Abortion, including medical abortion, is illegal in far too many countries, including Northern Ireland. But the internet still works.
Delicious smells permeate a small office in Nagpur as an elderly woman cooks lunch for the 40-odd staff: roti, steamed rice, moong bean dal, spicy potato hash and mutter paneer curry......................
It’s all a long way, geographically and culturally, from the streets of Belfast nearly 5,000 away. But the two cities are joined by a hidden thread, a pharma pipeline that is helping many hundreds of women in Northern Ireland to get around its stringent anti-abortion law.
From the “Orange City”, as Nagpur, in the Indian state of Maharashtra, is known, a company called Kale Impex sources abortion pills that are freely available across India, and sends them to places where women can’t get abortions. Places such as Northern Ireland.
Rebecca Gomperts is the founder of charity called Women on Web, which works with the company in India. It is to Gomperts, working from a bare white office in Amsterdam, that many women and their partners in Northern Ireland turn when they want an abortion.
Gomperts scrolls through some of the online messages from Northern Irish women her operation has helped. None of their real names will be used, because they would face life in prison if identified.Here's how it works after the screening.
“Being in an abusive relationship, I believed there was no one who’d help me,” read one message from Aishling. “He would kill me, literally kill me, if he found out I tried to get an abortion.” [my bolding]
Each year more than 2,000 women travel from Northern Ireland to England to have pregnancies terminated, but Aishling was too frightened of being discovered by her boyfriend. She Googled medical abortion and found Women on Web.
“You can’t just say because it’s in another country it doesn’t affect you,” says Gomperts. “Human rights affect all of us.”
The single item decorating the Amsterdam office is a map by the Center for Reproductive Rights colour-coding countries by the legal status of abortion. Northern Ireland is orange, category II: one of 59 countries where abortion is only allowed “to protect a woman’s life or health”. Others in this group include New Zealand and Zimbabwe.
Each week Women on Web gets more than 2,000 inquiries from around the world. In the first seven days of December, 49 of those were from Ireland. They include women who live in the Republic of Ireland where the pills are confiscated by customs, forcing people to use addresses in the north.
Each woman answers 25 questions: how many weeks pregnant are they; do they have diabetes, epilepsy, or other listed diseases; is somebody forcing them to have an abortion against their will; do they live within an hour of medical help in case of complications?
Two answers determine whether Women on Web can help. Women must live in a country where safe abortion is not available and medicines can get through the post. And they must be at most nine weeks pregnant to allow time to get the pills before they are 11-12 weeks. After that, the World Health Organisation recommends women who take abortion pills must be in a healthcare facility.
The parcel arrived two weeks after she put in the request. Inside the package were nine pills: a single mifepristone and eight misoprostol. First women take the mifepristone to block the effects of the progesterone hormone, which keeps the pregnancy viable.And the rest will be free to live their lives.
In countries where abortion is illegal, the moment women swallow that small round pill is usually the instant they commit the criminal act. [my bolding]
At least 24 hours later they take two misoprostol, which brings on contractions to expel the pregnancy. These can be taken vaginally, but Women on Web recommend under the tongue: that way doctors cannot trace the drug if they get help for complications, the abortion in every other sense being a miscarriage. Four hours later they take another dose. If the pills do not work, there are two more doses in the package.
Most women have cramps, some vomit and get a fever, typically they bleed for a week or so. A few will have complications and need to go to hospital for the remaining placenta to be removed, and in very rare cases for a blood transfusion or antibiotics for infection.
More typical is Sarah’s undramatic experience. “The package arrived Friday and I took the first tablet, the next one on Saturday,” she wrote to Women on Web. “[It] felt like early labour for three and a half hours before bleeding started … a few minutes later I pushed out the pregnancy, and the cramps subsided.”
A few weeks later women are asked to go for a scan: only one in 100 will still be pregnant.
(Update): Here are the voices of some of these women in the Guardian.