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.

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.”

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.

Gomperts no longer works from a boat. Eight years ago she started Women on Web, a “telemedicine support service” for women around the world who are seeking medical abortions. She and a small staff share a one-room office in Amsterdam on a residential street, where red-and-pink flowers bloom on the balconies of brick buildings.

Almost 40 percent of the world’s population lives in countries, primarily in Latin America, Africa, Asia and the Persian Gulf, where abortion is either banned or severely restricted. The World Health Organization estimated in 2008 that 21.6 million unsafe abortions took place that year worldwide, leading to about 47,000 deaths.

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.

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