The Last Resort: An Interview With an Underground Provider of Abortion Medication


Editors’ note: History and current events underscore that when women face rapidly diminishing access to safe, legal abortion care, they will take matters into their own hands. RH Reality Check neither endorses nor condemns the efforts of those such as the person interviewed below—individuals who provide women with supplies of abortion medications and information on their use. Rather, we recognize her efforts as one inevitable response to the rapid elimination of access to safe abortion care in the United States.

What follows is a lightly edited interview, which was conducted recently by email.

RH Reality Check has verified the claims made in this interview.

For years, she’s been reading their emails. Desperate, scared, broke women write to her, wanting to terminate a pregnancy without turning to sharp instruments, unknown drugs, or old wives’ tales. The woman interviewed below, who once wrote an online manual of do-it-yourself abortion techniques, offers them whatever help she can—usually an envelope of drugs, words of advice, and a warning to go to the hospital if anything goes wrong, because there is no punishment from authorities worse than losing their lives.

She has no medical training; she is a former journalist. Still, as anti-choice lawmakers across the country steadily eliminate access to safe, legal abortion care, she provides medications that induce miscarriage, and is one of an unknown number of sources to which pregnant women turn when they run out of money and options. She wrote about her experience in a recent piece for Jezebel, and agreed to do an extensive interview with RH Reality Check to explain exactly what she does, and why she is willing to put her own freedom at risk to help pregnant people in need.

RH Reality Check: Explain what you do as an underground abortion provider, and how you came to do it.

Anonymous: I send pills—misoprostol and mifepristone—to women who are in need of an abortion and have no way of obtaining one through legal channels. I started because I got desperate letters from women, and because at that time I was already buying my birth control through an international pharmacy, I already knew a reliable source for some medications. I’ve never had an abortion myself. People always look for that as the big reason [why I do this]—”Did you need an abortion and it was tough to get?”—that kind of thing. My reasons are political; there’s no personal abortion narrative that started me in this work.

RHRC: Why are you willing to risk so many things, like your liberty, your financial security, or your family, to do this?

A: Because it’s terribly important. When I was 17 years old, something traumatic happened to me—I don’t want to get into the details, and it wasn’t abortion-related, but I was sure I wouldn’t live through the night. After living through that night, not a lot scares me. Certainly not prison. Also, as far as the financial security aspect goes, you can’t risk something you’ve never had. My background is blue-collar, and I’ve lived near or below the poverty line for most of my adult life.

RHRC: A lot of what you do sounds modeled after Women on Waves (an international organization that gets medication to women in countries where abortion is illegal). Do you consider yourself to be a WoW for women in the United States?

A: I’m not, but what a compliment! They have better organization and more money than I do. I don’t even have a job right now; I’m on unemployment. But more importantly, I don’t know that having any kind of centralized organization distributing abortion pills is necessarily the right solution for the United States.

That’s because in the United States, our law enforcement can have very politicized priorities. Having one single, coordinated network means one big sting, and it’s all over. That’s what worries me most, by the way: that I’m out here alone doing this, and that if I’m arrested, other people will be intimidated into the status quo.

We need something different in the 21st century to make sure this [work] is bigger than one person. I think that the best way for this “organization” to work is by women saying, “I’m part of this. Today, this starts.” She starts to research, she starts to really do her homework, understand these pills. And then, within her networks of trust, she educates other women with the same knowledge, and helps them do their own research as well so nothing gets lost like a game of “telephone.”

I think that strikes a lot of people as scary. We talk a lot about women being in control of their own bodies, but when confronted with this—the ultimate reality of women taking decentralized control—people start getting freaked out.

They say, well, these pills aren’t safe. They’re safer than giving birth! Once you’re already up pregnancy creek, there is no perfect paddle that lets you opt out of danger.

The safety thing’s a canard, anyway. Imagine a literally perfectly safe abortion pill. No drug interactions, no side effects, just a painless, safe abortion on demand. Do you really think all these people who [are calling for] “safety” today would just say, “Oh, now it’s perfectly fine, keep a bottle in the bathroom cabinet”? No, of course not, and I think we all know that. It’s really not about safety, and never has been. It’s about who has control over women’s bodies.

RHRC: You mentioned the issue of potential counterfeit medication with respect to mifepristone. How do you ensure that the drugs you receive are safe, and is there any way for those who obtain drugs from someone who isn’t you to be sure that they have legitimate medication?

A: The truth is, I can’t take every pill to make sure they’re what they say they are. Chemical assays would cost a lot of money that I don’t have. Usually if a drug is counterfeit, it doesn’t mean someone put a dangerous active ingredient in—dangerous active ingredients cost more than sugar and fillers, and the whole point of counterfeiting is to make money.

There isn’t a good way to know I’m sendingreal pills, or that I’m even a person who wants to help and isn’t trying to hurt women with poison or bad pills. That’s why I’m emphasizing building networks of trust, communities of people who know how to do these things, groups of friends where you know which person has the pills and knows how to use them.

My advice to women is to trust themselves, and each other—to learn and make this part of their basic medical knowledge, the way you’d know what to do for first aid or CPR. Don’t trust strangers. Do research about online pharmacies from forums where people have talked about other types of hormonal medication—trans* groups actually have a ton of resources for finding legit online pharmacies, because a lot of trans* women get their hormones overseas.

RHRC: How do women find you in the first place? Is it all word-of-mouth? Do they hear from others who have worked with you?

A: They usually find a very old blog post that I wrote about how to perform abortions. You have to be getting pretty desperate to start looking up how to perform one yourself—that’s the level the women are at when they come to me. They’re considering sticking things into themselves to end their pregnancy. They’re in absolute panic.

RHRC: How do you safeguard the information and contacts of those who email you, given that you could potentially be arrested and your computer files searched?

A: Their messages are deleted about a week or so after I mail their pills. Just about any additional safeguards I could put in place are useless. When you send me an email, it’s possible Google and/or the government will take a look. That’s yet another reason I think women should create these smaller, trusted networks.

RHRC: Have you seen an increase in demand as new bills have been put into place across the country? Is there any one issue that people cite most often as the reason they cannot use a provider at a clinic?

A: I’ve personally seen it slowing down, because my blog has been down for a while and people don’t find me as much any more. Part of that is because I’ve been operating with more caution these days, to some extent. One of my hard and fast rules has always been “If someone seems sketchy, trust your instincts and don’t send the pills.” I won’t respond to emails that seem like something’s … not quite right. My instincts aren’t perfect—no one’s are—but so far they’ve kept me out of trouble.

Most women who contact me have multiple problems, but I’d say the single biggest one is that women who have kids, if they live far from an abortion clinic, have a nightmare getting child care arranged. There’s so much stigma. Waiting periods mean you can’t just take one afternoon away “for a doctor’s visit.”

Profiteers are already moving into this “market.” When I started sending pills, years ago, that didn’t happen as much. With the new laws, I think that’s the change I’ve really seen happening—a true black market, complete with all the counterfeiting and mistrust that entails.

RHRC: You’ve mentioned the risk that you are taking that could land you in jail. We’ve seen a number of cases where those who either have induced their own miscarriages or are suspected of having induced their miscarriages are also being threatened with criminal consequences. Do you talk to your recipients about this? Do they express any concerns, or seem determined to terminate anyway?

A: Interestingly, almost every woman who emails me says in their initial email that they know they could get in trouble. It seems like most of the women who get desperate enough to email a stranger, well, they’re literally taking their lives in their hands. When women are ready to do that, it seems like jail is a consequence they’ve thought about and consider actually “worth it” if it means terminating a pregnancy.

RHRC: Do they seem worried about going to a hospital if there are complications?

A: Every woman I ever send pills to gets a full warning about complications. I tell them what a hemorrhage looks like as opposed to a normal amount of bleeding. I tell them that when in doubt, go to the hospital—no consequence they will inflict is worse than dying.

RHRC: Do you see illegal providers as heroes, and do you think there are predators in the mix as well?

A: I think rather than predators, what we’re seeing a lot of right now is profiteers. The rest of the drug war has shown that when you make drugs illegal, you don’t make them unavailable. You don’t make them not a public health problem. You just push them underground and put them into the hands of the black market.

People on Silk Road, which is a “darknet” site where people sell everything from fake handbags to crack cocaine, are selling abortion pills for $500. In border towns, the “flea market abortion” is the new back-alley abortion—you buy misoprostol quietly at a flea market. There may be a few other women like me. I don’t know. Some part of me wishes we could be friends, but it’s probably better not to know them—if I get in trouble, I don’t want anyone else to.

RHRC: In an ideal world, pregnant people wouldn’t need underground providers like you to exist. What series of changes do you think would best make an underground abortion network disappear for good?

A: Abortion pills in my local pharmacy or my general practitioners’ office, after a brief consultation, for a reasonable fee—the pills themselves should not cost more than $50. Abortion education for girls. Giving women control over their bodies means giving women control over their bodies, not making up safety concerns that no one seems to have when it comes to women giving birth.

I think the pro-choice movement has been playing defense for so many years that it has forgotten to fight for more than just stopping bad laws. Women’s activism at the grassroots level can help change that. If abortion pills are in all our hands anyhow, that’s when people start talking about more legalization, normalizing access. It’s working with marijuana, and it’ll work with mifepristone/misoprostol, if women work together.

RHRC: Finally, what would you tell a “pro-life” activist condemning what you do? Or even a pro-choice activist condemning it as putting pregnant people at risk or legal abortion at risk? Do you have concerns that what you do could in some way be used to make abortion even less accessible by making it appear more dangerous?

A: I think “pro-life” and pro-choice activists don’t talk enough to each other. I think we can actually sometimes find unusual common ground. I think that while a lot of the people at the top of the pro-life movement are cynical and misogynistic, a lot of the pro-life rank-and-file are people who are honestly well-intentioned and have been told a lot of lies. I think the biggest disservice that the reproductive justice movement does itself is when it thinks of pro-lifers as monolithic. I prefer to take my anti-abortion critics on, one at a time.

If a pro-choice activist’s criticism is that it seems unsafe—if they have a problem with what I’d call the “stranger danger” aspect of this whole Jane 2.0 thing—I think that’s a fair criticism, and I’ve tried to address a lot of that here. If they think that I’m bringing bad publicity to the movement, then we’ll just have to agree to disagree, because I think that at this point, just about any civil disobedience for reproductive justice is good civil disobedience.

The day they make it illegal to import these medications, so that pharmacies won’t mail them anymore, I’ll start booking trans-Pacific flights to keep obtaining these medicines. I won’t stop until they stop me—either by arresting me, or by putting reproductive choices into the hands of women for real, no apologies, no excuses.

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  • athursto

    Wow. This is fascinating. She’s so brave!

  • MaiaDoe

    I live in the EU, so it might be different here (given the fact the ecology and related stuff is MUCH bigger deal here), but…
    I often notice that people think “childbirth = safe, abortion = dangerous” (and we are talking about abortions performed in hospitals by doctors) based on “childbirth = natural, abortion = unnatural”. Lot of people cannot grasp the fact that “natural” does not equal “safe and healthy”. And it’s not limited to the childbirthXabortion issue, which is very emotive. They have the same problem with just ANYTHING that’s related to health or nutrition and so on. The statistics are clear, but the “natural = healthy” dogma is too strong, they just refuse to see it, probably because it’s cornerstone of their opinions and behaviour, of their everyday choices and habits.

    • fiona64

      You are spot-on. Despite the information being readily available that a) the US is #50 in maternal mortality and b) early abortion is 14x safer than gestation, the anti-choice continue to double down on their ignorance.

  • Sally

    Is there any way we can help this woman? Could she use donations, perhaps administrated through RHRC (since you obviously can’t publish her contact details)?