, indicating a spike in people seeking non-traditional sources.
  • Quote (Dr. Angel Foster referencing the spike, 03:17):

    "In some ways, it's the best advertisement for this alternative way of accessing pills."

5. Rapid Response and Community Mobilization

• [03:24] The practice of obtaining abortion pills without a doctor’s involvement is not new; a global network’s infrastructure is robust and active.
• [03:37] Destiny Spaeth (abortion access advocate, North Dakota) shares insights into network responses to legal threats:
  • Initial reactions in group chats: panic, depression, anger quickly give way to coordinated strategizing.
  • Quote (Destiny Spaeth, 04:01):

    "When a decision like this comes down, we just rely on that network of rapid response, quick communication, and then dispersing that communication within our communities so that folks don't feel as lost and confused and as alone as some of these decisions are intended to make us feel."

• Focus on "advanced provision": Advocates encourage people to acquire and store abortion pills for potential future need, in anticipation of increased uncertainty.

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Notable Quotes & Memorable Moments

• Dr. Angel Foster [01:51]:

  "I feel like I can hold two things at the same time. The first is that this decision is terrible... and I’m incredibly grateful that we have a high quality alternative in misoprostol alone..."

• Elisa Wells [02:44]:

  "The website's traffic doubled this past Saturday following the appeals court's decision about mifepristone. That may indicate more people are looking for options on how to get pills outside of the formal medical system."

• Destiny Spaeth [03:37, 04:01]:

  "The feelings within the network were definitely like a little bit of panic, but also we have been and will continue to prepare for these moments."

  "We just rely on that network of rapid response, quick communication, and then dispersing that communication within our communities..."

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Important Timestamps

• 00:19 – Kelly McEvers introduces the episode and frames the urgency around mifepristone.
• 01:05 – Explanation of the standard two-pill abortion regimen and pending legal changes.
• 01:20 – Dr. Angel Foster on pivoting to misoprostol only.
• 01:51 – Dr. Foster's nuanced outlook on telehealth restrictions and alternatives.
• 02:44 – Plan C Pills and the surge in DIY access information-seeking.
• 03:24 – The longevity and strength of the global abortion pill access network.
• 03:37 – Destiny Spaeth on network mobilization post-legal rulings.
• 04:22 – Introduction of "advanced provision" as a strategy.

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Summary Takeaway

Despite looming restrictions on telehealth prescriptions of mifepristone, a determined and innovative coalition of medical professionals and advocates is ensuring that access to medication abortion continues. They are prepared to offer misoprostol-only regimens and rely on networks that transcend state boundaries and U.S. laws. The episode powerfully illustrates community resilience, rapid adaptation, and the enduring impact of underground support systems in the face of political and legal adversity.

Transcript

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[Kelly McEvers]

Hey embedded listeners, this is Kelly McEvers. Last year we published a series about a global network of folks who are helping people get safe abortions without a doctor, and that series feels pretty relevant right now after next Monday, May 11th. Depending on what the US Supreme Court decides, providers in the US might not be able to prescribe the abortion pill mifepristone via telehealth, but doctors and experts say it won't stop people from being able to get abortion pills through the mail. Listen here to Abby Wendle, who helped report and produce our series the Network as she explains what's going on. Then head back to embedded season 24 to hear the full story. Start with episode one.

[Narrator/Reporter]

Saintotech medication abortion in the US typically involves two pills, mifepristone and misoprostol. But as doctors face the possibility of no longer being able to prescribe mifepristone via telehealth, many are preparing to pivot.

[Dr. Angel Foster]

If we have to, we will switch to a misoprostol only regiment.

[Narrator/Reporter]

Dr. Angel Foster is the co founder of the Massachusetts Medication Abortion Access Project. The organization is a shield law provider, meaning they mail abortion medication to patients around the country regardless of state laws restricting abortion. Decades of research shows taking misoprostol alone is a safe and effective option to end early pregnancy, though the experience may be more uncomfortable. Foster says it's not her preferred regimen, but it's a crucial alternative.

[Dr. Angel Foster]

You know, I feel like I can hold two things at the same time. The first is that this decision is terrible and we should be able to provide mifepristone and misoprostol via telemedicine. All of the evidence supports that, and I'm incredibly grateful that we have a high quality alternative in misoprostol alone that we can pivot to to continue to provide patient care.

[Narrator/Reporter]

Other doctors we spoke with are also prepared to pivot to misoprostol. Only Planned Parenthood Direct posted a similar sentiment on Instagram Friday. If mifepristone becomes unavailable via telehealth, people will still be able to get it by going to a doctor in person, or they can order abortion pills online without a prescription. In many cases, both mifepristone and misoprostol

[Dr. Angel Foster]

there's an enormous network of people who are making access possible even now, despite these political restrictions that are happening.

[Narrator/Reporter]

Elisa Wells is a public health researcher and co founder of Plan C Pills. The Their website links people to a variety of places people can order abortion pills online, including pharmacies abroad that sell the pills and US Based groups that mail free pills to people living in states with abortion restrictions. Plan C periodically tests the pills from all these sources to make sure they're real. The website's traffic doubled this past Saturday following the appeals court's decision about mifepristone. That may indicate more people are looking for options on how to get pills outside of the formal medical system.

[Dr. Angel Foster]

In some ways, it's the best advertisement for this alternative way of accessing pills.

[Narrator/Reporter]

Getting abortion pills without a doctor's oversight isn't new. For decades, a global network has developed to help people access the pills this way, and since the latest upheaval over mifepristone, the network in the US has been abuzz.

[Destiny Spaeth]

The feelings within the network were definitely like a little bit of panic, but also we have been and will continue to prepare for these moments.

[Narrator/Reporter]

Destiny Spaeth is an abortion access advocate in North Dakota. Over the past few days, she says she's been in about a dozen group chats that at first were filled with people depressed and angry. Then they switched into a different strategizing.

[Destiny Spaeth]

When a decision like this comes down, we just rely on that network of rapid response, quick communication, and then dispersing that communication within our communities so that folks don't feel as lost and confused and as alone as some of these decisions are intended to make us feel.

[Narrator/Reporter]

Spaeth is currently focused on sharing resources about something called advanced provision, a way for people to access these pills to have them just in case they need them in an uncertain future.

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