Dangerous double talk on safety
In the wake of a recent decision by the Biden administration to drop enforcement of a government requirement that the abortifacient mifepristone be delivered only in person on site by certified prescribers, a proliferation of specialty online pharmacies and virtual abortion clinics has emerged, offering to sell and ship abortion pills by mail.
One such entity is Hey Jane, or Hey Jane Health, which offers “fast, safe, and affordable abortion care from home” for a fee of $199.
The website currently indicates that the service is only available to women in New York and Washington state. However, articles linked on the website suggest that Hey Jane has plans for distribution in California.
How we got here
Rebecca Gomperts and Aid Access have been working to challenge the regulations of the U.S. Food & Drug Administration (FDA) for years, striving to make foreign-made abortion pills available by mail to women in all fifty states while navigating the complexities of government regulation in court. Beverly Winikoff played a pivotal role in bringing mifepristone [“RU-486”] to the U.S. when she worked at the Population Council in the 1990s. In recent years, she has been offering abortion by mail to women in several states as part of her TelAbortion study with her new group, Gynuity.
However, following the temporary lifting of FDA restrictions on the distribution of abortion pills by lower courts in the summer of 2020 due to the pandemic, online pharmacies Honeybee Health and American Mail Order Pharmacy began shipping pills directly to patients (Ms Magazine, 11/16/20). Virtual abortion clinics such as “Choix” and “Just The Pill” began offering “medication [chemical] abortions” via telemedicine. Choix concentrated its efforts on California, while Just the Pill was established to serve women in Minnesota. Hey Jane also became involved at approximately the same time.
The recent suspension of operations by online “providers” appears to have been a direct consequence of the Supreme Court’s reinstatement of FDA restrictions on distribution in January of 2021. However, sales resumed within a matter of weeks when the new Biden administration assumed power and the FDA declared its intention not to enforce those regulations during the pandemic.
Despite the original limitations on distribution being reinstated once the pandemic subsided, the Biden administration has indicated that it will review and potentially revoke these regulations permanently (Endpoints, 5/10/21). It is evident that Hey Jane, Choix, and Just The Pill anticipate a long-term presence in the market.
Who is “Hey Jane”?
The group’s name, origin, leadership, the names or credentials of their prescribers, the location of their offices, and other pertinent information are not readily available on the group’s website. Instead, the Hey Jane website links to an online article published by Fast Company on October 2, 2020, which states that the name is one that evokes the Jane Collective, an underground abortion group that operated during the early 1970s in Chicago. This is noteworthy because the Supreme Court had not yet declared abortion legal at the time.
The website does not specify the credentials or training of the prescribers, yet it assures women that they can consult with a “licensed provider” via secure text chat. This “provider” is available around the clock, 24 hours a day, but only on Monday through Friday. The number provided for “Text Us” lists an Oklahoma City area code.
The company offers women the option of a video visit, though this is not a mandatory requirement. Jane, the company representative, states that the FDA-approved abortion pills can be delivered to the woman’s doorstep within one to three business days. She also assures the woman that the pills will be delivered in an unmarked box to protect her privacy.
The service is advertised as costing 60% less than the average cost of abortion care, with no need for travel to appointments, treatment, or follow-up. Free shipping for the pills is also offered, along with support during and after treatment.
Should the $199 fee (approximately $300 less than the standard charge for chemical abortions initiated on-site) still be deemed excessive, the company offers the option of financial assistance for those who qualify.
Double Talk on Safety
Hey Jane reassures women that “relief begins here,” and that they can “obtain the care you require from home—safe, fast, and effective.”
“Regardless of the type of abortion you undergo,” Hey Jane informs women, “it is a safe procedure.” Repeating unsubstantiated denials promoted by the abortion industry in opposition to studies that demonstrate the contrary, Hey Jane aims to clarify that “abortion does not cause breast cancer or mental health issues” and “does not make it more difficult to have children in the future.”
Regarding the safety of chemical or “medication” abortions, Hey Jane asserts that “complications from this treatment are very uncommon—they occur in less than 1% of patients.” This may be consistent with the prevailing narrative in the industry. However, empirical evidence suggests that the actual complication rates for chemical abortion in California are considerably higher—5.19%—more than four times higher than those observed for standard first-trimester suction abortions.
The group makes a passing reference to the potential inaccuracy of a woman’s self-dating of her pregnancy. However, this is a crucial point that merits further discussion.
The FDA initially approved mifepristone for pregnancies no more than seven weeks after a woman’s last menstrual period (LMP) due to the drug’s observed efficacy decline beyond that point. While the FDA extended the approval to ten weeks LMP in March of 2016, the reduced effectiveness of the drug as the pregnancy progressed remained a concern.
A woman seeking medical attention may undergo an ultrasound examination to ascertain the gestational age of her pregnancy. However, the potential for errors in self-dating, or the deliberate misreporting of dates to a licensed provider, not only increases the probability of an unsuccessful abortion but also raises the likelihood of a subsequent surgical procedure being required to address complications or complete the abortion.
Jane asserts that the risk of an undiagnosed ectopic pregnancy may be increased, yet simultaneously reassures women that ectopic pregnancies are rare. However, their advice in this regard appears to be at odds with their marketing model. They define “very rare” as occurring in 1-2% of pregnancies, which may spare most women. However, this definition seems self-serving, as it readily dismisses a condition that is likely to occur to perhaps every 50th patient.
The advice provided by the organization, which states, “You can ensure that your pregnancy is located within the uterus by undergoing an ultrasound examination,” appears to contradict their assertion that women can obtain “fast, safe, and affordable abortion care from home.”
Mifepristone is ineffective in the treatment of ectopic pregnancy. However, the combination of mifepristone and misoprostol can induce symptoms that closely resemble those of an ectopic pregnancy, including pain and bleeding. These symptoms can be mistaken for those of a ruptured fallopian tube, potentially leading to delayed diagnosis and treatment, which may result in irreversible damage and maternal mortality.
Not our problem
Despite the assertion that “Throughout your treatment, we’re here to support you,” and the provision of telephone numbers or websites where women can text or call if they have “urgent concerns,” Hey Jane’s “Terms of Service” makes the following disclaimer (emphasis ours):
It should be noted that Possible Health does not provide medical services or medical advice. Furthermore, Possible Health does not make any representations or warranties about the training or skill of any Providers who provide services via the Services. It is ultimately the responsibility of the user to choose their particular Provider, if any. All Providers are independent of Possible Health. Any information or advice received from a Provider comes from the Provider alone, and not from Possible Health. Possible Health is not responsible or liable for any advice obtained from a Provider or any other user of the Services. It is acknowledged that any reliance placed on information provided by a Provider or other user via the Services is done so at the user’s own risk. It should be noted that no doctor-patient relationship is created by the use of the Services. Furthermore, information received via the Services should not be considered a substitute for a formal diagnosis or physical examination, and should not be used to treat a medical condition. It is therefore recommended that users do not ignore or delay obtaining professional medical advice because of information obtained through the Services.
The designation “Possible Health” may be the legal name of Hey Jane, or it may be the name of the entity that hosts the website. Regardless of the designation, the message conveyed to women who rely on Hey Jane for their health and safety is clear: “You are on your own here.”
A minimum of two dozen women who have undergone the administration of mifepristone have perished, while thousands more have experienced severe and potentially life-threatening complications. Moreover, nearly all of these patients were met, screened, counseled, and physically examined by a trained medical professional at the clinic. This individual could confirm the pregnancy, verify the gestational age, eliminate the possibility of ectopic pregnancy, and ensure that the patient did not have any disqualifying medical conditions that could make these drugs deadly for them.
It is evident that women are not only endangering the lives of their unborn children, but also their own, each time they procure these pills from unidentified, unaccountable individuals with minimal medical qualifications, who are exploited by activists who are willing to overlook the loss of a few patients for the sake of the “cause.” These pills are often purchased from websites designed by enterprising entrepreneurs who recognize the potential for financial gain.
Daniel Miller is responsible for nearly all of National Right to Life News' political writing.
With the election of Donald Trump to the U.S. presidency, Daniel Miller developed a deep obsession with U.S. politics that has never let go of the political scientist. Whether it's the election of Joe Biden, the midterm elections in Congress, the abortion rights debate in the Supreme Court or the mudslinging in the primaries - Daniel Miller is happy to stay up late for you.
Daniel was born and raised in New York. After living in China, working for a news agency and another stint at a major news network, he now lives in Arizona with his two daughters.
