ELISSA NADWORNY, HOST:
A federal appeals court in Louisiana banned the mailing of abortion drugs across the country last week. The U.S. Supreme Court put that decision on hold until Monday. The prescribing and mailing of mifepristone and misoprostol account for more than a quarter of all abortions nationwide. And a couple of years back, after the Supreme Court struck down Roe v. Wade, I got the chance to see a mailing operation myself.
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ANGEL FOSTER: This is our office.
NADWORNY: Angel Foster, who has an MD and a Ph.D., is my tour guide. She motions to the walls, which are piled high with boxes the size of a hardcover book.
FOSTER: These are all kind of prepackaged and ready to go...
NADWORNY: Yeah.
FOSTER: ...To those...
NADWORNY: You look - honestly, this looks kind of like an Etsy store.
FOSTER: It really does.
NADWORNY: With the Supreme Court's pause on the ban ending on Monday, we thought it would be a good time to check back in with Angel Foster. She's the founder of the Massachusetts Medication Abortion Access Project - also called the MAP - and she joins me now.
FOSTER: Hi.
NADWORNY: So, Angel, when I visited you a couple years back and - I saw just how big of an operation it was. Small and mighty, I think you said. For folks who don't know, you were mostly sending medication to people in states where abortion was already effectively banned.
FOSTER: That's correct. We launched the MAP in September of 2023. And in the last 2 1/2 years, we've provided care to around 50,000 patients, and we're now providing care to between 3,000 and 3,500 patients a month. We provide care to patients in all 50 states, but about 95% of our patients are in states with near-total abortion bans or where there are restrictions on abortion in the first trimester of pregnancy.
NADWORNY: And what has your office looked like over the last week?
FOSTER: Since the stay, we have had a huge surge in demand. Our numbers are probably double, and one group that we've seen a lot of demand from are those who are seeking pills for future use. So advanced provision or providing mifepristone and misoprostol to someone who's not pregnant but wants the pills on hand to use in the future is something we've always offered our patients. And typically, it's about 1% of our patients, so we send between 30 and 35 future-use packages a month. On Tuesday, we sent 50.
NADWORNY: You told me some of the stories that come along with the patients seeking these medications. What have some of them been telling you, especially this last week?
FOSTER: Sure. So I'm right now in our patient portal. I'm looking at the medical questionnaires that our patients have completed in the last couple of days. We have a 22-year-old patient from Florida who wrote to us to say, you know, thank you for providing this service. I think you know how important it truly is. We have a patient who is 36 years old and from South Carolina who wrote, I'm a victim of domestic violence, and I'm pregnant by my abuser. I know having this baby would make it harder to leave. And so we know that medication abortion pills really are a lifeline for people, especially those who are in states with near-total bans and in states where there are gestational-duration restrictions in the first trimester.
NADWORNY: I guess one obvious question is - after the Supreme Court's pause expires, what happens to the project?
FOSTER: We will continue to provide care to patients in all 50 states as long as we are legally able to do so. And right now what we're planning is to continue to provide mifepristone and misoprostol. But if, for whatever reason, we can't provide that regimen, we will pivot to misoprostol alone. Our team has a lot of experience using misoprostol as a single abortifacient from our international work. We're very confident in the safety and efficacy of this regimen, and we have evidence-based standards for how to use it. So while we're obviously waiting for the decision and would be incredibly disappointed if we can't offer our patients mifepristone, we're also very grateful that we have such a high-quality, safe and effective alternative that we can turn to.
NADWORNY: I just want to take a second and kind of ask you about you. You told me at the time that you were being really careful about traveling to states that had bans for fear you might be targeted. Hearing, you know, all the stories from patients, knowing the ramifications of this decision, I'm wondering how you're feeling right now.
FOSTER: I feel - I have a number of different emotions. The first is real frustration with the judicial interference with science and the practice of medicine. It is still the case that because I'm public-facing and involved with a shield-law practice, I don't travel to or through states with near-total bans. And that includes South Carolina, which is where my mom and stepdad are based, and so I haven't been able to visit them at their home for over 2 1/2 years. And that makes me sad, and I think it makes them sad, and we do figure out ways to see each other in other places. But as a family, we all agree that it's worth it.
NADWORNY: That's Dr. Angel Foster, founder of the Massachusetts Medication Abortion Access Project. Thanks so much.
FOSTER: Thank you. Transcript provided by NPR, Copyright NPR.
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