In The Fight Over Abortion Access, Kiki Freedman Is Playing The Long Game

In the eight months since the Supreme Court overturned Roe v. Wade, Republican legislators have unleashed a bevy of anti-abortion bills around the country, producing whiplash news alerts. In January, for example, the FDA approved the sale of abortion medication in pharmacies, but then in early February, a Texas lawsuit was filed to stop the nationwide sale of mifepristone — one of the two medications in the abortion medication protocol, along with misoprostol — on the unproven grounds that it endangers women’s lives. A ruling in the case is expected imminently.

“We knew going into this that it was going to be extraordinarily difficult,” says Kiki Freedman, the co-founder of the abortion telemedicine website Hey Jane, about anti-abortion fervor. “If the [Texas] lawsuit does succeed, Hey Jane will very likely resort to misoprostol as the only protocol,” she tells Bustle. “Misoprostol can be used for medication abortion alone — it’s incredibly safe, it’s incredibly effective.”

“Gratitude from patients, reading those reviews, is what keeps me going in the darkest moments.”

Freedman, 32, founded Hey Jane in 2021 as a way to offer easy prescriptions for these drugs. (Medication abortions often cost around $500; in-clinic abortions often cost a few hundred dollars more.) The idea for the company came two years before that, between her first and second years at Harvard Business School. “This digital-clinic model had started to emerge, but it was focusing more on issues that primarily affect men’s health [like] hair loss, erectile dysfunction,” says the CEO, who was an early Kenya-based Uber employee. She’d attended undergrad in Missouri, which at the time only had one abortion clinic. She saw an opportunity to use the digital-clinic model.

Freedman’s approach to anti-abortion rhetoric is normalization through repetition: Roughly 1 in 4 American women will seek an abortion in their lifetimes, a figure that doesn’t include the many trans folks who seek abortion care; medication abortion is an incredibly safe procedure; reproductive rights are part of basic health care. Already, Hey Jane says it is “trusted by more than 20,000 patients.”

Below, Freedman talks to Bustle about rest, keeping Hey Jane nimble, and hope — yes, actual hope.

How does Hey Jane help people in states where abortion is now banned?

There are a few ways that we think about this. One, we make it quite easy to get cross-state care. If patients need to travel because their state doesn’t support access, they can go to the closest border. They can get access to care through our app, [and] we are typically able to prescribe the medication within 24 hours. We send it to a post office or other pickup location; they don’t need a permanent address. [And two,] an additional barrier to clinical care has been an increase in wait times, because demand has increased so dramatically in the clinics that are still able to operate. We can free up clinic capacity.

What topics do you think are missing from the current national conversation about abortion access?

Something that’s very top of mind for us is making sure Medicaid plans are covering abortion, particularly now that in-person clinics are often absorbing demand from other states.

Since you were involved in the early days of Uber, how have you applied learnings from that time to Hey Jane?

The biggest things I took away from [working at Uber] were having conviction about what the future of the world could look like, and being able to carefully evaluate regulations. Being comfortable operating in a regulated space has been very useful for this product.

What do you think are the most important qualities in leading a reproductive care business in the current environment?

Number one is having an extremely strong conviction for the vision you’re trying to achieve.

Another thing is the degree of curiosity you need to have, [about] learning new tactical functions, how to make things run better, [and] also, in a very dynamic regulatory environment, learning about new segments of the law that may be relevant to how we can operate.

Related to that, how do you manage morale in the workplace, and what care is available to staffers?

It’s really important to create space for rest and disconnection. We feel it is very important to be able to fully step away, as opposed to being sort of half-on, half-off. We’re a work-from-home company, so that gives us flexibility to accommodate people’s lifestyle needs. [And for me,] gratitude from patients, reading those reviews, is what keeps me going in the darkest moments.

In securing funding for reproductive health, are people willing to invest?

There are still challenges, for sure. Some people still view women’s health as a niche market, which is absurd — and when I say “women’s health,” of course, it’s inclusive of anyone with a uterus — because it’s significantly more than half of overall U.S. health care spending. But new funds are emerging, often [from] women investors, who understand these issues in more depth.

When speaking to people who are confused about the facts or, at worst, have an active ignorance about these issues, where do you start? What’s effective?

I find it really helpful to remind people of just how common [abortion] is. Just because they’re not hearing about it doesn’t mean it’s not happening. The numbers also paint a clear picture that people support access. Some new research came out that said 62% of U.S. voters, including a decent share of Republicans, support access to medication abortion and don’t want to see policies that would restrict access to it. The lawsuits that are most visible tend to reflect a really extreme stance that’s not reflective of voters, even conservative voters.

Going forward, how important do you think telemedicine will be for female and trans health?

I think it’ll continue to be a huge part of the landscape. Of course, we support all avenues of access, and telemedicine abortion will not replace in-person care. Clinics still need to be supported. But for many patients, we find it can increase convenience by reducing the need for travel, for taking off work, for finding child care. In many instances, it’s significantly more affordable for patients. People also value the privacy of not needing to leave their homes, of having medications delivered to their doorstep.

How are you feeling about the possibility of the federal government codifying Roe, and about the future of abortion rights in this country? Is there reason for hope?

There are definitely areas where optimism is warranted. While we’ve seen really dystopian regulations rolled out in some parts of the country, we’ve seen very creative protective regulations rolled out in others. Many states like California, New York, and others are working on or have already implemented shield laws, which essentially say they will protect patients and care providers from interstate lawsuits related to the provision of reproductive and gender-affirming care. We find those to be really compelling as a means of going beyond just the codification of Roe, making sure that patients can continue to have access even if their local governments are not supportive.

This interview has been edited and condensed for clarity.