April Lockley answers her phone while her 3-year-old daughter plays nearby. It’s another shift at the Miscarriage and Abortion hotline, another four to six hours of handling calls from people desperate for answers. Sometimes she takes these calls from the back of an Uber. Sometimes while her hair is being done at a salon. Most times from her New York City apartment, trying to balance the weight of other people’s crises with the very real demands of single parenthood.
“She doesn’t really know the concept of an abortion yet,” Lockley said about her daughter. “We’re working on the uterus right now. But she knows that mama helps people.”
The calls keep coming. Around 40 a day, plus another 40 text messages. Since the fall of Roe v. Wade nearly four years ago, the hotline has become something between a lifeline and a last resort for people navigating pregnancy in a country that’s increasingly hostile to their choices.
The Anxiety Is Different Now
Lockley has been with the M+A hotline since 2020. She’s a family medicine doctor and abortion provider, which means she’s spent years understanding what people need when they’re pregnant and unsure. But something shifted on June 24, 2022, when the Supreme Court overturned Roe v. Wade.
Before that decision, most callers worried about pain. Will it hurt? How much will I bleed? Those were the questions keeping people up at night.
Now, it’s different. Now people call asking: “If I go to the emergency room, will they call the police?”
“The anxiety around a medical provider knowing they’re pregnant at all, the concern about legal safety that anxiety is much more prevalent,” Lockley explained. “I went to the doctor, now my doctor knows I’m pregnant, are they gonna turn me in to the police? We get those questions all the time.”
This isn’t paranoia. This is rational fear in a landscape where 21 states have enacted abortion restrictions, with 14 of those near-total bans. People have actually been criminalized for their pregnancy outcomes, even though self-managed abortion with pills is technically legal in nearly every state.
Why the Hotline Exists at All
The physicians behind this operation saw it coming. After the first Trump administration, they realized the end of federal abortion protections wasn’t a question of if, but when. So in 2019, they created the M+A hotline as a piece of infrastructure designed to survive the worst.
“We recognize that abortion access has never been great in this country, but after the first Trump administration, we knew it was going to get worse and worse,” Lockley said. “This hotline was an important piece of infrastructure to continue to help people and answer their questions throughout their abortion or miscarriage.”
Last year alone, the hotline fielded a little over 14,000 phone calls. It’s staffed by more than 100 volunteers, nearly all of them health care professionals. Doctors, nurses, midwives. People who understand medicine but also understand what it means to be terrified and alone.
The Conversations Vary Wildly
Some callers want to know if they can take ibuprofen with abortion pills. Others are actively miscarrying and need to know: Am I bleeding too much? Am I not bleeding enough? Is this normal?
Then there are the heartbreaking ones. A positive pregnancy test followed by bleeding. “Am I having a miscarriage?” Sometimes the answer is yes. Sometimes it’s uncertainty.
Lockley has also noticed a surge in calls from people managing abortions later in pregnancy because they couldn’t get a clinic appointment. She gets calls from teenagers who’ve never had any real sex education. She gets calls from parents and friends trying to support someone else through this experience.
The demographic pattern is striking. Most callers live in the Southeast, where several states enacted near-total bans immediately after Roe fell. For people in red states, getting mail-delivered abortion pills through telehealth has become the most accessible option. The numbers back this up: telehealth abortions now account for one quarter of all abortions in the country.
The Real Threat
Here’s what makes this work genuinely risky: the threat of criminalization isn’t theoretical for physicians either. Although state shield laws protect providers who prescribe abortion pills by mail, a handful of red states have sued abortion providers from blue states anyway. It’s a grey area filled with legal jeopardy.
The people working this hotline aren’t prescribing the pills themselves, but they’re educating callers on how to access them. They’re giving people accurate medical information so folks can make informed decisions about their own bodies.
“When people feel like they don’t have any options, they are more likely to do something dangerous or get in legal trouble,” Lockley said. “In order to help protect people and help keep people safe, we want to give them accurate information so that they can decide for themselves if this is something that they want to do and what their options are.”
This isn’t just about health anymore. It’s about how we handle the criminalization of pregnancy and medicine in a fractured country. It’s about real people facing real fears while trying to make deeply personal decisions. And it’s about a network of volunteers answering phones in their apartments, their cars, their breaks at work, because the alternative is leaving people with no one to turn to at all.
The question hanging over all of this isn’t really about whether the hotline will keep operating. It’s about what happens when providing accurate medical information becomes an act of resistance.
