Vermont might feel removed from the front line of the fight for reproductive justice. The state stands poised to pass some of the most comprehensive legal abortion protections in the nation with the expected approval of Proposal 5 (by voter referendum) on November 8th of this year. The amendment would make the already existing legal bulwark safeguarding a Vermonter’s access to abortion significantly more durable in the face of the reversal of Roe vs. Wade. This all comes at a time when other states, like Idaho, have effectively banned abortion.
But abortion advocates from Vermont may have a part to play going forward in post-Roe struggles for reproductive justice. Planned Parenthood officials predict an influx of people seeking abortions from out-of-state, and the same is true in all states where abortion will remain legal. A cohort of sympathetic would-be activists – perhaps you are one of them – will join the clamor of people seeking to cross state lines for abortion services, looking to extend a hand in solidarity to those in need. The first question that newcomers will have to answer: How can safe abortion access be extended to as many Americans as possible when offering in-person support entails traveling vast distances and exposing everyone involved to significant liability?
Defining the Problem
“For many years we talked about choice, and about a person’s choice whether or not to have an abortion,” says Vermont State Representative Maxine Grad (cosponsor of the Prop 5 amendment), stressing the importance of language in the debate, “If you don’t have access, then you can’t exercise your choice.” Representative Grad’s observation about the language used in the abortion debate echoes the pivot of Planned Parenthood and other advocacy groups away from pro-choice and pro-life messaging in recent years.
As Grad succinctly stated, fighting for the right to bodily autonomy is now recognized to be only a facet of the larger fight for reproductive justice. Put simply, it would be great if bodily autonomy were protected (as it was by Roe vs. Wade) however, if there aren’t any resources available to people with a protected right to choose abortion, then their right to choose becomes moot.
Reproductive Justice (a term first introduced into the debate in 1994 by activist women of color associated with the SisterSong Collective) stresses the health disparities experienced by communities of color, the impoverished, and those who live in rural areas. It differs from the conversation around choice in that it focuses on health disparities between marginalized communities and white communities with financial means.
As the map of where someone can and cannot legally access abortion care becomes more restricted, those who seek an abortion will be faced with an impossible decision: travel great distances and put themselves and any provider that offers care in legal jeopardy, or seek a self-managed abortion. The World Health Organization found that nations with restrictive abortion policies did not experience any decreased quantity of abortions. Moreover they experienced an increase in what the WHO characterized as “unsafe abortions.” This restrictive climate will, of course, disproportionately affect people of color who account for the majority of abortions in the US.1See Rachel K. Jones & Jenna Jerman, “Population Group Abortion Rates and Lifetime Incidence of Abortion: United States, 2008–2014,”American Journal of Public Health 107, no. 12 (December 1, 2017): pp. 1904-1909; and Sarah K. Redd et al, “Racial/ethnic and educational inequities in restrictive abortion policy variation and adverse birth outcomes in the United States,”BMC Health Serv Res21, 1139 (2021).
The WHO report outlines three major pillars of “Quality comprehensive abortion care,” which boil down to: “A supportive framework of law and policy”; readily available, trustworthy information; and a universal, functional healthcare system. Those who fall between the widening cracks of our adversarial legal climate – not to mention our failed healthcare system – will be faced with the need to perform a self-managed abortion.
As the WHO report on abortion emphasizes, those seeking abortions will likely attempt it regardless of the availability of medical professionals and legal protections. For many without access to accurate and safe information this could lead to medical complications , which could place them in legal jeopardy should they seek medical care in the aftermath.
Avenues of Support
For those hoping to take legislative action against new abortion restrictions, the fight will be arduous. It will require strategies tailored to match the challenges posed in various states. A brief examination of the anti-abortion movement after Roe reveals that organizers piloted a grassroots efforts involving, among other things, five decades of holding elected officials to their word.
In Vermont, as well as California and New York, broad constitutional protection is likely to be implemented via popular referendum. Many more states are engaged in legislative and judicial actions that would offer expanded protections for their citizens seeking reproductive care. This approach is certain to drag on for many years, and won’t be of much use to people in states with bans in place.
There is only so much Americans can do via policy at the local level to benefit those living in states with strict anti-abortion policies. “I hope [Vermont’s laws] will be a model for other legislators,” says Representative Grad, but “there need to be networks to provide care.” She expects that in the coming months Vermont legislators will discuss the legal hazards for Vermont reproductive care providers offering care to out-of-state residents (from states in which anyone aiding in an abortion is legally liable – even across state lines).
Grad advises allies to seek involvement with local and regional Planned Parenthood, which goes beyond donating money. Those offering volunteer and organizational support can do so through groups like Planned Parenthood Defenders, who protect patients from the harassment of anti-abortion protesters and organize carpooling efforts. A tidal wave of donations and volunteer support immediately following the repeal has meant that many of these facilities are actually overwhelmed by the sheer volume of volunteer interest while facilities in states with bans are locked in a holding pattern; determining if they will exist long enough to accept volunteer work.
The National Network of Abortion Funds (and its local affiliates) directly fund transportation and medical costs associated with seeking reproductive care. These organizations are a good place to start for those seeking to offer monetary support.
The need for safe and accurate information about obtaining and performing safe home-abortions is more critical than ever. The rates of unsafe abortions will increase with the passing of restrictive laws. The experience and knowledge of midwives and seasoned activists is more important than ever. Newcomers to this fight could examine the methods and expertise of activists in countries where abortion has always been illegal (Brazil being the first case study).2See Coelho, Helena L., et al. “Misoprostol: The experience of women in Fortaleza, Brazil.” An International Reproductive Health Journal: Contraception, (1994) vol. 49, no. 2, pp. 101-110. Contraceptionjournal.org, https://doi.org/10.1016/0010-7824(94)90084-1. Furthermore, parallel struggles for reproductive healthcare in marginalized groups like sex workers may be invaluable experience for those interested in taking direct action.
Understanding Medical Abortion
There are two major types of abortions carried out by, or under the advisement of, medical professionals. The surgical abortion is what most anti-abortion rhetoric highlights. What is often seen as the ‘alternative’ is actually the most common form of abortion in the United States. Medical Abortion (M.A.) using the drug misoprostol (with or without a pretreatment of mifepristone) is effective and safe for home abortions in the first ten weeks of pregnancy, and accounted for 54% of abortions in 2020.3See Jones, Rachel K., et al. “Medication Abortion Now Accounts for More Than Half of All US Abortions.” Guttmacher Institute, (2022). Guttmacher.org, https://www.guttmacher.org/article/2022/02/medication-abortion-now-accounts-more-half-all-us-abortions.
The treatment is most effective with the administration of both drugs. Mifepristone is taken first, blocking the pregnancy hormone progesterone, thereby softening the uterine lining. It is then followed by a regiment of misoprostol, causing contraction of the uterus. In combination the drugs are up to 93% effective at inducing abortion in the first 70 days of pregnacy. However, a meta-analysis of trials using only misoprostol demonstrated that misoprostol alone is at least 78% effective at inducing abortion in patients in their first trimester (<93 days).4See Raymond EG, Harrison MS, Weaver MA. “Efficacy of Misoprostol Alone for First-Trimester Medical Abortion: A Systematic Review.” Obstet Gynecol, (Jan, 2019) vol 133(1), pp. 137-147. Ncbi.nlm.gov, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6309472/ This window is where the bulk of legal abortions occurred while Roe was in effect (91% of abortions occur before the first 13 weeks).5See Jatlaoui TC, Eckhaus L, Mandel MG, et al. “Abortion Surveillance — United States, 2016.” MMWR Surveill Summ, (2019) vol 68, no. SS-11, pp. 1–41. CDC.gov, https://www.cdc.gov/mmwr/volumes/68/ss/ss6811a1.htm?s_cid=ss6811a1_w The first and most accessible form of direct action anyone can take right now is disseminating information about medical abortion to communities under abortion bans.
Misoprostol was originally developed for use as an ulcer medication, but in Latin American countries like Brazil, women seeking abortions quickly picked up on its effecacy in inducing contractions. It is important that those seeking this treatment understand precisely how many days they have been pregnant and therefore how to dose the medicine, information which is provided in multiple languages by Women Help Women.
In the few instances where use of misoprostol is ineffective in inducing complete abortion, or causes excessive bleeding or other medical concerns, patients can go to the doctor and report a suspected miscarriage without fear of being held liable. The medical treatment of miscarriage and misoprostol induced contractions are exactly the same, and as long as the patient used the drug under their tongue, there is no way to determine whether an abortion was attempted.
Over reliance on any single regulated pharmaceutical introduces the risk that it will be sold on the black market, and that these sources will be inconsistent. Misoprostol is already becoming increasingly difficult to obtain for ulcerative care in many states, and prices have inflated since the beginning of the year. One only has to look at the struggle of people living with AIDS in the 80s and 90s to see how difficult it can be to obtain life-saving treatments in an adverse climate.
If one has the means to purchase abortion pills in states where it is legal, then one could theoretically furnish someone in need with the medicine and information to use it. Activists have emphasized the importance of being involved in coordinated support networks in order to connect with those in need. Furthermore, anyone involved with such efforts would have to be diligent about hiding their identities to avoid prosecution. Will people who support reproductive freedom be willing to transport a person or mail them pills if there is a weighty prison sentence attached to it? This is a dilemma many could face, and they’d have to decide for themselves.
Those who engage in such civil disobedience (which to many is a necessary part of extending life-saving care in states with bans) would require vigilance. After all, it is incredibly easy to place anyone involved in legal jeopardy without taking steps to ensure data privacy. Creating a new social media account under a fake name would likely not be enough. Some activists have found ways around these constraints, such as the members of Hacking and Hustling, who offer digital training to interrupt violence directed at sex workers and survivors.
Mutual Aid Hub catalogs mutual aid groups nationwide, and is recognized as a robust resource for building experience and connections. Without a coordinated plan the efforts of activists may actually impede effective action. Activists who go out and buy black market abortion pills (thereby driving up the market price) would probably do better to be in regular, secure contact with an at-risk community to understand their needs and how to help.
Ideally, mutual aid would facilitate the autonomy of those in need to access abortions, which means connecting them with information. Plan C and Aid Access are organizations that quickly connect people to doctors abroad and ship medicine from trusted sources for as low as $110. The impact of sharing this information with someone in need is profound, and significantly harder to track and prosecute. Finally, supporting communities and clinics already engaged in this struggle is as important as any other action people are taking. Abortion Access Front is an example of an organization providing this kind of support and is another inroad for new activists.
Though the scope of the tragedy is overwhelming, the best way to support those in need may not be to drive someone across state lines, nor to stockpile black market drugs for distribution. Direct action can take a myriad of forms, and activists have learned that it is best to begin by connecting with local mutual aid groups. Legal (or physical) retaliation poses a real risk to activists involved in support networks, and many have found that it is important to be well informed and prepared. It is likely that the struggle for reproductive justice will be long and arduous; communities of mutual aid and support are likely to be the most robust and enduring forms of assistance for those in need.