Abortion Pill Demand Is Driving an Underground Network

To Aiken, the international abortion pill market feels resilient because it is beyond the purview of any one country’s authorities. “If someone’s based outside of the country, it is unclear how to exactly force them to comply with the law in another jurisdiction,” she says. “It’s not clear what folks who are very motivated to outlaw abortion can do in response to that.”

Plan C’s Wells also believes these supply chains are robust. “We do worry that routes of access could get cut off. But we are in the 21st century, in a global economy. And there are so many routes of entry into this country for products that we feel that it’s fairly unstoppable,” she says. “If one of these companies were to get shut down, another would pop up.”

-Morgan Meaker, “Abortion Pill Demand Is Driving an Underground Network.” Wired. July 18, 2022.

In other news, prohibition simply creates a market. That’s Econ 101 and an predictable outcome of overturning Roe vs. Wade. You’ll see a Jane 2.0, and any woman with even the remote chance of becoming pregnant will have some of these pills in case of emergency. Now, ask yourself, did the number of abortions increase, or decrease?

The New York Times Problem, Exhibit: Abortion

“The Supreme Court seems all but certain to rewrite the country’s abortion laws when it rules in coming months on a case from Mississippi. But the real-world effects of that ruling will differ enormously depending on how far the justices go.

In one scenario, only a small share of abortions now being conducted in the U.S. — less than 2 percent, perhaps — would become illegal. In another scenario, the ruling could lead to sweeping changes in abortion access and a large decline in abortions.

-David Leonhardt, “A Portrait of Abortion.” The New York Times: The Morning Newsletter. December 14, 2021https://www.motherjones.com/politics/2021/12/the-fda-just-made-medication-abortions-a-whole-lot-easier-to-get/

Every weekday morning and Sunday, I read David Leonhardt’s The Morning Newsletter to my wife. Her politics are Democratic Party liberal politics, and The New York Times is the paper of record for liberals in the United States. So, this newsletter explains the thinking of that demographic.

While I enjoy talking to my wife about the issues of the day, I find the framing of these issues by the The Morning Newsletter bordering on incompetence. As you can see from the quote above, the framing of the issue is a false dichotomy, between less or more restriction, with an understanding that abortion is some surgical procedure done by a doctor, or by some illegal clinic harkening back to Prohibition. But, I’d say there’s a key element missing in The New York Times discussion. There are modern medical abortifacients, i.e., mifepristone and misoprostol, that can end a pregnancy. Together, they are an “abortion pill”. Here’s Planned Parenthood providing an overview:

“Abortion pill” is the common name for using two different medicines to end a pregnancy: mifepristone and misoprostol.

First, you take a pill called mifepristone. Pregnancy needs a hormone called progesterone to grow normally. Mifepristone blocks your body’s own progesterone, stopping the pregnancy from growing.

Then you take the second medicine, misoprostol, either right away or up to 48 hours later. This medicine causes cramping and bleeding to empty your uterus. It’s kind of like having a really heavy, crampy period, and the process is very similar to an early miscarriage. If you don’t have any bleeding within 24 hours after taking the second medicine, call your nurse or doctor.

-“The Abortion Pill.” Planned Parenthood.

So, you no longer have to have a surgical procedure to have an abortion. You simply have to take two medications, within 48 hours of one another.

Now, the implications of that fact are profound. This means that stopping abortions is as practical as stopping people from taking drugs or drinking alcohol. Decades of a U.S. “Drug War” and the experiment of Prohibition illustrates a simple fact. The minute you prohibit a legal means of getting something done, you create an illegal market for it.

The implications are obvious. The level of restrictions that the Supreme Court allows and individual states implement will create illegal markets in mifepristone and misoprostol. As with other drugs, it will be impossible to prevent these drugs from reaching the people that want them.

So,, prohibiting surgical abortion might have the counter-intuitive effect of creating a illegal market for abortion drugs that will make abortion more accessible, not less. And, when the Pro-Life movement understands this fact, they will then try to go after women using these medications, except instead of draconian drug laws, they’ll create abortion specific laws or try to make using these medications an action that can be charged as murder.

Action, reaction. All very predictable, and all not even hinted at in the The New York Times dichotomy of more restrictive and less restrictive options.

Perhaps, we should give David and the other writers at The Times the benefit of the doubt. It is a daily, and they are limited in the amount of detail they can put in. However, this doesn’t change the fact that their efforts are more likely to misinform people than provide them with a useful framework for understanding the world.

Fake news is everywhere because most of the thinking presented in mass media is bad, top to bottom. It’s not a problem of a particular political point of view. It’s a problem across the board. The real question one should be asking is: who benefits from viewing the abortion issue as a dichotomy hinged on the decisions on The Supreme Court? A question left as an exercise for the reader.

Update: Not even two days after writing this Mother Jones reports:

“The Food and Drug Administration announced on Thursday that it will loosen restrictions on the abortion pill mifepristone, allowing people to receive the pill via mail or pharmacy instead of having to appear in person at a clinic or hospital.” 

-Lil Kalish, “The FDA Just Made Medication Abortions a Whole Lot Easier to Get.” Mother Jones. December 16, 2021.

Action, reaction.

Sotomayor Spits Fire in a Dissenting Opinion in Whole Women’s Health v. Jackson

“This is a brazen challenge to our federal structure. It echoes the philosophy of John C. Calhoun, a virulent defender of the slaveholding South who insisted that States had the right to “veto” or “nullif[y]” any federal law with which they disagreed. Address of J. Calhoun, Speeches of John C. Calhoun 17–43 (1843). Lest the parallel be lost on the Court, analogous sentiments were expressed in this case’s companion: “The Supreme Court’s interpretations of the Constitution are not the Constitution itself —they are, after all, called opinions.”

The Nation fought a Civil War over that proposition, but Calhoun’s theories were not extinguished. They experienced a revival in the post-war South, and the violence that ensued led Congress to enact Rev. Stat. §1979, 42 U. S. C. §1983. “Proponents of the legislation noted that state courts were being used to harass and injure individuals, either because the state courts were powerless to stop deprivations or were in league with those who were bent upon abrogation of federally protected rights.” Mitchum , 407 U. S., at 240. Thus, §1983’s “very purpose,” consonant with the values that motivated the Young Court some decades later, was “to protect the people from unconstitutional action under color of state law, ‘whether that action be executive, legislative, or judicial.’ ” Mitchum, 407 U. S., at 242 (quoting Ex parte Virginia, 100 U. S. 339, 346 (1880)).

S. B. 8 raises another challenge to federal supremacy, and by blessing significant portions of the law’s effort to evade review, the Court comes far short of meeting the moment. The Court’s delay in allowing this case to proceed has had catastrophic consequences for women seeking to exercise their constitutional right to an abortion in Texas.

These consequences have only rewarded the State’s effort at nullification. Worse, by foreclosing suit against state-court officials and the state attorney general, the Court clears the way for States to reprise and perfect Texas’ scheme in the future to target the exercise of any right recognized by this Court with which they disagree.

This is no hypothetical. New permutations of S. B. 8 are coming. In the months since this Court failed to enjoin the law, legislators in several States have discussed or introduced legislation that replicates its scheme to target locally disfavored rights.5 What are federal courts to do if, for example, a State effectively prohibits worship by a disfavored religious minority through crushing “private” litigation burdens amplified by skewed court procedures, but does a better job than Texas of disclaiming all enforcement by state officials? Perhaps nothing at all, says this Court.6

Although some path to relief not recognized today may yet exist, the Court has now foreclosed the most straightforward route under its precedents. I fear the Court, and the country, will come to regret that choice.”

.” No. 21-463, December 10, 2021

The Best Abortion Ever

“The abortion room was tiny and plain and clean, like a studio-apartment kitchen. I squeezed my companion’s hand through the speculum portion of things, which is fine for me, but in this context, a little more traumatic than your average Pap smear speculum, then through the Novocain shot, which was actually more pleasant than a Novocain shot you get in your mouth. “We wait a few moments,” the doctor said, in an Eastern European accent.

In a minute or so, she said, “Okay, now instrument.” There was a feeling between uncanny and mildly unpleasant, then there was pain. It was like the worst cramp ever times three, but not worse than that. “Just look at me and keep squeezing my hand; just look at me and keep squeezing my hand,” said my companion, and I did what she said, and was finally glad that she’d invested more of her personality in solidity than in wit. It lasted about ten seconds. I was just about to say, “This really hurts,” when, suddenly, it didn’t hurt anymore, and the doctor was snapping off her gloves.

“Was that it?” I said as I felt the speculum come out. The doctor didn’t say anything, but my companion said, “That’s it. You did great.”

“Holy shit,” I said. “That was hands down the best abortion I ever had in my whole fucking life. You’re amazing.”

The doctor gave me a look that I interpreted to mean, ‘Crazy ladies are all the same.’ She left. I didn’t care. I loved her.”

—Sarah Miller, “The Best Abortion Ever.” The Cut. June 19, 2019.

More about the abortion experience than I’ve ever seen anywhere before. If you think RU-486 makes much of the aboltion discussion moot, it probably helps to know that it can also be “intense”?

Also, I loved the adjective, “hippie-adjacent”. Aspirational.

Mail-Order Abortions Are Now Available in the U.S. What Does That Mean for American Women?

“A well-established abortion-by-mail provider is expanding its services to the United States, The Atlantic reported on Thursday. Women on Web, run by Dutch doctor Rebecca Gomperts, has provided remote consultations, prescriptions, and pills to patients seeking abortions since 2006. But until now, Gomperts has never operated in the U.S., fearing the powerful pro-life lobby’s impact on her international service. Now, she’s started Aid Access, a spinoff of Women on Web that provides American women with mifepristone and misoprostol—a drug combination widely used for early-term abortions…

…Aid Access combines the two: A physician is available to talk through the procedure, and can prescribe and ship you the drugs. Also, the drugs only cost $95 (with a sliding scale for patients who can’t afford it), and they show up directly at your home.”

—Emma Sarappo, “Mail-Order Abortions Are Now Available in the U.S. What Does That Mean for American Women?Pacific Standard. October 18, 2018.

Janes, v. 20.18

The subtitle of the article really says it all:

“A secret network of women is working outside the law and the medical establishment to provide safe, cheap home abortions.”

—Lizzie Presser. “Whatever’s your darkest question, you can ask me.” California Sunday. March 28, 2018.

The prevalence of, for lack of a better term, Jane Networks, is probably an interesting social indicator worth some study. Facts:

  1. A society needs means of controlling reproduction.
  2. If reproduction is not controlled by society, then it will be controlled by Malthusian environmental forces.
  3. Society has a variety of techniques of dealing with the problem of reproduction that run the gambit from puberty rites to modern birth control.
  4. Jane Networks are typically talked about as informal networks that provide abortions, but it probably should include sex education services, use of contraception, etc.

Jane Networks have been around for as long as women have been having children. The only real question is how effective and safe are/were the methods used.

Ergot, for instance, was used as an abortifacient in medieval times. One person used it, survived, and used that experience to help other women. The knowledge spreads and a Jane Network forms.

The real need driving a woman to risk dying to prevent a pregnancy isn’t ever going to go away until we solved the problem of reproduction, i.e., when we can have babies only when we want them. It’s certainly not something the law can try to prohibit without making a mockery of itself, by creating the need for large Jane Networks.

Like with drugs, if government wants to control abortions, it needs to get in the business of providing it in a safer, more cost effective form than a Jane Network. Prohibition will cause Jane Networks to form anywhere there is unmet need.

Engaging with the problem and providing a comprehensive approach that includes multiple techniques, such as sexual education, birth control, adoption and yes, abortions is the only way to significantly reduce the number of abortions. The only real question, for a society, is: who provides these services? Should it be a Jane Network, the state er something else?

Personally, I think developing a modular, community approach that tries to bring as many techniques as possible to bear on the problem of reproduction is the way to go. Let there be millions of Jane Networks. Lets learn from each of these experiments and develop safe, inexpensive and effective techniques for handling the problem of reproduction.