Meet the Man Mailing Medical Abortion Pills to Vulnerable Women

This article appeared in the March issue of VICE magazine.

The CEO of Australia's only federal abortion provider, Marie Stopes, is a South African man. Alexis Apostolellis knows this is surprising to some, but it doesn't stop him from doing his job. In country as large as Australia, where abortion laws vary from state to state, it's a big task.

Marie Stopes is governed by pragmatism. It stays out of politics and does its best to keep quiet. This way, it avoids having a target on its back—like the one Planned Parenthood has right now in the US. The approach works, but it means you don't hear much about the work they're doing for the reproductive rights of women in Australia. Which is a lot.

Over the past decade, Marie Stopes has changed the way Australian women can access abortion. Because of them, the medical abortion pill mifepristone can be delivered straight to a woman's mailbox. Now, those in remote areas can safely terminate their pregnancies without travelling to their nearest clinic—which can be hundreds of kilometres away. It's a hard-won reality, but plenty of women and doctors still don't know about it. VICE met with Alexis to talk about reproductive health's quietest revolution.

VICE: Alexis, would you say your job is tough?
Alexis Apostolellis: It's a great responsibility. Our mission has always been to give all women access to abortion. To do so, we run certain regional clinics at a loss—like our Rockhampton and Newcastle clinics. Women in rural Queensland wouldn't have access to abortions unless we operated there.

Then there are the women who can't even access those sites—I know that for them, you've introduced another option: sending the medical abortion pill out by post.
We do, but it's taken us a long time to get here. The drug used in these medical terminations is mifepristone, or RU486. Marie Stopesbrought that pill to Australia in 2012. It was actually legalised here in 2006, but none of the pharmaceutical companies would touch it: it was a political hot potato. Finally, our colleague Maria Deveson Crabbe said "Well, we'll have to do it ourselves. We'll become a pharmaceutical company." And we did.

You created a non-profit pharmaceutical company just so women could get this drug?
Yes, and over 500 doctors signed up almost immediately. Every doctor that wants to prescribe mifepristone has to go online and do a course with us. In 2012, all these doctors registered, but guess what: they weren't prescribing. We'd encountered another barrier. Medical indemnity providers had categorised medical abortions with mifepristone as surgical procedures: forcing doctors to increase their insurance premium between eight and ten thousand dollars. GPs just couldn't take the hit. We lobbied for almost 15 months to change that classification, because it really is just tablet, not a surgery. In January of 2015, two major insurers dropped the premium: that was big.

Was that when mifepristone started getting out?
When the insurance problem disappeared we really thought we were there. We weren't. In regional areas, towns with just one GP, there was a still a barrier. Often, that GP wants to help women, but just doesn't feel qualified to provide an abortion because it involves specialised counselling. That's when we created the telehealth model, to say "Doctors, we can help you."

And telehealth refers to pills by post?
Yes, but it's a more rigorous process than that phrase implies.We work alongside a local GP—they'll do the Ultrasound to make sure the woman is within the gestational limits for a medical termination—then we take it from there. All counseling is done with us over Skype, which enables a woman almost anywhere in Australia to have an abortion without having to drive 600 kilometres. We launched in November.

From the legalisation of mifepristone to the telehealth launch, that was almost a decade.
We know. It's a long time, but it's really paying off. We've had around 50-odd telehealth appointments so far—that's 10 women each month who otherwise probably wouldn't have had access to an abortion.

Are there women in Australia who Marie Stopes still can't reach?
Yes. The Northern Territory is still the absolute worst: you need two practitioners to sign off on the procedure, and it has to be done in a hospital—our telehealth consults are illegal there. It's awful. We're also restricted by good clinical practice: when women take mifepristone at home, they must be able to reach an emergency department within a reasonable time. In the most remote areas of Australia, that's not always possible. There are rural towns with one GP, where that GP has an anti-choice stance—that's more common than we'd like. There's women who have limited English and women in abusive situations. Really, there are vulnerable women everywhere in our community: every story is different. It can get under your skin.

Speaking to the women working with you, I've heard many are driven by their own experiences with termination. Without that personal story, what's pushing you to fight for women's health?
Anything which is stigmatised that shouldn't be, that's what I'll fight against. Honestly, I just don't understand how this is an issue. The abortion debate was had, it's gone—it's legal. It's horrifying that people still want to bring abortion up for debate. In a sense, it's actually good to have a male CEO at Marie Stopes—it shows you don't need to be a woman to support women's rights. If I can somehow correct an inequality that shouldn't exist, I will.

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