Suzanimal
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- Jan 17, 2012
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This whole story is sad and sick, this woman also had an abortion ship.
I'm not sure where to put this, please move if it doesn't belong here.
I'm not sure where to put this, please move if it doesn't belong here.
....
On July 5, three days after the Brazilian woman’s initial query, her consultation was sent to a doctor to review. Five physicians work for Women on Web part time; some of them also have jobs in abortion clinics doing surgical procedures. Gomperts wouldn’t tell me where the doctors were based, only that she consulted with a law professor to determine that “everyone is operating in a legal setting.” Despite her earlier defiance on the ship, she decided on this front not to court controversy. “We are trying to demedicalize abortion, but the reality is the doctors are liable,” she said.
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At the Amsterdam office, Renata followed the Brazilian case. After reviewing and approving the woman’s consultation, the doctor wrote a prescription for mifepristone and misoprostol and sent it electronically to a drug exporter in India. The exporter would fill the prescription and send the medication to the woman, in a package with a tracking number, so she and the help desk could follow its progress. Renata sent the Brazilian woman an email telling her how to take the pills, once they were delivered, in a series of doses over 24 hours. The instructions explained what to expect when the medication takes effect — bleeding, cramping and discomfort. When taken together, the pills are 95 to 98 percent effective.
Gomperts designed her program — based on the radical idea of providing abortions without direct contact with a doctor — for women in countries where abortion clinics are nonexistent or highly restricted. But her model is invigorating abortion rights activists in the United States, where the procedure is simultaneously legal and increasingly hard to access. In their eyes, medical abortion, delivered through a known, if faraway, source, could be a transformative response: a means of access that remains open even when clinics shut.
Medical abortions take place over hours instead of minutes and can be more painful than surgical abortions. One Dutch woman I spoke with who had an abortion through Women on Web while she was living abroad in 2012 told me about her experience. “When the cramps started, I felt horrible,” she said. At the time, she was 40 and living in Burkina Faso in West Africa. She hadn’t meant to get pregnant; she wasn’t in a serious relationship, and she had a 7-year-old son she was raising on her own. During the abortion, she sent him to a friend’s house for the weekend and “cocooned” herself, making tea and putting on music. “I’d vomit, take a warm bath, feel the cramps, get into bed, have diarrhea, go back to the bath,” she said. “I was in pain. It really hurt. But I knew what was happening.”
When women take the pills and feel uncertain — worried, for example, about whether they are bleeding too much or not enough — they can write to Women on Web with questions. The help-desk staff is trained to send a standardized list of warning signs but not to weigh in about the severity of anyone’s particular symptoms. “We cannot judge your situation over a distance, so we advise you to visit your doctor,” Gomperts said. “This is the limitation of the service.” She argues that it’s not a constraint that puts women at risk. “If you think something is wrong, what’s crucial is to be able to recognize it. Women can do that. The help desk makes sure they’ll go to a doctor if there is an indication that they might have a problem.”
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Gomperts wouldn’t tell me where the doctors were based, only that she consulted with a law professor to determine that ‘everyone is operating in a legal setting.’
When women do seek medical attention, Women on Web also counsels them about how to avoid criminal charges if they live in countries where they have reason to fear prosecution. To ingest the mifepristone and misoprostol they are told to place the drugs in their cheek or under their tongue, where the medicine cannot be detected in the body. (If they are inserted vaginally, they may leave fragments.) Gomperts says there is no medical reason for women to tell anyone that they’ve used pills. Treatment, if needed, is the same as it would be for a spontaneous miscarriage. “Women shouldn’t be afraid to look for care when they need it, and at the same time they shouldn’t do anything to incriminate themselves,” Gomperts said.
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In Brazil, the legal risk is acute. This summer, some women who were sent drugs through Women on Web reported that custom officials were confiscating their packages. Gomperts and her staff started telling Brazilian women to look for help elsewhere, sending links to resources in other places, like public clinics in Mexico City that provide abortions inexpensively. The 22-year-old in Brazil told Renata she couldn’t travel. Renata warned that the delivery wasn’t guaranteed, saying, “You understand the situation: You need to keep looking for help because there is a chance the package won’t arrive.”
“I’m trying,” the woman wrote back. “But everyone here is misusing women. They are selling four pills” — an incomplete dose — “for three times my monthly salary. Thank you very much for what you’re doing. It is very important for many people.”
On July 13, the woman reported a new problem: The tracking number for her package had disappeared from the online system for international mail. “I wonder if the order was made,” she wrote. “Please help me! I am very worried!”
Gomperts took that plea to the person who is the last crucial link in the Women on Web delivery chain: Mohan Kale, a 44-year-old businessman in India who exports the pills.
Kale and Gomperts met two years ago when she went to India in search of a new supplier. His was one name on a long list, but when Gomperts went to his office, Kale’s relaxed way with his workers put her at ease. When they sat down to talk, Kale told Gomperts that his wife was a social worker and that he was involved with local charities. “He wasn’t showing off,” she said. “It was the opposite of that. He just felt a lot of responsibility for the suffering in his country.”
When I spoke to him over Skype last month, Kale told me that his company, Kale Impex, supplies 1,500 drug compounds, including mifepristone and misoprostol, and has $4.5 million in annual revenue. He said he understood why it was important to Gomperts to partner with a drug exporter. “It’s a simple pill and still not freely available,” he told me. At one point over Skype, he asked me to turn on my camera. “Can you see this?” he said, holding up a sheaf of papers that Gomperts gave him. “These are notes from women we sent the packages to.” I asked him to read one, and he chose a message from Malaysia. “Me and my boyfriend are not really fluent in English, but you guys at Women on Web really did a great job,” it read. “We are grateful for the help and support and thank you for all that you do.” I had seen other notes like this in Gomperts’s office. One message from Kenya read: “I retrieved the medicine from the post in Nairobi yesterday. I kissed the pills when they fell into my hand.” Another from Northern Ireland read: “I used your service a few months ago. Today I finally found out I was back to normal, whatever that really means, seems strange to say really, but I wanted to say a HUGE thank you.” Kale paged through more notes, reading off a list of the places they came from: Costa Rica, Malta, Pakistan, New Zealand, Chile, India, Uganda, Ireland, Brazil, South Korea, Saudi Arabia, the United Arab Emirates, Poland, Algeria. “So many countries,” he said, with a note of awe.
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Kale ships the mifepristone and misoprostol at cost; this helps Women on Web remain in the black. Women who request medical abortions are asked for a standard donation of 90 euros, which goes toward staff salaries and overhead. If women say they can’t afford this — the 22-year-old from Brazil said she couldn’t — they are still sent the medication. Last year, about two-thirds of the women made the suggested contribution; the others gave a small donation or none at all.
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http://www.nytimes.com/2014/08/31/magazine/the-dawn-of-the-post-clinic-abortion.html?_r=0
