In today's movement toward home abortions, echoes of past cultural battles

'The cultural atmosphere [today is] way worse than the atmosphere that the underground service worked in during the ‘68 to ‘73 period,' says a former 'Jane,' who helped women obtain abortions before Roe v. Wade legalized abortion.

Focus

In the fall of 1970, a schoolteacher named Judith Arcana walked into a meeting held at a church a few blocks from her Chicago apartment. She emerged hours later a newly minted member of Jane, an underground collective that counseled women through – and later performed – thousands of illegal abortions between 1968 and 1973.

To Ms. Arcana, then 27, the idea of providing women with safe, dignified abortions dovetailed with her interest in reproductive justice and the burgeoning women’s liberation movement.

“It seemed so right,” she recalls. “I was energized spiritually and politically, as well as intellectually.” 

Forty-seven years later, another group of women convened to talk about reproductive rights. They gathered not at a church but at the Los Angeles home of Francine Coeytaux, a veteran women’s health advocate. The conversation centered on the abortion pill – medication that when taken early in the first trimester can safely end a pregnancy more than 95 percent of the time.

The team is called Plan C. And for the women who are members, it is a sign of how the abortion debate in America is changing – even as it echoes the cultural battles of the past. 

The women of Jane operated in a world in which abortion was illegal but viewed as necessary, even by many in law enforcement and the clergy. Today, abortion is legal, but advocates for it often work in a climate where the procedure is increasingly fraught with the risk of persecution and prosecution.

Between 2011 and 2015, legislators across dozens of states implemented nearly 300 laws that regulate who can perform abortions and restrict how, when, and why a woman can undergo the procedure. The result is a two-tiered system where access to clinic-based abortion care is limited to those with the resources to get to a place that provides it, says Jill Adams, chief legal strategist for the Self-Induced Abortion (SIA) Legal Team, a nonprofit consortium that works out of the University of California, Berkeley. 

At the same time, women from both eras say the right to full control over when, where, and how women choose to have children – or not – remains at the heart of the abortion rights movement.

“[Jane] was about women trying to take back the night,” says Ms. Coeytaux, who founded Plan C. “It was women saying, ‘If it’s going to be illegal to go to a doctor then maybe we will be our own doctors.’ ” 

Plan C “is women saying, ‘OK, this system isn’t working for me, and I’m going to build something new,’ ” says Madison Liddle, who joined the group in November. “I see it as a reproductive health revolution, with women taking [their bodies] into their own hands.”

Some antiabortion activists have responded to the push toward more expansive abortion access – and the rise of groups like Plan C – by seeking to reframe the issue in feminist terms.

“We can do a lot of stuff now, but should we?” says Destiny Herndon-De La Rosa, founder of the pro-life group New Wave Feminists. “Is it ultimately good for us as a gender? Is this truly liberating and empowering?”

But both Plan C members and former Janes say that such perspectives only prove how much the debate has transformed over the past generation.

“The cultural atmosphere [today is] way worse than the atmosphere that the underground service worked in during the ‘68 to ‘73 period,” Arcana says. “Then there was an understanding that this was a necessity, that criminalizing [abortion] was a terrible mistake, that women and girls should be assisted. 

“Now it’s the other way.”

Politics in play

The difference between now and the 1960s is that today’s tug-of-war over abortion access – and women's overall health care – is more deeply tied to politics, culture, and morality than ever.

Democratic-led states are fighting to make birth control available over the counter even as congressional Republicans push a health care bill that cuts federal funding for Planned Parenthood and allows states to opt out of maternity care and contraceptive coverage. 

Within the medical community, more professionals are getting behind research that shows that the use of the abortion pill in the first trimester is safe and effective – but some clinics have begun to offer services that claim to reverse the procedure’s effects. 

Among women’s rights advocates, a debate is raging over whether a person can call themselves a feminist when they are against abortion rights.

“I’m all for women controlling their own bodies,” says Ms. Herndon-De La Rosa, whose group stands by the idea that “the unborn child is the most vulnerable member of the human family” and deserves protection. “The issue is when you have another body in your body. That’s a different story.”

As the conflict churns at both the personal and the policy levels, some analysts are noting a growing interest in abortions outside the clinic setting. In 2016, Seth Stephens-Davidowitz ran in The New York Times an analysis of Google searches of terms like, “how to have a miscarriage” and “how to self-abort.” He found that states with the highest rates of searches for self-induced abortion are also the ones where the procedure is most restricted.

“They show a hidden demand for self-induced abortion reminiscent of the era before Roe v. Wade,” he wrote. 

'Ask for Jane'

Arcana first encountered the Jane collective during a pregnancy scare in the summer of 1970. This was before the landmark 1973 case Roe v. Wade, which affirmed a woman’s right to seek an abortion. Back then terminating a pregnancy often meant finding “back-alley” doctors who might botch the procedure. Those who did perform it effectively often asked for outrageous fees or sexual favors in return.

Panicked, Arcana reached out to a friend who was in medical school. 

“After a while he comes back to me and says, ‘Everybody here says call this number and ask for Jane,’ ” she says. She did, and found herself chatting with the woman on the line not only about her situation, but about politics and women’s health. “We talked for nearly an hour,” she recalls. 

The woman advised Arcana to get a pregnancy test. (This was before home pregnancy kits were available over the counter.) The missed period turned out to be a false alarm. Arcana called the number again with the news, and this time the woman on the other end invited her to an orientation for new members of the Abortion Counseling Service of Women’s Liberation – the official name of the Jane collective – at a nearby church.

Arcana worked with the service for three years. She answered phones, scheduled women for abortions, and drove them to apartments where the procedure would take place. When the group, in 1971, began training its members to perform surgical abortions themselves, Arcana was among those who participated. 

“We literally, literally, had people’s bodies in our hands,” she says. “I found the interactions with my sister Janes and the women who came through the service to be so deep, so fruitful in terms of human value.”

The experience altered the way she and her colleagues viewed women’s rights, the female body, and the politics surrounding both, Arcana says. 

“We challenged the medical model for care,” says Laura Kaplan, another former Jane who published a book about the service in 1995. “We didn’t use drapes, we didn’t separate off a woman’s body. We sat with them, held their hands.

“We always said, ‘We’re not doing this to you but with you. We are a partner. You are putting your lives in our hands and vice versa,’ ” she adds.

Abortion via Amazon

Today, Plan C hopes to provide a similar service. By raising awareness about the abortion pill – and eventually making it accessible – the group hopes to give women the option to safely terminate their pregnancies without relying on distant or costly medical providers.

The team envisions a world where medical abortion pills are as ubiquitous as the morning-after pill, which is available not only over the counter at any pharmacy, but also online via Amazon. 

“You would get it delivered to your house. And it would come with information and also the option to have a telemedicine consult if you wanted it,” says Amy Merrill, Plan C’s communications director. “And otherwise you would have everything that you need to [administer] self care.”

“We are not pushing this on anyone,” she adds. “We just really believe it should be an option.”

The abortion “pill” is actually two pills, which together complete the procedure known as medical abortion: mifepristone, also known as RU-486, and misoprostol.

Studies in the US and abroad show the procedure’s success rate runs above 95 percent for women seven weeks pregnant or less. At least one study has found no significant difference in safety and effectiveness between women who had medical abortions at home and those who had them in clinic. 

“The [abortion] pill itself is actually very safe – except for the fetus,” says Matthew Harrison, a family physician who runs a prenatal clinic in a suburb of Charlotte, N.C. “But life itself begins at conception. My job as a physician is to protect human life. So that’s what I do.” 

Mr. Harrison works with a group called Abortion Pill Reversal, which claims to have developed a process that counteracts the effects of RU-486. Founded by California doctors George Delgado and Mary Davenport, the group bases its practice on a study the two published in 2012 detailing the experiences of six women – including one Harrison treated in 2006 – who took mifepristone then received doses of progesterone. Four carried their pregnancies to term. 

Since its founding APR has attempted close to 900 reversals, Harrison says, and about 200 babies have been born healthy. The rest of the would-be mothers failed either to show up for their appointments or follow through with the procedure, he says. APR representatives did not respond to a request to confirm the numbers. 

“We’re not just people who are yelling, ‘Don’t abort,’ ” Harrison says. “That’s very harsh and very scary for women who are in very vulnerable positions. This gives us the opportunity to be caring and help women and walk with them through this.”

Harrison stands by the procedure, but it has been challenged by the mainstream medical community. The American Congress of Obstetricians and Gynecologists says abortion pill reversal is not supported by scientific evidence.

Still, Arkansas and South Dakota now have laws that require doctors to tell patients seeking medical abortions that the procedure can be reversed if they don’t take misoprostol and act quickly to follow the reversal process. At least five other states are considering similar legislation, based largely on the model bill drafted by Americans United for Life, a national pro-life law firm and advocacy group.

“Women should be trusted with full and comprehensive information, including the facts about the dangers … and information that shows they can reverse it,” says AUL spokeswoman Kristi Hamrick. She says the effort to make the abortion pill available over the counter and online is irresponsible, especially for women experiencing ectopic pregnancies, allergic reactions to the drugs, or other conditions that a health care provider could identify and address. 

“We have medical boards and licensing boards to ensure that a person who tells you they’re selling you something safe is not lying, not harming you, not exposing you to risk,” Ms. Hamrick says. “You can’t know whether someone is in danger of the greater risk without proper medical supervision.”

'The new virtual Jane'

Coeytaux bristles at the mention of APR. “That’s the new anti-choice thing,” she says, shaking her head. “To me that’s an indication that we’ve begun to make some inroads, that the abortion pill itself is scaring them.”

It’s also a demonstration of how divisive abortion has become – at least in the US. Elsewhere in the world, the trend over the past 30 years has been toward liberalization and access. While Plan C struggles to gain a foothold in the US, others like it have been operating outside the country for nearly two decades. 

Women on Web, safe2choose, and Women Help Women are online, international abortion services that provide counseling and contraception to women in dozens of countries. They also the ship the abortion pill to women in places where access to safe abortion services either don’t exist or are heavily restricted.

None of them ship the drugs to the US, because of concerns that they could lose funding or support for projects in other countries – even though in 2016 a safe2choose site administrator told Britain's The Guardian newspaper that a fifth of its traffic in April that year originated here. The paper also reported that Women on Web, which sends the pill to countries where abortion is illegal, received more than 600 emails from the US in 2015.

To Ms. Liddle, the Plan C advocate, the fact that politics has kept these services from reaching women in the US was a shock. 

“As modern women growing up in the United States you are taught that you have all the options you need for you, that you’re leading the charge in health,” she says. “And then you come to find out you can get these pills shipped to Tanzania … and I can’t get it to Miami, Florida.” 

Liddle and her team work with the SIA Legal Team to navigate abortion laws and ensure they legally shield the women they seek to help. They dream of one day working out in the open, without having to occupy legal gray areas. 

“The very crux of what we’re doing, the reason we’re doing it, is because we believe [abortion] should be accessible and open,” Ms. Merrill says. “And yet the process of getting it there is inherently full of these obstacles and these risks.”

And the fact that Plan C – and other organizations like it – exist at all suggest that the strategies of the civil rights era endure. Only now, advocates say, technology also exists to democratize abortion, make it accessible, and address the issues that have dogged the procedure in the decades since it was legalized.

“The internet is the new virtual Jane,” says Susan Yanow, a longtime reproductive rights advocate and consultant for Women Help Women.