Gomperts “was a visionary in understanding the power of these pills to give the person who needs an abortion control over that process,” said Elisa Wells, co-director of Plan C, which provides information on medical abortions and conducts research on abortion pills. in the United States She said she and others who founded the organization in the mid-2010s were inspired by the accessibility of medical abortions in other parts of the world and promised to bring this ease of access to American women.
The growing availability and use of these pills to induce inexpensive and safe pharmaceutical abortions has transformed the way pregnancies are terminated in places where abortion is legal – and has also enabled the work of the network of activists to abortion in states and countries where this is not the case. The two drugs usually taken to induce an abortion, mifepristone and misoprostol, are on the WHO list of essential drugs. And according to the world health authority, they are very safe: the number of deaths linked to mifepristone is extremely rare (at 0.0006% of users). Complications from the pills are rare – accounting for less than 1% of cases at the high end of estimates. They’re also inexpensive, with a retail price of between $3.75 and $11.75 for the two together.
When the Covid-19 pandemic hit in 2020, access to medical abortions at home increased even further: with telemedicine being approved in more and more states and the Food and Drug Administration permanently allowing providers to health to ship abortion pills to patients by mail, new organizations have sprung up to meet the demand for home abortions. “I think we were going in that direction just because of more intense [abortion] restrictions that were just happening all over the United States,” said Julie Amaon, medical director of Just the Pill, which operates in four states and seeks to reach people in rural areas. “But I also think Covid has intensified that tremendously.” The use of medical abortion has increased rapidly in the United States: in 2020, the Guttmacher Institute estimated that medical abortions accounted for 54% of all abortions in the United States, a significant increase from 39% in 2017 .
From Amaon’s Just the Pill to Hey Jane, to Choice and Abortion on Demand, a constellation of new options has been created in the last two years alone. Organizations like these operate in states where abortion is legal, with providers overseeing (in person or remotely) abortion care for pregnant women who live in or can travel to states where abortion is is legal; in states where the procedure is illegal, Gomperts’ Aid Access and others fill the void by shipping the pills from overseas. Through this network of national and international organizations, activists are working toward their ultimate goal: to enable pregnant women in any US state, regardless of its policy, to have a medical abortion at home.
In Europe, Poland is the center of the work of these activists, for obvious reasons: the country is both the place in Europe where activists face the most organized opposition, and a society in full social change. In 2020, Poland’s constitutional court ruled that fetal irregularities are no longer an acceptable reason for pregnant women to have abortions in the central European country, removing one of the only remaining justifications for a legal abortion. Now the only remaining exceptions are when the life of the pregnant person is in danger, or for rape or incest.
However, voluntary abortion is not explicitly prohibited in Poland; it is only to provide the medicine for a voluntary abortion which is explicitly against the law. The service provided by Jelinska’s Women Help Women and Gomperts’ Women on Web therefore falls into a legal gray area. Both organizations work in a similar way: users complete an online questionnaire answering questions about their pregnancy and medical history. Venny Ala-Siurua, executive director of Women on Web, says responses are reviewed by an international team of doctors working mostly as volunteers. As long as the medical criteria are met, doctors issue a prescription to pregnant women and suppliers in Europe then ship the pills to people who need them, including countries where abortion is restricted.
(After the first trimester of pregnancy, when the use of abortion pills is no longer recommended, pregnant women in countries with restrictive laws can then travel abroad for a surgical abortion. This is where organizations like Clarke’s Abortion Support Network are stepping in, helping to facilitate and fund surgical abortions in other neighboring countries.)
Poland is not the only country where abortion restrictions have forced pregnant women to rely on the underground network of activists to access abortion pills: Malta too has strict abortion laws which have hampered the possibility of having an abortion. In the past, residents of the small island nation who wanted abortions had to travel to mainland Europe to receive them; when the pandemic hit and travel restrictions were put in place, that option all but disappeared. Groups like Women on Web have filled the void, said Andreana Dibben, a Maltese abortion rights campaigner: She and others help run the Family Planning Advisory Service, an online service launched in 2020 whose volunteers trained have already helped more than 500 Maltese women find appropriate abortion and contraception services. Together with the Abortion Support Network and Women on Web, the group has helped facilitate medical abortions at home for pregnant women in Malta who want them.
One day during the conference lunch break, Dibben said she saw reason to be optimistic about change, even in countries with strict restrictions: A small but growing group of human rights activists abortion in Malta, Dibben said, was successful in shifting public opinion. and a growing political will to discuss the issue. Until she and other activists launched Doctors for Choice in 2018, she says, “no one could even say the word ‘abortion’ because people were scared.”
While these international abortion networks have opened up new possibilities for people living in restricted states, they can carry significant risks for those involved – like Wydrzyńska, the activist who is on trial in Poland, knows it very well. The long-time abortion activist and co-founder of the Abortion Dream Team, an organization that provides abortion counseling, gave a set of abortion pills to a victim of domestic violence in Poland. The woman’s husband, who had prevented her from traveling to Germany for an abortion, informed the police. Today, Wydrzyńska awaits the next hearing of her trial in January. She faces up to three years in prison for assisting with a medical abortion.
Wydrzyńska’s case was a rallying cry for participants at the Riga conference, bluntly highlighting the sacrifices some are making to secure a woman’s right to terminate a pregnancy. When Jelinska brought it up during her speech, the audience cheered; outside the main hall, attendees could pose with their faces behind a cardboard cutout of Wydrzyńska, carrying the hashtag #IamJustyna. During coffee and lunch breaks, people constantly came to talk with Wydrzyńska.
Amsterdam-based Jelinska, living in a country that has far more liberal abortion laws, operates under less imminent danger of prosecution than those helping the cause in her native Poland. Yet she is open about the impact her work has had on her daily life, including the regular death threats she receives. “Of course it affects me,” she said. Despite these threats, she sees no other way out: “Sometimes you have to disobey harmful laws.
In Riga, activists mere attendance at the conference, and the impassioned speech they gave to attendees, demonstrated the extent of international cooperation and support to circumvent strict abortion laws. Cross-border aid based in other countries is, in many cases, what makes access to abortion pills possible for people in places where the procedure is severely restricted. Bringing together doctors working on research showing the safety and effectiveness of medical abortions and the pharmaceutical companies that make mifepristone and misoprostol and the activists creating this new network of support across the country’s borders was a way for them to learn from each other about the latest research and developments in abortion care, to be sure. But it was also an opportunity for activists like Jelinska and Clarke to make their point and seek help from a group of people most sympathetic to their cause, whether it was in front of a podium on stage or in individual conversations between sessions.
Toward the end of the conference, Clarke took the stage to speak about the Abortion Support Network and emphasized how important gatherings like these are for what they do. Rarely are there so many people in one room who are passionate about the right to end a pregnancy and finding the safest and best ways to do so; as another speaker noted, this area of medicine is “only political”. With that in mind, Clarke asked for public support, but he could provide it so he could grow his networks even further: pushing for softer laws in their respective countries, working to expand access , and even directly supporting groups like his (“We’d love to take your money in any amount in any currency!” his presentation said).
“Why is a bunch of abortion pirates coming to a science conference?” Clarke said. “We do this work because whether or not you can have an abortion shouldn’t depend on what passport you have, where you live, how much money you have, or your gender – nothing at all. that.”
Carlo Martuscelli, Mandoline Rutkowski and Jakob Korus contributed to this report.