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Announcer: From WNYC and PRX in collaboration with GBH News in Boston, this is The Takeaway with Melissa Harris-Perry in Winston-Salem, North Carolina.

Melissa Harris-Perry: It's been more than six months since The Supreme Court’s opinion in Dobbs overturned Roe v. Wade. Since then, anti-abortion activists have continued to try and restrict access to abortion care, even in cases where abortion is legal and the Food and Drug Administration and its oversight of the abortion medication. Mifepristone has been one of their targets. Medication abortions account for about half of abortions in the US, and Mifepristone is the first of two pills used in the method. It's used up to 10 weeks of pregnancy.

Last week, the FDA issued new rules on Mifepristone making it easier for people to access it from retail pharmacies with a prescription from a specially certified health provider. I want to talk more now with Andrea Miller, president of the National Institute for Reproductive Health. Andrea, thanks for being here.

Andrea Miller: Thank you for having me.

Melissa Harris-Perry: All right, these new rules by the FDA, will this actually increase access to medication abortion?

Andrea Miller: It's important to start with the facts, which the FDA recognizes that this is an extremely safe and effective medication as documented by reams of peer-reviewed studies and extensive real-world experience over decades, both here in the US and around the globe. The FDA's latest change regarding mifepristone is really about how you get that pill. As you noted, it still requires a prescription, but one of the things that the FDA just did is it said, okay, you've seen a provider, maybe it's through telemedicine and they prescribe you medication abortion.

Now instead of needing to go physically to that provider to get it, they could potentially call it into a participating retail pharmacy, perhaps one that's closer to where you live or work or go to school. What a lot of people may realize is prior to this change, it was required, although it was temporarily suspended during COVID, that you had to go in person to get this medication, to actually physically be there to get it. They've also said that you could now have this available at a retail pharmacy that participates, that is certified to do that.

The changes are a step forward, but it's important to remember it's just a half step because there's still a bunch of bureaucratic hoops for pharmacies that decide they want to opt into doing this.

Melissa Harris-Perry: Talk about some of those bureaucratic hoops.

Andrea Miller: The amazing thing is that in order to participate, a retail pharmacy would have to commit to doing 14 different things. 14 different things specifically for this medication, unlike what they have to do and more than what they have to do for others. It's a bunch of bureaucratic hoops like keeping authorization forms from clinicians who are writing the prescriptions, and if the pharmacy mails prescriptions, they have to track the shipments. There's a whole host of things. I actually encourage folks to read an excellent article in the Nation by Renee Bracey Sherman and Doctors Dan Grossman and Tracy Weitz getting into this.

The bottom line is, this is a safe and effective drug that is subject to a number of unnecessary and onerous regulations. Let's face it, most of us are intimately aware of how much pharmacies are overstretched and understaffed, so adding these additional medically unjustified requirements for them to become certified in order to be able to provide medication abortion with a prescription could be a deterrent for them to participate.

Melissa Harris-Perry: It does sound an awful lot at least in spirit like the trap laws which were affecting prior to state's capacities to simply outlaw abortion. These trap laws were used to create onerous restrictions rules that weren't actually medically necessary relative to abortion that was happening as a matter of procedure.

Andrea Miller: That's absolutely right. This is yet another example of what we call abortion exceptionalism. Which means you have an incredible safety record, you have all of the science and medicine and real-life experience demonstrating that this should be treated like other medical care, like other prescription drugs, and yet, there are all these additional burdens, these additional barriers. Whether that be placed on those who need to obtain abortions or placed on those who are trying to help them get them. Like healthcare providers who offer abortion care, and now in this instance, you have this opportunity for pharmacies to opt-in.

Of course, there's no guarantee that they're going to do that, there's no requirement that they do that, and yet, they have to go through all these additional hurdles. It just creates another disincentive and another mechanism to more tightly control a medication that is safe and effective. There's absolutely no reason for this other than politics frankly. Sadly, this drug has been overregulated since it was approved in this country in 2000.

Melissa Harris-Perry: Is it exclusively abortion exceptionalism or is it reproductive care exceptionalism? I'm thinking here about plan B and the restrictions that existed and even the Obama administration's reluctance to make it more available.

Andrea Miller: The reality is that anything that seems to enable women and others who can get pregnant to have control over their reproductive lives seems to get this heightened scrutiny in this country. That is really damaging and it means that people are not able to really access the care and the services that they need to be able to make these really fundamental decisions. Whether and when to become pregnant and have children is this core part of who we are and how we chart our futures and how we build our families. Honestly, that's really what this comes down to. It's all about control.

It's not about abortion per se, it's about fundamentally control, and I think that's so clear when you think about all of the kinds of attacks that you're seeing in these republican majority legislatures, these governors that are on a rampage on this. It's not just about attacking abortion or access to contraception, it's also about attacking voting rights and attacking LGBTQ folks and trans kids. It's all about this controlling of these fundamental decisions in our lives that are about whether we can participate equally in our society and chart our futures.

Melissa Harris-Perry: Andrea, pause with me for just a moment. We'll be right back. It's more of The Takeaway.

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It's The Takeaway. I'm Melissa Harris-Perry and we're back with Andrea Miller, president of the National Institute for Reproductive Health. We've been talking about the FDA's new rules on abortion medication and access to abortion care. Andrea, I'm wondering here about the ways that anything related to medicalized abortion care helps to expand access for folks either in states where procedural abortion has now been entirely banned or where there were simply many miles to cross before someone could actually get to a provider of abortion. Again, these new FDA regulations, even if they're still onerous, they provide some additional access. Does that help?

Andrea Miller: Unfortunately, it's unlikely this is going to bring any meaningful change for those who live in the 14 states as of today, and you have to keep tracking because keeps changing, where abortion is banned or effectively banned like at six weeks. There are also another half dozen states where abortion is legal, but their legislatures passed restrictions mirroring in some ways the former FDA requirements requiring you to be physically present when the clinician prescribing medication abortion administers those pills.

That's actually 20 states where we anticipate pharmacy access is basically off the table entirely.

Of course, there are certainly people who are already demonstrating that in order to obtain abortion care, they are finding creative ways often supported by friends and family and a whole network of abortion funds and practical support networks to help them get to places where abortion is available at a facility, as well as perhaps this would be something that they would also take advantage of if they were able. Again, let's just talk about many, many hoops. The idea of needing to travel to obtain medical care to get an abortion, it's unconscionable and it shouldn't happen, but people are doing it, and so it's possible that they would do so to obtain a prescription as well as a procedural abortion.

Melissa Harris-Perry: As you talk about the creative ways that people are seeking to respond to this moment, what are some of the ways that people who want to encourage and increase access to reproductive healthcare can actually help?

Andrea Miller: I think, first, it's really important for people to be talking about this with people in their lives because one of the ways we got to this point is that the shame and stigma that the opposition to abortion, and frankly, the opposition to reproductive freedom really was able to build into our culture and into our society. Talking about it so people know that they have someone that they can talk to when they're going through this, that they're not alone in this. The other thing that people can do is a couple of things.

First, there's tremendous opportunity at the state and local level even in states where abortion is banned or severely restricted to actually engage with local and state elected officials to advance access to abortion care. The National Institute for Reproductive Health analyzed the first three months after the Dobbs decision and a record. This was a historic moment that as many as 17 states and 24 municipalities enacted policies. This is in the middle of the summer, against the backdrop of a midterm election when this stuff doesn't happen. They enacted policies that advance access to abortion care, and that included in cities like Columbus and Austin and Atlanta and St. Louis.

These are all in states where abortion is banned, but there are ways to do things like make sure that abortion care is funded or the practical support services are funded, or to otherwise protect the providers of the services. There's a whole host of things and we've got a great list on our website if people want to go to it; nirhealth.org.

Melissa Harris-Perry: Andrea Miller is the president of the National Institute for Reproductive Health. Thank you again for joining us today.

Andrea Miller: My pleasure. Thanks so much for having me.

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