Interview with Rebecca Kelliher, author of Just Pills:

Mercer Gary: Hi there, this is Mercer Gary, and I'm here with Rebecca Kelliher, the author of Just Pills: the Extraordinary Story of a Revolution in Abortion Care. Hi, Rebecca. 

Rebecca Kelliher: Hi, thank you so much for having me.MG: That you for being here. So, if we could start out by having you give us a brief synopsis of your recent book, we'd love to hear you describe it and how you came to write it. RK: Just Pills, my book, is a history of abortion pills. It focuses on mifepristone and misoprostol, which are the two medications most commonly used in the U.S. today for an abortion. According to the WHO, you can also have a safe abortion using just misoprostol. The book goes into both of these two medications, starting as far back as the late 1800s before those medications existed, up until Trump's reelection as U.S. president in November 2024.

What I also do in the book is dive into some of the feminist activist networks that started to use these pills in countries with near-total abortion bans to safely support people through their abortions. These networks mostly started organizing in the late 2000s and the early 2010s. The book tries to not just focus on the United States––although what's happening here is obviously incredibly important––but it also tries to gather some learnings from different contexts that have been using these pills in creative and safe ways for a lot longer than we have in the United States. I interviewed nearly 200 people on five continents while reporting and researching the book. So, it really brings in a range of voices, including abortion providers, scientists, feminist activists, attorneys, and, of course, abortion seekers.

In terms of your question as to how I came to write it, it really was because I didn't know that abortion pills existed until a few years ago and I was pretty surprised that I didn't know about them. This was in 2016 when a friend of mine was researching misoprostol and was looking at some of these feminist groups in countries with near-total abortion bans, groups that were using misoprostol in particular to try to support people through safe abortions while also trying to change the law, to liberalize abortion. This friend was way ahead of me because I just, like I said, didn't even know that you could have an abortion with medications. I thought at the time that it would be helpful if some book out there existed that was written for everyday readers, not necessarily for academics, that broke down these medications, why they're important, how they can be used, and their history.

Fast forward to fall of 2020. At that point, I was at Columbia Journalism School, and there was a course available where you could pitch a book idea and develop a book proposal. The idea came back to me about a book on abortion pills, which still didn't exist as far as I could see. Ruth Bader Ginsburg on the Supreme Court had just died that fall, and she'd been a longtime supporter of the right to abortion. And Trump, who was still president at the time, rushed Amy Coney-Barrett, who had known anti-abortion views, onto the Supreme Court. To those who were watching this unfold, it seemed very likely that this new makeup of the Supreme Court would end Roe, or at least severely diminish it, very soon.

So, I thought back again to that conversation with my friend and asked, well, what do we already know about communities that have lived for many, many years under near total abortion bans? Because if Roe ends, many parts of this country could have near total abortion bans. And what we know is abortion pills become even more important in that context. Mainly because abortion pills are difficult to track and to fully stop despite bans. And we know that, around the world, bans do not stop everyone from having or seeking abortions. But again, I still could not see a book that was diving into these pills. And that led me to start working on this. 

MG: That's huge, and a really compelling explanation of the urgency behind this book. It leads me directly into my next question: near the end of your writing process, precisely what you were concerned with as you started it did happen: the Dobbs case was decided. How did that decision impact the final version of the book? 

RK: Yes, so as I was saying, to anybody who was paying close attention to what was going on, Dobbs was not a surprise. But then what happened afterwards––the fallout of Dobbs in the United States––was history happening in real time. For me, it meant that the book had to try to balance the bulk of the material, which was about the pills before Dobbs and going way back in history to understand the context of abortion in general, with keeping up to date on the developments here after Dobbs as far into the present as I could go. And it meant, frankly, that the book was twice as long as I initially expected––or at least the first draft of the book before we cut it down.

I think the purpose of the book for me expanded as well; it became not just that more people, including myself, should know about the history of these pills and their importance. It shifted toward the need for a record of what's happening right now. These interviews that I had, especially in the later parts of the book, showed abortion providers in the United States and different activists as well as abortion seekers here navigating a really complicated and quickly changing landscape of access—with pills becoming, again, increasingly important. But at the same time, the criminalization risks that people faced for distributing abortion pills, for instance, or even fears of sharing information about abortion pills in some states were also escalating. So, I think the urgency around the book, as you said, just became even stronger. 

MG: That makes sense. Rather than a purely historical question, you emphasize the active crisis in our current moment that requires us to attend to both the past and present of these pills in order to assess how we should mobilize them and respond to efforts to restrict them in the future. So, in in that vein, what do you think Dobbs, combined with other recent legislative and executive efforts, portend for the future of medication abortion in the United States? 

RK: I think that the reality is abortion pills themselves aren't going anywhere. They've been around for decades. They're produced globally and distributed globally. The question is, do enough people know that the pills are safe and how they can access them safely? There was an alarming KFF survey finding that just came out that found that more Americans today, compared to just 2 years ago, say that they're unsure of mifepristone’s safety. So, there is diminishing access to good quality information about mifepristone, that it is very safe and effective, and that we've known this for decades. The fact that fewer people are aware of that now than two years ago is something we all need to be paying attention to.

Because that's my worry: it is not that the pills themselves are going to go away. People who know how to find them will, for the most part, be able to find them. We're already seeing trends of people going online to buy prescription-less abortion pills or using community networks to get pills or, increasingly, telehealth abortion through licensed providers. On that last avenue of access, people in states with near-total abortion bans who can't travel across state lines to get legal abortion care can get pills mailed to them through these telehealth abortion providers operating in states with protective laws that are known as telehealth shield laws. So, we see there are these avenues for people to get pills, even with the threats at the state and national levels trying to stop or severely restrict access to the medications. But do enough people know about all of those avenues? I think that's something we all have to ask. 

MG: That makes sense: greater concerns about information scarcity and about the accuracy of the information available, over and above the actual availability of the pills for those who know where to look. I'm wondering if you could comment a bit on how you think medication abortion, changes the way that we think and argue about abortion. Does it impact our view of what abortion is? Its stakes? Its practice?

RK: This honestly has been a central question of the medications from their beginning. And it's important to talk about this in terms of the potential of the pills. In some ways, it's only recently that, here in the United States, that potential has started to be realized, meaning the potential of the pills to get into more people’s hands, expand access, and, along the way, possibly destigmatize abortion. A lot of that does go back to telehealth abortion, which in the US only started officially around 2023, even though the FDA approved mifepristone in 2000. At that point in 2000, the FDA placed an “in-person dispensing requirement” on that pill, which meant that mifepristone couldn't be mailed directly to patients, so people had to physically go and pick up the pill. What that meant was that, here in the US, for more than 20 years, the real potential of abortion pills that people had envisioned––that it could be something you could get easily, that it could be taken in your home, and that you wouldn't have to go to a clinic necessarily––that vision just didn't happen, largely because of that “in person dispensing requirement.”

So, all of this goes back to how we, and I'm focusing really on Americans, think about abortion. In 2016, I certainly had this view of abortion as needing to be in a clinic or with a doctor or licensed clinician in person. I thought abortion could only be a procedure. But all of that has changed so much in this country, not enough given that KFF survey finding, but, still, it's changed a lot in just the last 5 years. More than two-thirds of abortions in this country are done with pills, according to the Society of Family Planning, and we see an increased use of telehealth abortion services. People understand more today than just a few years ago that abortion doesn't necessarily have to be in a clinic; it can be in your own home.

And the potential of that, the most positive, empowering potential, is that it could cut through the anti-abortion messaging that has been so successful for so long that has made abortions seem really scary and dangerous and somehow really complicated. But if you get down to it, these pills are very safe and, medically, taking them is a pretty simple process. It might not be emotionally simple for that person. But medically, it generally is. I think the hope that I heard from many activists in this space is that, if we have more accurate information, more positive awareness, and more people just taking pills in this country, experiencing this for themselves, that maybe this could also help end some of the stigma and misinformation about abortion, which could maybe lead to political change. I don't know if that will happen, especially given criminalization fears for people living under state bans. No one can predict the future. But that’s the hope. Time will tell. 

MG: Thanks for giving some of that history on the regulation of telehealth abortion, that's really helpful and clearly crucial to making use of the potential of these pills in our current context. I'm wondering if you could speak a bit more to some of the difficulties with the expansion of telehealth abortion. Here I'll ask a version some questions you got from me and others at the book event where we first met––shout out to the Wooden Shoe Books in Philadelphia.I'm wondering whether you think telehealth abortion is primarily a pragmatic reaction to the closure of in-person clinics and the increasing legislative bans in certain areas, increasing concerns about criminalization, etc. or whether you think it is a move in the direction of the de-medicalization of abortion. I guess this is a question both about what, if anything, is lost with the move from the in-person clinic to the telehealth encounter and what could be gained by distributing these abortion provision networks more widely. 

RK: Yeah, I think this is such a great question because it really gets at the complexity of abortion provision in this country in particular. I think the answer to the first part of your question, about how much of telehealth abortion is a pragmatic response to restrictions and bans that we are seeing post-Dobbs and how much of it is an effort to de-medicalize abortion, I think the answer is it's both. And in terms of what we lose, as well as what we gain, that's really important to understanding the “yes, and” part of the answer. In terms of what we lose, I'm very clear in the book that pills are not at all a silver bullet to the crisis that we're in in this country. The most obvious reason being that, for people who need later abortion care, that is almost always going to require a procedure in this country. And a procedure means going to a facility, going to a clinic, having a licensed, skilled provider there with you. But the brick-and-mortar clinics that have provided later abortion care for many, many years in this country have relied on the revenue from early abortion care in order to stay open.

The problem is, if more people turn to various telehealth abortion services for their early abortion care, how do those clinics that rely on revenue from that early abortion care to provide later abortion care then stay open? This is super important in the post-Dobbs landscape because, now with the shuttering of clinics in states with near-total abortion bans, there are so few clinics that provide later abortion care in this country. And those clinics that still exist are now serving more patients given that people who need this care but live in a ban or severely restrictive state are crossing state lines to get that care. So, even though the vast majority of abortions in this country are done early in a pregnancy, and so can effectively use pills for their abortions, and even though we are only talking about a minority of people who need later abortion care, that is still a group of people in need of this important care—what happens to them?

This is the dilemma. As telehealth abortion expands, on the one hand, that's wonderful because we see greater and greater access to this vital form of healthcare, especially for people living in states with bans who can't travel across state lines. But again, what does that mean for the patients who still need or want to go in person to a clinic? I frankly don't have a clear solution to that problem, and I don't yet know anybody in the movement who does. But it is a very live problem right now and is one of the consequences of Dobbs.

I think one of the things we might see is some of those clinics that I'm referring to might try to find other ways of making up for whatever revenue that they've lost from the greater provision of telehealth abortion in order to stay open. But I don't know. It's something to pay attention to. It also points to the larger history in this country of abortion having been siloed from the mainstream medical establishment. These clinics were filling, and are filling, an important gap in the medical system by providing abortion care.

MG: That's helpful, thank you. Those ‘either/or’ questions often end up in a ‘both/and,’ so I'm grateful for your expansion on both sides of that coin. I'm wondering if you could speak a bit more to these other contexts in which telehealth abortion occurs. The term “self-managed abortion” can be misleading and can neglect some of the contexts where telehealth services are used in concert with other kinds of in-person support outside of brick-and-mortar clinics or traditional health systems. Could you talk about the use of telehealth in community-managed abortion? 

RK: This is where I can talk a lot about the history of what we can call the accompaniment movement, which really started outside of the United States, especially across parts of Latin America in the 2000s and 2010s when most of the countries in that region were still under near-total abortion bans. Like I was saying earlier in our conversation, in those contexts, feminist activists learned how to get their hands on abortion pills, which included using telehealth abortion providers. There was one provider in particular who has been credited with pioneering telehealth abortions, Dr. Rebecca Gombers, who's based in the Netherlands. She started a nonprofit around 2005 called Women on Web through which she was prescribing and mailing abortion pills to people who were living in countries with near-total bans.

At the same time, some activist networks on the ground––and I'll focus on Argentina in particular––were able to get pills or to tell people how to access pills through Women on Web or other global telehealth abortion services that were just starting. But they were also trying to provide community, in-person support of the person having their abortion. So, it wasn't just, “Here you go, you got the pills, you do you.” It was more like, “I'm going to be there with you either over the phone or in person as you take the medications and help you through it, give you the information, and, really importantly, hold space for whatever you're feeling about this experience.” And if you're having an abortion under a near-total abortion ban with so much sigma, chances are you're going to have a lot of feelings. So, this was so important for providing high-quality care to those communities.

But it was also important for trying to change the law. The Socorristas en Red, which is an accompaniment network in Argentina that still very much exists, was successful in changing Argentina's law from a near-total ban to what is now roughly a 14-week ban. It's still not where they want the law to be, which is with no abortion ban whatsoever, but it certainly is progress. That change was made in late 2020.

So, you might be thinking, what does this have to do with the United States? Well, one thing is that, yes, we are seeing greater use of telehealth abortion in the U.S. The latest numbers from the Society for Family Planning found out that, in the first half of 2025, there's been an uptick in the use of telehealth abortion; it now accounts for nearly 30% of abortions in the US. But those numbers are only accounting for abortions within a formal healthcare system, so, through a licensed provider prescribing the medications. There are all these other cases that are really difficult to count, since people could be having abortions outside the formal healthcare system, including people getting pills through community networks operating similarly to the Socorristas in Argentina. Abortion doula is a term more commonly used in the US than accompaniment network, or acompañante—but they all refer basically to the same thing, to peer-to-peer groups that usually have some kind of training but are not licensed providers and nonetheless are functioning as a support for the person having their abortion with pills.

Like with the Socorristas, usually that support will be over the phone. But sometimes, in especially vulnerable situations, such as with a minor or somebody who is experiencing intimate partner violence, it will be in-person support. These community networks are trying to fill those gaps.

I think it's helpful to think about all these different models of abortion care with pills as all working together. There's not necessarily one perfect model because it also all depends on where you are and what you need and what's available to you in that moment. 

MG: The case of the Socorristas is so compelling and I think how you lay it out and what they've done really demonstrates how telehealth abortion can be both a necessary response to extremely restrictive conditions and a bridge on the way to more fundamental changes to those conditions. So the combined immediate response and policy advocacy is a really helpful model there. I'd love to hear you expand a bit more on the work that you did with feminist political organizers around the world, the Socorristas especially, in writing this book. How did their practice inform your own approach to writing this book? 

RK: This is such an excellent question and a hard one to answer because I feel like it's hard to put into words for me how influential it was to talk to Socorrista members in particular. There is one moment in the book where I write about how, after having interviewed two Socorristas, one of whom talked about her experience of having been accompanied by a Socorrista during her abortion while she was experiencing intimate partner violence, and how she later became a Socorrista because that experience really motivated her––the safety and love that she felt through this network making her want to give that to others—that conversation helped me realize that while, yes, this book is about these medications and the importance of these pills. But these pills, kind of like you were saying, they cannot and they do not operate in a vacuum. And what's even more important, arguably, are the connections that people can form around these pills as a tool.

That is what I felt like I was witnessing in that particular interview because what was so important to that Socorrista in her abortion wasn't the mechanics of the medications. It was really the feeling of safety and love that she got from this Socorrista, this other person in her life, in her community. And she then became a Socorrista. Maybe it sounds obvious, but it wasn't obvious to me until that moment: that it's not just about the pills themselves. It's about these relationships that people can form. And these pills, in the best cases, can become a way of changing the dynamic of care. It doesn't have to be a hierarchical, I-know-best, let-me-tell-you-what-to-do kind of dynamic that is still often the case with a doctor-patient power dynamic. It can become something that's more fluid and more generous than that. 

MG: That's a wonderful note to end on. I have just one last, brief question about your process that I think some of our readers might be interested in as well. Given that one of your driving motivations in beginning of the project was to make this history available and accessible and to create a public record of these pills and of these connections that they enable, can you talk a bit about your approach to writing for a broader popular audience?

RK: That's such a great question. I think I tried to put myself as much as possible into my 2016 self, so to speak, the person who didn't know anything about abortion pills, and tried to imagine what that prior version of myself would have wanted to know. That became increasingly difficult the more I knew about the subject, because then it was harder for me to understand what I could assume a reader would know and what they wouldn't.

But I think, more concretely, people tend to be drawn to the human stories. So, I really tried to focus each chapter on one person––there were many voices in a chapter, but I tried to have one main character as a way of bringing in that human story to the history. It also, I think, is a more accurate telling of the story of these pills because It's so much more a story of us as a society than it is about the pills themselves. It is more about what the pills reflect about us, about our views of women and of pregnancy––the good and the bad, the ways we've inhibited the pills and the ways we’ve fought for them, who is left out or lifted up each time. So, I just kept trying to find the people behind the pills. 

MG: That makes a lot of sense and it really reflects exactly what you clarify as the focus of the argument––that this is about abortion pills as tools for creating new kinds of relationships conducive to different forms of care and, potentially at least, conducive to better forms of care.

Thank you, Rebecca, so much for your work. We will link to the book and where you can find it as well as to Rebecca's website. We look forward to seeing what you do in the future. Thank you!

RK: Thank you so much for having me. This was such a pleasure.

See previous related blog posts on mifepristone, contraception and obstetric violence, Argentina’s legalization of abortion.