Abortion in disguise

FOUR YOUNG WOMEN DRESSED IN BLACK stood in front of the Supreme Court on Dec. 1, holding little white boxes that read “ABORTION PILLS” in big black letters. Behind them, two more activists held a black banner. “WE ARE TAKING ABORTION PILLS FOREVER,” it said.

One of the activists, Shout Your Abortion founder Amelia Bonow, waved her box in the air as she chanted into a bullhorn, “Abortion pills are in our hands, and we won’t stop!” A little later, she and the three other smiling women holding boxes pulled water bottles out of their coat pockets and took a swig to wash down the pills they had popped into their mouths. They cheered with the gathered activists. Someone screamed, “We love abortion!”

According to the news outlet Jezebel, the women taking the pills weren’t pregnant. But the pills were real abortion drugs. The group had ordered them from the European-based abortion pill website Aid Access. After the demonstration, other pro-abortion activists handed out more boxes containing information about how to access abortion pills.

Bonow said the goal of the demonstration was to defy a Supreme Court that some abortion activists fear will bring an end to legal abortion in some states by overturning Roe v. Wade, the 1973 decision that legalized abortion.

“We have no faith in this Court to protect our 50-year-old constitutional right to abortion, but beyond that, we completely reject the idea that they ever had the moral authority to tell us we are not allowed to end our pregnancies,” Bonow told Rewire News Group.

To her and other abortion supporters, abortion pills are the solution to decreased abortion access in a possible post-Roe future. “We are helping each have safe abortions forever and they might be lining up checkmate on legal abortion,” Bonow told Jezebel. “But we are getting a new method of service delivery dialed in at the exact right time.” That “new method” is coming from the European group Aid Access, which since September has begun providing the abortion pill to U.S. women who aren’t even pregnant yet—to have on hand in case of an “emergency.” Expanding access to the pill even further, the U.S. Food and Drug Administration in December permanently removed an in-person dispensing requirement for the abortion pill, allowing people in states that don’t further regulate chemical abortions to access the drugs by mail.

Bonow’s right: It’s impeccable timing. But besides being bad news for unborn babies and their mothers, this increasing de-medicalization of the abortion pill will make it harder for pro-life groups to combat its spread. Pro-lifers are hopeful that the Supreme Court will issue a ruling in the case of a Mississippi pro-life law that will allow states to have more freedom to pass legislation that restricts abortion. But even if the justices overturn Roe altogether, abortions won’t stop. Pro-life states will have to continue contending with this now-prolific drug and prepare for pro-abortion groups trying to work around laws restricting their distribution. One evasive maneuver from the abortion industry could come in the form of language, a battle that has been a part of the abortion issue internationally, and for centuries.

Private maternity hospitals operated by Marie Stopes International (now known as MSI Reproductive Choices) in Sylhet, Bangladesh. Photo courtesy of Kevin Duffy

WHEN KEVIN DUFFEY VISITED his organization’s abortion facilities in Bangladesh, his goal was to become like a fly on the wall. His job was to review management practices at the Marie Stopes International (now MSI Reproductive Choices) facilities, so he would sit on the plastic or vinyl-covered chairs in the blue-and-cream-painted waiting rooms, observing the local staff and the patients. In the waiting rooms, some women—usually young university students—wore jeans and sat looking at their phones. But many married women came with their husbands or mothers and were covered Muslim-fashion in long skirts and head coverings. Sometimes, he’d strike up a conversation.

“Why did you choose to come to this clinic today?” he’d ask, sometimes to a single woman, sometimes to her husband. Then eventually he’d work his way into another subject: “What did you come for?”

Even at the maternity clinics, where women would come for prenatal care, it didn’t take much effort to find someone who would tell him she’s there for “MR” or “menstrual regulation.” That same term frequently appeared on Bangladesh medical reports that Duffy would examine during his standard reviews of case records. Sometimes it was “MRM,” standing for “medical” menstrual regulation, or the abortion pill. He knew what the terms meant. Before he made his first visit to MSI facilities in Bangladesh around 2016, his colleagues at MSI headquarters in London briefed him about the legal situation in Bangladesh: In that country, abortion is called “menstrual regulation.”

“It was a way of just staying legal,” said Duffy. According to the country’s law, abortion is illegal unless a woman’s life is in danger. But the government of Bangladesh in the 1970s declared “menstrual regulation” to be an “interim method of establishing non-pregnancy” in a woman who may or may not be pregnant. It was a thinly veiled scheme, and Duffy observed that everyone knew what it really was, from the clinic staff down to the women coming for the procedure.

“In the clinics there, we did nothing different than how we did it in any other country. … But the practice, the operational practice, the protocols followed, were exactly the same,” said Duffy, even down to sorting through the remains of the aborted baby to ensure that the abortionist removed all of the “products of conception.” But there was one key difference: The facility did not confirm the pregnancy before the procedure.

Sometimes women Duffy talked to would stick to the script. When he would ask why they were there for MR, some would say, “My bleeding hasn’t started, and I need my bleeding to start.” But the ones who opened up to him a little more gave reasons that sounded like the reasons he would hear from women in other countries who were seeking abortions: “It’s just not the right time for us to have another baby.” “Our family’s finished.” “Things are difficult at home.” “Money’s a problem.” “I had a difficult pregnancy the last time.”

“What I perceived as a white man in Bangladesh … was that everybody was lying to themselves,” said Duffy. Even in a closed-door meeting with a handful of other Marie Stopes staff at the Bangladesh head offices in Dhaka, a local director once corrected Duffy when he used the term “abortion,” telling him, “We don’t do abortion. Abortion is illegal. What we provide is menstrual regulation.”

Duffy said Bangladeshi drug shops that sold abortion pills over the counter for $2 to $3 per pack even marketed them as menstrual regulation pills. But he said those places offered women no clinical guidance: The people selling the pills were usually old men or young boys, not trained pharmacists. Duffy believes that’s why around 2018 he started hearing more and more clinic staff in Bangladesh telling him about increased cases of women coming in with complications from incomplete abortions: bleeding, hemorrhage, infection. Even though the packs included instructions for correctly taking the pills, there was a chance women were taking them too far along in pregnancy or not taking them at the right intervals.

Duffy, by then an independent consultant for Marie Stopes, left the organization in 2019, largely over concerns about how it encouraged these kinds of self-managed chemical abortions despite the increasing complications. (He has since left the pro-abortion movement entirely and works with pro-life groups.) But the concept of “menstrual regulation” is now appearing in the West.

Private maternity hospitals operated by Marie Stopes International (now known as MSI Reproductive Choices) in Dhaka, Bangladesh. Photo courtesy of Kevin Duffy

ON A WEDNESDAY IN AUGUST 2021, a mobile billboard truck arrived in West Texas. In Spanish and English, the display on the sides of the truck read, “Missed period? There’s a pill for that.” A QR code on the back of the truck directed passersby to the website of Plan C, an organization that works to normalize self-managed chemical abortions and make abortion pills available over the counter.

Plan C sent the billboard truck into Texas in the days leading up to Sept. 1, when the state’s new heartbeat law would go into effect, allowing people to sue anyone involved in helping a woman obtain an abortion of an unborn baby with a detectable heartbeat. The goal, according to a post on the Plan C website, was to “inform Texans about their option of self-­managed abortion.” The first stop was Texas Tech.

This idea of a Western version of Bangladesh’s “menstrual regulation” pill had been brewing among pro-abortion activists in the United States since long before Texas Gov. Greg Abbott signed that heartbeat bill in spring 2021. In the 1830s and 1840s, New York City’s top abortionist, Madame Restell, advertised her “female monthly regulating pills” and “a cure for stoppage of the menses” in city newspapers.

More than a century later, a 1972 Time article described the growing number of facilities in places like California, Washington, and New York that had begun to perform “menstrual extraction” using vacuum aspiration to “terminate suspected pregnancies before conception has been confirmed.” In pre-Roe America, this was a way to perform “an abortion in fact” although “not an abortion officially.”

Fast-forward to 2014, and one of the Plan C co-founders, Francine Coeytaux, pointed to these 1970s menstrual extractions and the menstrual regulation in Bangladesh in a commentary for Rewire News Group as inspirations for her own vision for a “Plan C pill.”

Coeytaux, now a matronly and silver-haired 60-something in Los Angeles, had previously succeeded in helping to bring the “morning after pill” (also known as “Plan B”) to pharmacy shelves. Today, the emergency contraceptive is available over the counter at drugstores—a result Coeytaux hopes to achieve with the Plan C pill.

Coeytaux and co-author Victoria Nichols described a hypothetical woman who has unprotected sex and both her Plan A (birth control) and Plan B (the morning-after pill) fail. What if her period doesn’t arrive on schedule and she’s afraid of being pregnant? Enter Plan C, a drug to bring back her period. The authors pitched the idea of using misoprostol as the Plan C pill. That’s the second drug in the abortion pill regimen that causes contractions and expels the baby. (The first drug, mifep­ristone, blocks the hormone progesterone.)

Women could take it early on, without medical supervision, and without even confirming their pregnancies, in case they’d rather not know. By allowing women to handle the matter privately, the Plan C pill “allows women who live in states where abortion is very stigmatized and resources are limited to safely manage her fertility.”

Two years later, Coeytaux and another Plan B advocate, Elisa Wells, launched a website called Plan C, an online database of websites where women can order the abortion pill to take privately at home. After Justice Anthony Kennedy resigned from the Supreme Court in 2018, Coeytaux and Nichols returned with Wells to Rewire News to urge yet again for the “missed period pill” as they predicted a shift in the court. But they recognized that the same barriers preventing mail-­order abortions (mainly FDA regulations on the abortion pill) were inhibiting the Plan C concept as well.

“I think the biggest barrier is an underlying fear of going against the administration, the laws, the regulation,” said Coeytaux in a February 2020 interview after a presentation to college students in California. She said there’s no reason why women shouldn’t be able to have abortion pills in their medicine cabinets, despite any governmental restrictions on the drugs. “Because after all, regulations are just regulations,” she said. “They need to be interpreted, and we’ve been all too willing to have a very conservative interpretation for too long.”

Since then, research studies have provided abortions marketed as missed period pills to U.S. women. A 2020 study by pro-abortion groups Gynuity Health Projects and Carafem offered “missed period pills” to D.C. women who didn’t want to take a pregnancy test. That study used the normal dosage of mifepristone and misoprostol used in other chemical abortions. A University of California study launched in October only uses high doses of misoprostol, the cheaper and less regulated of the two drugs.

Lead researcher Dr. Ushma Upadhyay said plans for the study began a couple of years ago. That was before anyone guessed the U.S. Supreme Court would agree to consider Mississippi’s law protecting the unborn after 15 weeks of gestation. But Upadhyay saw the timeliness of the study’s launch. “If it does provide an option, an additional option, in the context of increasing state-level restrictions or anti-abortion restrictions, that is wonderful,” Upadhyay said. “I do think that we need to be creative about ensuring that people have as many choices as possible, especially in that environment.”

Photo illustration of a woman shopping for abortion pills on abortionrx.com. Olivier Douliery/AFP via Getty Images

AMONG THE U.S. PRO-LIFERS I’ve spoken to on this topic, the concept of “missed period pills” is relatively new. But some have encountered the term “menstrual regulation” used to refer to abortion in medical settings overseas or from more old-school U.S. doctors years ago and know that pro-abortion groups like to manipulate terminology to hide the truth about abortion. Now that the FDA has taken another step back from the issue by allowing mail-order abortions, they recognize that it’s largely up to the states to crack down on attempts to skirt their own laws regulating chemical abortions.

“It’s kind of like the game of whack-a-mole,” said Sue Swayze Liebel, describing attempts to regulate the abortion industry as it continually comes up with ways to expand access to the procedure. She’s the state policy director for the pro-life Susan B. Anthony List and has been helping states craft legislation to put new safety precautions on the abortion pill. “I gotta hand it to them, they’re very clever … as would I be if I were trying to skirt health and safety protocols and legal regulations.” But, if nomenclature becomes a part of the pro-abortion strategy to avoid pro-life state laws, she doesn’t believe terms like “missed period pills” will work for very long.

Rebecca Parma said the law plays an important role in affecting the conscience of citizens. She’s the senior legislative associate for Texas Right to Life and has been tracking Plan C and other groups that are trying to bring abortion pills into Texas. She said the abortion industry’s switch to the language of “missed period pills” is an attempt to make abortive drugs more appealing. But the law can work to counter that public image, even if it can’t prevent all abortions.

“If things are legal, we tend to think they’re right,” she said. “And if things are illegal, that teaches us that they’re wrong. … That’s why our work is changing the laws but also changing hearts and minds, and we have to change society’s view of abortion as well.”