You’re pregnant and, for whatever reason—a reason you shouldn’t feel any need to justify to anyone else—you cannot have a baby or go through a pregnancy at that time. You know your own mind and you know that terminating the pregnancy is the right decision for you. But you can’t get to a clinic. You know there are pills you can get online, but are they safe? Will they work? And are secret, at-home abortions with pills a solution to laws that don’t allow women to control their own fertility?
Abortion Pills—How Does “a Safe Illegal” Work?
Women are known for being “hormonal” but, actually, men are, too. Hormones are chemical messengers which, while traveling through the blood, tell different parts of our bodies what to do. The process is highly specific; each hormone needs to exactly fit a protein called a “receptor” for it to work, the way that a key will only open the door if it exactly fits that lock.
The full protocol for a medical abortion involves two pills. Mifepristone (aka RU486) works by physically blocking the receptor for the progesterone hormone—like blocking up a lock with filler so the key can’t fit in and turn it. When progesterone is blocked in this way, the lining of the womb breaks down and the pregnancy can’t continue. Mifepristone should be followed by another drug, misoprostol, which induces contractions to flush the discontinued pregnancy out.
While unsafe abortions are a massive killer of pregnant women all over the world, accounting for 14.5 percent of all maternal mortality (interestingly, actual rates of abortions don’t change between places where it is legal and not), abortion with pills is remarkably safe, and many women’s rights groups refer to pills as “a safe illegal.” According to the Centers for Disease Control, less than 1 woman in every 100,000 dies from an abortion performed by a qualified medical professional, and a Princeton study found that less than 1 percent of people who had abortions with Planned Parenthood had complications.
Access to Abortions in Ireland and Mexico
In situations where abortion is illegal, the abortion pills can be a godsend. But even when a woman can legally attend a clinic for a termination, there may be any number of reasons that she can’t. For example, she might be in an abusive relationship or part of a community that frowns on abortion. The clinic might simply be too far away, meaning that a trip there would involve prohibitive costs for travel, accommodation, and childcare. In these circumstances, at-home medical abortion may be just as necessary as in situations where a woman can’t legally attend a medical center. University of Texas research has shown that at-home abortions using pills and online support from charity Women on Web is as safe as in-clinic abortions.
The Republic of Ireland and Mexico represent two different places in which women rely on abortion pills to get around restrictive laws. In Ireland, abortion is illegal. Women are legally allowed to have terminations outside the country and, since 1980, over 170,000 women and girls are known to have traveled to the nearby United Kingdom. But for many Irish women, this option is unaffordable.
The Abortion Support Network is a small charity that provides practical information and financial support to people traveling to the U.K. from Ireland, Northern Ireland, and the Isle of Man for an abortion. Their director, Mara Clarke, told me, “sometimes we’re the first call, and sometimes we’re the last call. Some people have rationed food for their families, sold the family car, cut off the landline.”
She quoted from a price list. For an Irish woman to get an abortion in the U.K. up to 14 weeks is between 380 and 535 euro, up to 19 weeks it’s up to €795 and up to 24 weeks it’s €1625. It’s worth remembering that these prices are only for the termination and don’t take into account travel, accommodation, childcare, and any extra expenses such as visa applications. Abortion pills, however, can be purchased for a non-mandatory suggested donation of €90.
In response to the recent news that the number of women known to travel to the U.K. for abortions has been gradually declining, the national crisis pregnancy agency pointed to research showing more Irish women are contacting providers of abortion pills.
Abortion is legal throughout Mexico in cases of sexual violence but is generally accessible only in Mexico City. According to local activist Oriana Lopez Uribe, though, misoprostol is widely available in Mexican pharmacies without a prescription, so there is a safe illegal in Mexico for women who know how to use it. The problem is that an at-home abortion with misoprostol alone is only approximately 80 percent effective, whereas the mifepristone/misoprostol combination is effective over 95 percent of the time.
Abortion Pill Activism—A Band-aid Solution
Women on Web and Women Help Women are doctor-led charities who provide consultations, medical abortions, and evidence-based online support to women in exchange for suggested, non-mandatory donations. Women on Waves is a Dutch-registered charity with a very mobile clinic—a boat. They sail into ports in countries where abortion is illegal, collect women and sail into international waters, where they receive medical abortions under conditions in line with European models of best practice before returning home.
The Women on Waves boat visited Mexico in April this year. According to Lopez Uribe, the press covered the visit but politicians responded with “a very Mexican response.”
“No one is responsible, everyone is like ‘No, no, this is not my issue. It’s your issue,’” she said. But the Mexican Minister for Health did eventually admit publicly that there was a greater need for safe abortion across the whole country.
Women on Waves issued a press release calling on the Mexican government to ensure access to contraceptives and evidence-based sexual education in Mexico. According to Lopez Uribe, contraception is available and free for women across the country. She believes that sex education in her country could be better but that the government is at least moving in the right direction.
“I think there is a lack of sexuality education and I think the government has made some sort of effort, it’s not that they are opposed completely. They do provide sex education but it’s very biological and very risk-reducing centered. So it’s not comprehensive, and it’s only fear-inducing. I think they are aware that they need to work on that and they are going in that direction. They are not necessarily opposing that.”
She believes the boat had a positive effect in terms of publicity and public awareness because it can be difficult to get media to cover sexual and reproductive rights. However, their visit coincided with the 10th anniversary of the Mexico City law, which allows women to have on-demand abortions up to 12 weeks in the capital and is in the public consciousness anyway. Arguably, there was already a news hook at the time Women on Waves visited and they enhanced rather than created awareness of the issue.
The availability of medical abortions is a definite and practical advance in terms of more women being able to control their fertility, regardless of the laws and culture where they live. However, illegally bought pills are not a substitute for full reproductive rights.
“I mean, the pills are great,” Clarke said, “but forcing women to have a certain kind of abortion…and one of the struggles now is that people are like, “oh, if somebody [in Ireland] wants an abortion now she can go to England. And, if they can’t afford it, the Abortion Support Network (ASN) can help them or they can get the pill.”
She describes the current legal situation in Ireland as a cancer, her organization a band-aid, and campaigning organizations the cure.
While Women on Waves should be commended for the similar work they do and the women they help, they are, similarly, a band-aid solution.
Similar to Clarke’s sentiments that campaigning organizations are the ultimate cure for a bad reproductive rights system, Lopez Uribe feels that it would be better if the boat campaign had been more linked to an advocacy effort. “Because we run the Maria fund, the abortion access fund in Mexico, I think that that boat campaign is not an access campaign. It’s an awareness-raising campaign more than it is an access campaign. It’s not going to solve anything, a boat that goes five days or three days.”
“And I think that it needs a lot more work in terms of planning from the local organizations to invite the boat instead of the other way around, the boat proposing itself to come,” she said. She also drily commented that Mexican storms don’t make boats an ideal solution.
On top of that, while complications are very rare, they can occur. Abortion pills essentially work by triggering a miscarriage, with cramps and bleeding. In a clinic, a woman will have the support of a medical team who will reassure her when something is normal and help her when it is not. Forcing her to go through this process alone adds unnecessary trauma to what should be a straightforward medical procedure.
According to Caoimhe Doyle of the Abortion Rights Campaign, in Ireland, “The Protection of Life During Pregnancy Act, introduced in 2013, means that anyone prosecuted for taking abortion pills can be sentenced to up to 14 years in prison. As of yet, no one has been prosecuted under this act. However, in Northern Ireland, we have seen a number of investigations and prosecutions, both of those taking and providing these pills, so it is not unlikely that we may start to see prosecutions here.
Fear of prosecution
The fear of prosecution often puts those who take these pills at risk, as they are afraid to seek medical assistance in the rare event that something goes wrong.”
Finally, there’s the issue of confiscated pills and fake pills. Clarke has had more women contact her in recent months saying that they ordered pills which had been stopped by customs or, for some reason, never arrived.
Women on Web and Women Help Women provide abortion pills to Irish women for €90, but these are suggested donations, and no one will be denied a medical abortion for lack of funds. Pro-choice groups in Ireland know about these organizations, but there’s confusion over whether or not it’s legal to give out any information on them.
Pro-choice groups in Ireland are nonprofit and volunteer-run, and with a referendum campaign to fight in 2018, this is not a time to risk the consequences of flouting laws. So while we can point people in the direction of resources that will give them information and support for traveling abroad, we can’t promote legitimate sources of the abortion pills.
Clarke has had women contact her organization after they went to websites that weren’t legitimate, and spent hundreds of euros on pills that never showed up. “I know that both Women on Web and Women Help Women have done research trying to identify what the fake providers are,” she said, “but there are just so many.”
Featured image by Oscar Keys