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Meet the Dutch Doctor Helping Expand Abortion Access by Mailing Safe & Legal Pills Worldwide

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As activists across the U.S. are mobilizing to defend reproductive rights, we speak to the Dutch physician Dr. Rebecca Gomperts, who has dedicated her life to circumventing anti-abortion laws, including providing abortions on ships in international waters and sending abortions pills around the world. She also discusses navigating censorship on social media platforms, telemedicine, the future of contraception and more. “This is not the moment anymore to stay within the law,” says Dr. Gomperts, referring to the end of Roe v. Wade. “This is the moment to make sure that women have access to safe abortions despite the law, because this is such an unjust law that is creating so much social inequality and that will affect, really, the most poor women in the country.”

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This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: This is Democracy Now! I’m Amy Goodman.

Protests are continuing across the country over the Supreme Court’s overturning of Roe. On Thursday, police arrested more than 180 protesters outside the Supreme Court as they peacefully blocked an intersection in a massive show of nonviolent civil disobedience.

We end today’s show looking at how demand for abortion pills is surging in the United States following the ruling. But access to medication abortion is coming under attack by anti-abortion politicians.

Earlier this week, I spoke with Dr. Rebecca Gomperts, a Dutch doctor who for years has defied abortion bans and restrictions around the world, prescribing abortion pills from overseas through her Europe-based groups Women on Web and Aid Access. She’s also the founder of Women on Waves, which set sail around the world to provide safe abortion services in international waters off the coasts of countries where abortion is illegal, and delivered abortion pills across borders using drones or robots. I asked Dr. Gomperts to explain what medication abortion is.

DR. REBECCA GOMPERTS: So, a medication abortion is a treatment which uses two types of medicine — one is called mifepristone, and the other is called misoprostol — that is basically inducing a miscarriage. The mifepristone is blocking the hormone that is necessary to keep the pregnancy intact. And then, 24 hours later — this medicine doesn’t have very much side effects. Nothing much happens. Women don’t really notice. But 24 hours later, they get four of the other tablets, of misoprostol, and this tablet is causing the contractions of the womb so that the pregnancy is being expelled. The process is very similar to a miscarriage. It’s extremely safe. It’s safer than many over-the-counter painkillers that are available over the counter, and much more safer than Viagra.

AMY GOODMAN: And now if we can go back and you can talk about your response to the Supreme Court decision making — well, gutting Roe v. Wade after a half a century?

DR. REBECCA GOMPERTS: So, I already initiated Aid Access, which is an Austrian organization, in order to reply to the response of women in need in the United States. We found, through Women on Web, that there were already many women in the U.S. that had real problems to access abortion services locally, because the clinics charged too — they charge. And many people are living in poverty, and they could not afford the fees that were asked by the clinics, but also to travel to large distances. We published a lot of research about this, together with Abigail Aiken from Texas University.

And actually, when we started, we did not really foresee that this would happen. But since the Supreme Court — the draft of the ruling leaked in May, we saw an incredible surge in requests from all over the United States. And I now work with nine U.S. providers that are providing prescriptions for the states where they are licensed. There is 19 states where they are working in, which is filled by a pharmacy from the United States. And I do the other states, where I provide prescription, and then the medicines are mailed from India. So, we can serve — Aid Access can serve all the states in the United States.

AMY GOODMAN: And how much do the drugs cost?

DR. REBECCA GOMPERTS: So, there is a sliding scale. So, for the services that I prescribe, we are asking around 95 euros, which is about $100. And the other providers, because the medicines are a bit more expensive in the United States, are asking $150. But women that cannot afford that amount, there is a sliding scale. So everybody will be helped.

AMY GOODMAN: So, you have people like the South Dakota Governor Noem saying that she’s going to try to stop these pills. Now, the Health and Human Services Secretary Xavier Becerra and Merrick Garland have made the point, the attorney general, that the FDA has approved these drugs. So, how could your mailing of these pills be stopped, and telemedicine appointments, overall?

DR. REBECCA GOMPERTS: So, I mean, I think it’s impossible to stop it. What I think is happening now, what a lot of the states are doing, the Republican states or where abortion is being banned, that it’s a bullying tactic to scare people, to scare people off. The United States is also known for its judicial injustice, where many people, once you’re being prosecuted or an attempt is being made, that it’s really hard to fight back. So I think it will scare off many people, this kind of language.

Aid Access cannot be stopped. I am not based in the United States, and I am practicing according to Austrian law and Austrian medical ethical guidelines and my own conscience. The other doctors that I work with, they are not working in South Dakota, so they wouldn’t be — it doesn’t affect them.

I think what is the problem with this, with what is being stated, is that the — so, these regulations, they can be applied to people within the states where these bans are being imposed. But with the other Supreme Court decisions, which are actually also — might even reduce the authority of some of the federal agents, we don’t know where it’s going to head.

AMY GOODMAN: It might surprise many in the United States to learn that already more than half the abortions in the United States are these medication abortions. Can you talk about side effects or what people should be concerned about?

DR. REBECCA GOMPERTS: Yes. So, I think it’s important to understand that this was also the consequence of COVID. With COVID, telemedicine has become mainstream medical care, overall. Not just abortion, but many of the medical services are delivered now by telemedicine.

So, the telemedical abortion services, which can only be done with abortion pills, it’s extremely safe. It’s the same as a miscarriage, and actually it’s safer than a miscarriage because people can plan it. You can plan to be near a first aid center when you take the — when a woman takes the pills. The side effects are bleeding and cramping, and sometimes women can have a little bit of nausea or diarrhea.

The complications are extremely rare, but I will mention them. Sometimes the pills don’t work. In 1% of the cases, they don’t work. But then you can repeat the doses, and then you have another 99% chance that it will work. Sometimes the abortion is not complete. And that is — what happens then is that women can experience too much bleeding. So, one of the things that people can do in order to treat that or prevent it is take an extra doses of misoprostol, which is the second drug, because the second drug is causing the contractions of the womb, which will then empty the womb, and so then the bleeding will stop, as well. And the other complication is an infection, which is even more rare, and it only happens when there is already a preexisting infection.

So, what we say is that there is a few symptoms that women have to watch out for, which is bleeding, which is more than two — filling up two maximum pads per hour for more than two hours, or it’s like opening a tap, or when people have a fever for more than 24 degrees. And in that case, they would need to look for medical care in order to check whether they need any follow-up care or not.

The pills are safe to use until 12 weeks of pregnancy. It’s supported by the World Heath Organization, home use 'til 12 weeks of pregnancy. However, research also shows that it's effective and safe to use after that time, up ’til 16, 17 weeks. So, what is important is that if people want to use it even later in pregnancy, that they are near a first aid facility, so that if there is a complication, that they can be treated.

Because it’s very similar to a miscarriage, they don’t have to say that they had an abortion; they can just say that they had a miscarriage, and there’s no way that any doctor or other healthcare provider will find out that they used the medication. Of course, there is concerns that people might be put under pressure to confess that they did the abortion themselves and that they might be criminalized. And so, sometimes the states are overstepping their boundaries. This happened in Texas when a woman was actually arrested after taking abortion drugs. But in the United States, women are not criminal when they induce their own abortions early in pregnancy. There is another organization called If/When/How, who is — will support women with legal assistance if they would face any legal problems.

AMY GOODMAN: And your reaction to this news that Instagram and Facebook are removing posts offering abortion pills, Dr. Gomperts?

DR. REBECCA GOMPERTS: Well, we have been censored, off and on, by Facebook and Instagram and Google and many of the other for more than 10 years. So this is one of the main problems. So, abortion pills is a solution for a large part of the people living in the United States. But the problem is, they will need to have to find the services that can be provided to them. And there, Google plays an important role. And the algorithms, they actually make it hard to find the services like Aid Access or any other online services that are available, on top of the censorship that’s there. And this is really unfortunately, and it’s really difficult to fight it, because these companies, they are not transparent. Nobody knows where to complain when this is happening. And so, there has to be a lot of public pressure put on them, I think, in the U.S. to make sure that instead of censoring it, they will promote these kind of posts.

One of the problems is that there will also be people now that are going to take advantage. So, there might be people that are saying that they are offering medication abortion, but they are not, and they are not providing it, and they’re just collecting money. And that is why these bans are so harmful, because it’s really making people vulnerable to abuse and misuse. And, of course, it will really discriminate against women that are in the most vulnerable socioeconomic circumstances, that, for example, don’t speak English very well, that are illiterate, that don’t know how to navigate the internet or how to find reliable information.

And what we also see happening now already is that the fear is tremendous. When we started Aid Access, we alway asked women if they would be willing to speak with the press about their experience and why they were looking for online care. And now — and there were many people that were willing to speak with the press. And now we see nobody wants to speak with press anymore, because everybody is scared.

AMY GOODMAN: Dr. Rebecca Gomperts, what motivated you to found Women on Waves?

DR. REBECCA GOMPERTS: So, I’m a medical doctor, and I’ve always been very invested in women’s health. And at a time, I also sailed with Greenpeace, which is an environmental organization. And when I was on the ship, this is how the conversation led to abortion services being illegal in some of the countries that I was visiting with the abortion — with Greenpeace. And so, this is how the idea came about, and that was the start of my work, which is more than 20 years now.

AMY GOODMAN: What exactly this movement is. I mean, it started with a boat.

DR. REBECCA GOMPERTS: Yes, it started with a boat.

AMY GOODMAN: But talk about what you did.

DR. REBECCA GOMPERTS: Basically, the idea was that if you have a ship that is registered in the Netherlands, then it’s Dutch law that applies on board the ship in international waters of countries where abortion is illegal.

So, what we did is we took the boat to countries like Ireland, Portugal, Morocco, Mexico, Guatemala and some others, where we went into the harbor with the ship, we take women on board in the harbor, then we sail outside territorial waters, which is 12 miles, so it’s about one, one-and-a-half hours’ sail. There they could receive the abortion pills. And then we sail back. And they have the miscarriage at home.

And so, this was a way to call attention to the inequalities that exist in between the different countries, but also the consequences of illegal abortion. And this is how Women on Waves started.

AMY GOODMAN: You have dealt with countries around the world where abortion is illegal. It’s much rarer where abortion is legal, as it was in the United States, for there to be this kind of regression back to, in certain parts of the country, make abortion access illegal. Are you concerned about women — though at this point it’s insisted that women themselves won’t go to jail. As you pointed out, in Texas, there was an example of a woman who went to the hospital for a miscarriage, talking to the doctors, talking about maybe having taken this pill, and she was directly arrested in South Texas — how this become increasingly common. And then if you could talk about — it’s unusual that you, as a doctor, could give not medical advice, but advice to people in this country, what it means to make abortion accessible and legal once again in the United States?

DR. REBECCA GOMPERTS: So, I want to add something to what is also something that is really concerning. What is happening when abortion is made illegal is that you also see that doctors are really reluctant to provide medical care to women that need it in pregnancy — for example, when they present with a miscarriage later in pregnancy or with an ectopic pregnancy — because they are afraid that they will be charged under the abortion laws.

So, there’s only a few countries where abortion has become more restrictive. One of them is Poland. In Poland, abortion was legal until 1993. When it became illegal, after that, what we saw is that the stigma and the fear was so big that you could hardly find any medical professions willing to speak in favor of legalizing again. And it’s become worse after that.

So, to reverse this decision will take another generation of activists to work really hard. The other — I mean, these Supreme Court judges are going to be there for 20, 30 years. So it will take another 20, 30 years before this might even be reversed again, this decision.

And the impact is immediate. The impact is immediate concerning the taboo, the shame, the fear. And, I mean, it’s already visible that it immediately happened in the U.S., where all the clinics in the states that implemented the trigger laws, they shut down. And even if you look at the reaction of the government, I mean, everybody is talking about how to stay within the law.

I think this is not a moment anymore to stay within the law. This is the moment to make sure that women have access to safe abortions despite the law and despite the fact that this — because this is such an unjust law that is creating so much social inequality and that will affect, really, the most poor women in the country.

AMY GOODMAN: And finally, this point that you raise about what actually happens now, in the end, it is not so much that women won’t be able to get abortion, although in many cases, and particularly for poorer women, it’s extremely, increasingly difficult to travel from one place to another, and it’s not clear that if someone helps someone travel — even getting on a bus, the bus driver could be, quote, “aiding and abetting.” The law is completely vague right now.


AMY GOODMAN: But that women will get abortions, as they did before 1973, when Roe v. Wade legalized it around the country, but it will be unsafe. The United States in 2022 goes back to back-alley abortions.

DR. REBECCA GOMPERTS: Well, I need to say, medical abortions, do by yourself, is not unsafe. Let me just say that straight. But I know, and that’s also something that we know from the emails that we received with Aid Access, that people will try to do other things to end a pregnancy if they don’t find help. So, we have had emails from people that have, you know, put things in their vagina and trying to put things in their wombs in order to induce the abortion, or started jumping off stairs, or started using all kinds of herbs. And that is unsafe, and nobody should do that, because that is really dangerous. But we also know that if people cannot find help readily or easy, then they will resort to these methods.

And the people that are still forced to continue their unwanted pregnancies and end in unwanted birth, the other reality is that the United States has extremely bad maternal healthcare. The maternity mortality is one in 5,000, which is four times as high as in Europe. And so, we will also see women that are going to die while they are forced to carry their pregnancy to term because of the really bad maternity care that’s being given.

AMY GOODMAN: So, Dr. Gomperts, can you talk about what your plans are for the future?

DR. REBECCA GOMPERTS: So, there’s different strategies that we have to follow. One is that women get access to abortion pills now. But you also have to look at the long-term strategy. And what we are developing now is we’re working on making mifepristone, the abortion pill, available as a once-a-week contraceptive and morning-after pill, so that you are blurring the line between anti-conception or contraception and what an abortion is. And this would be like really a method — a medicine that can be on demand, that women can use how they want, on their own terms, either as a contraceptive or as a morning-after pill.

And why we think it’s important is because this way, you can make it available as a contraceptive, which will be much less regulated, and possibly even over the counter in the future. And it’s very important because it doesn’t have the same side effects as the hormonal oral contraceptives that many women don’t want to use anymore because of the side effects.

AMY GOODMAN: And why can you just use one of the two pills?

DR. REBECCA GOMPERTS: Because this one, the mifepristone, is working to postpone or to block ovulation, and it has an impact on the endometrium itself. So, this pill alone, if you use it every week but in a lower doses, which is 50 milligrams, then it prevents pregnancy from happening. It also prevents pregnancy from happening when it’s used around sex, so as a morning-after pill.

AMY GOODMAN: And why hasn’t this been done before?

DR. REBECCA GOMPERTS: It’s because it’s not patented anymore, so the pharmaceutical companies are not interested in doing this research, and also because it has been registered as an abortion pill, so the pharmaceutical companies, they are scared to invest in something that they think that might not be successful to register as a contraceptive.

The medicine is also very effective against endometriosis and myoma. So it’s a very potent, very important medicine for women’s health. And so, because the pharmaceutical companies are not interested, that’s why we took it up, because it’s like when we started telemedical abortion 20 years ago, when everybody said, “It won’t succeed. It’s not going to work.” We really think this is going to be the future to make this medicine available on all the different indications that exist.

AMY GOODMAN: The Dutch doctor Rebecca Gomperts, speaking to us from Amsterdam, founder of groups Aid Access, Women on Waves and Women on Web.

That does it for our show. Tune in to our July 4th special Monday for more on the overturning of Roe and to hear James Earl Jones and Frederick Douglass’s — read his speech, “What to the Slave Is Your Fourth of July?”

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2024 Debate: Trump Lies About Abortions After Birth as Biden Fails to Defend Reproductive Rights

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