Rebecca Gomperts is a very polite Dutch doctor — when I first called her, she was out on her bicycle — whose revolutionary work is disguised by her demeanor. In 1999, Gomperts founded Women on Waves, a non-governmental organization that takes women from countries with restrictive abortion laws out to international waters — roughly 12 nautical miles from land — where they can legally obtain an abortion. (A 2014 film documented the work of Women on Waves.)
In 2001, Women on Waves set sail to Ireland for its first boat campaign. The journey attracted international media attention, flooded Gomperts’ inbox with emails from women around the world, and drew scorn from anti-abortion religious and political leaders. In 2004, the Portuguese government barred a Women on Waves boat from entering the country’s territorial waters. Paulo Portas, Portugal’s far-right minister of defense at the time, compared Women on Waves’ work to drug trafficking.
In 2006, Gomperts took Women on Waves’ work to the internet, creating a website called Women on Web to send abortion pills to women in countries where the procedure is banned. Women on Web has never shipped to women in the United States, for fear of backlash from anti-abortion activists and lawmakers. “There’s such an aggressive anti-abortion movement that will do anything they can to close down services. It could potentially jeopardize all the other work of Women on Web,” Gomperts told The Atlantic earlier this year.
Women in the U.S. who have been pregnant for less than nine weeks can end their pregnancy medically, so long as a patient does not have a condition that would interfere with the medicine. The recommended method for medical, non-surgical abortion is to take a sequence of two pills: the patient first takes mifepristone, followed by misoprostol 24 to 48 hours later, which induces an abortion. However, since mifepristone is restricted to specialty providers and thus more difficult to access in the U.S., it is possible to medically induce an abortion with misoprostol alone. Unlike other forms of abortion, once they obtain the drugs women can usually perform a medical abortion themselves, in the privacy of their own homes.
This year, Gomperts launched a new project through her own private medical practice to bring her services to America and other abortion-hostile countries. The project, called Aid Access, will allow women seeking a medical abortion to receive the needed pills through the mail, via prescriptions filled by Gomperts herself. The service costs $95 — far less expensive than similar services, which can charge up to $360 — and Gomperts says she will work to help cover the costs for women who cannot afford it (both Women on Waves and Women on Web accept donations). And while ordering abortion pills online is easier than ever, it can be difficult to ensure the pills’ quality. Gomperts, meanwhile, works with a trusted pharmacy in India.
I spoke with Gomperts, who says that she sees her work as “humanitarian aid,” about how both policies and cultural stigma around abortion has changed and the obstacles that women continue to face when trying to manage their own care.
The Outline: You’ve been doing this work for almost 20 years. In that time, has anything changed about your mission, or have you reevaluated anything about the work that you do?
Rebecca Gomperts: The mission has always been to make sure that women are able to access safe abortion services. But it has changed dramatically over the years — what strategies to use, and how to work with the existing realities in different countries around the world. By providing these services, we’ve gotten a much better understanding of what’s happening around the world.
I think one of the important things around Women on Web was that we published a lot of research to show that it is really safe for women to perform an abortion by themselves. The data of Women on Web, which is unprecedented, has contributed to policy change, to legal change, to changing awareness. That in itself has become a strategy to make it visible.
You don’t need a doctor to take an abortion pill. Women just need the information and access to the tablets. It should be taken out of control of the medical professions. Our data show it so clearly, that if you don’t make abortion accessible in a very fundamental way — very close to the women — there will always be women who cannot access it. And these are the women who most need it.
What are some obstacles to care that you’ve heard about from the women that contact you?
Even in countries where abortion is legal and even free, like in the United Kingdom, we get a lot of requests from women because they cannot access the existing services. There’s so many issues: because of distance; because of personal circumstances like domestic violence or controlling situations or even psychological conditions; childcare; poverty; privacy issues.
Cost is a huge issue. In the United States, it’s embedded in a health care system where there is a problem about accessing health care in general by poor people that don’t have insurance. So it’s a much larger problem than just access to abortion care.
What inspired you to start this new part of your work with Aid Access?
We got so many requests from women in the U.S. with Women on Web. You can’t just stand by and do nothing. I felt a moral obligation to do something, and I found a way to do it. We also knew from the emails that cost is the biggest obstacle for women in the U.S. (Advocacy group) Plan C came out with a report card, and it showed the pills are still too expensive. Women also don’t get enough information on how to use the medicine safely. So there was clearly a need for a doctor-supervised service, where there’s a check-up system to make sure that women know what to do, that they know it’s safe, that they have the proper information on how to use it.
“I felt a moral obligation to do something, and I found a way to do it.”
Can you walk me through the Aid Access intake process?
First, you go to the Aid Access website and fill out an online consultation form. You will be asked certain questions to find out how long you’ve been pregnant, if you’re healthy, if there are other contraindications. Then you’ll get an email explaining the legal abortion services that are available — what are the available services in the country where it’s directed to? It explains that [Aid Access] is for women that cannot access normal services in their own environment.
The women make a payment if they have the money. If they don’t have the money, they are asked how much they can pay. If they can’t pay anything, they get aid for free. Then the prescription is generated. I write the prescription based on the answers from the online consultation. The prescription is then sent to a pharmacy in India that mails the pills to the women. The women get information on how to use the pills. Finally, there is a follow-up email to make sure that everybody’s OK.
Let’s talk about the stigma associated with the idea of a “self-managed” abortion.
Any medical abortion is always self-managed. I think this term is used wrong. No matter whether it has been prescribed by a doctor or obtained through alternative ways, in an abortion with pills, the women take the pills themselves and they analyze themselves — what are their symptoms, and what are their needs for care? Women know how to do it. It’s exactly like a miscarriage, and 10 to 20 percent of pregnant women have miscarriages. It’s important to note that women who don’t need to disclose that they used the pills. Women can always go to a doctor and say that they had a miscarriage, and the treatment will be exactly the same.
While Roe v. Wade is still technically the law of the land, in many states in the U.S., abortion has basically been legislated to the point of being completely inaccessible. What is the legal framework that Aid Access uses?
I don’t know all the state laws. My only answer to that is that human rights agreements state that women have the right to access safe abortion services and essential medicines, which these medicines are. These laws are actually not valid, if there would be any law that would penalize women for obtaining the abortion pills and doing their own abortion. Human rights have precedent over all laws. These are international, basic rights that people have. People have a human right to access the health care that they need in order to be safe and to be healthy, and that is what women do when they obtain the medicines, period.
This interview has been edited and condensed for clarity.