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Duarte Geraldino, Narrating: This is "In Conversation" from Apple News. I’m Duarte Geraldino.
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Geraldino, Narrating: We could soon be living in a country where in half of all states, access to abortion is banned. In the past few months, a wave of states passed legislation either limiting access to this procedure or downright criminalizing it. And soon, the Supreme Court will weigh in when it announces a decision in Dobbs v. Jackson Women’s Health Organization. That case could substantially weaken or even overturn Roe v. Wade.
I recently sat down with Jessica Bruder. You might know her book, "Nomadland," which was turned into an Oscar-winning film. In a new cover story for "The Atlantic," Bruder reports on the abortion underground; this is a covert network of people who help women access this procedure, even if they have to work around the law. This network existed before Roe, it’s persisted in many places under Roe, and should Roe get overturned, Bruder says it will certainly exist after Roe.
To understand how and when this network first formed, and the groundwork they’re laying today to prepare for a post-Roe future, Jessica took me back to the beginning, to the days when our country was first founded.
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Jessica Bruder: When the United States was new, there wasn't really any kind of proprietary American legislation around abortion. And what we did have was drawn from British common law. and British common law didn't recognize the existence of a fetus as any kind of entity at all until what they called the "quickening," which sounds like a movie title or something. I don't know, "The Quickening." The quickening was the moment that a woman first felt the fetus move. This usually happens during the second trimester. And what's interesting is nobody can feel that for the pregnant person. So, this is also not just relying on when those first movements happen, but relying on when somebody actually reports feeling them. Before that, it was legal and accepted that women could seek relief from what doctors called an obstructed menses, essentially a blocked period. So, women could go to midwives. They could also consult all of these home health manuals that were published at the time. Many of them had herbal formulas that they said would bring down the menses. So, in early America, when people were looking at who has abortions, it was generally socially regarded as women who were desperate to avoid the stigma of having a child out of wedlock. We don't know exactly who was having abortions because there just wasn't great record keeping that's been handed down. But we do know that the attitude was that these are people who society should pity and maybe turn a blind eye towards. And that started to change over time.
Geraldino: So, what changed?
Bruder: Yeah. So, what happened was all of these patent medications started taking off. By mid-century, the newspapers had so many advertisements for all of these patent medications that these were kind of like a knowing wink. This will bring down your menses. The pills had names, everything from Dr. Vandenburgh's Female Renovating Pills to …
Geraldino: [LAUGHS] Renovating pills.
Bruder: I know. It sounds like DIY home improvement. It's totally bizarre. To my favorite was Madame Drunette’s Lunar Pills. And a lot of these formulas, they knew exactly what they were doing. And they were saying, "Hey, these can restore menstrual cycles." The problem is many of them were toxic. Some of them could be fatal. And the first laws that were out there, created to control abortion and restrict it, weren't ideologically framed or anything like that. They were quite simply poison control measures. And these were passed in the 1820s and '30s.
Geraldino, Narrating: A few decades later, however, things did get more ideological. People started to actively lobby to ban abortion. But a big difference between back then and now is, at the time, that effort was mostly coming from doctors.
Bruder: When the criminalization of abortion began in earnest, that was largely on account of the American Medical Association, which formed in 1847 and started lobbying against the practice. Ostensibly on moral grounds, but also because we know they were seeking to push other healthcare providers, traditional medicine people, homeopaths, midwives, many people who, again, traditionally and historically, had been involved with abortion care, trying to kind of neutralize them as the competition by just saying that this is something that should not be happening. Part of what was going on also was that America was changing. And there was a lot of nativism and racism happening. There was a growing awareness that there were white, married, Protestant, native-born women who were in the upper and middle classes who might wish to put off having children or already had all the children they wanted and that this demographic was also having abortions. And the person who led the crusade, they literally called it the Physician's Crusade Against Abortion for the American Medical Association, was this guy named Dr. Horatio Storer who used a lot of what we would now refer to as dog whistle politics but was really quite unabashed in saying that the future of America relied on the loins - literally used the word loins - of white women, essentially. Because if white women were not reproducing rapidly enough, and if they were getting abortions, basically they would soon be outnumbered. And it was such a successful effort that by the turn of the 20th century, every state had a law or laws criminalizing abortion.
Geraldino, Narrating: This, Jessica says, is when the abortion underground really started to take form. It was made up of all sorts of people who, in the face of laws criminalizing abortion, started organizing efforts to help women still get the procedure.
Bruder: So, it's incredible. There were referral services for underground abortions that began popping up all over the country. For example, many, many people have heard of the Jane Collective in Chicago. They started referring patients to abortion providers and then there was a great demand. They started learning how to perform the procedure themselves and performed what historians tell us was about 12,000 abortions between 1969 and 1973. We know that the Clergy Consultation Service, about 1,400 Protestant ministers along with a few rabbis and Catholic priests, were connecting women with abortion providers. In California, you had something called the Army of Three. They traveled all over the country, and they distributed lists of well-vetted abortion providers in other countries. Of course, one would have to be able to afford to get overseas to do that. And then there's a couple people that I focused on a little in this story who called themselves the West Coast Sisters. This was Carol Downer and Lorraine Rothman out of the L.A. area who developed a technique that they called menstrual extraction, which was really a way to have an early-stage abortion. And they traveled the country, helping get women more educated about their own bodies, handing out speculums, the tool that's used to access the cervix. They were spreading this gospel and this technology all over the country.
Geraldino: You mention the Clergy Consultation Service and how it helped connect women with abortion providers during this time. That’s surprising to hear that a religious group would be an advocate for abortion. Can you explain what they actually did?
Bruder: So, the Clergy Consultation Service started popping up in the late '60s and into the '70s and ended up connecting what is estimated to be hundreds of thousands of women with access to safe abortions. And they weren't talking a lot about morality of abortion and ideology and abstraction. Rather, they were focusing on this idea that as pastors, they had an obligation to help women, and they focused on the practical realities for women who needed this care.
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Geraldino, Narrating: Even when the Supreme Court legalized abortion in the 1971 decision Roe v. Wade, the abortion underground persisted. That’s partly because, as Jessica writes in her piece, "For many Americans, Roe already feels meaningless." Since Roe was decided, states have passed more than 1,300 restrictions on abortion, and nearly 90% of U.S. counties don't have a clinic that offers abortion.
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Bruder: The result of that is a really complicated mosaic where women often have to spend a lot of time and a lot of money, and again, class becomes a big issue here, race and class, in that getting access to an abortion really connotes considerable amounts of privilege. People have to travel long distances. That means they have to be able to arrange and afford transportation, lodging, in some cases childcare. There are states where people, and sometimes they don't even realize it at the outset, have to make two visits to a clinic. The first one is for counseling. And then the second one is for the abortion. And in some places, there's a waiting period of up to three days in between. So, if it was hard enough to get there just for one visit, you can only imagine what it's like to set it all up so one can get there for two. We know that when it comes to an in-clinic abortion, the cost starts around $500 in the first trimester and can easily exceed more than $1,000 further along. And that expense is not eligible for federal funding under something called the Hyde Amendment, which activists have pointed out make abortion inaccessible for many, many low-income people.
Geraldino: I hear someone mention numbers, I have to do the math in my mind. So, you're talking about $1,000 that doesn't include hotel fees, the cost of traveling. But if we work with that $1,000 number, that's more than what a person who earns minimum wage earns in a week.
Bruder: Yeah.
Geraldino: That's a lot of money.
Bruder: It's a ton of money.
Geraldino: So, we know what they're up against. What about the folks who are trying to help them? The grassroots infrastructure that already exist to help them?
Bruder: Yeah. Because there are so many restrictions already, there already is a really powerful and hardworking, and unfortunately chronically under-resourced, grassroots helping women get access to this sort of care. There are many communities that are working with abortion funds, and abortion funds raise money to help people who are under-resourced connect with abortions. Whether that's money for the procedure, whether that's money for transportation and lodging, all sorts of stuff. Pre-COVID, there were groups that would put women up in their own homes. There are practical support groups that help arrange all those things, including childcare. There are clinic escorts who help women get actually up to the door of a clinic, even if there's a crowd of protesters. There are doctors who travel hundreds of miles from where they live to areas that might be hostile openly to abortion to do the work that they do and then go home. So, there's already this gigantic grassroots, and often the resources they have aren't enough to serve all the people who are seeking access to abortion, given all the restrictions that exist. So, I think there's so many people who are mired in all of those complications already that the possible overturning of Roe is a huge deal, but they're basically already still trying to put out the house that’s on fire. And this is like somebody's throwing more gasoline on it. But the house is still on fire. The house has been on fire.
Geraldino, Narrating: The underground also includes a network of people who will perform abortions outside of the formal medical system. They call themselves "community providers." This network includes midwives, herbalists and doulas who perform the procedure at home. Then, there are other people who will mail abortion pills across state lines. Because, you may not realize this, but the most common way to terminate a pregnancy is by taking two pills. One is sold under the brand name Cytotec. But increasingly, states are cracking down on medication abortion too.
Bruder: I spoke with an American midwife living in Canada who told me that she's provided hundreds of women with abortion care. Whether it was using pharmaceuticals or procedures, including manual vacuum aspiration, just running the gamut, to somebody else who might just be mailing pills, even to places where it's not legal to send or receive them by mail. I mean, there's so many ways that people can get around the restrictions. You can walk across the border into Mexico. And I've spoken with activists who told me that boxes of Cytotec are just stacked up on the counter as if for an impulse buy, almost the way stacks of chocolate might be on the counter here, when you go into a convenience store.
Geraldino, Narrating: Jessica also told me how, for a long time now, abortion activists have come up with DIY approaches. At a hacker conference in 2020, Jessica watched a presenter demonstrate how to build an abortion device using items like a mason jar, some plastic tubing, and a syringe without a needle. This is a device that’s been around for about 50 years, and while it’s certainly not what any doctor would recommend, it just goes to show the desperation some people face when access to legal abortion is so heavily restricted.
Bruder: And the presenter was a woman who went by the name Maggie Mayhem. And she was talking about the history of abortion, and in particular, a device called the Del-Em, which was something that women built at home using mostly simple parts to do early-stage abortions. And she was really passing this knowledge along for possible future use, but also symbolically to show that, look, there are people who dealt with intense restrictions and criminalization of abortion before. We know women have always had abortions. And that, in her mind, just having that knowledge is something that could empower people going forward.
Geraldino: Was she showing how to build this thing as a point of fact, or actually as a tool for the future?
Bruder: Yeah, so it was both symbolic and practical. Although when I did speak with her later, she told me that she had actually managed to go online and buy - and she said this was from Amazon, although they're not listed there anymore - what's called a manual vacuum aspiration kit. This is essentially the commercially produced medical standard version of equipment that the Del-Em was seeking to emulate back in the day. So, in her mind, if she was ever called on to use a tool like this, she wouldn't be building her own, she'd be using the same thing one might see in a clinic.
Geraldino, Narrating: The underground also helps provide legal services. Increasingly, states are cracking down not just on people who terminate their pregnancies, but also the people helping them do so. Jessica gave us one recent example.
Bruder: Jennifer Whalen was from Pennsylvania, and her 16-year-old daughter was pregnant and didn't want to be. So, she went online and found some gray market pills - she didn't get them with a prescription - and gave them to her daughter and the miscarriage began. Which is no easy thing under any circumstances, whether it's a self-induced miscarriage or just a miscarriage. So, the daughter got frightened when the stomach pains began. And I can't imagine watching your daughter feeling scared. Whalen did something that sounds perfectly reasonable, she took her to an emergency room and told the doctors about the pills. Well, the daughter was fine and the miscarriage went as expected, but Whalen ended up getting charged and pleading guilty to offering medical advice without a license. She was sentenced to nine to 18 months in jail.
Geraldino: In your article, you write about how advocates are talking to people and encouraging them to avoid self-incrimination while still being able to help folks get access to abortion. How do they do that? That's such a fine line.
Bruder: Absolutely. Absolutely. So again, there are just these really complicated patchworks of laws. We do know that in Texas, helping somebody get an abortion could legally expose you and open you up to all sorts of penalties. We know that other places are working to enact the same sorts of legislation that Texas has already. So, activists and concerned laypeople do find themselves in a tricky situation where they want to help women get abortions but could end up doing that at considerable risk to themselves. I spent a few hours in a training session with a group called Self-Managed Abortion, Safe and Supported. And the woman running that session, Susan Yanow, was talking about sharing information about pills. And she made the argument that it is legal to share information and that you can do that without giving somebody specific medical advice. So, she was urging people to pass along information about the pills in a very general way, saying, "This is what studies have shown. This is what one can do," rather than, "Hey, go to this pharmacy just across the border."
Geraldino: In a post-Roe world, what does abortion look like in states where it's legal versus those where it is illegal?
Bruder: Yeah. Well, it's pretty incredible to think about because according to researchers on the issue, 26 states are likely to ban or try to ban abortion altogether if the Supreme Court gives them that legal space to do it. So, then there's just this patchwork map where places that were already abortion deserts de facto, just because of all the restrictions and the lack of clinics, dry out completely, and a lot more people end up moving around. So, we have states, including New York where I am and California, that are preparing to absorb more patients, that people are talking about wanting their states to become sanctuary states for … Gosh, there's this new coinage people are referring to, "abortion refugees," and states are staffing up. It's interesting to think about what happened in Texas when the six-week ban went into effect through SB8 because a lot of activists saw that as pretty much a dress rehearsal for the end of Roe. We know that one in 10 of all U.S. women at reproductive age lives in Texas. So this was no small thing. And what happened was just this giant … you can't even call it a ripple effect because I mean, think somebody just heaving a boulder into a pond and this kind of shock wave of going out, in that women who could afford to do this were just rolling out of the state and ending up in clinics and neighboring states. And people in the neighboring states who were seeking abortion care couldn't always get it in their home areas anymore and they had to go further. So, there was this huge diaspora. We know that clinics as far as Washington State and Maryland saw an uptick in Texas patients. We know that there were certain situations where people who were seeking first-trimester abortions, who might have been eligible for medication abortion, couldn't get what they were trying to do because they had to wait too long. And that meant that they had to go with second-trimester procedures that were more complicated and more expensive. So, it really upended the whole abortion ecosystem. And multiply that by however many, if 26 states rather than just Texas are banning abortion.
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Geraldino, Narrating: You can read Jessica Bruder’s article for "The Atlantic" on Apple News.
And before I sign off, I want to let you know this is … it's my last show. I’m leaving Apple News to finish up some other projects that you may be hearing about soon and to explore new opportunities. It’s been an amazing journey with you, launching two shows. Next week, Shumita Basu will join you right here on "In Conversation."
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