Underground networks for abortion pills appear as states limit access

Key Concepts

• Medication Abortion: Abortion achieved through the use of medications, primarily mifepristone and misoprostol.
• Underground Networks: Informal, often clandestine systems operating outside legal frameworks to provide access to abortion medication.
• Doulas: Support persons who assist individuals through pregnancy, childbirth, and postpartum. In this context, some doulas also facilitate access to abortion care.
• Roe v. Wade reversal: The Supreme Court's decision in 2022 that overturned the federal right to abortion, leading to increased restrictions and bans in many states.
• Mifepristone and Misoprostol: The two primary medications used in medication abortions.
• Controlled Substances: Drugs that are regulated by the government due to their potential for abuse or harm.
• Jane Collective: A historical underground organization that provided illegal abortions in the U.S. before Roe v. Wade.
• Midwifery: The practice of assisting women during pregnancy, childbirth, and the postpartum period.
• Encrypted Messaging Apps: Communication platforms that use encryption to secure messages, making them difficult to intercept.
• Resiliency: The capacity of a network or system to withstand and recover from disruptions.

Medication Abortion Access in a Post-Roe America

Rise of Medication Abortion and Legal Challenges

Medication abortions now constitute over 60% of all abortions in the United States, a significant increase from just 25% a decade ago. However, following the reversal of Roe v. Wade in 2022, abortion pills have been banned in at least 14 states. This has led to the emergence of underground networks that operate outside the legal system to ensure access to these medications.

Underground Networks and Doula Support

• Ashaba's Network: Ashaba, an anonymous teacher and part of an underground network, trains doulas in Chicago to provide support for pregnancy, childbirth, and also to help women end their pregnancies. Her network extends from Illinois to states like Tennessee, Mississippi, and Louisiana.
• Delivery of Supplies: Ashaba personally drives once a month through the South, delivering abortion pills and herbal remedies to fellow doulas who then distribute them to women in need.
• Empowerment and Autonomy: Ashaba emphasizes that these networks empower women to control their own bodies, particularly highlighting the experiences of Black and Indigenous women who may not feel heard in traditional medical settings.

Anti-Abortion Perspectives and Legal Actions

• Safety Concerns: Anti-abortion activists, such as John Seago, President of Texas Right to Life, argue that women cannot safely manage abortions at home without medical supervision.
• Texas Law: Texas lawmakers have implemented measures to halt the flow of abortion pills, including a law that allows private citizens to sue anyone distributing these pills to Texas residents. Seago states, "Texas has a state interest in protecting its citizens from the violence of abortion, both the mother and the child."
• Arguments Against Home Abortions: Seago criticizes the distribution of pills "in two little bags without medical instructions, without any oversight from a medical professional without any accountability for follow-up care." He deems this practice "too dangerous for women and their children."

Evidence of Medication Abortion Safety

• Global Usage: Abortion pills are widely used globally.
• U.S. Statistics: In the U.S., six out of ten women end a pregnancy using medication.
• Research Findings: Decades of research indicate that the risk of major complications from medication abortion is 0.4%, which is considered safer than commonly prescribed drugs like penicillin, Tylenol, or Viagra.

Risks and Motivations of Network Operators

• Legal Risks: Individuals involved in these underground networks acknowledge the significant legal risks, including potential jail time and the loss of everything they have worked for.
• Personal Motivation: Participants are driven by a desire to protect their daughters, friends, and loved ones, stating, "I know I cannot wait on a system that does not and has not cared for us."

Legal Reclassification and Law Enforcement Challenges

• Louisiana Law: In Louisiana, mifepristone and misoprostol have been reclassified as controlled substances, with possession without a valid prescription carrying a prison sentence of up to ten years.
• Difficulty in Disruption: Elisa Wells, co-founder of plancpills.org, notes that the decentralized nature of these networks makes them difficult for law enforcement to shut down, as they operate outside formal regulatory systems.

Historical Precedents and Inspiration for Networks

• Plan C Pills: Plan C Pills.org provides information and education on accessing abortion pills at home.
• International Models: The community networks are inspired by similar efforts in countries like Mexico and Poland.
• Legacy of the Jane Collective: These networks carry on the legacy of groups like the Jane Collective, which provided abortions when they were illegal.
• Historical Context: The practice of women supporting each other in reproductive health is traced back to midwifery and even to enslaved women using cotton root for contraception.

Healthcare Worker Networks and Mail-Order Services

• M and E's Network: In another part of the South, a group of healthcare workers, identified as M and E, have established their own network. This is particularly significant as many in their region previously had to travel two to three hours for abortion services.
• Mail Delivery: M and E mail abortion pills within their home state, sending them in plain envelopes without packaging to avoid detection.
• Focus on Authenticity: M and E note that recipients are more concerned about the authenticity of the pills than their safety, indicating the desperation of those seeking access.
• Motto and Adaptability: Their network operates under the motto, "We're going to move at the speed of trust." They prioritize being ready to "pivot" and adapt to changing legal landscapes, comparing themselves to a surfer ready for the waves.
• Capacity and Impact: Their group of five members can serve up to 100 people per month. Messages shared by M highlight the urgent needs of women facing unplanned pregnancies due to financial and emotional inability to care for a child.

Building Resiliency and Future Sustainability

• Network Support: The networks are designed for resilience, with members stepping in when others are unable to provide services due to events like weather.
• "Coyote" Analogy: The operators aim to be like coyotes, able to survive and adapt in changing environments.
• Local Sourcing: There is a vision of growing herbs locally for abortion care.
• Decentralized Structure: Ashaba's home in Louisiana is being prepared as a safe space for self-managed abortions, emphasizing that the network's strength lies in its decentralized nature, ensuring that if one member is affected, the entire network can continue to provide services.

Conclusion

The transcript details the growing reliance on medication abortion and the emergence of underground networks in response to state-level bans following the overturning of Roe v. Wade. These networks, often operated by doulas and healthcare workers, provide crucial access to abortion pills for individuals in restrictive states. Despite facing significant legal risks and opposition from anti-abortion groups, these networks are built on principles of community support, historical precedent, and a commitment to reproductive autonomy. Their operational strategies, including encrypted communication and a focus on resiliency, aim to ensure continued access to care in a challenging legal environment.