Dr. April Lockley typically manages her volunteer shifts for the Miscarriage and Abortion Hotline from her New York City apartment, often while simultaneously entertaining her energetic 3-year-old daughter. Juggling urgent medical questions with toddler care presents unique challenges, but Lockley believes her young child grasps the essence of her work. "She doesn't really know the concept of an abortion yet. We're working on the uterus right now," Lockley shared with a laugh during a recent interview. "But she knows that mama helps people."
A Hotline Responding to a National Crisis
As a family medicine doctor, abortion provider, and the medical director of the M+A Hotline, Lockley's commitment extends far beyond her living room. She has fielded calls from the back of Ubers, supermarket aisles, and even hair salons. During her typical four- to six-hour solo shifts, she may address dozens of inquiries ranging from straightforward medication questions to urgent pleas for help.
The nature of these calls has transformed dramatically since the Supreme Court overturned Roe v. Wade in 2022. Previously, callers' primary anxieties often centered on the physical experience: potential pain levels and bleeding. Today, the overwhelming fear is legal prosecution. "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. Questions like, "'I went to the doctor, now my doctor knows I'm pregnant, are they gonna turn me in to the police?' We get those all the time."
The Rise of Telehealth and Self-Managed Care
In the nearly four years since Roe fell, 21 states have enacted significant abortion restrictions, including 14 near-total bans. Paradoxically, the total number of abortions in the U.S. has increased, largely due to the expansion of telehealth abortion services. These virtual consultations, where a physician prescribes abortion pills sent by mail, now account for one-quarter of all abortions nationally.
Self-managed abortions using pills—accessed without direct physician assistance—have also risen. Both methods are medically safe and effective, becoming a critical lifeline in states where clinic access is banned. However, this shift has triggered intensified efforts by Republican lawmakers to restrict these alternative pathways.
"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 stated. "This hotline was an important piece of infrastructure to continue to help people and answer their questions throughout their abortion or miscarriage." For legal concerns, the hotline refers callers to the Repro Legal Helpline.
Inside the Hotline's Operations
The M+A Hotline operates seven days a week, staffed by over 100 volunteer physicians, nurses, midwives, and other healthcare professionals. Last year, it received slightly over 14,000 phone calls—averaging about 40 per day—plus an additional 40 daily text messages.
Lockley, who joined in 2020, has navigated a vast spectrum of conversations. Callers inquire about medication interactions, seek affordable options for managing miscarriages without insurance, or request guidance for supporting a loved one. Increasingly, she fields medical questions from individuals terminating pregnancies later in gestation because they couldn't secure timely clinic appointments.
Educating the Most Vulnerable
Some of the most poignant calls come from teenagers who have received little or no factual sex education. Lockley often begins these conversations with foundational questions: Have you had sex? Have you taken a pregnancy test? Do you understand your menstrual cycle? She then assesses their safety, asking if they have a secure address for receiving mail or a trusted adult in their life.
According to anonymous post-call surveys, most callers reside in the Southeast, where multiple states implemented near-total bans immediately after Roe was overturned. For those in restrictive states, Lockley provides referrals to safe physicians or clinics that can confirm a telehealth abortion was successful. Many former abortion clinics in states like Texas, Oklahoma, and Tennessee remain open, offering pregnancy tests and ultrasounds for this purpose.
The Legal Landscape for Providers and Patients
The threat of criminalization looms not only for patients but also for healthcare providers. While state shield laws in some areas protect doctors who prescribe abortion pills via telehealth, several conservative states have initiated lawsuits against providers based in more permissive states. Although Lockley and her hotline colleagues do not prescribe medication, they frequently educate callers on how to access it safely.
"In order to help protect people and help keep them 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," Lockley emphasized. "Because when people feel like they don't have any options, they are more likely to do something dangerous or get in legal trouble."
Lockley's dual role as a hotline director and a mother underscores the deeply personal integration of this vital work into daily life. From her apartment, with her daughter playing nearby, she continues to offer a confidential medical lifeline in an increasingly complex and restrictive national landscape.
