Nearly a decade ago, Francine Coeytaux, a public health expert who has spent more than thirty years developing and evaluating reproductive health programs around the world, walked into a pharmacy in the Ethiopian highlands and bought a Medical Termination of Pregnancy kit for $5.
The kit contained mifepristone and misoprostol, drugs that have been used internationally since the late 1980s to safely terminate unwanted pregnancies.
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“Although the Food and Drug Administration approved medical abortion during the first ten weeks of pregnancy in 2000, our doctors and clinics had largely not embraced it,” Coeytaux tells The Progressive. “Even though 90 percent of early abortions in Europe are medical, when I returned from Africa, I realized that we had to let people here [in the United States] know that this technology existed. We needed, and still need, to make sure people understand that this is a legitimate way to end a pregnancy.”
In 2013, Coeytaux and Elisa Wells, another longtime family planning and reproductive health specialist, started Plan C to provide concrete information about accessing the drugs. The Plan C website has since expanded to include information about the various laws in all fifty states. In addition, Plan C provides step-by-step guidance about what to expect, including signs of rare infection or other complications that can occur after taking the medication; the group does not sell the drugs but instead provides referrals to reputable online vendors.
Interest in Plan C is booming. Coeytaux reports that, in the two weeks following Texas’s draconian ban on abortion (known as SB 8) after the sixth week of pregnancy took effect on September 1, traffic to the Plan C website increased by 2,357 percent, with 30 percent of those visits coming from Texas. By mid-September, she says the group had raised $69,000 from donors wanting to do something to help promote self-managed care.
“Abortion is unstoppable” says Erin Matson, executive director of the national direct-action group ReproAction. “As much as abortion opponents try to restrict access, they will never be able to stop it. You can’t put these pills back in the bottle.”
But the government can, and has, made them difficult to acquire.
According to the New York City-based Guttmacher Institute, fourteen states require a doctor to be present when a patient takes the first drug, a progesterone blocker called mifepristone (also called mifeprex) that prevents the pregnancy from developing. Additionally, twenty-six states require patients to have an ultrasound, and twelve mandate in-person counseling before the medications can be dispensed. Thirty-two states bar the pills from being distributed by anyone other than a licensed physician.
“Abortion is a common good, but we don’t say the word abortion out loud very often.”
Such restrictions, of course, essentially ban telemedicine in these places. This, despite the fact that twenty-two states and, D.C. have successfully used telemedicine to counsel patients who—as long as their last menstrual cycle began less than seventy days earlier—can easily receive the pills via the U.S. mail.
Reproductive health activists say that this is how it should be and they are working hard to make the pills more readily available. They’re also helping people navigate the roadblocks and obstacles that make acquisition difficult.
But despite the evident impediments, Coeytaux remains enthusiastic about self-managed abortion and notes that numerous groups have stepped up to offer the pills by mail in areas where it is legal to do so—including Choix; Hey Jane; and Honey Bee Health, an online pharmacy.
“People are eager for information on self-managed care,” ReproAction’s Matson says. “We did a teach-in about the pills in front of the [U.S.] Supreme Court a few weeks ago and went through all of the protocols. Over the next few months and years, we plan to host house parties all over the country to help people understand that the primary risk of medication abortion is not medical, but legal.”
Matson adds that, while ReproAction stresses that the pills are safe and effective, in many states it is illegal to order them online; already twenty-four people have been arrested and prosecuted for unlawfully obtaining the drugs. This, they say, is why complications—the most common being heavy and prolonged bleeding, a fever, or digestive discomfort—should be presented as a miscarriage if it becomes necessary to seek post-pill aftercare.
“There is no blood test to screen for abortion pills in the bloodstream,” Matson explains.
Still, as important as it is to get the word out about Plan C to the widest possible audience, Lizz Winstead, founder and chief creative officer of the Abortion Access Front (AAF), described on their website as “a coven of hilarious badass feminists,” cautions that activists need to move beyond pill access to reframe how we discuss abortion more generally.
“Abortion is a common good, but we don’t say the word abortion out loud very often,” Winstead explains. “We see our work at AAF as reminding folks that independent clinics are jewels in our communities.”
The AAF will be launching a YouTube program in December. “Viewers will hear from abortion providers, lawyers, and activists who are fighting for reproductive justice,” Winstead says. “We’ll also make it fun, with comedians and musicians, and every episode will have an action component.”
In the meantime, the AAF will join other groups and individuals concerned about abortion and reproductive justice in the Rallies in Support of Reproductive Rights set to take place throughout the country on October 2.
”We need to grow the conversation about abortion and Plan C among doctors and clinicans,” Winstead adds. “But it’s also important that we do more than that. Abortion has to be normalized. We have to push back against the so-called respectable people who continually present abortion as a necessary tragedy.”
(NOTE: While the FDA concedes that medical abortion is safe, it cautions against taking the pills if you have an ectopic pregnancy, have any adrenal gland problems or inherited porphyria, have an IUD in place, or take corticosteroid or anti-coagulant medications.)
Riley Gunderson