A Dutch Doctor and the Internet Make Sure Americans Have Access to Abortion Pills

A little-known European medical team is poised to become one of the most important groups in the changing landscape of US abortion bans.

Aid Access, an online-only service run by a Dutch doctor, Dr. Rebecca Gomperts, began shipping abortion pills to Americans from abroad four years ago. The organization’s team consists of about four doctors supervising about 10 medical staff, and it is difficult for US authorities to contact them because they are all out of the country and ship the pills from a pharmacy in India.

Until now, opponents of abortion rights have been powerless to stop Aid Access from sending abortion pills to even the most conservative corners of the country, at least as long as opponents of the organization don’t control the White House. That has transformed Aid Access almost overnight from an obscure foreign group to an essential part of the effort to keep abortion accessible across the country.

“It is the only clinically supported service that mails to states where telehealth for abortion is prohibited,” said Ushma Upadhyay, an associate professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.

Gomperts, who founded Aid Access in 2018, said he has no intention of changing his job now that the Supreme Court has overturned Roe v. Wade. Aid Access has been receiving 4,000 requests a day since Roe v. Wade said 600 to 700 a day before.

Last year, after Texas banned abortions after about six weeks of pregnancy, the state’s orders tripled in the weeks after the law went into effect, according to a study published in JAMA Network Open.

“We will continue to serve women who need it. We’re not going to stop,” Gomperts said in a phone interview, adding: “We’re expanding our capacity again, so we can help with all the requests we get.”

Image: Rebecca Gomperts after a press conference at the Marina Pez Vela in the port of San José, Guatemala, on February 23, 2017.
Rebecca Gomperts after a press conference at the Marina Pez Vela in the port of San José, Guatemala, on February 23, 2017.Johan Ordonez / AFP – Getty Images

The steps are relatively simple: Potential patients visit the Aid Access website and answer a series of questions, including how long they’ve been pregnant and whether someone is forcing them to have an abortion. The medical team reviews responses and may write prescriptions that are sent to pharmacies. For pills coming from India, the process can take a couple of weeks. Gomperts said the organization is prioritizing people who are pregnant over those who want to stockpile pills for the future.

About 25 people work at a help desk to answer patient questions, with three people at any one time, Gomperts said. Aid Access charges $110 to $150 depending on where the patient is.

The ease of the process makes Aid Access yet another example of how a global Internet can frustrate and undermine local law enforcement, at least so far.

James Bopp, general counsel for the National Right to Life Committee, said that without control from the presidency or a new federal law, there is little his organization or its allies who oppose abortion rights could do against a group based outside the US

“The reality is that state laws have limited extraterritorial effects,” he said. “There is no question that the federal government has much more authority, and we hope to have them on our side to make these state laws much more effective.”

A medical abortion usually involves five pills of two different medications. Women take one pill of mifepristone, followed a day or two later by four pills of misoprostol.

The pills became easier to obtain during the pandemic, when first a federal judge and then the Biden administration allowed patients to obtain them without visiting clinics in person. Medical abortions accounted for 54% of abortions in the US in 2020, according to the Guttmacher Institute, a research institute that supports abortion rights. In 2011, the share was 24%.

But even before Roe was struck down, 19 states had banned the use of telemedicine for medical abortions or required the physical presence of the prescribing doctor, according to KFF, a health information nonprofit.

Now, more than 20 states have banned or restricted abortions, according to an NBC News state law tracker.

Gomperts said that Aid Access is hearing confusion and fear from women in the US.

Rebecca Gomperts at Aurora, a floating abortion clinic, in Dublin in 2001.
Rebecca Gomperts at Aurora, a floating abortion clinic, in Dublin in 2001.Jeroen Oerlemans/Shutterstock

“The people affected are poor women in red states that have these activation laws,” he said. “So much social injustice is being committed, over and over again, against the most vulnerable part of the population.”

Other online pharmacies will ship abortion pills to states where abortion is prohibited, according to the website of Plan C, an advocacy group, but experts said Aid Access is different because it is based outside the US, has staff available to answer questions and has been cooperative. with outside researchers.

“We know it’s safe, because it’s one of the options for self-managed abortion that we’ve been able to study,” said Dr. Abigail Aiken, a physician and associate professor of public affairs at the University of Texas at Austin. , which has done research on Aid Access.

About 96% of those who used abortion pills from Aid Access reported successfully ending their pregnancies without surgery, according to research Aiken published this year. About 1% reported receiving treatment such as antibiotics or blood transfusions, and no deaths were reported.

“They really are a humanitarian nonprofit, not a business like an online pharmacy is,” Aiken said.

Gomperts founded Aid Access in response to tightening US laws on access to abortion. She had already been running a similar service, called Women on the Web, in other countries, with Aid Access receiving 57,506 requests from people in the US in its first two years.

“It was clear in recent years that access in the US was getting more and more difficult. We started out primarily helping women in the military in Iraq and Afghanistan, in South Korea and Japan,” she said, because American service members in those countries had limited access.

Gomperts’ resume has made her a hero in the abortion rights movement; she has performed abortions in international waters off Portugal and other countries where abortion was restricted, and she has used drones to deliver pills in Northern Ireland in defiance of authorities there.

Time magazine named Gomperts one of its 100 Most Influential People of 2020, and in a tribute in the magazine, Cecile Richards, former president of Planned Parenthood, called her “one of the bravest people I know.”

“She is doing her ethical and moral duty as a physician to ‘do no harm,’” said Dr. Emily Godfrey, an associate professor of family medicine and of obstetrics and gynecology at the University of Washington Health System. “The problem is that when non-physicians restrict access to health care, to qualified licensed health care, people are more likely to seek unsafe abortion, and that is what kills, unsafe abortion.” .

Aid Access has already faced a hostile US presidency. In March 2019, under then-President Donald Trump, the Food and Drug Administration sent a warning letter asking Aid Access to cease operations. Aid Access refused and sued the FDA to block any potential action. The agency never complied with his request. Last week, an FDA spokesman had no immediate comment on the agency’s plans, if any, regarding Aid Access.

The agency’s position could change if an opponent of abortion rights were to become president. But at the state level, said Dr. Richard Hearn, a physician and attorney in Idaho who represented Aid Access, regulators and prosecutors might have a hard time banning the organization like their counterparts did to stop the importation of alcohol during Prohibition in the 1920s. .

“No state like Texas or Idaho will be able to do anything for Aid Access in Amsterdam or Austria. They are not going to have jurisdiction and the Netherlands is not going to extradite,” he said, emphasizing that he was speaking for himself, not the organization.

Complicating legal efforts at the state level is the fact that Attorney General Merrick Garland has said that states cannot enforce abortion pill bans because the FDA has approved the regimen, which preempts state action. The issue is already being litigated in federal court in Mississippi, where a generic maker of mifepristone is suing to block state restrictions.

It’s unclear if any state or federal prosecutors plan to take action against Aid Access directly. The Mississippi attorney general’s office, which argued the case that led to last month’s Supreme Court ruling, did not respond to a request for comment.

“It is useless to try to stop mifepristone and misoprostol. They are perfectly safe, especially early on,” Hearn said.

However, opponents of abortion rights have proposed even harsher penalties for online prescriptions of abortion pills. The National Committee for the Right to Life posted a model state law on its website that, if adopted by states, would make it a crime to maintain a website that provides instructions for self-managed abortions, but enforcement would remain a challenge.

One of the few things that limits the reach of Aid Access is that it is not yet well understood. Gomperts criticized social media apps like Instagram and Facebook for removing posts about abortion services.

“Free speech is one of the key constitutional rights in the US, but because of these laws, even that right is under pressure because people are so scared,” he said.

The lack of awareness is something abortion-rights advocates and some doctors hope will change, even if Aid Access becomes a Planned Parenthood-like lightning rod.

Gomperts said his goal is for Aid Access to eventually become unnecessary.

“It should not be a foreign organization,” he said. “What should happen in the end is that states like New York and California, liberal states, should make it possible for doctors and providers to ship the pills to the other states.”

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