It's your body
+ Hey Jane's Medical Director on abortion access, contraception, and more
If you have a cold, you can try an at-home remedy, go to the doctor, get a prescription medication. If you have cancer and the medication isn’t working, you get to decide if you want to stop using it, try something else, or participate in a clinical trial.
These are examples of bodily autonomy. It’s the right to choose what happens to you and your body.
When a woman gets pregnant, she should decide what happens next, shouldn’t she? According to the Pew Research Center, 63% of U.S. adults say “yes,” abortion should be legal in all or most cases. Why, then, do we continue to politicize the female body?
For most of my life, I didn’t believe in abortion. I thought, sure, in some cases it makes sense. But certainly, there were other, better options.
It took me a long, long time to understand that our bodies are ours and it doesn’t matter how or why you get pregnant, you should have the right to decide if you’re going to carry a fetus or not. It’s your body, your choice.
Alyssa Wagner, DNP, RN, APRN, WHNP-BC, is a board certified women’s health nurse practitioner specializing in reproductive and sexual health care for over 14 years and the Medical Director at Hey Jane.
Raised on the understanding that reproductive health is a human right (and by a mother who regularly attended pro-choice marches), Dr. Wagner knew she’d pursue a career in medicine and specifically reproductive health. After earning her nursing degree and becoming a nurse practitioner, she went on to receive her Doctor of Nursing Practice from the University of Michigan.
Prior to joining Hey Jane, Dr. Wagner was on the Cuyahoga County Board of Health in Ohio, so we discussed our shared experiences of living in the Midwest. She now resides in California, where she oversees the Hey Jane clinical team, works directly with patients, and considers how to expand access to abortion pills and make the patient experience more enjoyable.
Dr. Wagner was everything I hoped she’d be – friendly, relatable, open, and deeply passionate about the work she’s doing. She even came to our interview with medication abortion painted on her fingernails!
Being an abortion provider and a mother who experienced her own need for abortion pills amidst an unexpected pregnancy loss (as she details in this op-ed), Dr. Wagner knows firsthand how important it is to make abortion legal and safe for all who need or want it.
In our discussion, we cover the political landscape surrounding abortion, what providers are doing to support patients, what mifepristone is for, and the many different types of contraception that are now available for women.
How has being a mother shaped your perspective on abortion rights?
Having that firsthand experience really solidified my commitment to making this care accessible and stigma free and as nice as possible for patients. With my abortion, it was in Ohio during the heartbeat ban. The worst part was it was a wanted pregnancy and I was devastated that I wasn't going to have a baby. That was sad. But knowing that and waiting [to officially end the pregnancy] was pretty cruel. It was the worst I've ever felt in my life. I had decided this is what I want to do right now, but I couldn’t.
I ended up doing the procedure at my job, which was great. All these friends who I've worked with for 10+ years were there – and that's how they treat everyone. I can’t imagine not having that support. Even with support, it was really hard. You can't understand it unless it's happening to you.
Can you explain why abortion access is necessary for all pregnant people?
Bodily autonomy is so important for mental health, physical health, emotional health, and generational health. In the Turnaway study, they looked at what happened to parents and families and individuals who were denied abortion care and they found they have worse outcomes in life when they want abortion and can't have an abortion.
It impacts the whole family, not just the individual. You know, there's also all these links between trans health and abortion care and all the side effects of what happens when people don't have that bodily autonomy, and how devastating that can be for their mental health which can lead to issues with physical health as well. Body autonomy is your right as a person and when people don't have that they aren't really free.
Let’s talk about mifepristone – what is it, what is it actually used for and why are the restrictions around it concerning?
In other countries, it’s used for a ton of stuff [ex. Treating endometriosis, managing uterine fibroids, cushing’s syndrome, etc.] and they’re seeing some amazing trials using it, but we’re severely limited in the United States.
It is FDA approved for ending a pregnancy. Not only is the combination of mifepristone and misoprostol really effective at ending a pregnancy, it is also the most effective way to medically manage miscarriage or early pregnancy loss.
But because of the restrictions on mifepristone, patients in many states are only able to be given misoprostol, which works great, and if you don't have mifepristone, misoprostol really does work well. That being said, it is not the most effective, the most effective is mifepristone and misoprostol together.
But many patients who have early pregnancy losses are given misoprostol only which can have worse side effects – diarrhea, nausea, vomiting – and doesn't work quite as well as mifepristone and misoprostol for early pregnancy loss, but so many people are not even given that option to manage the miscarriage. They’re told you can wait it out and we'll follow you with labs. If you want to do that, that is a great way to do it. If you don't want to do that, if you want to be able to pass this pregnancy with a more predictable window of time and a greater sense of efficacy than you should be given the option of mifepristone and misoprostol to manage that or the option of a clinic procedure which is also amazing.
There are occasions, too, when the body doesn’t pass the fetus and would require medication or a procedure to remove it.
Yes. I joke that I have a hoarder uterus because I’ve had two pregnancies where the fetus didn’t grow, but there were no clues other than me having zero chill and getting ultrasounds all the time. My body was going to keep growing that first pregnancy for I don't know how long because I was 12 weeks when I ended up having my procedure. It would have kept going; there were no signs, no bleeding, nothing. My body was hanging on tight. It was not going to pass that pregnancy anytime soon and when you want to be pregnant that is delaying your opportunity to become pregnant again.
Regarding Hey Jane, how do you support women and pregnant people in states in abortion bans or restrictions? Is it still possible?
It's rough, but you don't have to be a resident of one of our covered states to receive care from us. You can travel to one of our states to receive care with us and we do have patients who do that. We also like to do outreach to find friendly providers in ban states so if you need to see somebody and you are traveling we give you a friendly face to visit so it's not just you on your own. For now patients do have to be in one of the states that were active.
Being a healthcare and abortion provider in today's political landscape is challenging. How are you navigating this and what changes day to day?
I always say that nobody's better at pivoting than abortion providers. Because we've had to, especially the last four years. Regulations have been wild. That being said, I came from Ohio, where things got wild after every election. We are just constantly dealing with change – sometimes in a good way. We definitely have to be on our toes.
Once you receive your medication, what is the process like for a patient?
We have a beautiful guide that comes with it. We also have a HIPAA compliant chat app where we talk to patients before we send it and then they get messages throughout their journey, checking in on how they're feeling, letting them know about when they should be expecting certain steps along the way. But basically, people get their treatment, they can take the mifepristone as soon as they want, and generally they take the misoprostol 24 to 48 hours later. Patients can chat with us. If they have questions, we have an urgent line. We’re there every step of the way.
Let’s shift to contraception. How do you work with patients to determine what type of birth control works for them and how do you kind of improve the access for more people?
One thing I'm really proud of is our birth control intake because we talk to patients about what they're looking for in a method. We ask a lot of questions. How frequently do you want your periods? What are you comfortable with as far as the method? We have a Nuva ring, which is a great option but if you're not comfortable putting your fingers in your vagina, it's probably not the method for you. We ask: Do you have any other medical conditions that we know birth control helps? Do you experience painful periods?
From there, we can give them recommendations. Patients get to decide how much input we provide. We like to do shared decision making with them based on what's safest for them and what fits best with their lifestyle.
What are some non-hormonal options?
There’s a lot out there about hormones and birth control now. Yes, hormones have side effects, and for some folks, those side effects are rough. For other folks, they're mild to none. With any medication, we're weighing the side effects with how much you want to prevent pregnancy.
In some cases, patients are so interested in preventing pregnancy that they're willing to accept a method that may cause some side effects that they don't like. That being said, we do have a lot of non-hormonal options that we can prescribe for patients. The biggest issue is getting insurance to cover them. There's a one-size-fits-most diaphragm. There’s a pH modulator, which is a gel that you could put in your vagina before you have sex, but your insurance might say you have to try something else first before it’s covered. There’s the copper IUD, which is super effective and doesn't have hormones. It’s all a balancing act – and not all pills are created equal. A pill that might work great for me might not for somebody else. There’s a bit of a trial and error component, which can be challenging.
In terms of the future of reproductive rights and women’s health, what are you excited about?
The thing that really gets me excited is that there are more and more ballot initiatives in states where people are saying, “abortion really matters to us.” The one in Ohio was very near and dear to my heart and I helped collect signatures for that. It’s really been an obvious demonstration of how important abortion access is to people, which helps move the needle for access, but also moves the dialogue.
If we know people are getting abortions, we can talk about it and work to decrease the stigma around it. Just seeing the undeniable evidence that people care about abortion access makes me excited.
Obviously, we have a lot of really scary stuff going on with our Supreme Court and then the individual states and what they're trying to do to stifle these democratic processes, but what keeps me excited is the fact that we know patients want it and we know how important it is. It’s also amazing to see the impact we have. At Hey Jane, we’ve seen over 60,000 patients. That to me, even though I've been here, is still pretty mind blowing.
Can you share a success story?
We have patients who let us know all the time what a difference it’s made for them. We know that a lot of our patients and abortion patients in general are parents. We hear all the time how long it takes for patients to get to a brick and mortar, which we love brick and mortar clinics, there's always a need for them, but for someone who wants a medication abortion, it can take three weeks at a clinic which puts them out of range for a medication abortion.
That’s not even touching on the logistics it takes to get to a clinic, especially with kids. The logistics can be really hard and parents message me all the time about how much of a difference it has made for them. My favorite, though, is when a patient said the first time they were able to take a breath after learning of their pregnancy was when they got the message from Hey Jane saying their medication was sent and the second time was when it came in the mail. I know that feeling, that feeling of relief and doing it on your own terms.
One last question: what’s one healthy habit you can’t live without?
I like to craft. I like to make funny abortion shirts. I like to make funny regular shirts. I like to sew. My son likes to do crafts with me. So I think crafting is probably my healthiest habit that I can't live without.
Do you know the existing abortion policies in your state? View this interactive map to find out.
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