Pills Have Legs

Julia Lloyd George interviews Rebecca Kelliher about her new book “Just Pills: The Extraordinary Story of a Revolution in Abortion Care.”

By Julia Lloyd GeorgeOctober 14, 2025

• Science & Technology

• Politics

SINCE THE FALL of Roe v. Wade (1973) in 2022, restrictive abortion bans have proliferated across the country, along with more covert threats to limit and restrict abortion access. Most recently, Health and Human Services Secretary Robert F. Kennedy Jr. announced that the US Food and Drug Administration (FDA) is reviewing evidence about the safety of a widely used abortion pill, mifepristone, suggesting that it requires more regulation. Meanwhile, platforms like Meta are censoring abortion-related content, particularly posts about abortion pills. But on October 2, the FDA quietly approved a generic version of mifepristone, a decision that increases the drug’s supply amid efforts to further curtail and limit abortion access.

Rebecca Kelliher’s astonishing new book about the global history of abortion pills, Just Pills: The Extraordinary Story of a Revolution in Abortion Care, could hardly be timelier. I spoke with Kelliher at her home in New York about her reporting process ahead of the book’s release.

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JULIA LLOYD GEORGE: Where did you first get the idea for this book?

REBECCA KELLIHER: I was having lunch with a friend during the summer of 2016. She was in graduate school, and her dissertation was about the abortion pill, misoprostol, that’s used in many parts of the world. I had never heard of it before and hadn’t even known of abortion pills more generally. I was really shocked at my own ignorance, and I thought about how somebody should write an accessible book about abortion care. But it wasn’t until the fall of 2020, when Ruth Bader Ginsburg died and Trump, as president, rushed Amy Coney Barrett onto the Supreme Court, that I launched the project. I was in Columbia Journalism School at the time, in a course on book-writing where students had to pitch a book idea. I was thinking, well, this book still hasn’t been written, and the topic is only going to become more important if abortion does get banned in huge swaths of this country. One of my sources, Dr. Beverly Winikoff, says “pills have legs,” which means they can travel across state borders and so their use is only going to grow. If you know about them, you can get them. But back in the late 2010s, people weren’t talking about them, at least not in my experience; when you said “abortion,” people thought about a procedure with stirrups in a free-standing clinic, not pills. Survey data backs that up too. Even by 2020, only a third of women between the ages of 18 and 49 had ever heard of a medication abortion.

So, you started working on this seriously in that class in 2020?

Yes. One of the first questions that the professor, Samuel Freedman, asked me was “What do we know about the numbers of abortion pill users?” The truth is, we don’t know the numbers. We only know of the pill-induced abortions that take place within the formal medical system, but there are so many other avenues to getting prescription abortion pills that we don’t track.

What numbers do we have?

The World Health Organization (WHO) estimates that “around 73 million induced abortions take place worldwide each year.” Medication abortion with mifepristone and misoprostol is approved in 96 countries currently. There’s a protocol for taking both these medications together, as well as for taking misoprostol alone. Misoprostol is not registered as an abortion pill, so it’s more available than mifepristone for that reason.

Can you explain the difference between these two medications? Do they operate differently? What’s the science behind how they work?

I should first say, as I do at the start of my book, that I’m not a doctor, and this isn’t medical advice. Mifepristone stops the development of an early pregnancy, whereas misoprostol triggers uterine contractions, helping to expel the contents of a uterus. These two medications complement each other, and the FDA has approved the use of both for a medication abortion in early pregnancy since 2000. Mifepristone is an antiprogesterone, meaning it blocks the hormone progesterone in the uterus, a hormone important for continuing a pregnancy. As an antiprogesterone, mifepristone also makes a person’s uterine muscle more sensitive to contractions. When a person then takes 200 milligrams of mifepristone followed one to two days later by 800 micrograms of misoprostol, the body is better able to expel the contents of the uterus.

According to the WHO’s latest abortion care guidelines from 2022, it’s safe to use mifepristone and misoprostol for an abortion in the first 12 weeks of pregnancy. The WHO also recommends 800 micrograms of misoprostol alone, though misoprostol-only abortions are not common in the United States, and most research has shown that using mifepristone and misoprostol together has slightly higher efficacy. Misoprostol-only abortions, however, are common in other parts of the world, particularly when mifepristone is not accessible. Once you understand how mifepristone and misoprostol work, you also can see why these same medications are commonly prescribed in the US for safely managing miscarriage and for inducing labor. These medications are lifesaving in many ways.

Who did you talk to while researching the book?

There were the obvious high-profile people I wanted to contact. For instance, Dr. Rebecca Gomperts, a Dutch activist, was the first person to start prescribing and mailing abortion pills to people around the world when she founded her nonprofit, Women on Web, in 2005. She started another nonprofit, Aid Access, just for the United States in 2018, when abortion access was being severely restricted in many states. As for whom else I reached out to, it snowballed: I talked to one person, who led me to the next, and so on. I was also reading a lot of research papers in PubMed (the National Library of Medicine’s database) and looking at the bylines to get the lay of the land, even going back to the work of those who were studying this in the 1930s. From 2021 to late 2024, I interviewed nearly 200 people—a mix of public health researchers, abortion providers, abortion seekers, activists, and lawyers. I was trying to develop different ways of understanding the medication.

How did your vision for the book change over those years, if it changed at all?

My vision changed a lot, largely because abortion was legal in the US when I started and now it isn’t. I had an epiphany when I was interviewing feminist activists in Argentina who, for almost a decade now, have been supporting women through pill-based abortion. Their work started when Argentina was under a total ban. The activists themselves didn’t have medical training, but they had allies in the medical and legal communities to assist if needed. They rarely required help, however, since the pills are so safe. Additionally, they partnered with epidemiologists to produce reports on the safety and efficacy of misoprostol, and this work then helped the pills become part of the WHO’s updated recommendations.

What was so interesting to me was how, when I was interviewing them, they often focused on their relationships to each other and the people they supported rather than just on the pills. That made me realize that, yes, the pills are obviously very important, but so are the connections that the pills open up between people. These are based not on a doctor-patient hierarchy but on a mutually empowering peer-to-peer support model of care.

I know one of your sources, Dr. Caitlin Gerdts, said that those community networks in Latin America might not work as well in the US because we have such a punitive criminal system.

Part of the reason Argentine activists can be so public is that their policing infrastructure is less well resourced than it is here in the United States. For instance, the Argentine underground abortion network known as the Socorristas was public about helping people access pills under a near-total abortion ban. That publicity does not happen in the US, but covert networks do exist to avoid policing. When I interviewed David Cohen, who is a lawyer and law professor, he was very clear about not wanting to minimize the concerns of pregnancy criminalization, but he wanted to put into context how few cases are known of people who have been criminalized for taking abortion pills in the US. It’s a really small number so far, but part of the reason why it’s a small number is that these networks are very good at being discreet. There are also other avenues to getting free support, like abortion funds.

What was the most surprising part of working on the book?

I did not expect FDA v. Alliance for Hippocratic Medicine, the legal case that tried to revoke FDA approval for mifepristone, to go as far as it did. It was initially filed in the fall of 2022, right after Dobbs v. Jackson Women’s Health Organization. Not only did it eventually go to the Supreme Court, but when Matthew Kacsmaryk (the presiding judge in Amarillo, Texas, where the case originated) ended FDA approval, there was also a brief moment when mifepristone was temporarily banned in this country.

This didn’t change on-the-ground access for people, but the confusion alone was staggering. I think it revealed my own naivete as to how far the American anti-abortion movement could go, and how successful it has been with controlling certain Supreme Court apparatuses. This is a medication that’s been around for decades and has stellar safety credentials. To think that the US would try to get rid of it entirely was astonishing.

What are you most concerned about right now?

I don’t think that the FDA will take away mifepristone’s original approval, but I’m concerned that it will instead be pressured into doing something more subtle: namely, rescinding the agency’s decision that lets prescribers mail mifepristone to patients. Rescinding that decision at a time when one in four abortions in the post-Dobbs US is provided via telehealth (according to the Society of Family Planning’s latest #WeCount report) would be devastating. I fear the American public won’t fully understand the consequences of losing telehealth access, and it’s easier to curb access when people can’t see what is happening right in front of them. Now with HHS Secretary RFK Jr. ordering the FDA to review mifepristone’s data—citing a widely discredited report from a right-wing think tank, which has not been peer-reviewed—we should all be concerned that national restrictions on this medication may be coming. Those restrictions will be based not on science but on politics and on the compulsion to control women’s bodies.

You spoke to activists who were frustrated that more people weren’t taking advantage of these telehealth abortion shield laws.

There’s a worry that these telehealth shield laws won’t last long and that it therefore might not be wise to rely on these protections. There’s the complication, too, of keeping clinic doors open in certain states. Abortion hardly gets any federal funding, so abortion clinics are trying to stay open, and they compete with telehealth shield law providers for business. I think that’s a real concern for the movement. How should it weather the complexities of the current financial setup?

In the United States, people further along in their pregnancies need surgical procedures, and almost all of these happen in independent abortion clinics. Those clinics can’t survive financially by only doing later abortion care. They need to include early abortion care as part of their work as well. On the flip side, the telehealth abortion shield law providers will rightly argue that they are serving some of the most vulnerable people in the US right now because they are sending so many packets of pills to people who live in states with abortion bans. What about people who can’t travel or can’t go to brick-and-mortar clinics?

Is there a debate over how much money to pour into clinics versus telehealth providers?

I think it’s a debate over how to avoid having all these abortion access options swallow each other up. In an ideal world, you would have all of them available, but that’s not the world that we live in. If telehealth abortion becomes dominant, what happens to the people who need late abortion care but can’t access it because clinics have closed or because those clinics have to increase their prices so much that abortion care becomes unaffordable?

What’s interesting is that the countries whose abortions are almost all done with pills tend to be countries with nationalized healthcare systems. Some of the countries that were among the first to approve mifepristone—France, the UK, and Sweden—did so with the logic that providing abortion pills would be cheaper for their governments. That argument doesn’t work here in the US because the government doesn’t pay for abortion care.

How have things changed in the past year?

I’ve been shocked at how aggressively and quickly the Trump administration has dismantled the federal civil service. What’s been happening with the CDC is pretty astonishing. However, I’ve been pleasantly surprised that telehealth shield abortion providers are still doing what they’re doing. You can make a strong argument that it’s scarier now to do that work, but they’re still doing it. This said, there could be a case that comes before the Supreme Court that puts an end to it.

Your book emphasizes the importance of community in abortion care. How do you see community evolving in the wake of Dobbs?

I think that people are already pivoting to rely more on each other for help, and a lot of it comes down to word of mouth. Even if you’re not living under a state abortion ban and are just in a difficult situation—maybe abortion is very stigmatized in your household or you’re experiencing intimate partner violence—knowing whom to turn to is the hardest part of the equation. That could mean turning to somebody you trust. It could mean taking advantage of resources like the Repro Legal Helpline from If/When/How or the Miscarriage and Abortion Hotline, which is staffed by clinicians and is free and confidential. There’s also the Reprocare Hotline. There still are local abortion funds. Those are all forms of community. Mutual aid is going to be more important.

It’s difficult when everyone is so isolated. You wrote that there’s been more social media censorship of abortion resources since Dobbs.

That’s a huge concern. Online censorship creates more obstacles for the community networks operating locally on the ground. They can’t make their presence super visible because of criminalization, which means they need to find news way of accessing the people who need help. With this book, I was trying to think of what anybody, wherever they are, can do to make a difference. I think publicly talking about abortion is itself important. This subject, which was such a big part of the presidential campaigns, is no longer covered so much in the mainstream press.

If telehealth shield abortion laws were to end, do you think that the US ban states would start to look like Latin America and rely on misoprostol?

I think that parts of the country are already relying on misoprostol alone. I don’t have the figures on that, but that’s my hunch. Because mifepristone is so widely approved, you can’t just stop the global supply of that medication. There will still be ways to procure both pills outside of the United States. Misoprostol would probably be more available because it’s less restricted. I interviewed the WHO’s Paul Van Look, who directed their Human Reproduction Programme and helped lead many of the first medicated abortion studies around the globe. I asked him about abortion pill access in the US now and he said that these medications are here to stay; people will find ways to get them.

Is there anything else people should know?

There are two main points. One is that the story of abortion has always been about politics, not science; [politicians have] repeatedly impeded access to both pills, but especially to mifepristone and especially in the United States. This has been a pattern for years, and we’re really seeing it kick into high gear with the Trump administration and Project 2025. The second thing, which is more inspiring, is that this book taught me that ordinary people can do extraordinary things. Again and again, the people I spoke to about the history of these pills would say that making these pills accessible takes an entire community. There is no lack of people who are working on this in some way, and that was fortifying to realize.

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Rebecca Kelliher graduated from the Columbia School of Journalism. Just Pills: The Extraordinary Story of a Revolution in Abortion Care (2025) is her first book.