By Randall K. O’Bannon, Ph.D., NRL Director of Education & Research
So how are a boat anchored in international waters off Dublin, Ireland, border town flea markets in Texas, a businessman in India, and a storefront in rural Iowa all related? According to an article written by Emily Bazelon appearing in last Thursday’s New York Times (8/28/14), they’re all key pieces of the abortion industry’s transition from relying almost exclusively on standard brick and mortar clinics that performed surgical abortions to a new model where chemical abortifacients can be ordered over the internet or purchased over the counter and performed at home by women on themselves—hence the acronym D-I-Y (Do-It-Yourself) abortions.
Bazelon’s article, “The Dawn of the Post-Clinic Abortion,” begins largely as a profile piece on Rebecca Gomperts. As we will explained later in this story, while Gomperts herself is not currently working in countries where abortion is legal, abortion activists in the United States are watching her “radical idea of providing abortions without direct contact with a doctor” with great interest. (NRL News Today last wrote about Gomperts, a Dutch general-practice physician, at “’Women on Waves’ bringing abortions performed off shore to Morocco.”)
Gomperts is the former Greenpeace activist who launched the “Abortion Ship” from the Netherlands in June of 2001, heading for the coast of Ireland on a ship stocked with abortion pills—mifepristone (RU-486) and the prostaglandin misoprostol. She called her effort “Women on Waves.”
The plan was to anchor just outside Ireland’s coastal boundary and have women ferried out to the ship to take the pills and start their abortions. However disputes over licensing and strategy kept the group from performing any abortions there.
Undeterred Gomperts tried again in Ireland the following year, then tried Poland and later, Portugal. Met with great fanfare every time, but also resistance (according to Bazelon, warships, in one case), it is unclear whether Gomperts or her crew ever performed a single abortion or even gave out any abortifacients pills.
Gomperts was the beneficiary of enormous publicity, nonetheless, and made use of it. Gomperts began appearing on TV promoting chemical abortions and telling women there were other pills already on the market (misoprostol, which is legitimately used to deal with ulcers) that women could use. Bazelon says Gomperts began receiving emails from women from all over the world. At that point, Gomperts revised her strategy.
Women on Waves, Gompert’s group, set up hotlines in several countries where abortion was not legal – Chile, Argentina, Peru, Pakistan, Venezuela, Morocco – telling women how they could get misoprostol and use it to self-abort. Misoprostol is a widely available prostaglandin that is used to help prevent stomach ulcers in patients taking lots of non-steroidal anti-inflammatory drugs. It also has, used in a particular fashion, the property of inducing powerful uterine contractions that can kill and expel the unborn child. Misoprostol is used in conjunction with RU-486 to complete those abortions, but can and has been used as a stand alone abortifacient.
Seeing an opportunity, Gomperts shifted her attention to the development of the website, womenonweb.org, where women from all over the world could click a few buttons, say “I need an abortion,” and have pills shipped from a manufacturer in India, Kale Impex, to have them delivered to their door in a matter of weeks. Indian pharmaceutical firms manufacture generic versions of many popular drugs, and several advertise and sell mifepristone (RU-486) and misoprostol on-line.
This is not the only effort to push for DIY abortions. Another Indian firm, Sun Pharmaceuticals has teamed with international abortion promoters like IPAS, PATH, and the Concept Foundation to push “Medabon,” a prepackaged blister pack of RU-486 and misoprostol pills, complete with cartoon illustrations of administration and complications for those who might be illiterate.
As noted Gomperts doesn’t work in the U.S. or in countries where abortion is legal. But the move to reduce direct medical involvement in abortion have already been seen here. Here is a key paragraph from Bazelon’s 7,000+word long profile:
Gomperts designed her program — based on the radical idea of providing abortions without direct contact with a doctor — for women in countries where abortion clinics are nonexistent or highly restricted. But her model is invigorating abortion rights activists in the United States, where the procedure is simultaneously legal and increasingly hard to access. In their eyes, medical abortion, delivered through a known, if faraway, source, could be a transformative response: a means of access that remains open even when clinics shut.
Note the “progression”: From a multi-step, highly supervised regimen that was recommended by the FDA when it approved use of the chemical abortifacients RU-486/prostaglandin combination in September of 2000; to fewer trips to the abortionist’s office (not coming back to take the prostaglandin in his office); to so-called “webcam abortions” where the abortionist never even sees the woman in person; to advertising how a woman can avoid a physician’s involvement all together—Womenonweb.org.
(For more background on webcam abortions, see here.)
The next “logical” step for abortion advocates, as we will see below, is to figure out how to make mifepristone available “as a normal pharmaceutical product physicians can write a prescription for.” This would be followed (they hope) by making the RU-486/prostaglandin available over the counter.
Much has been made of the abortion clinic closures in Texas that followed the legislature’s effort in 2013 to make sure that those clinics met basic safety standards and require that abortionists have admitting privileges in a local hospital if women suffer complications from their abortion. Many clinics decided they’d rather close than bring their buildings up to code and word on the street went out that women could get black market misoprostol pills at border town flea markets.
Bazelon shared the story of one activist, Yatzel Sabat, from Austin who was setting up a website called the “Texas Abortion Access Project.” There, on a page declaring “Abortion Without Apology,” Sabat shared a map of abortionists in other states and links to groups who would offer to assist women with travel and abortion expenses.
On another page titled “What Else Can I Do?” Sabat offered information on misoprostol. While avoiding saying directly where or how women could get the pills, she did offer standards (presumably some sort of protocol) from the World Health Organization telling women how to use misoprostol and links to Women on Web.
Though, as mentioned earlier, Women on Web does not officially sell to women in the U.S., it not only tells a woman how to do a chemical abortion on herself, but refers women back to the Women on Waves site. That site tells women how they might go about obtaining misoprostol from the black market or from a local pharmacist by writing a fake prescription or telling the pharmacists that you need a few pills for your visiting grandmother who has rheumatoid arthritis and forgot to bring her prescription.
That is hardly the end of it. Bazelon points to an article appearing in this past February on the pro-abortion website RH Reality Check, in which Francine Coeytaux and Victoria Nichols “argued for over-the-counter status for misoprostol.” They called it “Plan C,” hoping to follow the pattern of “Plan B,” the so called “morning-after pill,” which a federal judge declared in 2013 had to be made available over the counter to women of all ages.
It wouldn’t end there.
Beverly Winikoff was one of those originally responsible for bringing RU-486 (mifepristone) to the U.S., now heading a group called Gynuity Health Projects. She told Bazelon that a first step towards increased access to chemical abortions would be making mifepristone available “as a normal pharmaceutical product physicians can write a prescription for.”
The next step would be “we could carefully think about how the combination of mife[pristone] and miso[prostol] might become available over the counter. How do you organize that, with the proper safeguards, so that women have the information they need?”
Bazelon mentions, but downplays the considerable risk involved. She admits that these abortions “take place over hours instead of minutes and can be more painful than surgical abortions.” (In fact, it is a matter of days.)
And there is the issue of ectopic pregnancies. A clinic with an ultrasound and a trained technician should be able to identify an ectopic pregnancy, which these pills have no effect on. The impact could prove deadly.
She shares that cramps, pain, diarrhea, vomiting may be part of the process (most of these are standard) and even grants that there have been 11 reported deaths.
In fact over three years ago, the FDA admitted (in April of 2011) that at that time, there had been 14 deaths reported in the U.S. and another five identified in other countries. Because patients are advised by groups like Women on Web not to tell doctors they’ve taken abortion pills, there is reason to believe that there may be many more.
This, of course, is largely under the current, doctor [read abortionist]-supervised protocol. Minimal though it is, at least a woman has a trained doctor to tell her how to take the drugs, how they work, how to recognize and deal with problems, and to answer any questions she might have if she has any. It is hard to imagine that any remote session will be as thorough. In addition, the woman should be able to contact the abortionist who performed the abortion if there are complications.
None of that is the case, of course, if she merely buys her abortifacient drugs over the counter or orders them over the internet.
The more you read Bazelon, the more worried you should be worried that women are placing themselves at enormous risk.
Women on Web’s site asks women if they have any high blood pressure, heart, kidney or liver conditions or other diseases that might disqualify them as candidates. But only a doctor can examine a woman, ask questions, and determine whether there are signs of such conditions that she may not be aware of and may not have been previously diagnosed.
When any chemical abortion begins, there is considerable pain, cramping, bleeding and often some form of gastrointestinal distress. The problem is, these are also the sort of signs and symptoms a woman might display if she were dealing with an infection or a ruptured ectopic pregnancy. It is hard enough for a doctor to tell the difference, much less a woman out in a rural farm village without emergency facilities or professionals nearby.
“When women do seek medical attention, Women on Web also counsels them about how to avoid criminal charges if they live in countries where they have reason to fear prosecution. To ingest the mifepristone and misoprostol they are told to place the drugs in their cheek or under their tongue, where the medicine cannot be detected in the body. (If they are inserted vaginally, they may leave fragments.) Gomperts says there is no medical reason for women to tell anyone they’ve used pills. Treatment, if needed, is the same as it would be for a spontaneous miscarriage. ‘Women shouldn’t be afraid to look for care when they need it, and at the same time they shouldn’t do anything to incriminate themselves,’ Gomperts said.”
It seems, though, such information would have been highly relevant to doctors treating the inordinate numbers of chemically aborting women who suddenly and mysteriously came down with rare but lethal Clostridium sordellii infections in their reproductive tracts. That these were not simple miscarriages, but initiated events whereby certain bacteria could have been introduced into their birth canals was significant medical information.
The biggest lie, of course, behind this whole push for DIY abortions is that there is ever going to be some simple, private, safe way to dissolve the reality of baby away.
Will Women on Web be there when the woman is suffering through the throes of her chemical abortion? Will the web-cam abortionist be there when she is all alone, bleeding, doubled over in pain, struggling with the reality of her lost child? Will Gynuity make sure that there are instructions on how to deal with post-abortion grief stuffed into the bottle of pills sold over the counter?
They’ve disregarded the child all these years. Why should we be surprised if they abandon the mothers as well?