Q & A Abortion

The Last Resort: An Interview With an Underground Provider of Abortion Medication

Robin Marty

An underground provider of abortion medication to women in desperate circumstances agreed to do an extensive interview with Rewire to explain exactly what she does, and why she is willing to put her own freedom at risk to help women in need.

Editors’ note: History and current events underscore that when women face rapidly diminishing access to safe, legal abortion care, they will take matters into their own hands. Rewire neither endorses nor condemns the efforts of those such as the person interviewed below—individuals who provide women with supplies of abortion medications and information on their use. Rather, we recognize her efforts as one inevitable response to the rapid elimination of access to safe abortion care in the United States.

What follows is a lightly edited interview, which was conducted recently by email.

Rewire has verified the claims made in this interview.

For years, she’s been reading their emails. Desperate, scared, broke women write to her, wanting to terminate a pregnancy without turning to sharp instruments, unknown drugs, or old wives’ tales. The woman interviewed below, who once wrote an online manual of do-it-yourself abortion techniques, offers them whatever help she can—usually an envelope of drugs, words of advice, and a warning to go to the hospital if anything goes wrong, because there is no punishment from authorities worse than losing their lives.

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She has no medical training; she is a former journalist. Still, as anti-choice lawmakers across the country steadily eliminate access to safe, legal abortion care, she provides medications that induce miscarriage, and is one of an unknown number of sources to which pregnant women turn when they run out of money and options. She wrote about her experience in a recent piece for Jezebel, and agreed to do an extensive interview with Rewire to explain exactly what she does, and why she is willing to put her own freedom at risk to help pregnant people in need.

Rewire: Explain what you do as an underground abortion provider, and how you came to do it.

Anonymous: I send pills—misoprostol and mifepristone—to women who are in need of an abortion and have no way of obtaining one through legal channels. I started because I got desperate letters from women, and because at that time I was already buying my birth control through an international pharmacy, I already knew a reliable source for some medications. I’ve never had an abortion myself. People always look for that as the big reason [why I do this]—”Did you need an abortion and it was tough to get?”—that kind of thing. My reasons are political; there’s no personal abortion narrative that started me in this work.

Rewire: Why are you willing to risk so many things, like your liberty, your financial security, or your family, to do this?

A: Because it’s terribly important. When I was 17 years old, something traumatic happened to me—I don’t want to get into the details, and it wasn’t abortion-related, but I was sure I wouldn’t live through the night. After living through that night, not a lot scares me. Certainly not prison. Also, as far as the financial security aspect goes, you can’t risk something you’ve never had. My background is blue-collar, and I’ve lived near or below the poverty line for most of my adult life.

Rewire: A lot of what you do sounds modeled after Women on Waves (an international organization that gets medication to women in countries where abortion is illegal). Do you consider yourself to be a WoW for women in the United States?

A: I’m not, but what a compliment! They have better organization and more money than I do. I don’t even have a job right now; I’m on unemployment. But more importantly, I don’t know that having any kind of centralized organization distributing abortion pills is necessarily the right solution for the United States.

That’s because in the United States, our law enforcement can have very politicized priorities. Having one single, coordinated network means one big sting, and it’s all over. That’s what worries me most, by the way: that I’m out here alone doing this, and that if I’m arrested, other people will be intimidated into the status quo.

We need something different in the 21st century to make sure this [work] is bigger than one person. I think that the best way for this “organization” to work is by women saying, “I’m part of this. Today, this starts.” She starts to research, she starts to really do her homework, understand these pills. And then, within her networks of trust, she educates other women with the same knowledge, and helps them do their own research as well so nothing gets lost like a game of “telephone.”

I think that strikes a lot of people as scary. We talk a lot about women being in control of their own bodies, but when confronted with this—the ultimate reality of women taking decentralized control—people start getting freaked out.

They say, well, these pills aren’t safe. They’re safer than giving birth! Once you’re already up pregnancy creek, there is no perfect paddle that lets you opt out of danger.

The safety thing’s a canard, anyway. Imagine a literally perfectly safe abortion pill. No drug interactions, no side effects, just a painless, safe abortion on demand. Do you really think all these people who [are calling for] “safety” today would just say, “Oh, now it’s perfectly fine, keep a bottle in the bathroom cabinet”? No, of course not, and I think we all know that. It’s really not about safety, and never has been. It’s about who has control over women’s bodies.

Rewire: You mentioned the issue of potential counterfeit medication with respect to mifepristone. How do you ensure that the drugs you receive are safe, and is there any way for those who obtain drugs from someone who isn’t you to be sure that they have legitimate medication?

A: The truth is, I can’t take every pill to make sure they’re what they say they are. Chemical assays would cost a lot of money that I don’t have. Usually if a drug is counterfeit, it doesn’t mean someone put a dangerous active ingredient in—dangerous active ingredients cost more than sugar and fillers, and the whole point of counterfeiting is to make money.

There isn’t a good way to know I’m sendingreal pills, or that I’m even a person who wants to help and isn’t trying to hurt women with poison or bad pills. That’s why I’m emphasizing building networks of trust, communities of people who know how to do these things, groups of friends where you know which person has the pills and knows how to use them.

My advice to women is to trust themselves, and each other—to learn and make this part of their basic medical knowledge, the way you’d know what to do for first aid or CPR. Don’t trust strangers. Do research about online pharmacies from forums where people have talked about other types of hormonal medication—trans* groups actually have a ton of resources for finding legit online pharmacies, because a lot of trans* women get their hormones overseas.

Rewire: How do women find you in the first place? Is it all word-of-mouth? Do they hear from others who have worked with you?

A: They usually find a very old blog post that I wrote about how to perform abortions. You have to be getting pretty desperate to start looking up how to perform one yourself—that’s the level the women are at when they come to me. They’re considering sticking things into themselves to end their pregnancy. They’re in absolute panic.

Rewire: How do you safeguard the information and contacts of those who email you, given that you could potentially be arrested and your computer files searched?

A: Their messages are deleted about a week or so after I mail their pills. Just about any additional safeguards I could put in place are useless. When you send me an email, it’s possible Google and/or the government will take a look. That’s yet another reason I think women should create these smaller, trusted networks.

Rewire: Have you seen an increase in demand as new bills have been put into place across the country? Is there any one issue that people cite most often as the reason they cannot use a provider at a clinic?

A: I’ve personally seen it slowing down, because my blog has been down for a while and people don’t find me as much any more. Part of that is because I’ve been operating with more caution these days, to some extent. One of my hard and fast rules has always been “If someone seems sketchy, trust your instincts and don’t send the pills.” I won’t respond to emails that seem like something’s … not quite right. My instincts aren’t perfect—no one’s are—but so far they’ve kept me out of trouble.

Most women who contact me have multiple problems, but I’d say the single biggest one is that women who have kids, if they live far from an abortion clinic, have a nightmare getting child care arranged. There’s so much stigma. Waiting periods mean you can’t just take one afternoon away “for a doctor’s visit.”

Profiteers are already moving into this “market.” When I started sending pills, years ago, that didn’t happen as much. With the new laws, I think that’s the change I’ve really seen happening—a true black market, complete with all the counterfeiting and mistrust that entails.

Rewire: You’ve mentioned the risk that you are taking that could land you in jail. We’ve seen a number of cases where those who either have induced their own miscarriages or are suspected of having induced their miscarriages are also being threatened with criminal consequences. Do you talk to your recipients about this? Do they express any concerns, or seem determined to terminate anyway?

A: Interestingly, almost every woman who emails me says in their initial email that they know they could get in trouble. It seems like most of the women who get desperate enough to email a stranger, well, they’re literally taking their lives in their hands. When women are ready to do that, it seems like jail is a consequence they’ve thought about and consider actually “worth it” if it means terminating a pregnancy.

Rewire: Do they seem worried about going to a hospital if there are complications?

A: Every woman I ever send pills to gets a full warning about complications. I tell them what a hemorrhage looks like as opposed to a normal amount of bleeding. I tell them that when in doubt, go to the hospital—no consequence they will inflict is worse than dying.

Rewire: Do you see illegal providers as heroes, and do you think there are predators in the mix as well?

A: I think rather than predators, what we’re seeing a lot of right now is profiteers. The rest of the drug war has shown that when you make drugs illegal, you don’t make them unavailable. You don’t make them not a public health problem. You just push them underground and put them into the hands of the black market.

People on Silk Road, which is a “darknet” site where people sell everything from fake handbags to crack cocaine, are selling abortion pills for $500. In border towns, the “flea market abortion” is the new back-alley abortion—you buy misoprostol quietly at a flea market. There may be a few other women like me. I don’t know. Some part of me wishes we could be friends, but it’s probably better not to know them—if I get in trouble, I don’t want anyone else to.

Rewire: In an ideal world, pregnant people wouldn’t need underground providers like you to exist. What series of changes do you think would best make an underground abortion network disappear for good?

A: Abortion pills in my local pharmacy or my general practitioners’ office, after a brief consultation, for a reasonable fee—the pills themselves should not cost more than $50. Abortion education for girls. Giving women control over their bodies means giving women control over their bodies, not making up safety concerns that no one seems to have when it comes to women giving birth.

I think the pro-choice movement has been playing defense for so many years that it has forgotten to fight for more than just stopping bad laws. Women’s activism at the grassroots level can help change that. If abortion pills are in all our hands anyhow, that’s when people start talking about more legalization, normalizing access. It’s working with marijuana, and it’ll work with mifepristone/misoprostol, if women work together.

Rewire: Finally, what would you tell a “pro-life” activist condemning what you do? Or even a pro-choice activist condemning it as putting pregnant people at risk or legal abortion at risk? Do you have concerns that what you do could in some way be used to make abortion even less accessible by making it appear more dangerous?

A: I think “pro-life” and pro-choice activists don’t talk enough to each other. I think we can actually sometimes find unusual common ground. I think that while a lot of the people at the top of the pro-life movement are cynical and misogynistic, a lot of the pro-life rank-and-file are people who are honestly well-intentioned and have been told a lot of lies. I think the biggest disservice that the reproductive justice movement does itself is when it thinks of pro-lifers as monolithic. I prefer to take my anti-abortion critics on, one at a time.

If a pro-choice activist’s criticism is that it seems unsafe—if they have a problem with what I’d call the “stranger danger” aspect of this whole Jane 2.0 thing—I think that’s a fair criticism, and I’ve tried to address a lot of that here. If they think that I’m bringing bad publicity to the movement, then we’ll just have to agree to disagree, because I think that at this point, just about any civil disobedience for reproductive justice is good civil disobedience.

The day they make it illegal to import these medications, so that pharmacies won’t mail them anymore, I’ll start booking trans-Pacific flights to keep obtaining these medicines. I won’t stop until they stop me—either by arresting me, or by putting reproductive choices into the hands of women for real, no apologies, no excuses.

News Politics

Clinton Campaign Announces Tim Kaine as Pick for Vice President

Ally Boguhn

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

The Clinton campaign announced Friday that Sen. Tim Kaine (R-VA) has been selected to join Hillary Clinton’s ticket as her vice presidential candidate.

“I’m thrilled to announce my running mate, @TimKaine, a man who’s devoted his life to fighting for others,” said Clinton in a tweet.

“.@TimKaine is a relentless optimist who believes no problem is unsolvable if you put in the work to solve it,” she added.

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

Kaine signed two letters this week calling for the regulations on banks to be eased, according to a Wednesday report published by the Huffington Post, thereby ”setting himself up as a figure willing to do battle with the progressive wing of the party.”

Charles Chamberlain, executive director of the progressive political action committee Democracy for America, told the New York Times that Kaine’s selection “could be disastrous for our efforts to defeat Donald Trump in the fall” given the senator’s apparent support of the Trans-Pacific Partnership (TPP). Just before Clinton’s campaign made the official announcement that Kaine had been selected, the senator praised the TPP during an interview with the Intercept, though he signaled he had ultimately not decided how he would vote on the matter.

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Kaine’s record on reproductive rights has also generated controversy as news began to circulate that he was being considered to join Clinton’s ticket. Though Kaine recently argued in favor of providing Planned Parenthood with access to funding to fight the Zika virus and signed on as a co-sponsor of the Women’s Health Protection Act—which would prohibit states and the federal government from enacting restrictions on abortion that aren’t applied to comparable medical services—he has also been vocal about his personal opposition to abortion.

In a June interview on NBC’s Meet the Press, Kaine told host Chuck Todd he was “personally” opposed to abortion. He went on, however, to affirm that he still believed “not just as a matter of politics, but even as a matter of morality, that matters about reproduction and intimacy and relationships and contraception are in the personal realm. They’re moral decisions for individuals to make for themselves. And the last thing we need is government intruding into those personal decisions.”

As Rewire has previously reported, though Kaine may have a 100 percent rating for his time in the Senate from Planned Parenthood Action Fund, the campaign website for his 2005 run for governor of Virginia promised he would “work in good faith to reduce abortions” by enforcing Virginia’s “restrictions on abortion and passing an enforceable ban on partial birth abortion that protects the life and health of the mother.”

As governor, Kaine did support some existing restrictions on abortion, including Virginia’s parental consent law and a so-called informed consent law. He also signed a 2009 measure that created “Choose Life” license plates in the state, and gave a percentage of the proceeds to a crisis pregnancy network.

Regardless of Clinton’s vice president pick, the “center of gravity in the Democratic Party has shifted in a bold, populist, progressive direction,” said Stephanie Taylor, co-founder of the Progressive Change Campaign Committee, in an emailed statement. “It’s now more important than ever that Hillary Clinton run an aggressive campaign on core economic ideas like expanding Social Security, debt-free college, Wall Street reform, and yes, stopping the TPP. It’s the best way to unite the Democratic Party, and stop Republicans from winning over swing voters on bread-and-butter issues.”

Roundups Sexual Health

This Week in Sex: The Sexually Transmitted Infections Edition

Martha Kempner

A new Zika case suggests the virus can be transmitted from an infected woman to a male partner. And, in other news, HPV-related cancers are on the rise, and an experimental chlamydia vaccine shows signs of promise.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Zika May Have Been Sexually Transmitted From a Woman to Her Male Partner

A new case suggests that males may be infected with the Zika virus through unprotected sex with female partners. Researchers have known for a while that men can infect their partners through penetrative sexual intercourse, but this is the first suspected case of sexual transmission from a woman.

The case involves a New York City woman who is in her early 20s and traveled to a country with high rates of the mosquito-borne virus (her name and the specific country where she traveled have not been released). The woman, who experienced stomach cramps and a headache while waiting for her flight back to New York, reported one act of sexual intercourse without a condom the day she returned from her trip. The following day, her symptoms became worse and included fever, fatigue, a rash, and tingling in her hands and feet. Two days later, she visited her primary-care provider and tests confirmed she had the Zika virus.

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A few days after that (seven days after intercourse), her male partner, also in his 20s, began feeling similar symptoms. He had a rash, a fever, and also conjunctivitis (pink eye). He, too, was diagnosed with Zika. After meeting with him, public health officials in the New York City confirmed that he had not traveled out of the country nor had he been recently bit by a mosquito. This leaves sexual transmission from his partner as the most likely cause of his infection, though further tests are being done.

The Centers for Disease Control and Prevention (CDC)’s recommendations for preventing Zika have been based on the assumption that virus was spread from a male to a receptive partner. Therefore the recommendations had been that pregnant women whose male partners had traveled or lived in a place where Zika virus is spreading use condoms or abstain from sex during the pregnancy. For those couples for whom pregnancy is not an issue, the CDC recommended that men who had traveled to countries with Zika outbreaks and had symptoms of the virus, use condoms or abstain from sex for six months after their trip. It also suggested that men who traveled but don’t have symptoms use condoms for at least eight weeks.

Based on this case—the first to suggest female-to-male transmission—the CDC may extend these recommendations to couples in which a female traveled to a country with an outbreak.

More Signs of Gonorrhea’s Growing Antibiotic Resistance

Last week, the CDC released new data on gonorrhea and warned once again that the bacteria that causes this common sexually transmitted infection (STI) is becoming resistant to the antibiotics used to treat it.

There are about 350,000 cases of gonorrhea reported each year, but it is estimated that 800,000 cases really occur with many going undiagnosed and untreated. Once easily treatable with antibiotics, the bacteria Neisseria gonorrhoeae has steadily gained resistance to whole classes of antibiotics over the decades. By the 1980s, penicillin no longer worked to treat it, and in 2007 the CDC stopped recommending the use of fluoroquinolones. Now, cephalosporins are the only class of drugs that work. The recommended treatment involves a combination of ceftriaxone (an injectable cephalosporin) and azithromycin (an oral antibiotic).

Unfortunately, the data released last week—which comes from analysis of more than 5,000 samples of gonorrhea (called isolates) collected from STI clinics across the country—shows that the bacteria is developing resistance to these drugs as well. In fact, the percentage of gonorrhea isolates with decreased susceptibility to azithromycin increased more than 300 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent).

Though no cases of treatment failure has been reported in the United States, this is a troubling sign of what may be coming. Dr. Gail Bolan, director of CDC’s Division of STD Prevention, said in a press release: “It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persists. We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it.”

HPV-Related Cancers Up Despite Vaccine 

The CDC also released new data this month showing an increase in HPV-associated cancers between 2008 and 2012 compared with the previous five-year period. HPV or human papillomavirus is an extremely common sexually transmitted infection. In fact, HPV is so common that the CDC believes most sexually active adults will get it at some point in their lives. Many cases of HPV clear spontaneously with no medical intervention, but certain types of the virus cause cancer of the cervix, vulva, penis, anus, mouth, and neck.

The CDC’s new data suggests that an average of 38,793 HPV-associated cancers were diagnosed each year between 2008 and 2012. This is a 17 percent increase from about 33,000 each year between 2004 and 2008. This is a particularly unfortunate trend given that the newest available vaccine—Gardasil 9—can prevent the types of HPV most often linked to cancer. In fact, researchers estimated that the majority of cancers found in the recent data (about 28,000 each year) were caused by types of the virus that could be prevented by the vaccine.

Unfortunately, as Rewire has reported, the vaccine is often mired in controversy and far fewer young people have received it than get most other recommended vaccines. In 2014, only 40 percent of girls and 22 percent of boys ages 13 to 17 had received all three recommended doses of the vaccine. In comparison, nearly 80 percent of young people in this age group had received the vaccine that protects against meningitis.

In response to the newest data, Dr. Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center, told HealthDay:

In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer. Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe.

Making Inroads Toward a Chlamydia Vaccine

An article published in the journal Vaccine shows that researchers have made progress with a new vaccine to prevent chlamydia. According to lead researcher David Bulir of the M. G. DeGroote Institute for Infectious Disease Research at Canada’s McMaster University, efforts to create a vaccine have been underway for decades, but this is the first formulation to show success.

In 2014, there were 1.4 million reported cases of chlamydia in the United States. While this bacterial infection can be easily treated with antibiotics, it often goes undiagnosed because many people show no symptoms. Untreated chlamydia can lead to pelvic inflammatory disease, which can leave scar tissue in the fallopian tubes or uterus and ultimately result in infertility.

The experimental vaccine was created by Canadian researchers who used pieces of the bacteria that causes chlamydia to form an antigen they called BD584. The hope was that the antigen could prompt the body’s immune system to fight the chlamydia bacteria if exposed to it.

Researchers gave BD584 to mice using a nasal spray, and then exposed them to chlamydia. The results were very promising. The mice who received the spray cleared the infection faster than the mice who did not. Moreover, the mice given the nasal spray were less likely to show symptoms of infection, such as bacterial shedding from the vagina or fluid blockages of the fallopian tubes.

There are many steps to go before this vaccine could become available. The researchers need to test it on other strains of the bacteria and in other animals before testing it in humans. And, of course, experience with the HPV vaccine shows that there’s work to be done to make sure people get vaccines that prevent STIs even after they’re invented. Nonetheless, a vaccine to prevent chlamydia would be a great victory in our ongoing fight against STIs and their health consequences, and we here at This Week in Sex are happy to end on a bit of a positive note.