No Man’s Land

by Kate Van Brocklin

Illustration by Allison Grosso

published April 27, 2013

Click “I Need an Abortion,” and you will be led through a medical consultation and referred to a licensed doctor who will ensure that a medical abortion pill is delivered to you. On the caveat is that the doctor can only help the patient if she lives in a country where access to safe abortion is restricted, is less than 9 weeks pregnant, and has no severe illnesses. With the use of the pills Mifepristone and Misoprostol, women can now perform safe abortions on themselves.

Worldwide, abortion contributes to 13 percent of maternal mortality. In 2006, Dutch physician Rebecca Gomperts, a former resident doctor for Greenpeace, created Women on Web with the intent of providing services for women who seek to end an unwanted pregnancy but are limited by the laws of their country. Women on Waves, its sister organization, was founded in 1999 by Gomperts as an international nongovernmental organization headquartered in Amsterdam. Women on Waves provides abortions and advice from boats anchored in international waters near countries where abortion is illegal. The idea for Women on Web emerged in 2004 after the Portuguese government blocked the Women on Waves ship campaign from entering Portuguese waters because the Minister of Defense said Women on Waves was “a threat to national security and health.” In reaction to this, Gomperts went on a Portuguese talk show and explained what Misoprostol is, how women can get it in a pharmacy, and how women can perform an abortion on themselves. This dispersal of information through television sparked the idea for Women on Web. The website offers information to ensure that it’s theoretically possible for women in every country (North Korea, Saudi Arabia, and Libya included) to do drug-induced abortions in their own homes.

“This organization recognizes that every woman has the human right to scientific information and to the benefits of science,” said Susan Yanow, a consultant to Women on Waves and Women on Web. The website has a help desk, working in over 13 different languages at every hour of the day, that guides women through the process of procuring the necessary pills. Between 40 and 50 people work on Women on Web at any given time, sending about 100,000 emails a year to women in over 130 countries. The organization is a self-sustaining service; after women go through an online consultation, they are encouraged to make a 90 euro donation at the end if they complete the whole process. If a woman can’t pay, or can only pay partially, the service is still provided.

The website states that “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.” Mifepristone and Misoprostol are the two medicines that Women on Web disperses information about and supplies free of charge. These drugs provide the “safest, most effective type of medical abortion” a woman can perform on herself. Both drugs are on the World Health Organization’s (WHO) list of essential medicines, and Misoprostol is often available in many countries where abortions are illegal. Misoprostol is sold under a number of brand names in different countries and has multiple uses: it prevents gastric ulcers and treats rheumatoid arthritis. It can induce labor and prevent postpartum hemmoraging (PPH) in addition to inducing a safe abortion. PPH is the leading cause of maternal mortality worldwide.

Women on Web features an online diary called “I had an abortion” where women can choose to write entries about their abortion experiences. Anjali Sidhu from India wrote about using Mifepristone and Misoprostol tablets on her own. “I had a very safe and painless abortion without any complications,” Sidhu said. When asked about how the illegality of her abortion affected her feelings, Sidhu responded, “No, the illegality didn’t affect me, because my health is more important than any rule or law.”

Mifepristone blocks the hormone progesterone, which is necessary to maintain a pregnancy. Based on research by the WHO Department of Reproductive Health and Research in 2012, using Misoprostol to cause an abortion will be successful 90 percent of the time within the first nine weeks of pregnancy. In Morocco, for example, a woman can go to a pharmacy and buy Misoprostol for the equivalent of 10 US dollars and use it to perform a safe abortion on herself. Abortion procedures are illegal in Morocco unless the woman’s life is at risk.

“It’s a beautiful loophole in the system,” Julia EllisKahana B’13, an intern at Women on Waves, explains of the organization. Women on Waves operates one ship that takes women into international waters to perform safe, legal medical abortions up until six and a half weeks of pregnancy, in accordance with Dutch law. Women on Waves made its maiden voyage aboard the Aurora to Ireland in 2001. The ship carried two Dutch doctors and one Dutch nurse. EllisKahana calls it a symbol of mobility, but it’s more than that.

The ship can reach many countries where abortion is illegal, so long as they aren’t landlocked. Since 2001, the ship has traveled to Ireland, Poland, Portugal, Spain, and Morocco. Each campaign lasts about a week and the ship makes a few voyages to and from international waters throughout its stay. The group also averages 200 women aboard its ship for its open houses, where leaflets about safe abortion and birth control are distributed. In the Ireland ship campaign diary, featured on the Women on Waves website, the group writes that it is usually greeted by “eggs and paint being thrown at [them] while at the same time supporters are screaming ‘Welcome! Welcome!’”

The idea of bringing women to international waters to perform abortions is innovative—but it’s not cost-efficient. The ship campaigns are meant to function more as a symbolic gesture rather than a practical solution to a problem of facilitating access to abortion in countries where it remains illegal.

Before the ship departs, organizers work to establish partnership programs. Women on Waves has safe abortion hotlines in 11 different countries. Partners range from local NGOs to informal social justice groups. The most recent hotline was established in Morocco in October of 2012 as part of the safe abortion ship campaign. The Alternative Movement for Individual Freedoms (MALI) invited Women on Waves to come to Morocco with its ship. Abortion is illegal and taboo in Morocco, but approximately 600 to 800 women still have abortions every day, according to figures published by the Moroccan government. While wealthy women can afford safe abortion access by leaving the country, women
of low socio-economic status must often resort to unsafe methods that can result in complications and death.

While informational hotlines are incredibly useful, by publicizing information on home-induced abortions, organizations like Women on Web unintentionally threaten accessibility. If the organization has all this information, so does the government. Ultimately though, Women on Web feels the benefits of publicizing it outweigh the negative aspects.

“The local women’s movement, they didn’t know about Misoprostol,” Gomperts said in an interview with The Daily Beast, explaining the benefits of her organization’s awareness campaigns. “Nobody I talked with in Morocco in preparation for the campaign had any idea about the availability of Misoprostol.” But often, the premise of the organizations hinges on technological accessibility, which inevitably limits who they can serve. “The organizations recognize that not every woman who needs a safe abortion has access to the internet,” Yanow said. Despite the looming threat of censorship and the challenge of dispersing information to women, WoW aims to break the silence about abortion.

KATE VAN BROCKLIN B’13 hinges on technological accessibility.