I first spoke with Gomperts in 2018 and was struck by his complete lack of equivocation on an issue that is so often superimposed, on all sides, on legal, moral and clinical justifications: “The laws unfair should not be respected,” she told me. .
I expected similar candor when I called her to talk about post-deer future of telehealth abortion. Gomperts’ experience gives her insight into the abortion debate that may surprise many Americans. For example, she told me that access to abortion follows the democratic direction of a country – the more authoritarian it is, the more restrictions there are. And she noted that already in America, access to abortion has more to do with a person’s wealth and access to information and childcare than it does with local laws.” Laws don’t matter when you have money, do they?” she says.
Franchising, Gomperts said, can be a very important way to preserve access to abortion in the United States. “Asking why people want to have an abortion is already framing it,” she told me. “Because that means people have to have a reason. You don’t need to have a reason to have an abortion. The only reason you want to have an abortion is because you have an unwanted pregnancy. Period.”
This transcript has been edited for length and clarity.
Chelsea Conaboy: I have heard various people involved in reproductive rights describe Judge Alito’s draft opinion to overturn deer like not unexpected, but still shocking. But you foresaw this probability. Why?
Rebecca Gomperts: When I started in 2018, there was already a huge demand for the pills in the United States. For me, what has always been important are barriers to abortion care – no matter what causes them. What matters is that they exist. Barriers we saw in 2017 and 2018 were cost and distance [to a clinic].
Plan C had researched the pills provided by online pharmacies, to see if they were real and how much they cost, and it was really expensive. We received comments from women: “I can’t use these services because I can’t afford it. And then of course Trump came along. … By the time Trump was able to install the last Supreme Court justice, it was clear – or even before that – [that Roe] was not going to hold.
If Hillary had won, this wouldn’t have happened. But the need [to help people overcome obstacles to abortion] would still exist.
Conaboy: Given your extensive work on abortion around the world, I wonder if there is something you see in America’s fight against abortion today that Americans themselves may not understand. ?
Gomperts: Yes and no. In the end, laws don’t matter when you have money, do they? And this is the case all over the world. If you have money, access to information, or privileges, you can always find an abortion provider, whether traveling or locally or otherwise. It is by definition always a problem of poverty. And one of the problems in the United States is the enormous poverty.
I’ve always thought that in the United States there’s this mentality that if you’re poor, it’s your fault. And that’s just not true. It is the system that causes poverty, not the people themselves. And it’s the system that keeps people in poverty. This is also what you see in studies – the Turnaway study [by Diane Greene Foster and colleagues] show that. You keep people poor by refusing abortions.
Conaboy: Is the United States, by increasingly restricting access to abortion, an exception at the global level? Or is it the avant-garde?
Gomperts: This is no exception in countries that have very autocratic regimes. The United States therefore placed itself in the same category as [Hungarian Prime Minister Viktor] Orbán and as [Turkish President Recep Tayyip] Erdoğan and like [Russian President Vladimir] Cheese fries. These are the countries where there are autocratic regimes and where democratic processes no longer work, where the right to abortion is blocked. And in every country where democratic processes are improving, there is an improvement in access to abortion, or there is an intention to do so.
Conaboy: The core of Aid Access’s work has remained the same since your launch in 2018, but it seems that much of how you deliver your service and how it is perceived has changed.
Gomperts: Covid really changed everything, because suddenly telemedicine abortion services were what saved access to abortion in many places. In the UK, telemedical abortion services have become common. And it’s now also part of mainstream abortion services in France, Ireland, Canada, Australia – in many, many places.
In the United States, of course, the FDA immediately authorized telemedical abortion services during Covid. It also allowed US suppliers to join Aid Access. So there are now nine US providers using Aid Access as their front-office system and back-office system, and they serve people in their states, where they are registered to practice.
Conaboy: But there is a growing gap, isn’t there? In states where telemedicine abortion is legal, it has quickly become commonplace. But in states where it is explicitly prohibited or where abortion will be severely restricted without deerit is something very different.
Gomperts: There are several things here. Misoprostol is available in all pharmacies in the United States – also in Texas. And misoprostol alone is really effective for abortion. You don’t need mifepristone. So I think there are still ways to think about what can be done locally.
If you’re thinking about how to object to what’s going on, it would be for all the doctors there to prescribe mifepristone and misoprostol to everyone who isn’t pregnant. Even if these laws come into force – all women, as soon as they have their period, are given a packet of abortion pills. You don’t have to wait until someone is pregnant. In this way, the laws no longer apply.
Conaboy: Do you think there is a reasonable medical argument against providing pills in advance?
Gomperts: There is nothing. If you buy bleach from the supermarket, it’s more dangerous. If you don’t use it the way you’re supposed to – you drink it instead of using it to clean – you die.
Abortion pills are something you actually cannot die from. There’s no way you can overdose on it. And what we know from research is that you don’t need to do an ultrasound for a medical abortion. The World Health Organization says that you can simply determine the duration of pregnancy based on the menstrual cycle. People can make a very good prediction of the duration of their pregnancy.
The reason many women are pregnant longer when they access abortion services is because they have barriers to getting an abortion – because of cost, because of childcare, because of violence domestic. But if you have these drugs in the cupboard, this obstacle no longer exists.