They call it the Pill Pipeline or Abortion Without Borders, and it’s a telemedicine “charity service” called Women on Web that provides women abortion pills through the mail if they can’t legally get one in their country.
Women on Web promotes two campaigns: the “I had an abortion” campaign, in which women share their stories to destigmatize abortion; and the “I need an abortion” campaign, where women can find information about having an abortion by mail-order pills.
“A medical abortion can be done safely at home as long as you have good information and have access to emergency medical care in the rare case that there are complications,” Women on Web states. An online doctor can help a woman seeking an abortion if
- you live in a country where access to safe abortion is restricted [not just illegal, but restricted, however that is defined]
- you are less than 10 weeks pregnant [since an ultrasound isn’t absolutely required, how will the by-mail pill providers know]
- you have no severe illnesses [again, there is no way to regulate this]
Before the online consultation is done, the woman is advised to do a pregnancy test and an ultrasound, “if possible.” She is then asked a series of questions, her case is given to a doctor for review, and once the case is approved, the abortion pill is shipped. If she is able, the woman is asked to make a donation to the service. All information remains confidential.
Northern Ireland, which has outlawed abortion, is a common recipient of Women on Web services as women have been provided a way to get around the law. This connects Northern Ireland to countries across the globe in a web of abortion by mail, presented by Women on Web as a kind of health support network based on the act of charity.
While the service claims to be only for countries where abortion is restricted, women in nations that have made abortion legal are clamoring to get the pills, even if they have to be transported across the border from countries where abortion is outlawed.
In the UK, where abortion is legal, many women aren’t able to get an abortion because of lack of access under the socialized healthcare system. Waiting time in some areas is over three weeks, which might push women past the timeframe in which they can get a chemical abortion by pill. So they are turning to the international pill pipeline to get their abortion by mail.
In the United States, as hundreds of thousands of people descend on the nation’s capitol to protest abortion in the March for Life, with Donald Trump becoming the third sitting president to address the event, the pill pipeline is quietly snaking its way across the globe to make abortion more accessible.
Abortion by mail is already making headway in the United States as the research and technical assistance organization, Gynuity, has been providing women the abortion pill by mail as part of a study in four U.S. states.
The Gynuity study is allowing women in Maine, Hawaii, Washington and Oregon to confer with a doctor from home via video chat, and then get the pills delivered to their homes by mail. In California, women may soon be offered an even more streamlined medication-by-mail option. In Hawaii, the American Civil Liberties Union recently filed a lawsuit that could open the door to ordinary doctors nationwide prescribing the pill, and women picking it up at their local pharmacies.
“I feel optimistic,” said Francine Coeytaux, co-director of Plan C, an abortion-rights project that hopes to offer pills by mail in California soon via a demonstration study, and then expand to other states as well. Plan C offers a website with information about pill-based abortion and anticipates that established international telemedicine-abortion initiatives, such as Women on Web, will find a way to ship pills to women in the U.S.
“It’s not about what we’re doing. It’s a fact. It’s happening. It has so much potential, and there are so many ways in which it’s beginning to happen, that nobody’s going to be able to stop this,” Coeytaux said.
Twenty states have prohibited abortion via telemedicine since 2011, with the Supreme Court reversing the ban in Iowa. But through efforts such as those by Women on Web, laws have only become nuisances to circumvent.
Anti-abortion activists are trying to get this practice stopped, but little has been done about international schemes.
“We’ve been working with our state affiliates to stop (pill-based abortion), prevent this, protect the babies and mothers any way we can, whether it is preventing telemedicine from being used for chemical (pill-based) abortions or making sure that women can reverse the abortion if they act quickly enough,” Carol Tobias, president of the National Right to Life Committee, told the Chicago Tribune. “Certainly that’s been something we’ve been focusing on, and we will continue to do so.”
Abortion pills have been provided by mail and through video conferencing in the United States since 2008, but the process is still limited for Americans.
The woman still has to get to a clinic, and the median distance to an abortion clinic is 180 miles or more in three states (North Dakota, South Dakota and Wyoming), as well as in large portions of states such as Texas, Alaska, Kansas and Nebraska, according to a 2017 study in The Lancet Public Health, which found the number of abortion clinics declined 6 percent from 2011 to 2014.
Gynuity Senior Medical Associate Dr. Elizabeth Raymond points to the dramatic example of Hawaii, where only two of the five most populous islands have abortion clinics.
Until recently, that meant that if a woman on another island wanted an abortion, she had to fly to Maui or Oahu, said Raymond.
But under the Gynuity study, a woman living on another island can get an ultrasound and bloodwork close to home, then video chat with a doctor on Oahu. The pills arrive by mail, no plane flight required.
Whether it’s a teenager who doesn’t want to miss school or a busy professional woman who doesn’t want to be sidetracked with an involved procedure, the abortion pill is a compelling option, especially if it comes through the mail — and advocates of the process want to make it even more convenient.
Gynuity hopes to expand its medication-by-mail study to more states this year, and Coeytaux is working on a Plan C study that would allow California women to get abortion medication by mail without blood tests or an ultrasound.
As pro-lifers protest to make abortion illegal, they need to be aware of this new front in the battle for life, and it’s a big one. As Web for Women shows us, evil has no borders.