The Future of Abortion Is Here - No Clinic Needed

The word abortion usually conjures images of tile-floored clinics, doctors in white lab coats and waiting rooms full of anxious women. But one Dutch doctor is working to revolutionize access to the procedure, bypassing the clinic and turning to a novel method of delivery: the Internet.

In a powerful New York Times Magazine piece coming out this weekend, Emily Bazelon profiles Rebecca Gomperts, a Dutch doctor and abortion rights activist who runs Women on Web, a “telemedicine service.” The Amsterdam-based group connects with women in countries where abortion is severely restricted or illegal, providing them with medical advice, support and prescriptions for mifepristone and misoprostol, pills that are given to women during the first trimester in order to induce miscarriage. Some 2,000 women a month, from countries as far-flung as Chile, Saudi Arabia, Costa Rica and South Korea, contact Women on Web asking for help accessing the drugs, which are known as a medical abortion. When taken together, the pills are 95 to 98% effective—roughly the same effectiveness rate as the surgical procedure.

Once clients are in touch with the organization’s representatives and have paid for the medication according to a sliding scale, the process goes like this:

  • Their consultation is sent to one of the group’s five physicians for review.
  • After it has been approved, the doctor writes a prescription for mifepristone and misoprostol and sends it electronically to a drug exporter in India.
  • The exporter fills it and sends the medication to the women in a package with a tracking number so that delivery can be monitored.
  • Once the pills arrive, a Women on Web employee sends an email instructing the women how they should be taken and what side effects to expect.
  • Help-desk staff remain on call to follow up with women who have concerns during the procedure and to advise them how to avoid criminal charges if they require medical attention, but fear legal persecution.

Though it may seem radical to conceive of an abortion performed without any doctor visits or in-person care, the service offered by Women on Web has proved life-changing for women in countries where abortion is forbidden under any circumstances, such as Chile, or where women have lost loved ones to botched abortions, such as Uganda. As Bazelon points out, almost 40% of the world’s population lives in countries where abortion is either banned or severely restricted. Women on Web provides an alternative for women whose lives have been derailed by unintended pregnancies.

Gomperts refuses to operate in the US because there are safe abortion services available to women here (as she says, “This a problem the U.S. has to solve itself”). But the system she devised has attracted attention among abortion rights activists here, especially in remote regions of the country and areas where conservative legislatures have imposed strict new regulations that have forced clinics to close their doors. Experimental efforts to treat patients via videoconferencing, like one established by Planned Parenthood for women living in rural Iowa, were highly successful but were quickly suspended due to pressure from anti-abortion groups.

And so more than 40 years after Roe v. Wade was passed, self-administered abortions are on the rise in states like Texas, where the number of clinics fell from 44 in 2011 to only six this year thanks to unnecessarily strict new operating laws. Instead of keeping pace with science and technology and offering women safe, legal access to the procedure, the United States is criminalizing pregnant women and forcing them to take desperate, dangerous measures to end their pregnancies. In one case, in Indiana, Chinese immigrant Bei Bei Shuai was imprisoned for over a year after attempting suicide while pregnant and delivering a baby who didn’t survive.

According to the Guttmacher Institute, a nonprofit reproductive health organization, 47,000 women around the world die each year from unsafe abortions and millions more are injured. If family planning and access to contraception are fundamental human rights, as the United Nations declared in 2012, access to abortion services and the ability to decide if and when to have a child should be as well. The important work of organizations like Women on Web facilitates the ability of women to take their health in their hands and determine the course of their own lives.

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