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A Guide to Abortion Resources in a Post-Roe America

A Guide to Abortion Resources in a Post-Roe America

In a perfect world, abortion access would be easy. The minute you realized you needed an abortion, you’d be able to grab some abortion pills from the drugstore, or make an appointment with your regular gynecologist for a quick and easy vacuum aspiration. But we don’t live in a perfect world. In modern-day America, abortion access can be impossible at worst and fraught at best: even in “safe” states like California and New York, abortion pills are heavily restricted and can be pretty pricey. And since few gynecologists offer abortion services out of their private practice, you need to find a specialized clinic—which can be a challenging process, particularly since many anti-abortion “crisis pregnancy centers” are easy to confuse with actual abortion providers.

And chillingly, things are only going to get worse. Across the country, expansive bans like Texas’ Senate Bill 8 have rendered abortion functionally inaccessible; now, with the US Supreme Court overturning Roe v. Wade, access is about to disappear in close to half of America. No one is safe from these bans: Even if abortion rights are legally protected in your home state, an influx of patients from other states is likely to tax an already overstressed system, making appointments difficult to get.

All of this is exacerbated by a general truth about abortion: Most people don’t actually think about how they’re going to get one until they’re dealing with an unwanted pregnancy. But that is something you can change. One of the best things you can do in our post-Roe world is know your options ahead of time and make an abortion access plan long before you need one—and share that information with others, so they can be prepared as well.

What Abortion Method Is Right for Me?

There are two main types of abortion, surgical and medical (also known as medication abortion or abortion with pills). A surgical abortion is performed by a trained professional, who uses techniques like vacuum aspiration or dilation and curettage (D&C) to empty the contents of a uterus. In a medication abortion, a combination of pills (either mifepristone and misoprostol, or misoprostol on its own) is used to induce a miscarriage. There are pluses and minuses to each method. A surgical abortion requires traveling to a clinic, but it’s over and done quickly. A medication abortion can be done from anywhere, but it usually takes a few days for the abortion to be complete. Additionally, not everyone can do an abortion with pills: If you have a bleeding disorder, an IUD, or need an abortion later in pregnancy, a surgical abortion might be your safest bet.

Your abortion plan is going to look different depending on whether you opt for a surgical or medication abortion, so it’s good to learn about both and decide early on which option feels like the best fit for you. If you can do a medication abortion, it might be the better choice; as abortion clinics get swamped with clients, wait times for appointments increase. The longer you wait to get an abortion, the more complicated and expensive it can get. Ultimately, a medication abortion now can be a better option than a surgical abortion in a few weeks—even if a surgical abortion would be your first choice in an ideal scenario.

Where Is My Closest Abortion Provider?

If you do choose a surgical abortion, your first stop should be Abortion Finder, a database of hundreds of trusted and verified abortion providers in the United States. Unlike Google, which sometimes turns up anti-abortion organizations when you search for an abortion clinic, Abortion Finder will show you only actual abortion providers, along with the relevant abortion laws in that state. If you live in a state with severe abortion restrictions, Abortion Finder’s filters allow you to find the nearest clinic that meets your needs—a clinic that doesn’t require a waiting period, one that will provide an abortion after six weeks, or whatever else you may be looking for.

If a medication abortion is a good option for you, there are even more resources available. While you can go to a brick-and-mortar clinic to get your abortion pills, research has repeatedly shown that taking these pills at home, by yourself, is just as safe as taking them in a doctor’s presence. Plan C maintains a large database of verified abortion pill providers, including both telehealth services that provide support through the abortion process and online pharmacies that will mail you the pills with no additional support.

What If Abortion Is Illegal in My State?

Even if abortion is illegal where you are, abortion with pills is still an option. If you’re able to travel to a state where abortion is legal, a telehealth service can mail you the pills there. And if you’re not able to travel, the European site AidAccess will connect you with an Indian pharmacy that sends abortion pills to all 50 US states, regardless of abortion laws. Because abortion is time sensitive, and the process of getting pills sent from India can take a few weeks, AidAccess is also willing to prescribe abortion pills to people who aren’t currently pregnant in case they need them in the future. That’s right: You can go to AidAccess and get abortion pills right now. (How’s that for planning ahead?)

Anything Else I Should Know?

While an abortion with pills is incredibly safe, going it alone can be intimidating. Thankfully, a number of sites have been set up to walk people through the process of self-managing an abortion with pills. How to Use Abortion Pill and Self-managed Abortion; Safe and Supported offer everything you need to know about both mifepristone-misoprostol and misoprostol-only abortions. There’s also the Reprocare Healthline, which offers peer-based, trauma-informed emotional support to anyone having an abortion at home with pills. And although self-managed abortion with pills is medically very safe, it’s important to know that it can come with legal risks, especially if you live in a state where abortion is illegal. The Repro Legal Helpline is a free, confidential helpline that provides information and advice to people seeking to self-manage their abortions. And if you wind up getting in trouble, the Repro Legal Defense Fund provides bail and legal defense for people who’ve been investigated, arrested, or prosecuted for self-managed abortion.

No matter what kind of abortion you get, it’s likely going to cost you money—not just the abortion itself but potentially travel expenses as well. If you can put money aside for a future abortion, great! But since many people opt for abortion because of financial issues, that’s not necessarily a realistic option. Abortion funds can provide help. The National Network of Abortion Funds will connect you to an organization that will help you sort out your financial and logistical needs and do everything they can to remove the barriers between you and your abortion. (Looking to support abortion access? Donating to abortion funds is a great idea—as is donating to independent clinics.)

Everyone deserves easy access to a safe, affordable abortion. There’s no question that the United States is on the wrong track and that the abandonment of abortion rights will needlessly hurt many pregnant people. But if you need an abortion, please know that you are not alone. There are many, many people and services willing and eager to help you get the care you need. The biggest hurdle is knowing where to find them—and you’ve just overcome it.

Covid Shots for Little Kids Are Here. Now for the Hardest Part

Covid Shots for Little Kids Are Here. Now for the Hardest Part

In some pediatric practices, shots are already going into arms. Children’s Medical Group, a private practice in Atlanta, ordered doses as soon as it was allowed, and received their first shipment on Monday, the Juneteenth holiday. They began vaccinating at lunchtime. “We’ve had huge demand,” says Jennifer Shu, a pediatrician in the practice and editor for the American Academy of Pediatrics. “We’ve even gotten calls from patients in other practices whose doctors aren’t carrying any Covid vaccine for this age group.”

As that suggests—and as parents are reporting on Twitter—availability varies. That may be due to those advance predictions of low uptake; practices and hospitals might not want to invest freezer space and staff time if they don’t expect much interest. But it may also be due to a bureaucratic hurdle that has dogged Covid vaccination since its earliest days. Unlike almost every other vaccine, this one doesn’t come from a commercial distributor; it is dispensed by the federal government and funneled through state health departments. So to receive it, healthcare providers have to complete CDC paperwork. That’s true even if they already participate in other government programs, including Vaccines for Children (known as VFC), which guarantees shots for families without private health insurance.

“Participation by the providers who usually participate in the VFC program has been pretty good,” says Marcus Plescia, a physician and chief medical officer of the Association of State and Territorial Health Officials. “Getting it out into private practice sites has been a slower process. They’re not used to being part of government-run vaccine programs. Some of them don’t want to do that, because of the paperwork and hassle.”

The child-vaccination program may also be hobbled by another long-standing issue: the size of the vaccine vials. Each holds 10 doses, and once thawed and opened, has to be used within 12 hours. “Pediatricians, especially, don’t like to waste vaccine. They view it as a precious commodity,” Hannan says. “Getting them to order enough vials to have vaccine on hand every day, when they’ll potentially be giving a vaccine to one person and discarding nine doses because you don’t have nine other kids—that’s a challenge.”

Another complication is that all Covid protections so far, including vaccination, have been distributed inequitably. Half of those 19 million kids under 5 are children of color, according to a Kaiser analysis; 41 percent rely on Medicaid for insurance and 4.5 percent are uninsured. With public sites, pharmacies, and schools all unavailable to help with the youngest kids, there will be extra pressure on community and federally qualified health centers to reach children near them. “We know from every part of the rollout that some of the groups that are most disadvantaged were not getting vaccinated at the same rates early on,” says Jen Kates, the director of global health and HIV policy at the Kaiser foundation. “These are children that are vulnerable for a lot of different reasons, and the last thing that anyone wants is for them to suffer disproportionately or have worse access to this intervention.”

At this point, experts are hoping for a slow uptake, rather than no uptake. Parents whose kids have well-child visits coming soon, or summer appointments to get them ready for sports, might opt to wait a few months rather than make a special trip. That has pros and cons: It leaves the kids vulnerable to Covid longer, but it normalizes the vaccine as just one among the slew of shots that they receive in their early years.

For some parents, the issue won’t be scheduling, but trust. They’ll need extra patience from people within the medical system as they work through it, perhaps as they worked through it for themselves last year. “At their next pediatrician appointment, they may ask for a conversation—which is different from calling the office” to arrange the shot, says Angela K. Shen, a visiting research scientist at the Children’s Hospital of Philadelphia who studies attitudes to vaccination. “It may take multiple conversations, with their brother, their sister, their pharmacist, as well as their pediatrician. These people in the middle are who public health messaging strategies will want to go after, to answer their questions in a non-paternalistic way.”

Monkeypox Can Be Contained—but Time Is Running Out

Monkeypox Can Be Contained—but Time Is Running Out

When monkeypox briefly found its way into the US in 2003, it infected prairie dogs. “We know that ground squirrels are highly susceptible to the virus and that there is a wide host range of species,” says Rimoin. “If monkeypox were able to become established in a wildlife reservoir outside of Africa, it would be a very complicated situation to navigate.”

To pinpoint exactly how widespread the current outbreak is, the UK has chosen to make monkeypox a notifiable disease, meaning all health professionals and laboratories that detect suspected cases are required to alert the UK Health Security Agency (UKHSA).

“I think the UKHSA has done the right thing because they’ve put the surveillance net out much wider,” says David Heymann, an infectious disease epidemiologist at the London School of Hygiene and Tropical Medicine who has spent many years studying monkeypox in sub-Saharan Africa.

“They’ll begin to identify whether or not it is in other populations as well. It’s early on, and we don’t know which groups are really at risk, or besides MSM. And we expect there probably are other groups.”

There are additional challenges ahead. Because the virus has already been linked with the MSM community—even though it is thought to be capable of spreading through all sexual networks—scientists say that health officials will have to clearly communicate with the public to avoid monkeypox becoming stigmatized. If vaccines begin to be rolled out in a targeted fashion to select subpopulations, and the disease builds up stigma, it could inhibit contact-tracing efforts, something epidemiologists fear might be already happening.

“There’s a concern about people wanting to self-identify, for fear of stigma,” says Brownstein. “There’s a concern that this virus, like others, could get unfairly associated with certain subpopulations.”

There are also questions about the capacity of health care systems, which are already exhausted and stretched to their limits by the demands of Covid-19, and whether they have the capacity to ramp up their response to monkeypox.

“Public health infrastructure is barely built to deal with the response to one virus, let alone two,” says Brownstein. “But there are a lot of people working very hard around case identification, contact tracing, testing. It’s definitely stretching capacity, and there may be exhaustion, but I don’t think there’s apathy on the part of public health to respond to this.”

While scientists feel that there is room for optimism—and we will see in the coming weeks and months whether the rates of new cases start to drop—it is vital that the ongoing outbreak is taken seriously before the virus becomes too entrenched within society.

“I think that the stakes are actually quite high when we think about having a poxvirus that can circulate relatively efficiently in humans,” says Rimoin. “If it establishes itself, we could end up in a situation where we’re going to have to continually devote resources, which are already stretched, to combating a poxvirus that’s spreading globally.”

Antibiotic Use in US Farm Animals Was Falling. Now It’s Not

Antibiotic Use in US Farm Animals Was Falling. Now It’s Not

That was thought to be the best the US could do, especially with the pro-business Trump administration about to take over. But researchers knew in advance that a growth promoter ban would be inadequate. They already had an example of why it wouldn’t work: A few years earlier, the government of the Netherlands had noticed that, despite the EU ban in 2006, sales of antibiotics to Dutch farms kept rising. An investigation by academics working with regulatory agencies revealed that companies selling ag antibiotics in the Netherlands had changed the labeling on growth promoters to “preventative use” to circumvent the new law.

That seems to be what has happened in the US. One means of using antibiotics was made illegal, so producers found a different path. “There was a huge increase in ‘therapeutic’ use right after the elimination of growth promotion,” says Lance Price, a microbiologist and professor at the George Washington University’s Milken Institute School of Public Health and founding director of its Antibiotic Resistance Action Center. “It was a perfect parallel to what happened in the Netherlands, where they just changed what they called it.”

The new federal data does hold one bright spot. The 2020 report reveals that of all the antibiotics sold for agricultural use, raising chickens—the most commonly consumed meat in the US—accounts for only 2 percent of the drugs. That’s compared to 41 percent each for cattle and hogs, and 12 percent for turkeys. It represents a complete turnaround for the US chicken industry that began in 2014, when Perdue Foods, then the nation’s fourth-largest producer, announced it was taking its entire operation antibiotic-free.

“Only 1 percent of broiler chickens in the US are produced with what the industry calls ‘full-spectrum antibiotics,’” Wellington says. “And more than half are raised ‘No Antibiotics Ever.’ That’s incredible. But it means that we’re at a standstill with pig and cattle production.”

In 2018, the year after the growth-promoter ban went into effect, the FDA announced it was launching a 5-year plan to further regulate farm antibiotics. But progress has been slow. In June, the agency introduced new rules that would reclassify those remaining over-the-counter drugs—a small number of injectable and topical antibiotics—as prescription-only.

Activists are impatient for the agency to do more. An open letter by researchers published earlier this year, asking the Biden administration for big sweeping actions, did not provoke any response. So advocates are focusing on smaller changes that they feel are reasonable for the FDA to make: more regulation, especially on how long antibiotics can be used in any single animal or herd, and more data-gathering that would allow better insight into how antibiotics are being misused. Annual reporting that tracks resistance rates in bacteria taken from humans and animals, and matches it to both sales and use data, is routine in the EU. In the US, no such comprehensive reports exist.

“First, if the FDA had actually done what it proposed in 2017, we would know more—that is, instead of just reporting sales, report sales with a denominator that reflects the size of the animal population,” says David Wallinga, a physician and senior officer at NRDC and coauthor of the analysis of FDA data. “That’s what they’ve been doing in Europe since 2010. And the second thing is to actually collect data at the farm level on antibiotic use.”

The UK Government Wants to Sequence Your Baby’s Genome

The UK Government Wants to Sequence Your Baby’s Genome

In November 2019, Matt Hancock, then the United Kingdom’s health secretary, unveiled a lofty ambition: to sequence the genome of every baby in the country. It would usher in a “genomic revolution,” he said, with the future being “predictive, preventative, personalized health care.” 

Hancock’s dreams are finally coming to pass. In October, the government announced that Genomics England, a government-owned company, would receive funding to run a research pilot in the UK that aims to sequence the genomes of between 100,000 and 200,000 babies. Dubbed the Newborn Genomes Programme, the plan will be embedded within the UK’s National Health Service and will specifically look for “actionable” genetic conditions—meaning those for which there are existing treatments or interventions—and which manifest in early life, such as pyridoxine-dependent epilepsy and congenital adrenal hyperplasia. 

It will be at least 18 months before recruitment for participants starts, says Simon Wilde, engagement director at Genomics England. The program won’t reach Hancock’s goal of including “every” baby; during the pilot phase, parents will be recruited to join. The results will be fed back to the parents “as soon as possible,” says Wilde. “For many of the rare diseases we will be looking for, the earlier you can intervene with a treatment or therapy, the better the longer-term outcomes for the child are.”

The babies’ genomes will also be de-identified and added to the UK’s National Genomic Research Library, where the data can be mined by researchers and commercial health companies to study, with the goal of developing new treatments and diagnostics. The aims of the research pilot, according to Genomics England, are to expand the number of rare genetic diseases screened for in early life to enable research into new therapies, and to explore the potential of having a person’s genome be part of their medical record that can be used at later stages of life. 

Whole genome sequencing, the mapping of the 3 billion base pairs that make up your genetic code, can return illuminating insights into your health. By comparing a genome to a reference database, scientists can identify gene variants, some of which are associated with certain diseases. As the cost of whole genome sequencing has taken a nosedive (it now costs just a few hundred bucks and can return results within the day), its promises to revolutionize health care have become all the more enticing—and ethically murky. Unraveling a bounty of genetic knowledge from millions of people requires keeping it safe from abuse. But advocates have argued that sequencing the genomes of newborns could help diagnose rare diseases earlier, improve health later in life, and further the field of genetics as a whole. 

Back in 2019, Hancock’s words left a bad taste in Josephine Johnston’s mouth. “It sounded ridiculous, the way he said it,” says Johnston, director of research at the Hastings Center, a bioethics research institute in New York, and a visiting researcher at the University of Otago in New Zealand. “It had this other agenda, which isn’t a health-based agenda—it’s an agenda of being perceived to be technologically advanced, and therefore winning some kind of race.”