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Administering abortion from abroad in Post-Roe America

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(LONDON) — When Roe v. Wade was overturned in June, Dr. Rebecca Gomperts, a Dutch physician who has made a reputation for providing abortion services overseas in countries that restrict reproductive rights, saw a huge increase in emails from the U.S.

“When the draft of the decision leaked, we already saw a huge increase in the amount of requests for the service indicating that people were really scared and panicking,” she told ABC News. “But I think what is more important is what I feel is that the enormous fear that we hear in the voices of the women or the parents.”

Though she is licensed in Austria, in 2018 Gomperts founded Aid Access, a team of doctors and advocates that work with counterparts in the U.S. to provide abortion medication and information, and has continued to work despite a Food and Drug Administration request to cease their activity. Medication abortions done at home involve patients taking a regimen of two drugs — mifepristone and misoprostol — which are approved by the FDA to end pregnancy up to 10 weeks.

Before Roe v. Wade was overturned, Aid Access would receive around 400 emails per day from the U.S. On June 24 — the day the landmark ruling was struck down in the Supreme Court — they received 4,000 emails, a record for the organization, and now comfortably see 1,000 emails per day, two-and-a-half times more interest than before the draft leak, Gomperts said.

“I’ve been working in this field like creating different possibilities with different laws for more than 20 years,” Gomperts told ABC News. “But this service specifically, it’s under my Austrian doctors license and in Austria it’s allowed to provide abortion services or to write prescriptions for medication abortion up till 14 weeks of pregnancy. The conditions under which I do it are also allowed. Which is telemedicine.”

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The legal position of such services in states that have banned abortion is unclear. In December of last year, the FDA permanently lifted restrictions allowing mifepristone to be delivered by mail.

According to the Center for Reproductive Rights, part of the confusion lies in states passing multiple laws that have overlapped, but states could go further in criminalizing people who obtain abortion pills in online pharmacies. The confusion, Gomperts said, has already led to cases where the authorities have misapplied the law.

Already providing for women in states with restrictive laws, Aid Access has also been used by those who cannot afford in-clinic care. One study from the University of Texas found that requests increased ten-fold after the legislature banned abortion after six weeks. But while data is still being collected on telemedical services post-Roe, all the indications are that requests for the service will be significantly higher.

Telehealth services such as Aid Access, operating in part outside of the jurisdiction of states where abortion is banned, could now be one of the few ways to end pregnancies in post-Roe America.

One trend that Gomperts has noticed is the uncertainty surrounding the laws themselves, with women fearful that they, rather than providers and those who aid them, could be liable for prosecution.

Aid Access has explored a way to potentially circumvent the strict laws in parts of the U.S. by administering abortion medication for future use — essentially as a preventative measure for women who can access the pills when they need it from their own medicine cabinets.

“Time and time again, medication abortion has been scientifically proven to be a safe and effective method to terminate a pregnancy,” Nimra Chowdhry, senior state legislative counsel at the Center for Reproductive Rights Abortion, told ABC News. “Abortion restrictions flagrantly disregard people’s health and put people and providers at risk of punishment just for accessing and providing essential health care. We have started to see more and more states target the use of medication abortion because they recognize that medication abortion is safe, effective, and in-demand. People should not have to live in a state of fear when obtaining or providing abortion care including medication abortion.”

One U.S. study into the safety and effectiveness of self-managed medication abortions provided by Aid Access found that 96% of people self-reported they were able to end their pregnancies using the pills alone after consulting with online telemedicine. These are numbers, according to one of the study’s authors, Abigail Aiken, that are on par with what can be expected in a clinical setting.

In her work, Gomperts has found that obstacles to abortion services, and not abortions themselves, have proved most traumatic. One of the fundamental misconceptions about abortion, she said, is that it is treated as an “exception,” rather than one “part of our reproductive lives.”

“The discourse around trauma is something that is created by society,” she said. “It’s not based on our experience of the stories of women. They experience the trauma because their access to the abortion has been taken away and restricted.”

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