Bring back the abortion underground railroad

On Oct. 14, the Supreme Court allowed 13 Texas abortion clinics to reopen, blocking parts of a state law that impose onerous requirements on abortion providers. Without this ruling, all but eight of the state’s abortion clinics would have been forced to close, and many women would have had to travel up to 600 miles for an abortion.

Though a welcome decision, the ruling provides only temporary relief for Texas women, since the entire law is currently under review. Most of the clinics that have reopened aren’t bringing abortion services closer to those who need them so much as expanding the capacity of large cities such as Houston and Dallas, where abortion was already more accessible than elsewhere in the state.

Abortion restrictions in Texas reflect a nationwide trend. Last year the Virginia Board of Health voted to require abortion clinics to meet medically unnecessary hospital-style building codes designed to put many of them out of business. Oklahoma, Alabama, Louisiana and Wisconsin have passed similar laws designed to shutter clinics by requiring doctors who perform abortions to obtain hospital admitting privileges. The fate of Mississippi's sole remaining abortion clinic is hanging by a thread, thanks to a court order blocking a similar restriction.

These ongoing crackdowns belie the popular notion that abortions are readily obtainable in the United States. The truth is that while the procedure is legal, its accessibility depends on having time, money and a flexible schedule. The injustice created is so gross that the only recourse for many women may be civil disobedience.

White women of means living in major cities in the U.S. have benefited tremendously from Roe v. Wade, the 1973 Supreme Court decision that found laws prohibiting abortion unconstitutional. The risky abortions many had in secret are now legal and safe. By contrast, poor women, black and Latina women and women in rural areas, who also benefited from Roe in the 1970s, when it was relatively easy to get an abortion in the U.S., are not significantly better off now than they were before Roe.

State politicians in the U.S. have enacted more than 200 abortion-related restrictions since 2011. In 2013 alone, 22 states enacted 70 restrictions on abortion services. More restrictions were enacted in the last three years than in the previous decade. Half the states in the U.S. severely restrict abortion coverage in the new health insurance exchanges created under the federal health care reform law. Nine prevent even private insurance plans from covering most abortions.

The type of woman who can most easily get an abortion today is least likely to need one. Blacks account for 13 percent of American women but 30 percent of women who have abortions in the U.S. Hispanics make up 16 percent of American women but 25 percent of women who have abortions in the country. Black and Hispanic women have much higher abortion rates and much higher rates of unintended pregnancy than their white counterparts.

Poor women and women of color are likelier than middle- and upper-class women and white women to need abortions in the first place, in part because they’re likelier to lack access to birth control. They are also likelier to receive substandard treatment or be denied care because of the cost of an abortion, lack of insurance that covers it, the cost of missing work and traveling hundreds of miles to a clinic or discrimination by doctors, who are more likely to be white males. Lack of access forces women to delay their abortions, increasing both the cost and the risk of the procedure. 

Abortion access is not just a women’s issue; it is a human rights issue. Conflating abortion’s legality with its availability to those who need it masks an injustice so deep that it justifies the kind of civil disobedience widely practiced before Roe.

Before that ruling, conscientious and courageous caregivers risked imprisonment, fines and loss of their medical licenses to help women who needed abortions. But women also helped themselves. The Abortion Counseling Service of the Chicago Women’s Liberation Union, also known as Jane, was a female-run underground abortion service that operated from 1969 to 1973. It was started by activists concerned about the rising number of back-alley abortions. Pre-Roe, abortion was not only illegal and dangerous but also cripplingly expensive. Jane provided counseling and helped women obtain safer, more affordable abortions. Many of its members learned to perform abortions themselves.

A first-trimester abortion, the most common kind, is a simple, low-risk procedure. It can now be performed safely and effectively via pills taken in the privacy and comfort of home, with follow-up care as necessary. It is far physically safer than carrying a pregnancy to term. Individual women may or may not find having an abortion traumatic, but there is no credible evidence that safe, chosen abortions increase rates of anxiety and depression.

Every woman has both the right and the responsibility to make informed choices about her body, her family and her future. Our elected representatives have effectively denied that right to the large and growing number of American women who are neither white nor affluent.

In August, The New York Times Magazine published a story about Rebecca Gomperts, a Dutch doctor who runs Women on Web, a support service that distributes abortifacients to women through the mail. She estimates that 40 to 60 of the thousands of emails Women on Web receives each month come from the United States — double the number from two years ago.

An email that Women on Web recently received from a woman in Florida read:

Please tell me where I can get miso [a pill that induces abortion] without a prescription ... I live in the United States and have no health insurance. I have two children, and I am currently out of work, there’s no way I can afford another child. Please help. I’m desperate.

Unfortunately for that woman and thousands of others like her, Women on Web serves only countries where abortion is illegal. Gomperts is sympathetic to American women who lack access to abortion, but, as she told the Times, “I think this is a problem the U.S. has to solve itself.”

When abortion laws were unjust, women and men of conscience broke them. When denied access to abortion, women learned how to end their own pregnancies. When some stores and pharmacies refused to carry the morning-after pill, women stockpiled it to share with others. Now that the anti-abortion terrorism of the 1990s has failed and zealots are targeting clinics through other means, women are helping one another end pregnancies without clinics.

It’s abhorrent that dozens of Americans per month — mostly poor, mostly minority — are reduced to pleading with foreign NGOs for safe, effective medical treatment. Lack of access to abortion is a shameful problem the U.S. has to solve itself. But until government acts, women can and must take matters into their own hands.