Sunday, August 31, 2014

The Dawn of the Post-Clinic Abortion

In June 2001, under a cloud-streaked sky, Rebecca Gomperts set out from the Dutch port of Scheveningen in a rented 110-foot ship bound for Ireland. Lashed to the deck was a shipping container, freshly painted light blue and stocked with packets of mifepristone (which used to be called RU-486) and misoprostol. The pills are given to women in the first trimester to induce a miscarriage. Medical abortion, as this procedure is called, had recently become available in the Netherlands. But use of misoprostol and mifepristone to end a pregnancy was illegal in Ireland, where abortion by any means remains against the law, with few exceptions.

Gomperts is a general-practice physician and activist. She first assisted with an abortion 20 years ago on a trip to Guinea, just before she finished medical school in Amsterdam. Three years later, Gomperts went to work as a ship’s doctor on a Greenpeace vessel. Landing in Mexico, she met a girl who was raising her younger siblings because her mother had died during a botched illegal abortion. When the ship traveled to Costa Rica and Panama, women told her about hardships they suffered because they didn’t have access to the procedure. “It was not part of my medical training to talk about illegal abortion and the public-health impact it has,” Gomperts told me this summer. “In those intense discussions with women, it really hit me.”

When she returned to the Netherlands, Gomperts decided she wanted to figure out how to help women like the ones she had met. She did some legal and medical research and concluded that in a Dutch-registered ship governed by Dutch law, she could sail into the harbor of a country where abortion is illegal, take women on board, bring them into international waters, give them the pills at sea and send them home to miscarry. Calling the effort Women on Waves, she chose Dublin as her first destination.

Ten women each gave Gomperts 10,000 Dutch guilders (about $5,500), part of the money needed to rent a boat and pay for a crew. But to comply with Dutch law, she also had to build a mobile abortion clinic. Tapping contacts she made a decade earlier, when she attended art school at night while studying medicine, she got in touch with Joep van Lieshout, a well-known Dutch artist, and persuaded him to design the clinic. They applied for funds from the national arts council and built it together inside the shipping container. When the transport ministry threatened to revoke the ship’s authorization because of the container on deck, van Lieshout faxed them a certificate decreeing the clinic a functional work of art, titled “a-portable.” The ship was allowed to sail, and van Lieshout later showed a mock-up of the clinic at the Venice Biennale.

As the boat sailed toward Dublin, Gomperts and her shipmates readied their store of pills and fielded calls from the press and emails from hundreds of Irish women seeking appointments. The onslaught of interest took them by surprise. So did a controversy that was starting to brew back home. Conservative politicians in the Netherlands denounced Gomperts for potentially breaking a law that required a special license for any doctor to provide an abortion after six and a half weeks of pregnancy. Gomperts had applied for it a few months earlier and received no reply. She set sail anyway, planning to perform abortions only up to six and a half weeks if the license did not come through.

When Gomperts’s ship docked in Dublin, she still didn’t have the license. Irish women’s groups were divided over what to do. Gomperts decided she couldn’t go ahead without their united support and told a group of reporters and protesters that she wouldn’t be able to give out a single pill. “This is just the first of many trips that we plan to make,” she said from the shore, wrapped in a blanket, a scene that is captured in “Vessel,” a documentary about her work that will be released this winter. Gomperts was accused of misleading women. A headline in The Telegraph in London read: “Abortion Boat Admits Dublin Voyage Was a Publicity Sham.”

Gomperts set sail again two years later, this time resolving to perform abortions only up to six and a half weeks. She went to Poland first and to Portugal in 2004. The Portuguese minister of defense sent two warships to stop the boat, then just 12 miles offshore, from entering national waters. No local boat could be found to ferry out the women who were waiting onshore. “In the beginning we were very pissed off, thinking the campaign was failing because the ship couldn’t get in,” one Portuguese activist says in “Vessel.” “But at a certain point, we realized that was the best thing that could ever happen. Because we had media coverage from everywhere.”

Without consulting her local allies, Gomperts changed strategy. She appeared on a Portuguese talk show, held up a pack of pills on-screen and explained exactly how women could induce an abortion at home — specifying the number of pills they needed to take, at intervals, and warning that they might feel pain. A Portuguese anti-abortion campaigner who was also on the show challenged the ship’s operation on legal grounds. “Excuse me,” Gomperts said. “I really think you should not talk about things that you don’t know anything about, O.K. . . . I know what I can do within the law.” Looking directly at him, she added, “Concerning pregnancy, you’re a man, you can walk away when your girlfriend is pregnant. I’m pregnant now, and I had an abortion when I was — a long time ago. And I’m very happy that I have the choice to continue my pregnancy how I want, and that I had the choice to end it when I needed it.” She pointed at the man. “You have never given birth, so you don’t know what it means to do that.”

Two and a half years later, Portugal legalized abortion. As word of Gomperts’s TV appearance spread, activists in other countries saw it as a breakthrough. Gomperts had communicated directly to women what was still, in many places, a well-kept secret: There were pills on the market with the power to end a pregnancy. Emails from women all over the world poured into Women on Waves, asking about the medication and how to get it. Gomperts wanted to help women “give themselves permission” to take the pills, as she puts it, with as little involvement by the government, or the medical profession, as possible. She realized that there was an easier way to do this than showing up in a port. She didn’t need a ship. She just needed the Internet.

by Emily Bazelon, NY Times |  Read more:
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