DIY Abortions and 3D-Printed Specula Can't Replace Lost Reproductive Rights

Earlier this month, as Ohio legislators successfully passed a bill banning abortion after 20 weeks of pregnancy, I found myself thinking about the GynePunks. A collective of radical biohackers, the GynePunks first caught my attention in the summer of 2015, when they burst onto the public stage with a nifty 3D-printed speculum and a manifesto for body sovereignty.

Back in 2015, I'd mentally filed the GynePunks into the category of "interesting, but not immediately relevant to my experience." At the time, reproductive rights had seemed fairly secure in the United States. DIY gynecology seemed like an interesting commentary on bodily autonomy and the corporatization of medicine, but nothing that I, personally, would ever need.

But with the Affordable Care Act on rocky footing, Republicans gearing up to defund Planned Parenthood, and Ohio likely just the first of many states to enact further barriers to abortion access, that sense of security in my own bodily autonomy and access to quality gynecological care and affordable birth control started to feel a lot shakier. Suddenly, the GynePunks mission to make gynecological care widely available to anyone with internet access seemed a lot more urgent. And, for that matter, a lot more personal.

But how's a woman like me to access DIY gynecology? The GynePunks garnered media attention with a speculum, so I figured I'd start there. So long as you've got access to a 3D printer (let's just imagine we're in a world where $1000 pieces of machinery are somehow easier to get ahold of than cheap, plastic specula), the files are freely available on Thingiverse.

But unless you're Annie Sprinkle, a speculum on its own isn't going to do much for you. And in the world of 3D-printed reproductive rights, specula seem to be as good as it gets. Despite my fantasies of 3D-printed diaphragms and IUDs, repeated searches came up short. Tellingly, a collection titled "health" contains the GynePunks speculum and nothing else.

I probably shouldn't have been surprised. Despite the inevitable hype about the potential 3D printing has to "change the world," most consumer 3D printers are better suited to creating toys than medical equipment. But 3D printing isn't the only way to hack healthcare—and thankfully, a friend was able to put me in touch with Mary Maggic, a bioartist looking to upend our relationship to the hormones most essential to most forms of commercial birth control.

Open Source Estrogen examines the feasibility of synthesizing estrogen through citizen science. Originally conceived as a way to make hormonal birth control open source, the project's since been expanded to include the needs of anyone who might benefit from access to estrogen (notably, trans women and genderqueer people). The theoretical end goal, Maggic told me, is anyone in need of estrogen—whether a cis woman hoping to prevent pregnancy or a trans woman taking a DIY approach to hormone replacement therapy—"hacking in the kitchen and synthesizing their own estrogen," pulling the molecule from urine or other natural sources where it happens to reside.

But just as I started to get excited, reality set in. Open Source Estrogen isn't coming to a kitchen near you any time soon—or, perhaps, ever. When I pressed Maggic for a timeline, she bristled in response. "We're not working towards that goal," she told me. "We're not a company."

Like the Bearina IUD, a low cost concept contraceptive which, by its own creator's admission, "absolutely should not be used as an IUD," Open Source Estrogen is more a statement about body sovereignty and anti-capitalism than an actionable strategy for reproductive freedom.

But even you won't be able to fashion birth control pills from your urine any time soon, that doesn't mean there's no DIY way to take control of your uterus. Just as I was about to give up my search, I stumbled upon a guide to a safe, DIY abortion put out by the International Women's Health Coalition (an organization which, full disclosure, employs my sister) in partnership with Gynuity Health Projects, a research and technical assistance organization focused on making reproductive health technology more convenient, safe, and accessible.

IWHC's guide offers a step by step instruction manual for inducing an abortion with misoprostol, an abortifacient that does double duty as an anti-ulcer medication (and, as a result, is widely available even in countries that ban mifepristone, its sister in pregnancy termination). In the US, it's sold under the brand name Cytotec; though it requires a prescription in the States, it can be purchased over the counter in Mexico. Although misoprostol alone is not as effective as the mifepristone/misoprostol combo currently used to induce medical abortion, it's still 75-85 percent effective in the first trimester, and, of course, far, far safer than the many unsafe abortion methods desperate women turn to (including, but not limited to, drinking toxic fluids like turpentine, inserting a twig or coat hanger into the uterus, or attempting a D&C in unsanitary conditions) that often lead to infection, infertility, or even death.

Misoprostol can also be used to induce an abortion in the early portion of the second trimester (from 13 to 20 weeks in), but it's significantly riskier at that stage. And, notably, misoprostol isn't an option after twenty weeks, meaning it doesn't do much for any Ohioans who find themselves in need of a late term abortion.

And that points to one of the biggest issues with taking a DIY path to reproductive freedom. Even if we're able to make estrogen open source, securing easy access to hormonal birth control for anyone who wants it; even if a misoprostol abortion is leagues ahead of options available in the pre-Roe v. Wade era; even if we can 3D-print specula and teach the basics of pelvic exams and IUD insertion to anyone who wants to learn; all of these options work best for people in the peak of health, with relatively uncomplicated reproductive needs. For anyone dealing with something more complicated—for instance, the severe fetal anomalies that might lead someone to pursue a late term abortion, or even a slightly complicated IUD insertion—DIY options are at best ineffective and at worst life threatening.

There's no safe, effective DIY substitute for an experienced and knowledgeable physician who's legally allowed to provide their patients with the best possible reproductive health care: whether that's prescribing affordable birth control, performing an abortion, providing STI tests and treatment, or any other essential reproductive health services. And no matter how good DIY tech gets, it's unlikely to ever enable ordinary people to safely navigate a complicated, dangerous medical procedure like late term abortion—making the fight for late term abortion rights that much more essential.

It is noble to fight for cheap and effective forms of reproductive health care, and projects like Open Source Estrogen are an important step in pushing the conversation forward. But that fight works best in an environment where DIY is an option, and not one's only recourse. We should advocate for our body sovereignty, but that fight isn't just about making reproductive health care open source. It's also about ensuring safe, legal, and affordable access to the medications, procedures, and professionals essential to reproductive health.