A Dutch doctor and the internet ensure that Americans have access to abortion pills

A little-known European medical team is poised to become one of the most important groups in the changing landscape of US abortion bans.

Aid Access, an online service run by a Dutch physician, Dr. Rebecca Gomperts, started shipping abortion pills to Americans from abroad four years ago. The organization’s team consists of about four doctors who oversee about 10 medical staff, and they are difficult for US authorities to reach because they are all outside the country and they ship pills from a pharmacy in India.

Abortion rights opponents have so far found themselves largely powerless to stop Aid Access from shipping abortion pills even to the most conservative corners of the country, at least while the organization’s opponents don’t control the White House. That almost overnight transformed Aid Access from an obscure overseas group into a vital part of efforts to keep abortion accessible across the country.

“It’s the only clinically supported service that mails to states where telehealth for abortion is banned,” said Ushma Upadhyay, an associate professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco.

Gomperts, who founded Aid Access in 2018, said she has no plans to change her job now that the Supreme Court has dismissed Roe v. Wade. Aid Access has received 4,000 requests a day since Roe v. Wade was quashed, she said, going from 600 to 700 the day before.

Last year, after Texas banned abortions after about six weeks of pregnancy, the state order tripled in the weeks after the law went into effect, according to a study published in JAMA Network Open

“We continue to help women who need it. We are not going to stop,” Gomperts said in a telephone interview, adding: “We are expanding our capacity again so we can help with all the requests we get.”

Rebecca Gomperts
Rebecca Gomperts, founder of the Dutch organization Women on Waves, in 2020. Remko De Waal / ANP / AFP via Getty Images

The steps are relatively simple: Visiting potential patients the Aid Access website and answer a series of questions, including how long they have been pregnant and whether someone is forcing them to have an abortion. The medical team reviews the answers and can write prescriptions that are sent to the pharmacy. For pills coming from India, the process can take a few weeks. Gomperts said the organization prioritizes people who are pregnant over those who want to stock up on pills for the future.

About 25 people work at a help desk to answer patient questions, three people at a time, Gomperts said. 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 a global internet can frustrate and undermine local law enforcement — at least until now.

James Bopp, the general counsel to the National Right to Life Committee, said that without presidency control or a new federal law, his organization or its allies opposing abortion rights could do little against a group outside the US.

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

A drug abortion generally involves five pills of two different drugs. Women take one pill of mifepristone, followed a day or two later by four pills of misoprostol.

The pills became easier to obtain during the pandemic, when for the first time a federal judge and then the Biden administration allowed patients to get them without visiting the clinics in person. Medicated abortions accounted for 54% of U.S. abortions in 2020, according to the Guttmacher Institute, a research institute that supports abortion rights. In 2011, the share was 24%.

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

Now more than 20 states have banned or restricted abortions an NBC News tracker of state laws.

Gomperts said Aid Access is associated with confusion and fear among women in the US

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

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

Other online pharmacies will ship abortion pills to states where abortion is prohibited, according to the website of Plan Can advocacy group, but experts said Aid Access is different because it is based outside the US, has staff available to answer questions, and has collaborated with outside investigators.

“We know it’s safe because it’s one of the options for elective abortion that we’ve been able to study,” said Dr. Abigail Aiken, a physician who is an associate professor of public affairs at the University of Texas at Austin. , who has researched Aid Access.

About 96% of those who used Aid Access abortion pills reported being able to successfully terminate their pregnancy without surgery, according to research that Aiken published this year† About 1% reported receiving treatment such as antibiotics or blood transfusions, and no deaths were reported.

“They really are a humanitarian non-profit, not a business like an online pharmacy is,” Aiken said.

Gomperts founded Aid Access in response to the tightening of American legislation on access to abortion. She already had a similar service called Women on Web in other countries and got Aid Access 57,506 requests of people in the US in the first two years.

“It has been clear in recent years that access in the US has become increasingly difficult. We usually started helping women in the military in Iraq and Afghanistan, in South Korea and Japan,” she said, because US military personnel in those countries had limited access.

CV of Gomperts made her a hero within the abortion rights movement; she performed abortions in international waters for Portugal and other countries where abortion was restricted, and she used drones to deliver pills to Northern Ireland, despite the authorities there.

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

“She lives her ethical and moral duty as a physician to ‘do no harm,'” said Dr. Emily Godfrey, associate professor of family medicine and obstetrics and gynecology at the University of Washington Health System. “The problem is that when non-medical people restrict access to medical care, to qualified, licensed medical care, people are more likely to seek unsafe abortion — and that’s what kills, unsafe abortion.”

Access to help already pointing down a hostile American presidency. In March 2019, the Food and Drug Administration under then-President Donald Trump sent: a warning letter Ask Aid Access to cease operations. Access to help refused and sued the FDA to block any possible action. The agency never complied with his request. Last week, an FDA spokesperson had no immediate comment on any plans the agency may have regarding Aid Access.

The agency’s stance could change if an abortion rights opponent became president. But at the state level, said Dr. Richard Hearn, an Idaho physician and attorney who has represented Aid Access, regulators and prosecutors could have just as much trouble blocking the organization as their counterparts would have had to stop alcohol imports during Prohibition in the 1920s. †

“No state like Texas or Idaho will be able to do anything about Aid Access in Amsterdam or Austria. They will not have jurisdiction and the Netherlands will not extradite,” he said, emphasizing that he was speaking for himself, not for the organization.

Complicating state-level legal efforts is the fact that Attorney General Merrick Garland has said that states: cannot enforce prohibitions on abortion pills because the FDA approved the regimen, which preempts state action. The problem is already litigated in federal court in Mississippi, where a generic manufacturer of mifepristone is suing to block state restrictions.

It’s not clear whether a state or federal prosecutor plans to take direct action against Aid Access. The Mississippi Attorney General’s office, which argued the case leading to last month’s Supreme Court ruling, did not respond to a request for comment.

“It’s just pointless trying to stop mifepristone and misoprostol. They’re perfectly safe, especially in the beginning,” Hearn said.

Nevertheless, abortion rights opponents have proposed even tougher penalties for prescribing abortion pills online. The National Commission on Right to Life published a model state law on its website that if states passed it would make it a felony to maintain a website with instructions for self-administered abortions, but enforcement would remain a challenge.

One of the few things that limits Aid Access’s reach is that it’s still not well known. Gomperts criticized social media apps such as Instagram and Facebook for delete posts about abortion services

“Freedom of speech is one of the most important constitutional rights in the US, but these laws are putting even that right under pressure because people are so afraid,” she said.

The lack of awareness is something abortion rights advocates are hoping will change, even if Aid Access becomes a lightning rod, akin to Planned Parenthood.

Gomperts said her goal is that Aid Access will eventually become redundant.

“It doesn’t have to be a foreign organization,” she said. “Ultimately, what should happen is that states like New York and California, liberal states, should just allow the doctors and health care providers there to ship the pills to the other states.”

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