The Doctor Prescribing Abortions from Overseas

I first spoke with Gomperts in 2018 and was struck by her complete lack of equivocation on an issue that so often is layered, on all sides, with legal, moral and clinical rationale: “Unjust laws should not be respected,” she told me then .

I expected similar forthrightness when I called her to talk about the post-Roe future of telehealth abortion. Gomperts’ experience gives her insights into the abortion debate that may surprise many Americans. For instance, she told me that access to abortion tracks with a country’s democratic direction — the more authoritarian, the more restrictions. And she noted that already in America, access to abortion has more to do with a person’s wealth and access to information and child care than it does to local laws “Laws don’t matter when you have money, right?” she said.

Candor, Gomperts made clear, may be one very important means of preserving abortion access in the United States. “Asking for the reason why people want to have an abortion is already framing it,” she told me. “Because it means that people have to have a reason. You don’t need to have a reason to have an abortion. The only reason you want to have an abortion is because you have an unwanted pregnancy. Period.”

This transcript has been edited for length and clarity.

Chelsea Conaboy: I’ve heard various people involved in reproductive rights describe the draft of Justice Alito’s opinion to overturn Roe as not unexpected, yet still shocking. But you’ve been planning for this likelihood. Why?

Rebecca Gomperts: When I started in 2018, there was already a huge request for pills from the US For me, what was always important were the obstacles to abortion care—it doesn’t matter what causes them. What matters is that they exist. The obstacles that we saw in 2017 and 2018 were cost and distance [to a clinic].

Plan C had done research on pills provided by online pharmacies, looking at if they were real and the cost, and it was really expensive. We got feedback from women: “I can’t use these services because I can’t afford it.” And then of course, Trump came. … The moment that Trump was able to install the last Supreme Court judge, it was clear — or even before that — [that Roe] wasn’t going to stand.

If Hillary would’ve won, then this wouldn’t have happened. But the need [to help people overcome obstacles to abortion] would have still existed.

Conaboy: Given your extensive work on abortion around the world, I wonder, is there something that you see about the American fight over abortion today that perhaps Americans themselves don’t understand?

Gomperts: Yes and no. In the end, laws don’t matter when you have money, right? And that is the case everywhere in the world. If you have money, access to information, or privileges, you can always find an abortion provider, whether traveling or locally or whatever. It’s by definition always a problem of poverty. And one of the problems in the US is huge poverty.

I always felt that, in the US, there is this mentality that if you’re poor, it’s your fault. And that is just not true. It’s the system that causes poverty, not people themselves. And it’s the system that keeps people poor. That’s also what you see in the studies — the Turnaway Study [by Diane Greene Foster and colleagues] shows that. You keep people poor by denying abortions.

Conaboy: Is the United States, by increasingly restricting access to abortion, an outlier globally? Or is it the vanguard?

Gomperts: It’s not an outlier in the countries that have very autocratic regimes. So the US has placed itself in the same category as [Hungarian Prime Minister Viktor] Orbán and as [Turkish President Recep Tayyip] Erdoğan and as [Russian President Vladimir] Whore. It’s these countries where there are autocratic regimes and the democratic processes don’t function anymore, where abortion rights are being turned off. And in all the countries where the democratic processes are improving, there is an improvement of access to abortion, or there’s an intent to do that.

Conaboy: The core of Aid Access’s work has remained the same since you launched in 2018, but it seems that so much of how you deliver your service and how it’s perceived has changed.

Gomperts: Covid really changed everything, because suddenly telemedical abortion services was what was saving abortion access in many places. In the UK, telemedical abortion services have become mainstream. And that is now also part of the mainstream abortion services in France, in Ireland, in Canada, in Australia — in many, many places.

In the US of course, the FDA immediately allowed for telemedical abortion services during Covid. That also made it possible for US providers to join Aid Access. So there are now nine US providers using Aid Access as their front-office system and back-office system, and they’re serving people in their states, where they’re registered to practice.

Conaboy: But there’s a growing gap, isn’t there? In the states where telemedicine abortion is legal, it has quickly become a mainstream thing. But in the states where it is explicitly banned or where abortion will be severely restricted without Roeit is something very different.

Gomperts: There’s a couple of things here. Misoprostol is available in all the pharmacies around the US — also in Texas. And misoprostol on its own is really effective for use in abortion. You don’t need the mifepristone. So, I think there are still ways to think around what can be done locally.

If you think about how to oppose what is happening, it would be for all the doctors there now to prescribe mifepristone and misoprostol to everybody who is not pregnant. Even if these laws take effect — all the women, the moment they get to menstruation, they get a package of abortion pills. You don’t have to wait until somebody’s pregnant. That way, the laws don’t apply anymore.

Conaboy: As you see it, is there any reasonable medical argument against providing pills in advance?

Gomperts: There’s nothing. If you buy bleach in the supermarket, that’s more dangerous. If you don’t use it as you’re supposed to use it — you drink it instead of use it to clean — you die.

Abortion pills are something that, actually, you cannot die from. There’s no way that you can overdose on it. And what we know from research is that you don’t need to do an ultrasound for a medical abortion. The World Health Organization says you can just determine the duration of pregnancy based on menstrual cycle. People can make a really good prediction of how long they’re pregnant.

The reason why many women are pregnant longer when they access abortion services is because they have obstacles to obtaining an abortion — because of cost, because of child care, because of domestic violence. But if you have those medicines in the cabinet, that obstacle doesn’t exist anymore.

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