This is FRESH AIR. I'm Terry Gross. An abortion underground is mobilizing in preparation for the weakening or end of Roe v. Wade. It's expected that in June, the Supreme Court will decide on the constitutionality of a Mississippi law that directly challenges Roe. If the law is upheld, which many court watchers expect it to be, abortion law will be determined at the state level. My guest, journalist Jessica Bruder, wrote the cover story in the new edition of The Atlantic. It's titled "The Abortion Underground."
Jessica Bruder, welcome to FRESH AIR. How did you first find out about the abortion underground?
JESSICA BRUDER: In a pretty backwards way. I was - during the pandemic, just doing a lot of poking around on the internet. And I was reading the conference schedule for something called HOPE - Hackers On Planet Earth - from 2020. And there was a session that wasn't like most of the other sessions. It wasn't about privacy. It wasn't about coding. It was called Hackers In A Post Roe v. Wade World. And I watched with rapt attention as a woman who went by the name Maggie Mayhem talked about parts of abortion history that I didn't know about, in particular, the invention of a device called the Del-Em 1971 that was used to help women safely get underground abortions before Roe legalized abortion. And just the fact that nowadays people were still talking about this really fascinated me. And for me, that was what cracked the door into a world that was much wider than what I knew.
GROSS: You met a woman who actually showed you the device that you refer to that was created shortly before abortion was legalized. And you describe it as looking like a cross between an at-home brewing kit and a seventh-grade science experiment. So tell us what this device is made of.
BRUDER: So this is a device with a few components. One of them is a needleless syringe, which creates suction. The other most important one is something called a cannula. It is a flexible plastic tube that's used to be introduced into the uterus and is used also for suction. In the middle, there is a mason jar that's connected to both of those elements using aquarium tubing. And there's also a one-way valve that prevents backflow.
This is basically a homemade version of what was been - what had been used at the time as a relatively novel underground solution for abortion that was created by the owner of a clinic that was illegal at the time. His name was Harvey Karman. And he'd invented this soft cannula, which was actually much less traumatic than the standard medical procedures at the time. They started referring to his method as a lunch-hour abortion because women were able to go in for the procedure and then go on about their business, you know, maybe a half hour later without any time needed to recuperate. So the underground adapted that and wanted to create a version that women could make on their own and implement in the absence of legalized abortion.
GROSS: So is that happening now? Are people, like, reviving that now in preparation for the possibility of abortion becoming illegal?
BRUDER: Yes and no. For a lot of people, it's totemic. It's a symbol that even when abortion was illegal last time, people found a workaround. There is a small number of people who are taking an interest in it and passing the knowledge around. There are other people who say, well, look, this is an early version of something called a manual vacuum aspiration kit, which is mass produced now and used by doctors and can be found and purchased. So why not just use that? The majority of people who are talking about self-managing abortion, they're referring to using abortion pills, which accounted for more than 50% of abortions last year.
So that's really the mainstream underground and aboveground tool for abortion in first trimester now. But some people are saying, look, we need to have all the tools on the table that we can possibly have. The pills will never be a one-size-fits-all solution for everyone, no procedure or drug ever is. So there are people and activists who want to teach manual vacuum aspiration and the Del-Em just so women have all the tools available if they lose the right to have an abortion.
GROSS: You attended a session in which you witnessed a demonstration of how this kind of device can be used to perform an abortion. So tell us a little bit about what your reaction was and how safe you thought this was for women to administer to other women.
BRUDER: It was surprisingly anticlimactic, actually. I had done so much reading about this device and its use and talked to so many people that when I was actually there, I don't want to say it was boring, but there was nothing that shocking about it. I had already spoken with this professor emeritus of obstetrics and gynecology at Stanford, and we'd been speaking a lot about how manual vacuum aspiration in countries in South and Southeast Asia is something that technicians have been trained to do successfully for a very long time. And he had told me that he believes laypeople can be trained on wielding vacuum aspiration devices without much of a risk of infection, that this is something that one didn't necessarily need a medical degree to learn how to do, that it wasn't actually a complicated procedure.
GROSS: Is there a network of women who have been trained to do this and are willing to risk their safety by performing illegal abortions?
BRUDER: Absolutely. So there's a network of people in general who refer to themselves as community providers. And the idea is a community provider could be anybody who's willing to connect women with abortion pills who might not otherwise be able to get them, or in some cases, offer alternate options. I spoke at length with an American midwife who lives in Canada and described to me that she performed hundreds of abortions, some of them with a Del-Em, but also with commercially made manual vacuum aspiration kits, with abortion pills, with herbs.
And, you know, she was telling me also that, look, the clinic, for all sorts of reasons, hasn't always been the answer for everyone. Some people really want to do this at home and want to do it in a different sort of environment. So from her perspective, this wasn't even a matter of Roe v. Wade getting overturned possibly. This was just something that midwives had been participating in forever and something that was about body autonomy in a way and self-determination. And that was very new to me hearing that.
GROSS: So tell us more about the different facets, the different aspects of the abortion underground, because there's different branches of it.
BRUDER: There are also sorts of people doing this work. And the abortion underground, admittedly, is a very kind of rough and lumpy umbrella to shade them all. So there are groups that are trying to help get women access to the pill, even if it becomes difficult. So that ranges from activists in Mexico, for example, where abortion has now been decriminalized and where a drug called misoprostol, which is also used for stomach ulcers and induces abortions when used correctly, has been legal over-the-counter forever. So we've had people crossing the border for that. And there are Mexican activists who now want to help American women get the pill.
We also have groups like Aid Access, which was founded by a Dutch doctor who originally started something called Women on Waves, where she was piloting a boat to places that didn't allow abortion and then bringing women into international waters where they could take abortion pills. She more recently started something called Aid Access, which is a telemedicine service that provides the pills to women in all 50 states, regardless of whether a state has banned them.
GROSS: You describe one group as outfitting bulletproof vans that can travel to different states where abortion is illegal and perform abortions and then get out of town. Tell us about that.
BRUDER: Yeah, absolutely. That is a group called Abortion on Demand. And even though they want their vans to be stealthy, they're not even deep underground. This is a group that used to be called Just The Pill that began providing abortion pills via telemedicine when restrictions were loosened early in the pandemic. And the group has evolved. They recently bulletproofed two vans. So they're based up in Minnesota, but they're planning on using these vans just outside the Texas border to make it easier for people to access clinics who would usually have to travel maybe far out of Texas. So one of the vans will be providing - basically, there'll be a doctor who is able to provide manual vacuum aspiration abortions in that van. It will have a table and an ultrasound and all that. And the other van will have somebody who can prescribe and administer abortion pills.
GROSS: A lot of women are looking to pharmaceutical abortions, the two abortion pills that you can use to bring on an abortion. But now, as The New York Times reports, these drugs are the new front for the war against abortion. So what are some of the new laws that are springing up to try to prevent women from using pills to have an abortion?
BRUDER: Well, there are a lot of them. So already, there are 19 states that have made it illegal for these pills to get prescribed via telemedicine or delivered through the mail. We've got nine other states that are trying to do the same where sort of legislation is in the works. Texas, meanwhile, made it a felony to send abortion pills through the mail and made it harder for doctors to prescribe them - just new testing procedures, new reporting procedures, just more red tape, really. And we know that early in this year, more than 100 restrictions were proposed on medication abortion. So we're seeing a combination - just like with abortion in the past, the states that are looking to criminalize it outright or to restrict it so much that it might as well be criminalized.
GROSS: So the FDA has approved these drugs, and a lot of women get them through the mail. So if these drugs are outlawed in a specific state and a woman in that state asks for the pills to be sent from another state, what law would pertain to that?
BRUDER: That's a great question. And I don't think there's been a lot of tests of these new laws yet. But because they are federally approved, there's no way federal law would be brought down on people. And we know the U.S. mail is a federal system. It strikes me that the person receiving it would probably be the most exposed because that person is in the state that has made it illegal. And while I'm no lawyer, I can only imagine it'd be very difficult for states to enforce their laws beyond their boundaries.
GROSS: So you need a prescription to get these drugs, right?
BRUDER: Absolutely.
GROSS: And how are you going to get a prescription in states that are making or trying to make the pills illegal?
BRUDER: Yeah, that's complicated. So I know when people call Aid Access, there are actually doctors in Europe who are prescribing the pill to people who are trying to order it. In other cases, the pills are being mailed around without prescriptions, and in some cases, it's only misoprostol, which can be used alone to induce an abortion but is more effective with mifepristone. The challenge is mifepristone is expensive and tightly regulated. It costs more than $100 a pill, typically. Misoprostol is cheap and abundant in that it's also used for treating stomach ulcers. And it has veterinary uses, and it's over the counter in Mexico. So there are situations where people have access to misoprostol and not mifepristone, and there are protocols for using it on its own.
GROSS: There's a case you mention in your article where a mother who helped her 16-year-old daughter take the medical pills for abortion, you know, take the pharmaceutical pills for abortion - and the mother was targeted. Tell us that story.
BRUDER: The mother's name was Jennifer Whalen, and this is a case out of Pennsylvania. Jennifer Whalen learned that her 16-year-old daughter was pregnant and did not want to be and went online to buy the abortion pills. And her daughter took the pills. Then the miscarriage began because essentially, abortion pills are inducing a miscarriage. And that involves cramping. That involves bleeding.
And when the stomach pains hit, apparently, the daughter was frightened, and Whalen ended up driving her to the ER and telling the doctors about the pills. The daughter was fine, but Whalen ended up getting charged and pleading guilty to offering medical advice without a license. And she was sentenced. She had a sentence that was between nine and 18 months, so I'm not sure which she ended up serving.
GROSS: So there's a case coming before the Supreme Court that could result in the virtual end of Roe and leave abortion laws to states to decide. And many states would legally outlaw abortion if that was the case. So tell us about this Mississippi case.
BRUDER: Absolutely. That case is Dobbs v. Jackson Women's Health Organization. And in that case, the justices are looking at a Mississippi law that bans almost all abortions past 15 weeks of pregnancy, and that goes directly against the court's holdings in Roe and another follow-on decision, which was Planned Parenthood v. Casey. Basically, those two decisions together preserve a lot of leeway for legal abortion in America. The court held that states can only ban abortion after the point of fetal viability, which in Casey, they found is about 23 to 24 weeks pregnant. Of course, that's all out the window if the mother's health or life is threatened, and nobody is supposed to ban abortion in that case.
But before viability, according to the court, states can impose limited restrictions on abortion as long as they don't pose an undue burden. And again, what that means is debatable, which is why we have so many restrictions. Right now, the court has a 6-3 conservative majority, and if that majority upholds the Mississippi ban, as many people expect them to do, that would basically nullify Roe's recognition of the constitutional right to an abortion all over the country before viability.
GROSS: New laws are being written in Oklahoma. The Oklahoma State House just passed a bill making performing an abortion a felony punishable by 10 years in prison and a $100,000 fine. As we record this on Wednesday, the governor has not yet signed it into law, but the governor has promised to sign all anti-abortion legislation. So what is the significance of this bill? What do you understand about it?
BRUDER: Well, it's fascinating because it's beyond a trigger bill. It's not spring-loaded. It's not waiting for federal permission. It's just stepping out and banning abortion, which is incredibly audacious because it does go against the Supreme Court's recognition of a constitutional right to abortion. It isn't setting something up to change if the court stops recognizing that right. It's not really teeing up something to happen. It's just creating the ban outright if the governor signs it. So that would be the most restrictive law in the country on abortion.
GROSS: Missouri is trying to prevent people from Missouri, residents of Missouri, from going to another state to get an abortion whether it's through pills or a medical procedure. Tell us a little bit about that and its significance.
BRUDER: Yeah. That is particularly wild and new, the idea that one could prevent somebody who's a resident from traveling and doing something else. I - we haven't seen anything like that among these restrictions before, and it seems really hard to imagine that that could stand legally just because Missouri doesn't have jurisdiction over what happens in other states.
GROSS: You write that America wasn't always so sharply divided over abortion and that there used to be, like, patent medicines in, like, the 1800s - great names like Dr. Vandenburgh's Female Renovating Pills and Madame Drunette's Lunar Pills, which claimed to restore the menstrual cycle. Tell us about the pills. And I mean, they weren't marketed as abortion pills. Was it understood that that's what they were supposed to be?
BRUDER: Yeah, they were essentially wink-wink-nudge-nudge treatments. If you go back in time when America was new, traditional British common law was essentially the law of the land when it came to abortion, and that law didn't recognize the existence of a fetus until the quickening, which is when a woman first feels those fetal movements, maybe a kick, and that's usually during the second trimester. So before that, even if somebody suspects she's pregnant, there's no way to confirm it. We don't have pregnancy tests you can buy at the dollar store. Science isn't where it is today. So in that phase before the quickening, it was legal for women to seek relief from what people characterized as a blocked cycle and obstructed menses. These women could go to midwives for treatments. And there were even all sorts of home health manuals that recommended herbal recipes to bring down the menses. Going forward, there were all sorts of advertisements in all sorts of newspapers for people offering these patent medicines. And many of them were herbal.
The challenge is, you know, even when you're dealing with herbs, you're dealing with toxins. So it's very hard to tell which ones might have been effective and which ones might have actually been pretty dangerous, to the point where the first abortion statutes, the ones that were passed in the 1820s and '30s, were basically poison-control measures. They weren't really ideologically freighted. They were aimed at regulating this Wild West of patent medicine.
GROSS: You say that after the AMA, the American Medical Association, organized in 1847, the AMA lobbied against abortion. Why?
BRUDER: Well, this was partially a canny business decision. If you go back, medicine didn't always - as a profession, didn't always have the respect that it does today. There were all sorts of people providing care. We had traditional healers. We had midwives, all sorts of homeopaths and doctors who at that point in time weren't always able to deliver on claims that they made in terms of what they could do. Obviously, science has advanced quite a bit since then.
GROSS: So did you get the sense that people in the abortion underground that you write about in your Atlantic article are really determined to make abortion as accessible as possible if the Supreme Court further restricts or overturns Roe?
BRUDER: One of the activists I spoke with told me that she believes reproductive rights aren't something that's granted by the state at all, that these are rights that people have inherently. And that seemed to be the M.O. of a lot of people I spoke with. So, yes, absolutely, there are lots of people who want to keep abortion accessible for everybody who might want access to abortion, regardless of what the Supreme Court does.
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