A Dutch doctor and the Internet give Americans access to abortion pills

A little-known European medical group 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 Dutch doctor Rebecca Gomperts, began shipping abortion pills to Americans from abroad four years ago. The organization’s team consists of about four doctors overseeing about 10 health workers and is difficult for US authorities to reach because they are all out of the country and ship the pills from a pharmacy in India.

Opponents of abortion rights have so far been powerless to stop Aid Access from sending abortion pills to even the most conservative corners of the country, at least not without the organization’s opponents controlling the White House. Almost overnight, it transformed Aid Access from an obscure overseas group into an essential part of the effort to make abortion accessible domestically.

“This is the only clinically supported service that mails to states where telehealth for abortion is prohibited,” said Ushma Upadhyay, 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 plans to change his case now that the Supreme Court has overturned Roe-Wade. According to him, Roe v. Since the Wade trial was overturned, Aid Access has received 4,000 applications a day, up from 600 to 700 a day previously.

Last year, after Texas banned abortions after about six weeks of pregnancy, orders from the state 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 in need. 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.”

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

The steps are relatively simple: Prospective patients visit the Aid Access website and answer a series of questions, including how long they’ve been pregnant and whether someone forced them to have an abortion. The medical team reviews the answers and can write prescriptions that are sent to pharmacies. For pills from India, the process may take several weeks. Gomperts said the organization prefers people who are pregnant rather than those who want to stock up on pills for the future.

Gomperts said there are about 25 people working at the help desk to answer patient questions, with three people on at any given time. 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 the global internet can frustrate and overwhelm local law enforcement — at least for now.

James Bopp, senior counsel for the National Right to Life Committee, said without presidential oversight or a new federal law, there is little his abortion-rights organization or its allies can do against a group based outside the United States.

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

A medication abortion usually consists of five pills containing two different drugs. Women take one pill of mifepristone, followed by four pills of misoprostol a day or two later.

During the pandemic, the pills became easier to obtain when first a federal judge and then the Biden administration allowed patients to buy them without visiting clinics in person. According to the Guttmacher Institute, a research institute that supports abortion rights, 54% of abortions performed in the United States in 2020 were medical abortions. In 2011, this share was 24%.

Even before Roe was overturned, 19 states banned the use of telemedicine for medication abortions or required the physical presence of a prescribing physician, according to KFF, a health information nonprofit.

More than 20 states have now banned or restricted abortions, according to NBC News’ state laws tracker.

Gomperts said Aid Access has heard confusion and fear from women across the United States

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

“The people who are affected are poor women in red states who have these trigger laws,” she said. “So much social injustice is being done – over and over against the most vulnerable.”

Other online pharmacies will ship abortion pills to states where abortion is banned, according to the website of Plan C, an advocacy group, but experts say Aid Access is different because it’s based outside the U.S., has staff to answer questions and is cooperative. with outside researchers.

“We know it’s safe because it’s one of the only self-administered abortion options we’ve been able to study,” said Dr. Abigail Aiken, MD, associate professor of public affairs at the University of Texas at Austin. , who conducted research on Aid Access.

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

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

Gomperts founded Aid Access in response to tightening US abortion laws. She already ran a similar service called Women on the Internet in other countries, and Aid Access received 57,506 requests from people in the United States in its first two years.

“In the past few years, it has been clear that it has become harder and harder to get into the United States. “We started mostly by helping women in the military in Iraq and Afghanistan, South Korea and Japan,” she said, because access to the U.S. military in those countries was limited.

Gomperts’ biography made him a hero of the abortion rights movement; he performed abortions in the international waters of Portugal and other countries where abortion is restricted, and used drones to deliver pills to Northern Ireland in defiance of authorities there.

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

Associate Professor of Family Medicine and Department of Obstetrics and Gynecology at Washington Medical School. “He lives by his ethical and moral duty as a physician to ‘do no harm,'” says Emily Godfrey. “The problem is that when non-medical people limit access to medical care, to licensed qualified medical care, people are more likely to seek unsafe abortions — and that kills unsafe abortions.”

Aid Access has already faced one hostile US president. In March 2019, under then-President Donald Trump, the Food and Drug Administration issued a warning letter asking it to suspend Aid Access. Aid Access refused and sued the FDA to block any potential action. The agency never complied with his request. An FDA spokeswoman last week did not immediately comment on what, if any, plans the agency has for Aid Access.

The agency’s position could change if an opponent of abortion rights becomes president. Dr., a doctor and lawyer representing Aid Access in the state of Idaho. Richard Hearn said state regulators and prosecutors may have as hard a time banning the organization as their counterparts did stopping alcohol imports during Prohibition in the 1920s. .

“No state like Texas or Idaho will be able to do anything for Access to Aid in Amsterdam or Austria. They will not have jurisdiction, and the Netherlands will not extradite,” he said, noting 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 states cannot impose bans on abortion pills because the FDA has approved a regime that preempts state action. The issue is already being litigated in federal court in Mississippi, where the generic maker of mifepristone is suing to block state restrictions.

It’s unclear whether any state or federal prosecutors plan to take direct action against Access to Help. The Mississippi Attorney General’s Office, which argued the case that led to the Supreme Court decision last month, did not respond to a request for comment.

“Trying to stop taking mifepristone and misoprostol is just pointless. They are absolutely safe, especially early on,” Hearn said.

Despite this, opponents of abortion rights have proposed tougher penalties against online prescriptions of abortion pills. The National Right to Life Committee has published a model state law on its website that, if states adopt it, would make it a crime to maintain a website that provides instructions for self-administered abortions, but enforcement remains a problem.

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

“Freedom of speech is one of the basic constitutional rights in the United States, but even that right is under stress because of these laws because people are so afraid,” he said.

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

Gomperts said his goal is to be redundant at the end of Aid Access.

“It shouldn’t be a foreign organization,” he said. “What ultimately needs to happen is that states like New York and California, liberal states, will have to allow doctors and providers there to ship the pills to other states.”

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