Dr. Rebecca Gomperts & Abortion as Healthcare
Aiyana Knauer and Laurel Leckert, 30 May 2019 - published in Got a Girl Crush Blog & Magazine
This interview was originally conducted in the beginning of 2018 and since then Dr. Gomperts has launched Aid Access which supports those who cannot otherwise access an abortion and protects their human rights. On March 8, 2019, she received a letter from the FDA ordering her new (since 2018) organization, Aid Access, to stop providing telemedical abortion services to women who cannot otherwise access safe abortions because of costs, domestic violence, distance, or other reasons, and who they do not have access to other doctors willing or able to prescribe Misoprostol and Mifepristone.
This letter was applauded by Republican members of Congress, of whom 92 percent are male.
Women on Waves is a Dutch non-profit founded by Dr. Rebecca Gomperts in 1999. After completing her training as an abortion doctor, Dr. Gomperts worked as a physician on board Greenpeace's ship, the Rainbow Warrior II. In South America she met many women who greatly suffered both physically and psychologically due to unwanted pregnancies and lack of access to safe, legal abortion services.
Women on Waves travels by boat to countries where abortion is illegal or highly restricted. Once there, they pick up women seeking abortions, travel to international waters (where local laws don’t apply), and perform medical abortions. They've also launched several drone campaigns, using drones to deliver medicine across international borders. Women on Web is their online arm which provides real-time medical and emotional support over email to folks around the world who are doing at-home abortions with pills. Contact them at firstname.lastname@example.org or womenonweb.org.
Dr. Gomperts is a friendly, articulate, and inspiring activist and doctor, and it was our great honor to interview her for this issue of Got a Girl Crush.
When someone asks you “What do you do for a living?” how do you reply?
I work for an organization that supports women all over the world to get access to a safe abortion.
When watching VESSEL (the documentary about Women on Waves), we were struck by your ability to so clearly and succinctly articulate your position. Make believe that you’re talking to someone who you don’t hate, who you want to or have to continue to have a relationship with, who says to you “How can you be supportive of abortion? It’s murder.” What do you say to that person?
I respect your belief. In a democratic society we can only live together if we respect each others differences of opinions, religions and needs. Therefore I also ask you to respect me and the women who need an abortion.
Can you talk a little bit about your experience as a doctor prior to founding Women on Waves? Where did you practice/in what contexts (hospital, private clinic, non-profit, in the Netherlands or abroad)? Or did you immediately join the Greenpeace ship?
I worked in hospitals in surgery and radiology departments and in a private abortion clinic but also with a travel insurance firm. I did some of my medical internships abroad (Surinam and Guinea in Africa).
We work with a decentralized national storytelling project called Shout Your Abortion, and we work to destigmatize, un-silence, and build community through sharing abortion experiences. Our tagline is “Abortion is normal. Our stories are ours to tell. This is not a debate.” We noticed that in a 2014 interview with Jezebel, you specifically mention not using the term “normal” in reference to abortions. While we understand that there is an infinite range of abortion experiences, we feel that because of how statistically common abortion is, the term “normal” is applicable. Could you share some more insight as to your opinions on using the word “normal,” or about language in general when discussing abortion?
Different language can and should be used for different audiences, moments and places to be effective. It is not about some absolute truth but about context and framing.
As I explained in the interview, for me an abortion is normal but for a woman who cannot access it, it is not normal. Normal is something that is achievable, but an abortion is out of reach for many women.
When I say an abortion is a need, it reflects much more the reality of women. When one speaks publicly about abortion the aim is not to speak the same language as those who already agree with you, but to connect with other people who might not have given the issue much thought. We can only achieve this connection by being nuanced and recognizing other people's realities, doubts and sensitivities without making it a taboo, which is what you mean by saying it is normal, I assume.
People primarily recognize you for the sailing campaigns, but Women on Web slash Women on Waves does a lot of work beyond that. What does the actual bulk of your work consist of? In a given week, for example, what sort of things would you be doing?
It depends totally what moment we are in. When we’re preparing campaigns, it’s focusing on more-or-less the logistics of it and what it takes to organize it and make sure everything works. It’s supervision of the help desk, medical stuff, lots of research things that we’re doing at the moment—it’s supervising research, initiating research—creating new campaigns, strategizing and doing legal research, answering emails. The campaigns are always the much-needed, positive exciting moments where it’s all condensed in one day or five days. Everything is kind of concentrated there, but to work up to it, it takes months and months—sometimes even a year. And things fail, we initiate things that don’t work.
Of course, we’re constantly developing new things: whether it’s new research, new actions or new initiatives. We travel a lot for conferences.
How often do you do a ship campaign?
It’s hard to say. We have existed now since 1999, and the first years we did a campaign every year or every other year. In Ireland, it was 2001, Poland was 2003, Portugal 2004… The next campaign was 2008, so it was four years later. That was also because Women on Web needed attention. Then it was again four years later in 2012, and that was because I needed a break.
The last campaign—we had one year where we did two campaigns. Last year in 2017 we did a campaign in Guatemala and in Mexico. We had planned two campaigns for this year, but we have had a lot of issues with crew and the ship and we didn’t manage to pull it off this time. We are wrapping up our campaigns in Latin America now, and then perhaps in another four years we’ll do another one.
In the meantime, we’ve done the drone campaigns—one in 2015 and one in 2016. Every year we do things, but also, we do a lot of trainings with local women’s organizations, so that requires a lot of preparation; fundraising; and a lot of media—it’s always kind of busy with new media. The drone was also a lot of work to prepare because we’re new. Now we’re looking at a totally new form of campaign again, which we hope to launch this year.
What is it?
I can’t tell you yet. [Laughter]
Well that’s very exciting.
It will be mind-blowing I think.
What did you mean when you said you were having trouble with crew? Are you looking for crew members?
No, we found crew—so, first of all you have to understand that we are actually quite a small-budget organization. It’s not a huge organization like Greenpeace that has people constantly working on it all the time. Our annual budget is about €100,000 euros (ed note: that’s $12,3817.00 USD) and that’s what we [operate on], like the campaigns—everything. That is for Women on Waves. Women on Web is a separate organization, so it has a separate budget.
We do a lot of things for very little money. It also means that we are very dependent on people that…when they say things they will do them and that they’re dedicated. We have had really bad luck the last half-year with crew that committed to doing work and then they suddenly quit. Also, I think we underestimated the effort that it takes. The ship was in Mexico and we wanted to do a campaign in Chile, and actually, we wanted to launch it when the Pope was there. Then there was an earthquake in Mexico and we weren’t sure we could get the ship in the water, and then the crew suddenly quit. We found a new crew really quickly and then there were problems there—and I had no idea why. It never happened before. It was just too much, so we decided this is just not going to happen.
You only see the things that succeed, and you don’t see the things that don’t succeed. A ship campaign is extremely difficult to organize. It’s a really, really difficult thing to organize. Everything has to work. It’s like a very complicated puzzle.
So far, we’ve been very good and most of the things worked. Now, this time it didn’t, and that means you have to move on. We hope that we’ll do a ship campaign in Chile another time, but the two campaigns last year also exhausted the resources and also some of the personal energy in people. So, then you have to recuperate.
That’s where we are now—a little bit recovering; a little bit going to do this really new thing, which is a little bit easier to organize, a little bit less expensive. That’s what activism is right?
But it’s very hard because you’ve worked with people and everybody’s gearing up to doing it and making it happen. It’s so hard when it falls apart because people spend so much energy and resources in it, but then if some people don’t do it then it doesn’t work.
But the campaign in Guatemala was extremely good and Mexico as well. We had really, really good experiences.
So, you mentioned the budget for Women on Waves, and one of the things we were curious about was how both of the organizations are funded. Do you receive grants from organizations? Or are they private donors?
Women on Waves is funded mostly by the women that need the service. How it works is that we ask for solidarity donations from women and about 90% of the women have the funding and the means to do it. 10% of the women don’t, and then they get the service for free. So, the women who are able to afford [the service,] sometimes give more.
But there’s also a lot of people that give solidarity donations because they really support the organization. That’s really all donation-based and it’s self-sustainable. So, Women on Waves is a self-sustainable organization. It’s a non-profit, it doesn’t make any profit, but at least it can cover its expenses.
Women on Waves has always been fundraising and we have individual donors, sometimes we have foundations that fund us. So that varies because usually donors are not there for the long term, so we find new different donors, different forms of income and things like that.
We do have some foundations, like sometimes Mamacash, which is a foundation that gives money and sometimes another foundation, and some American foundations have as well.
Women on Waves is kind of small and it makes it very flexible and we can do the things that we want to do, but we can also do the things that donors wouldn’t usually want to fund because it’s kind of “out there” or it’s experimental, it’s innovative. You have big organizations that do ongoing, on-the-ground constant work. Usually they fundraise because they know there’s money for a certain kind of work or they make programs because they know there’s money available for that type of work. We always do what we want to do, and we try to find the money to cover the cost.
Can you tell us some statistics about the organization? Like how many abortions has Women on Waves provided and has Women on Web assisted with? How many trainings have you done around the world? Stuff like that.
We do abortions on the boat, but they are few. We’re a few days in the country and if we can sail out at least two or three times—in Mexico we did three abortions in the four days that we were there. In Guatemala we were kicked out by the military, so we couldn’t even sail out to the mainland. The same in Portugal, we couldn’t even sail into Portugal because we were stopped by war ships. In Spain we were able to sail out. I think also we did three abortions then, or four. In Poland it was more, 10 or 15 women.
The total amount of abortions that have been done on the ship are relatively few. The way you have to see them is that they’re ready to make the problem visible. There are few, but they are extremely important ones. They are very visible, and they totally change the taboo, the discourse about abortion in these countries.
I think that Women on Waves, what it does, is it’s reframing the abortion issue in a lot of countries where it’s usually not talked about, it’s very hidden, and the ship is bringing it into a human rights framework.
For example, in Guatemala, the fact that the military kicked us out—before we came, it was really not an issue that was discussed at all in the media or by people. If it was, it was dismissed as a women’s issue. Because the military intervened, it suddenly became clear to a lot of people that it’s actually more about fundamental freedoms than about women. It’s a military dictatorship there more or less and people really don’t like the army, so they suddenly understand that there’s much more at stake when the military intervenes on something that is normally considered just something about women.
That is what we want to do. We want to re-create the framework in which abortion is placed in the public domain. That’s extremely important to create change.
Now Women on Web. I don’t think it’s really relevant how much abortions are being provided. I think for us it’s much more relevant how many women we help. Sometimes I get emails from women in countries where it is legal and it’s accessible and they don’t know where to go, and we direct them to the right places.
That’s actually the next question we had. How many people contacted Women on Web for help last year?
Women on Web is answering, per month, 10,000 emails. We have answered about 120,000/130,000 emails in the past year.
Wow. And who’s answering all those emails? It’s all volunteers?
It’s a special-trained help desk. We have about 20 people and we have about 17 languages covered and every day there’s somebody from a language who’s answering emails.
So, yea, it’s like a very—and they are paid—but it’s a very basic payment. It’s quite intense work to do. It’s pretty intense if you have to answer 70 emails in Croatian a day, for example. But it’s very rewarding as well, because many of the women are extremely grateful. They cannot sometimes believe that they can actually get help, and I think that is where we are really proud of what we’ve made. I think it’s special, creating this solidarity network where women are co-responsible to making sure that other women can also continue to have care, is very important.
“This total fundamental change in perception about whether it’s safe to do what we’re doing and to support it has just created this—the scientific research that we’ve done that I’ve published has managed to maintain that, and that was a strategy as well to do that.”
How do people mostly hear about you? Is it all word of mouth? Do you do any sort of advertising?
No, but we have done a lot of research that was widely publicized. Through Google, you can find us through Google; word of mouth; they read about us; many different ways. We ask it in the prologue form, but I haven’t looked at it in a long time, so I don’t know what is the most known. We are also doing research and publishing research as a tool to change policy and to make mainstream this idea that you’re able to do an abortion yourself as a woman. We’ve been extremely successful in doing that as well. When I started Women on Web in 2005, it was extremely controversial. The first research that we published in 2008, there was a headline of the Daily Telegraph that said, “Women risk their health using abortion website.” Then not even seven years later, the same newspaper wrote “Medical abortion: anything you need to know go to Women on Web.”
This total fundamental change in perception about whether it’s safe to do what we’re doing and to support it has just created this—the scientific research that we’ve done that I’ve published has managed to maintain that, and that was a strategy as well to do that.
So, you’re saying that the catalyst for that shift was the research that you have published?
That’s awesome. Speaking of that, your work is incredibly inspiring and certainly people around the world would love to expand the work, let’s say—hypothetically—there was a small collective that was interested in distributing and educating about Misoprostol, what advice would you give them? Can you disclose any of your sources for acquiring the drug in bulk or—
Oh yea, I mean that is not a problem at all. Actually, that was one of the hardest things to set up with Women on Web—to find where to get it in a way that it was legal. So, people who want to do that, first of all, Misoprostol is easier to get than Mifepristone—almost everywhere. There’s places in the world where you can very easily buy it in a pharmacy. We don’t get it in bulk, either. We work with the pharmacy as well because that is the legal way to do it. Unless you are a pharmacy or you’re a distributor in the country—you have a license to distribute—then you cannot distribute in bulk.
What they could do is they could go to India, and they can easily find it there. There’s many, many pharmacies there that will sell it for very cheap and it’s good quality, if you’re taking kind of the bigger brands. You can get it in Vietnam, you can get it in Bangladesh, in every pharmacy in Nepal. You can buy a lot of it, and the only thing is you won’t always be allowed to travel and take it back in your country.
I would say for the groups that do that, that they would want to—there’s different places to do it, some people say to take it out of the blisters and you put it in a bottle of vitamin pills. I am not such a strong supporter of that because the quality of the medicines deteriorate quite quickly. I also feel that when you have loose pills, I think it’s quite disrespectful to women because they don’t know what they’re swallowing. There’s a lot of abuse of women anyway who are in that condition. I say you have to keep it within the original packaging so that the people that you give it to actually know what they’re taking. I think that’s just a fundamental form of respect.
The risk is bigger when you take it out of the blister. You would have to respect the maximum doses that you can bring along, which is 270 pills when you talk about Misoprostol when you start bringing it from another country.
And how many pills do you need to end a pregnancy?
For Misoprostol alone it’s 12 pills. If you take Mifepristone with you as well—which you can also buy in pharmacy in Nepal, India—it is four Misoprostol and one Mifepristone.
Do you know if pharmacies in Latin America sell either of the drugs? I don’t know if you know that, but I was just curious.
Well the problem is they used to—it depends on the country. So, in Peru, it’s easy. It’s easy to get Misoprostol. In Ecuador it used to be easy and now it’s getting harder. In 2008 you could get Misoprostol in Nicaragua for a few dollars, no problem. Now it’s impossible. It’s getting harder and harder to get from pharmacies there.
And is that because people know that they are using it for abortion.
Yea. Some countries they really don’t care, and so they leave it. Other countries there’s an active campaign in trying to get the pharmacies to make sure that they are not going to prescribe it.
How about the U.S., do you know if it’s accessible over the counter?
It’s really hard to get it over the counter, you would need a doctor’s prescription in the U.S. It’s very easy to buy it in Mexico and it’s very cheap to buy it in Mexico. People from the U.S. who want to go and help women in the U.S., they just go to Mexico City, they buy a lot of these pills and they fly back and they distribute it, and it’s cheap to go to Mexico City.
I would advise you, if you do it, just make sure you’re not like riding with a truck full of stuff, because the U.S. accepts the amount for personal use. I think it’s worthwhile to travel more often and take a limited amount instead of traveling once and taking more. What we all have to take care of is to try to be safe. Sometimes it means it’s more expensive, but it’s still worth it.
Would you tell us more about yourself? We know that you were working with Greenpeace, at one time you were in art school, you’re a doctor now and obviously you run this incredible organization. What were—was providing abortions a specific goal of yours when you decided to become a doctor?
No. No, no, no. It was something that I just encountered in my life. Not a goal, no.
“ What I’ve seen now is that there’s not a world where there’s different countries with different laws, or rich countries and poor countries—the only thing that matters is rich people and poor people. That’s everywhere in the world. Whether abortion is legal or not, it doesn’t matter. For the rich people it doesn’t matter when the people with no money come. It matters only for the wealthy.”
How about your art? Do you still have an artistic practice?
No. You know, I don’t see things so separated, so for me life is all one thing. I think art comes into what we do as well. Like Women on Waves, it comes to it as well and I work a lot with artists for the design and the things that we do.
I mean, art you can define in any way that you want [laughs]. It’s everything. We have been in art shows as well as Women on Waves. Some people consider it an art form. I don’t know, I don’t care too much about all of these definitions to be honest.
I think I want to say something, which I think is very important within the context of the U.S. I think I’m very privileged because in the Netherlands, when you study, it doesn’t cost much. It is about 1,000 euros per year, and you could get a grant or a loan against a very low interest rate. It means that you’re not left with a huge debt when you do medical school—or any field of study—which means you have much more freedom to do the things that you may want to do without having the necessary, you know, burden to pay back your debt.
I realize how important that is. I think all these things, like in the U.S. as well—everything is connected somewhere. In the U.S. as well, we get a lot of emails from women there, and it’s always the poor women. They’re really the most heartbreaking stories that they’re suffering with access to abortion. What I’ve seen now is that there’s not a world where there’s different countries with different laws, or rich countries and poor countries—the only thing that matters is rich people and poor people. That’s everywhere in the world. Whether abortion is legal or not, it doesn’t matter. For the rich people it doesn’t matter when the people with no money come. It matters only for the wealthy.
That reminds me. In an earlier interview that you did with the website Jezebel, you said that you didn’t want to endanger the work that you do by campaigning in the United States. I was wondering what those dangers were, specifically?
I mean what I said is that Women on Web is not providing services in the U.S. because it could potentially close down the organization. I think the reason is because the U.S. has a very long legal arm, and if the anti-abortion groups wanted to do something against it could potentially undermine the work for the U.S. and the world. That’s just something we didn’t want to risk.
That makes sense.
Also, because there’s no rule of law in the U.S., so it’s not that you can rely on a fair justice system. It’s more like, it’s exhausting, and it costs a lot of resources if you get entangled in something. Even if there’s no legal basis for it, the moment that you are being sued for something, you per-definition “lose,” because of the resources that are not available.
It’s just a system that if—it’s not a system that you can fight. If you want to do other work—or you just fight the U.S., and that’s what you spend your life doing.
It also just felt like there’s so many resources there—it’s the richest country of the world. It’s a scandal that there are so many women that have no access to abortion services there. Then it’s so hopeless as well when people vote for somebody like T***p.
Tell us about it. That’s of course only if you believe in the voting system, that the person who won is actually the person who got voted in.
Well it’s the same problem as with the justice system, right? The U.S., in that sense, is a—it’s so unjust in all the ways that you can think of.
It feels hopeless, but here we are stuck in—
It’s so hard to fight it. I mean there are so many examples of people that have done things that are challenging that end up spending time in jail because they are not able to fight the legal system; because they don’t have to resources to pay for a good lawyer, because there are juries that are corrupt and judges that are corrupt—or not even corrupt, that are just too conservative and have no vision of any justice system. It just doesn’t work.
On a personal level, how do you manage the stresses that accompany the work that you do? How do you make time for yourself and your family, and what do you do to take care of yourself?
[chuckles] Such a funny question. I don’t know, I think that…
Or is there any compartmentalization that you do? I mean, maybe you don’t…
No, I don’t. There’s no compartmentalization.
To be honest, I think that there’s a lot of other work that is so much more stressful that people have to do. I can have stress, sure, and be under pressure, but there’s so many people that have to do work that they don’t love, and they don’t like, and they have to do it because they have to make an earning. They’re being treated like shit and they’re worn out and they do very heavy physical work…I mean, yea—self-care is in place there.
I think I’m in an extremely privileged situation where I can do what I love and help other people with it. What else can I ask for?
Do you have any hobbies or what do you do in your free time? Or do you have free time?
I started doing a lot of yoga, and it’s really good for me [chuckles].
I have two children, and they demand a lot of time and attention and it’s really fun—they are the best people to hang out with. That is also keeping my feet on the ground and—you know, having to let go of all the other things. When I didn’t do that, I used to run.
I try to have friends that are not connected to the work, so I have a lot of friends that are architects or artists or lawyers—people who have nothing to do with the type of work that I do and are living a different life. I think that’s very important as well, because sometimes we think what we live is the only reality that is there and there are many, many, many other realities out there and it’s very important to keep that perspective. I think people should try to do that in general. To have friends and hanging out in scenes that they don’t work in, that is in their own fields. It’s very refreshing and it’s very inspiring as well because you find things that you can use in your other work as well.
I think that’s it. Is there anything else you’d like to be sure to highlight for the interview in the magazine?
Oh, yea, yea you were asking about the local women’s organizations that we train. We train many all over the world. We started that and now everybody’s kind of doing it on their own, which is great. We’re not here to keep doing what we’ve been doing before. For example, in Latin America, there’s many—when we started the first training in 2008 in Ecuador, most women’s groups didn’t know about Misoprostol, and the same in Africa, and now everybody is training everybody, and everybody knows about it. Also, in the U.S., I read an article where you have all these underground training networks about Misoprostol abortion providers for women. I think that’s very exciting because it was something that wasn’t there. That is also because doctors tend to keep the knowledge for themselves. I think it’s also extremely interesting what happened with the Internet, that it has democratized this knowledge in an amazing way, and we were just lucky to be one of the first ones that were around to do that.
When we started Women on Waves it was 1999. The Internet was already there, but it wasn’t used then as widely as it is used now, and I think we’ve been able to be part of that revolution and to form it, actually, to create it. It’s cool.