The pandemic began during Dr. Julie Amaon’s final four months of a Family Medicine residency at the University of Minnesota Medical Center. Care changed dramatically.
In-person visits went to phone or video, abortion procedures were temporarily halted, and elective surgeries were put on pause. At the same time, the pandemic opened the door for providers like Dr. Amaon to answer a need for virtual healthcare platforms. That’s where Just the Pill came in. Now the mobile nonprofit clinic’s founder and medical director, Dr. Amaon is changing Minnesota’s approach to reproductive healthcare—in a way that stretches beyond the pandemic.
Based in Minneapolis, Just the Pill expands safe access to medication abortion, as well as birth control and other primary-care offerings, to rural Minnesotans. Minnesota currently has five brick-and-mortar abortion clinics. “I was seeing patients travel three-plus hours to the University of Minnesota for specialized care,” Dr. Amaon says.
Medication-abortion care is FDA-approved as a safe and effective two-pill regimen—administered with mifepristone and misoprostol—for ending early pregnancy up to 10 weeks after conception. Just the Pill’s mobile clinic format allows patients to initially meet with providers via video or phone call, to receive a consultation and guidance through the medication process from home. They then meet a clinic representative at a convenient location to obtain medication via a locked pill box.
In light of the pandemic, a federal court decision in July 2020 reversed some of the FDA’s Risk Evaluation and Mitigation Strategies (REMS) that had prohibited the mailing of medication-abortion pills. In September, Just the Pill began mailing out pill orders, as well. “It is important to us that our patients can access our services from the comfort of their home,” explains Amaon. “They don’t have to arrange childcare, travel for hours, and risk exposure to COVID-19 coming into a clinic.”
Just the Pill currently delivers only in Minnesota, with hopes of expanding into other states through current fundraising efforts. After the pandemic, Dr. Amaon plans to grow the mobile clinic’s services to include gender-affirming care, IUD and nexplanon placement, suction abortion procedures, and other primary-care services for rural areas, where access is limited.
A voice for women’s health and reproductive justice, Dr. Amaon believes that “these types of services should be available no matter your geography, income, the language you speak, or the color of your skin.” She adds, “It is a privilege for me to meet our patients, hear their stories, and know at the end of the day that my work enabled them to have access to safe, supported abortion care at home.”
What does your process look like for patients?
JA: Just the Pill’s mission is to make the process of medication-abortions care safe and incredibly easy. Our patients have a video or phone counseling session where a patient educator goes over how to take the pills, offers doula support, and explains our no-touch process. Then the patient has a video visit with me, the physician, to go over their health history, confirm they are a good candidate for our no-touch protocol (no ultrasound or blood work needed), make sure the patient understands how to take the pills, what our 24/7 call line is, discuss their informed consent, and then finally read the 24-hour state-mandated information.
What was one of the biggest challenges you faced in starting your organization?
JA: Fundraising is always a struggle, especially during these trying times. Marketing and getting the word out to these rural communities has been more challenging than in urban markets, so we’re exploring different options. However, we’ve had a great response from our local community providing billboards in rural communities. There are only two pharmacies that are able to mail mifepristone, and everyone was scrambling to get processes and procedures up and running as soon after the injunction as possible.
How has the pandemic opened the door for your organization to flourish?
JA: The pandemic has allowed doctors to innovate, and helped ease some of the restrictions that prevented moving forward with new models of care. For example, the pandemic allowed for the mailing of mifepristone, which definitely allowed our business to get off the ground sooner without having to fundraise for a mobile clinic. The rapid adoption of telemedicine also helped tremendously. As more and more people began using telemedicine for their routine doctor’s visits, I think we all see the benefits of receiving medical care from professionals at home.
How do you envision healthcare changing post-pandemic?
JA: The pandemic forced the medical community to look at how we provide care. By turning to telemedicine, we have found that we are actually doing a better job of meeting our patients’ needs for accessible and immediate care. All of the changes that came about for telemedicine due to the pandemic need to stick around afterwards. Video and phone visits need to be reimbursed as much as in-person visits. Patients and physicians should be able to be in their homes, or any other setting, for telehealth services. Patients shouldn’t need an existing relationship with the physician who is providing telehealth visits, and medication abortion should be able to be prescribed by a qualified healthcare provider, and patients should be able to receive their medications in the way that makes the most sense for them, whether that is at a health center, their local pharmacy, or delivered to their home. We need to continue this expanded access to healthcare, this basic human right.