A little-known European medical team is set to become one of the most important groups in the changing landscape of abortion bans in the United States.
Aid Access, an online-only service run by a Dutch doctor, Dr. Rebecca Gomperts, began shipping abortion pills to Americans from overseas four years ago. The organization’s team consists of about four doctors overseeing about 10 medical staff, and they are difficult to reach for US authorities because they are all out of the country and they ship pills from a pharmacy. in India.
Opponents of abortion rights have so far found themselves largely powerless to stop Aid Access from sending abortion pills to even the most conservative corners of the country, at least until the organization’s opponents control the White House. It transformed Aid Access almost overnight from an obscure group overseas into a vital part of the effort to maintain access to abortion nationwide.
“It’s the only clinically backed service that sends couriers to states where abortion telehealth is banned,” said Ushma Upadhyay, associate professor of obstetrics, gynecology and reproductive sciences at the University of California to San Francisco.
Gomperts, who founded Aid Access in 2018, said she has no plans to change her job now that the Supreme Court has overturned Roe v. Wade. Aid Access has received 4,000 requests a day since Roe v. Wade, she said, compared to 600 to 700 a day before.
Last year, after Texas banned abortions after about six weeks of pregnancy, state orders tripled in the weeks after the law took 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 increasing our capacity again, so we can respond to all the requests we receive.”
The steps are relatively simple: potential patients visit the Aid Access website and answer a series of questions, including how long they’ve been pregnant and if someone is forcing them to have an abortion. The medical team reviews the responses and can write prescriptions that are sent to pharmacies. For pills from India, the process may take a few weeks. Gomperts said the organization prioritizes pregnant women over those who want to stockpile pills for the future.
About 25 people work on a help desk to answer patient questions, with three people at any one time, Gomperts said. Aid Access charges $110 to $150 depending on where the patient is.
The ease of the process makes Aid Access another example of how a global internet can frustrate and upset local law enforcement — at least until now.
James Bopp, general counsel for the National Committee for the Right to Life, said that without presidential oversight or new federal law, his organization or its allies who oppose abortion rights will not couldn’t do much against a group based outside of the United States.
“The reality is that state laws have limited extraterritorial effects,” he said. “There’s no doubt that the federal government has a lot more authority, and we’re hoping to put them on our side to make these state laws a lot more effective.”
A medical abortion usually involves five pills of two different drugs. Women take one tablet of mifepristone, followed a day or two later by four tablets of misoprostol.
The pills became easier to get during the pandemic, when a federal judge and then the Biden administration allowed patients to get them without going to clinics in person. Medical abortions accounted for 54% of abortions in the United States in 2020, according to the Guttmacher Institute, a research institute that supports abortion rights. In 2011, the share was 24%.
But even before Roe’s overturn, 19 states had banned the use of telemedicine for medical 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, according to an NBC News tracker of state laws.
Gomperts said Aid Access hears the confusion and fear of women in the United States
“Those affected are poor women in red states that have these trigger laws,” she said. “There is so much social injustice being committed – again and again and again, towards the most vulnerable part of the population.”
Other online pharmacies will ship abortion pills to states where abortion is banned, according to the website of advocacy group Plan C, but experts said accessing help is different because it is based outside the United States, has staff members available to answer questions, and has cooperated with outside researchers.
“We know it’s safe because it’s one of the self-managed abortion options we’ve been able to study,” said Dr. Abigail Aiken, medical associate professor of public affairs at the University of Texas at Austin. , who researched access to help.
About 96% of those who used Aid Access abortion pills said they successfully terminated their pregnancy without surgery, according to a study published by Aiken this year. About 1% said they had received treatment such as antibiotics or blood transfusions, and no deaths were reported.
“They’re really a non-profit humanitarian organization, not a business like an online pharmacy,” Aiken said.
Gomperts founded Aid Access in response to the tightening of US abortion access laws. She already ran a similar service, called Women on Web, in other countries, and Aid Access received 57,506 inquiries from people in the United States in its first two years.
“It was clear in recent years that access to the United States was becoming increasingly difficult. We started primarily by helping servicewomen in Iraq and Afghanistan, South Korea and Japan,” she said, because US servicemen in those countries had limited access.
Gomperts’ resume made her a hero in the abortion rights movement; she performed abortions in international waters off Portugal and other countries where abortion was restricted, and she used drones to deliver pills to Northern Ireland in defiance of the authorities.
Time magazine named Gomperts one of its 100 most influential people of 2020, and in a tribute to the magazine, Cecile Richards, the former president of Planned Parenthood, called her “one of the most brave that I know”.
“She is living 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 limit access to medical care, to licensed skilled medical care, people are more likely to seek unsafe abortion – and that’s what kills, unsafe abortion .”
Aid Access has faced a hostile US presidency before. In March 2019, under President Donald Trump, the Food and Drug Administration issued a warning letter asking Aid Access to cease operations. Aid Access refused and sued the FDA to block any potential action. The agency never responded to his request. Last week, an FDA spokesperson had no immediate comment on the agency’s plans, if any, regarding access to aid.
The agency’s stance could change if an opponent of abortion rights becomes president. But at the state level, said Dr. Richard Hearn, an Idaho physician and attorney who represented Aid Access, regulators and prosecutors could have as much trouble banning the organization as their counterparts did. to stop the importation of alcohol during Prohibition in the 1920s.
“No state like Texas or Idaho will be able to do anything for 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, Attorney General Merrick Garland said states can’t enforce bans on abortion pills because the FDA approved the scheme, which prevents state action. . The issue is already the subject of litigation in federal court in Mississippi, where a generic maker of mifepristone is suing to block state restrictions.
It’s unclear whether a state or federal prosecutor plans to pursue the lawsuit against Aid Access directly. The Mississippi attorney general’s office, which argued the case that led to the Supreme Court’s ruling last month, did not respond to a request for comment.
“Trying to quit mifepristone and misoprostol is simply futile. They are perfectly safe, especially in the beginning,” Hearn said.
Nevertheless, opponents of abortion rights have proposed even harsher penalties for online prescriptions of abortion pills. The National Committee for the Right to Life has posted a model state law on its website that, if states pass it, would make it a crime to maintain a website with instructions for self-directed abortions, but its application would remain a challenge.
One of the few things that limits the reach of Aid Access is that it is not yet well known. Gomperts criticized social media apps such as Instagram and Facebook for deleting posts about abortion services.
“Freedom of speech is one of the main constitutional rights in the United States, but because of these laws, even that right is under strain because people are so scared,” she said.
Lack of awareness is something abortion rights advocates and some doctors hope to change, even if Aid Access becomes a lightning rod similar to Planned Parenthood.
Gomperts said his goal was that access to help would eventually become useless.
“It shouldn’t be a foreign organization,” she said. “What should happen ultimately is that states like New York and California, liberal states, should just allow doctors and providers to ship the pills to the other states.”