HOW DO WE FREE ABORTION?

A protester shouts at a counterdemonstration against an anti-abortion march in San Francisco, US, on the 40th anniversary of Roe v Wade in 2013. That ruling has since been repealed, stripping the constitutional right to abortion. STEPHEN LAM/REUTERS

17 June 2024

Bethany Rielly

Bethany Rielly learns how feminist movements are organizing to put abortion back in the hands of the people – and keep it there.


In a narrow street deep in Barcelona’s Raval district is a building with an inconspicuous oval hole in its facade. Above the wooden door is the faint lettering ‘Casa d’Infants Orfes’ (House of Orphaned Infants). From the Middle Ages up to the 19th century, women would place their newborn babies in the wooden hatch and rotate it, allowing the anonymous and safe delivery of the child to the orphanage. This small window into the past is emblematic of a time when the social stigma of having an illegitimate child and extreme poverty forced many women to abandon their child in the dead of night. Today in the US, conservatives are promoting a modern-day equivalent: the ‘baby box’.

An insulated pull-out drawer installed at police and fire stations, these boxes allow desperate women to give up their babies anonymously without fear of prosecution. Introduced in the 1990s to prevent the most extreme cases of child abandonment, the religious Right are now pushing to expand these ‘safe haven’ laws as an alternative to abortion.

In the two years since the US Supreme Court removed the constitutional right to abortion by quashing the 1973 Roe v Wade judgment, severe restrictions have been enacted in 41 states. Of those states, 14 now have total abortion bans.

This disturbing trajectory has sparked a global reckoning. It demands we interrogate the state of abortion rights globally to reveal how abortion is far from being universally accessible, safe and free from stigma – even in countries where it’s been legal for decades. Take Japan, where doctors ask for proof of spousal consent, or Britain, which requires authorization from two doctors. Why is abortion, defined by the World Health Organization (WHO) as a ‘simple and common healthcare procedure’, wrapped up in so much red tape?
BAD LAWS

Many of the regulations on legal abortion today do not make sense – on legal or public health grounds alike. Instead, they are a ‘reflection of stigma or how we treat abortion exceptionally in law’, explains Hazal Atay, a researcher on gender at Sciences Po Paris. ‘You wouldn't find any other healthcare service in a criminal or a penal code.’ Today abortion remains a ‘fragile right’ because even in countries where it’s legalized, it’s still treated as a crime with exceptions, she explains.

Atay speaks to me over Zoom from her home in Paris, where feminists have just celebrated a huge win after law-makers enshrined abortion rights in the French Constitution. While the move was undoubtedly a milestone, France is still not a safe haven for abortion. In fact, research shows that many French citizens travel abroad to seek care due to laws on gestational time limits: France’s legal limit on abortion is 14 weeks.

Silvia De Zordo, a researcher at the University of Barcelona, has studied this phenomenon. Her research found that between 2017 and 2018, over 3,800 women travelled from European countries where abortion is legal on demand or on broad grounds to Britain and the Netherlands, which permit abortions beyond the first trimester. There are many reasons why people might need abortions in the second trimester – defined as between 13 and 26 weeks of gestation – De Zordo tells me. Many don’t know they are pregnant until after the limit due to a lack of pregnancy symptoms, irregular periods or a wrong assessment by a doctor. These limits are harmful and delay care, she says. Aside from the financial and psychological toll of going abroad for the procedure – which disproportionately impacts low-income people – six per cent of survey respondents tried to end their pregnancy by hitting their abdomens or using medications not typically used for abortions to induce a miscarriage.

‘Gestational age limits are not evidence-based in any possible way, other-wise there would be the same limits everywhere,’ De Zordo says. ‘The reason that they [vary is] the result of a political compromise between different political forces in each country when abortion was legalized there.’

In 2022, the WHO issued new guidelines calling for ‘medically unnecessary policy barriers’ like criminalization, mandatory waiting times, consent from partners or family members and time limits to be removed, warning such barriers put women and girls at greater risk of unsafe abortion, stigmatization and health complications.

To date, Canada is the only country to have fully stripped abortion from its criminal code. The harm of criminalizing abortion came to the fore in Britain in 2022 when a mother was jailed for taking abortion pills beyond the legal limit. She was charged under a law dating back to 1861, sparking national outrage and prompting a landmark vote in Parliament to decriminalize abortion earlier this year. In Britain and around the world, many current abortion laws and policies are ‘not fit-for-purpose’ and when it comes to freeing abortion, law reform is only half the battle.




A woman plays the cello amid riot police at a demonstration for safe and legal abortion in Mexico City, on 28 September 2023. Earlier that month Mexico's Supreme Court decriminalized the procedure. RAQUEL CUNYA/ REUTERS

REVOLUTIONARY PILLS

Many abortion advocates also call for demedicalizing abortion to some degree, arguing that the medical profession itself has contributed to barriers and stigma. Abortion pills make this call a possibility. The drugs misoprostol and mifepristone have largely replaced ‘back-alley’ abortions, and the growth of medication abortion has been linked to a global reduction in annual deaths from unsafe abortion, from an estimated 115,000 to 204,000 women three decades ago to around 39,000 today.

This has forced researchers to rethink the relationship between safety and in-clinic care. Today WHO guidelines state that people who follow the protocol can safely and effectively self-manage their own abortions with pills, also known as medication abortions, for up to 12 weeks outside a clinic.

This is the preferred method for many, allowing them to avoid travel costs, taking time off work and finding child care.

Activists like Kinga Jelińska, of the Polish group Abortion Dream Team, have asked why medication that is proven to be safer than paracetamol isn't available over the counter at pharmacies.

‘It’s like we have a super-fast broadband but we’re still using telegrams,’ she said in a recent webinar.

Some formal steps towards demedicalization are being taken through tele-medicine. Countries like France, the US and Britain rolled out telemedicine during the pandemic, removing the requirement for patients to attend an in-person appointment to receive abortion pills. Instead, the pills are posted to them to take at home. This model is built on the pioneering work of feminist activist groups like Women on Web, which for 20 years has been sending abortion pills to people with unwanted pregnancies in countries where abortions are restricted. ‘Women on Web were the first to say “if it’s just a pill, why not allow direct access to it?”’ says Atay, who also works with the organization.

When abortion pills came on the market in the 1980s, countries were quick to restrict them because ‘[doctors] were so scared they’d normalize abortion’, explains Atay. ‘The requirement was absurd, that you have to take the pill in front of a medical practitioner, but it is just a pill and the doctor is not doing anything. In many countries abortion is not a right given to women and pregnant people, it’s a right given to medical doctors.’

‘In many countries abortion is not a right given to women and pregnant people, it’s a right given to medical doctors.’

Abortion pills that can be safely administered outside a medical setting puts abortion back in the hands of the people and allows them to circumvent bans. Advocates stress however, that the option of self-managed abortion should not negate the responsibility of states and healthcare services to provide abortion care, nor should it replace calls for decriminalization. Clinics are a vital part of a system that ensures pregnant people are able to access the type of abortion method that is right for them and to treat complications, which are rare but can happen.

‘It’s not an either/or question,’ Atay explains. ‘It’s a spectrum, and it’s a matter of adjusting it for the abortion-seekers themselves and not the medical profession. We want it to be healthcare that’s accessible for all.’

UNHOLY ALLIANCES

With headlines dominated by the abortion wars ahead of the US elections, it’s easy to lose sight of the fact that the overwhelming global trend has been towards liberalizing abortion. Over the past 30 years, more than 60 countries – including Benin, South Africa, Argentina and Colombia – have brought down legal barriers. Only four – Nicaragua, El Salvador, Poland and the United States – have bucked this trend. But this trajectory of liberalization is happening at the same time as the emergence and rapid growth of a sinister counterforce: the anti-gender movement.


This patriarchal, homophobic and transphobic conspiracy theory partly originated within the Catholic Church. It came about as a backlash to 1990s UN conferences on women’s rights in Cairo and Beijing that instilled a wider recognition that reproductive rights are human rights. The anti-gender movement today brings together a bizarre array of characters, including the Vatican, far-right politicians, European aristocrats and Russian oligarchs, who are all united by the belief that ‘gender ideology’ threatens the only true and moral way to live: as a patriarchal and nuclear family unit.

‘It’s not a real ideology or theory, it’s something made up which is used to describe everything they don’t like,’ explains Neil Datta, the founder of the European Parliamentary Forum for Sexual and Reproductive Rights, and an expert on the global anti-gender movement.

It’s a highly organized and well-funded international movement that has been ‘dynamized’ by the overturning of Roe v Wade to target not just abortion but also trans rights, gay marriage, feminism and sex education. ‘What happened in the US was the result of a 30-year strategy by the US Christian Right to infiltrate the justice system, showing the rest of the anti-rights ecosystem what strategies can work in their own countries,’ explains Datta. The movement’s influence is growing thanks to generous financing in part by the wealthy US Christian Right. According to Datta’s research over $700 million was given to ‘anti-gender’ campaigns in Europe from 2009 to 2018.

Today the movement is buoyed by around $150-160 million a year compared to $20 million in 2009. The epicentre of the movement is also shifting, he says, from civil society to far-right political parties such as Poland’s PiS, Spain’s Vox and the AfD of Germany, which are gaining popularity and entering the mainstream.


An anti-abortion demonstrator puts pieces of dolls into a storage container after harassing women entering a family planning clinic in Michigan , US, on 5 November 2022. EVELYN HOCKSTEIN/ REUTERS


In Europe, these perceived threats to ‘traditional values and the family’ feed into the racist Great Replacement conspiracy theory, which is the idea that native white populations are being ‘replaced’ by migration. ‘Some are motivated to attack abortion not in defence of life,’ Datta explains. ‘What they care about is that abortion means one less person of the desired background or race, and so in countries that are experiencing the very real challenge of demographic decline, abortion is seen as a national threat to their identity and preservation.’ This marriage of anti-abortion and anti-immigration thinking is epitomised in Hungary’s hard-right president Victor Orban, who has pursued stricter abortion rules at the same time as violent policies against migrants and refugees.
A HUMAN RIGHT

Resisting these threats to bodily autonomy today requires looking at abortion through the lens of reproductive justice, which sees abortion as a human right and challenges the idea of it simply as a matter of choice – something that has shaped abortion advocacy since the 1970s.

As US abortion activist Renee Bracey Sherman explains: ‘There could be no laws on abortion, but if you can’t afford one… what choice do you really have? And vice versa, if you want to continue a pregnancy but can't afford to take on another child, you don't have the choice either.’ The central pillars of reproductive justice, a phrase and framework coined by African American feminists Loretta Ross and Rickie Solinger, are bodily autonomy, the rights to have or not have children, and the ability to raise children free from state sanctioned violence in safe and sustainable communities. This framework embeds the fight for abortion rights into the wider struggle against racist and patriarchal systems of oppression.

A greater awareness of the human rights framework would also help counter the misuse of rights arguments by the opposition, Ross notes.

‘When people are claiming that they are fighting for the human rights of people who aren’t even here yet and violating the human rights of people who are here, they’re gaslighting you. When we read the Universal Declaration of Human Rights, it says very specifically, all humans are born equal in rights and dignity… it was the logical recognition that you have to be here to claim the damn rights.’

‘When we read the Universal Declaration of Human Rights, it says very specifically, all humans are born equal in rights and dignity… it was the logical recognition that you have to be here to claim the damn rights.’

BEYOND LEGAL CHANGE

Progress to date on abortion rights has been achieved largely through grassroots feminist movements, including those that that help people get abortions irrespective of the law and provide emotional support through the feminist practice of accompaniment. These strategies provide ways for people to continue accessing safer abortions in countries where the procedure is heavily restricted.

Feminist researchers argue that these groups are not just plugging the gap, but are also offering an alternative model and vision of care that centres the pregnant person and their needs.8 In doing so they are shifting the very idea of abortion from something that is medicalized and individualized to a process that is collective and centred on empathy and care. ‘In Latin America, the entire care infrastructure has been provided by friends, family and these networks of providers and activists,’ says Sandra Rodríguez, a Peruvian anthropologist whose research focuses on self-managed abortion. ‘There’s a lot the Global North can learn about this way of organizing.’ Indeed, today we see abortion activists in Mexico sending pills into the US and building networks of volunteers in Texas to help women access abortions.

As the rollback of abortion rights in some countries has reinvigorated anti-rights groups, so too has it dynamized feminist movements worldwide. This has helped moved the conversation on in ways that incorporate the diverse experiences of people who have abortions and the linked struggles with other justice and liberation movements, as well as tackling pervasive stigma.

‘Over the last few years, we’re being more radical around how we talk about abortion,’ says Camila Ochoa Mendoza, an abortion doula and reproductive justice activist. ‘You see activists in court hearings sharing the instructions for using [abortion] pills. We are unapologetic and taking up space rather than being on defence mode. It’s making people who have had abortions so much more seen.’

For Ochoa Mendoza, this is a vital part of the journey towards freeing abortion. On her podcast, Abortion, with Love, she challenges depictions of abortions as inherently traumatic and sad, and instead highlights the normality and many positive outcomes of abortion. ‘If we start with the basis that abortion is a human right, that abortion is an inherently good thing, how much further can we bring this conversation?’



WOMEN HELP WOMEN
An international activist-led organisation working on access to and support for self-managed abortion through different organizations

WOMEN ON WEB
A service providing safe access to abortion pills by mail to over 200 countries

IF WHEN HOW
A movement of lawyers providing support for reproduction-related criminal defense

WE TESTIFY
Elevates the voices and expertise of abortion storytellers

CENTER FOR REPRODUCTIVE RIGHTS
A global organisation to protect reproductive rights as fundamental human rights in law

REPRODUCTIVE JUSTICE: AN INTRODUCTION BY LORETTA J. ROSS AND RICKIE SOLINGER
An intersectional analysis of race, class, and gender politics

THE ABORTION DIARY
Provides a healing space for people to tell their abortion stories

ABORTION, WITH LOVE
A home for vital conversations about the complexities of abortion and reproductive justice

THE A-FILES
Unpacks the hidden history of abortion



This article is from the May-June 2024 issue
ABORTION: WHY IS YOUR BODY STILL A BATTLEGROUND?
SUBSCRIBE TODAY