Abortions are as inevitable as the sun rising. Every year, around 56 million people around the world induce their own abortions, but this doesn’t need to come in the form of a “back-alley” abortion. Dutch activist and doctor Rebecca Gomperts has made it her life’s work to ensure the abortion pill is accessible—even in places where it is outlawed. She describes her work as a form of harm reduction: using medication to induce abortion is the safest alternative to fully legal abortion. So making this method available (and raising awareness of it) mitigates the consequences of harsh laws that criminalize or limit access to abortion. Gompert’s work reduces the potential of self-induced abortion causing harm or a person having to unwillingly carry a pregnancy to term.
To this end, Gomperts has launched and overseen a wealth of innovative strategies. In 1999, she founded Women on Waves, which offers medication abortion aboard a ship stationed in international waters where local laws don’t apply. She later founded Women on Web, which mails medication that induces abortions to countries where the procedure is illegal. Last year, Gomperts brought her services to the United States for the first time with Aid Access, a sliding-scale online clinic that ships abortion medication to countries where abortion is legal, but often inaccessible. All three services involve an abortion by medication.
Though medication that induces abortion is between 95 and 99 percent effective and has very low risks, the Food and Drug Administration sent Gomperts a letter in March 2019 that ordered her to immediately stop sending abortion medication to the United States, but she is not letting this threat deter her. “When U.S. women seeking to terminate their pregnancies prior to nine weeks consult me, I will not turn them away,” Gomperts wrote in a response she published online. “The FDA is violating the rights of all U.S. women seeking safe abortion by preventing them from accessing necessary medications.”
I spoke with Gomperts about her refusal to be deterred from providing abortion-inducing medication to people around the world.
What are some common misconceptions and fears that people have about non-clinical abortion with medication?
One common misconception is that it is dangerous. It’s actually one of the safest medical procedures that exists. It’s safer than [using] Viagra. It’s safer than many over-the-counter medications. It’s actually safer than a miscarriage because you can plan the abortion with the pill and a miscarriage can happen wherever you are.
Another misconception is that a medication abortion is a clinical abortion. It’s always an at-home abortion. It’s very similar to a miscarriage, so [you experience] cramping and bleeding. The second tablet (Misoprostol) is always taken at home and that is the tablet that induces the miscarriage. In some countries (like the United States), the first tablet (Mifepristone) [is still taken] in the clinic, but this first tablet doesn’t do anything [but block] the hormone that’s necessary to maintain the pregnancy; it doesn’t cause any symptoms.
The [final] misconception is that you need a doctor in order to access a medical abortion. As long as [users] have access to the medicine and information on how to use it, they can do it safely at home. [Almost] anyone can swallow a pill by themselves. They can handle the miscarriage by themselves and, if they have complications, they can handle going to the hospital themselves.
Since the symptoms mirror a miscarriage, can people go to a doctor and not say they had an abortion?
Yes, they can just say they had a miscarriage. If there are complications, the treatment is exactly the same. So, it’s not essential information to tell [a medical professional] that you took the pills.
What prompted you to offer services in the United States?
Women on Web started receiving a lot of emails from women in the United States. There was also research being done on the need [in America]: There was a study published by Plan C and Gynuity [that] analyzed all the online pharmacies that are sending medicine to the United States. It [became] clear that there was an enormous gap in abortion-care provisions. The feedback that we got is that [people] could not afford [the online pharmacies], and they didn’t have any information on how to use the medicine; sometimes they didn’t receive it [and] sometimes there were rogue websites. There was not a good service available.
In March 2019, the FDA ordered you to stop providing abortion medication to people in the United States. The letter expresses concern about the “inherent risk to consumers” who purchase these products. Is there any actual medical justification for these concerns?
No. There are so many studies on telemedicine abortion that have proven it is extremely safe. The quality of medicine is guaranteed because it is produced under the supervision of India’s Central Drugs Standard Control Organization in a World Health Organization certified facility. [There’s] no scientific or medical justification for [these concerns] at all. It’s political.
The home use of medical abortions with telemedicine have been researched for over 10 years and all this research has shown that it’s as safe as [a] clinical abortion. The morbidity rate associated with giving birth is much higher [than those associated with a medication abortion]. So it’s really harm reduction. It saves their health, their lives.
Rebecca Gomperts has launched innovative abortion strategies. In 1999, she founded Women on Waves, which offers medication abortion aboard a ship stationed in international waters where local laws don’t apply.
You write in your response letter, “My patients have the constitutional and human right to access safe abortion services. That is what I provide them and what I will continue to provide them.” Could you elaborate on the importance of those rights?
It’s only [those] with money and information who are able to get an abortion. Abortion restrictions are [especially] violating and harming women who are living in poverty. Since 1973 in the United States, it has been established that women have the constitutional right to an abortion, meaning that any state agency or the federal government cannot pose any undue burden to their ability to access a safe abortion. And that is what is happening at this moment. [Multiple documents crafted] by international human-rights organizations have over and over again stated that access to a safe abortion is a human right.
If people don’t have access to a safe abortion, their health will be harmed. Their life will be harmed. It’s a form of torture to not be able to decide [on what happens to and within] your own body; it’s a form of torture to take away people’s self-determination.
Do you have any numbers about how many people in the United States have used Aid Access so far?
I only have the numbers for 2018. I did 2,500 prescriptions. I don’t [physically] send any medicines. I consult with [those seeking these abortions] and then I provide them with the prescription that they need, referring them to a pharmacy in India. The pharmacy will fill the prescription and send the medicine to the women in the United States or other places in the world.
There are more pharmacies I could have worked with, but it’s just [one] that I know and trust. The medicines are usually marketed and distributed for the Indian public. So I am sure the medicines are not rogue [unlike many websites], they’re not fake, and they’re properly handled.
You described Aid Access as a harm reduction strategy. Could you describe what that means and how it applies to your work?
Harm reduction means that you provide a service that will always diminish the harm being done to people if they don’t have an alternative. That is absolutely the case with my patients—they don’t have the alternative to turn to a local clinic. [In this case], telemedicine abortion is so much better than any of the alternatives available to them. Otherwise, they either invoke dangerous methods, which are invasive and have a very high death rate, or they have to continue with the pregnancy to term, which is also much more dangerous.
What are the barriers to clinical access that your U.S. patients cite?
High costs. Distance. Domestic violence.
How do you work with local activists in countries with restrictive abortion laws?
Over the past 10 years, Women on Waves has [led trainings for] safe abortion hotlines, which are local organizations that provide information on how to use the abortion pill safely and effectively. Now there is a whole movement of groups who are supporting and training other people. It’s really important because this is the way [people can gain access to] information about the pills. Then, they’ll be able to find them wherever because they’re also available on the black market. They won’t have to harm themselves with invasive abortion methods.
In your ideal world, what would structural change concerning abortion look like?
No obstacles at all for anyone [who needs] access to abortion care. Undocumented women have to pay for their abortions and won’t be able to get it. It’s women living in domestic violence. The World Health Organization has written really good policy guidelines on how access to abortion can be most equal and the most just. It means abortion medication is available by prescription or even over-the-counter at pharmacies. Of course, it’s not enough. We need sex education. There needs to be access to contraceptives. It’s the whole package that matters.
What can people in the United States do to support those without abortion access?
In the United States specifically, people should support the abortion funds [they do have] because they do really great work, and they help [people who need abortions but who are] without money [to] access abortion services. In other countries, there are also abortion funds and activists who work on providing information on safe abortions. They can also support women’s funds like MaMa Cash and the Global Fund for Women, so they can give it back to local organizations that are fighting the stigma on abortion and working to change the laws and policies [that need to be changed].