In the wake of the US Supreme Court’s decision that men need Viagra but women don’t need birth control, one reproductive rights activist released a DIY guide to the basics of abortion, birth control, emergency contraception, and more.
Abortion-rights activists rally outside the Supreme Court on Monday. Photo via Flickr user American Life League
On Tuesday, I was wandering around the internet and fell into a random binder full of women, which it turns out is a great place to meet badass genius revolutionaries. Jane Doe is a doula and an underground abortion provider. She writes romance novels, dreams of expatriation, and makes the best sea-salt caramels you’ve ever had. She’s spoken at statehouses and chased down riot cops. In the wake of the US Supreme Court’s decision that corporations like Hobby Lobby are people with important religious beliefs about contraception (and that men need Viagra but women don’t need birth control), she released a DIY guide to the basics of abortion, birth control, emergency contraception, and more. We got together in a hidden pocket of the binder so I could ask her for the details.
VICE: Why did you write this guide?
Jane Doe: That's a complicated question. About ten years ago, I wrote a guide to surgical abortions after South Dakota banned all abortions in that state. Since that time, I've learned a lot, and I've been receiving—at least once a month or so—emails from desperate women who find my surgical abortion how-to and want to abort their pregnancies. For a long time, I didn't know what to tell them, and then I found out more about medical abortion—how safe it is (especially compared to birth), how women are undergoing medical abortions at home, in privacy, and how there's a law that lets anyone in the United States import up to 90 days of any non-scheduled prescription drug.
From there, I started actually giving away the pills to women who emailed me—a proposition that became both expensive and incredibly (legally) risky.
Then I started sending them URLs to websites that sold the pills—which is when I thought, Wait, what am I doing? I could be letting people know all of this information, everything I know about how to find these medications, how to use them, what to do if something goes wrong.
I think this information belongs to women. It's ours. And now it's out there. Once it's on the Internet, it's hard to scrub.
Were you inspired by the Supreme Court decision or was the timing purely coincidental?
I'd been working on A Womb of One's Own for about six months in total, and like many writers tend to do, I found myself procrastinating toward the end of the project. When the Hobby Lobby decision came down, and I realized the Supreme Court wasn't actually saying that all religious expression was protected—just things pertaining to women's health—I dropped everything else on my plate and finished the pamphlet that day.
Wow. Has your motivation always been purely political or were there personal experiences that got you started?
One thing a lot of women are surprised about when they get to know me and my activism is that I've never had an abortion. What's more, I am pretty sure that for the vast majority of my reproductive life, if I'd become accidentally pregnant, I'd have been likely to carry the pregnancy to term. I'm into birth. I've been a doula. I helped deliver my former roommate's baby in our living room. I say all this because a lot of people get this very particular idea of what kind of woman would write an abortion manual: She must hate kids, they'd think, or must have had an experience where she was denied an abortion. But that never happened. What did happen is that I was raised in a very pro-choice family, and I saw friends and family struggle with their reproductive choices. The biggest thing I learned is that what's right for one person isn't for another. I will say that starting to send the abortion pills to desperate women started after a mother of three in West Texas emailed me asking which of several sharp household implements might be best for her to use if she wanted to self-terminate.
That's intense. I remember a friend telling me about doing an early term abortion on herself with a smooth chopstick. Does that kind of thing usually work, or was my friend just lucky?
I'm sorry your friend had to go through that. Well, it's a tricky thing to say. Here's how it worked when your friend did it: Any time you dilate the cervix past a certain point, sometimes, pregnancies—especially early ones—will spontaneously abort. Dilation of the cervix is the first part of any abortion procedure, though it's generally followed up with extracting the uterine contents, either with a vacuum or curettes. Now, the reason they do that second step is this: When you just dilate the cervix, it's not going to work nearly as often. Moreover, you're introducing yourself to a pretty big risk of infection to induce a miscarriage that way. I'd advise against any kind of instruments being introduced to the cervix—and if anyone does that, they need to be incredibly careful about infection, including getting to a hospital if they notice symptoms.
I noticed you didn't provide any information about surgical abortion and advised against DIYing that procedure. But you did write a guide to surgical abortions once, right? Why the change?
That's a good question, and I'm glad you asked it. Originally, I planned to include information about surgical abortions, but the problem is that surgical abortion is really a top-down procedure. You can't really do it to yourself, you need someone else to do it, and it's better—much better—if that person is trained and experienced, not a nervous wreck doing something for the first time. The supplies, the skill level involved—surgical abortion is relatively simple and safe for surgery, but there's a reason it takes a long time to become a surgeon. What's more, misoprostol (pill) abortions are regularly done through the end of the second trimester in Europe, and studies show them to be statistically just as safe as a surgical procedure. Given the fact that a medical abortion's supplies cost $10 and a woman can do it on her own, I didn't think it was wise to include information on a more dangerous, more expensive, more difficult procedure just for the sake of completeness. If anyone wants a guide to surgical abortion, they're welcome to check it out here. Someone asked me when I published that one whether I'd provide a guide on home appendectomies. I told them: As soon as a state makes appendectomies illegal, you bet I will. The original guide was written more as an angry howl, a political statement—though a medically accurate one. I do not expect anyone actually used it to provide or obtain a surgical abortion, having never heard anything to the contrary.
So now that we’re talking about reproductive justice again, what do you think is the root of the problem?
Imagine a basketball game where one team is only—and I do mean only—playing defense. It doesn't matter how good their defense is, or even whether the other team is bad at basketball. If you're only playing defense, they rack up the points and you lose. Ever since Roe v. Wade, that's been the state of abortion politics in the United States. The left has played defense, acquiescing to little regulations here, waiting periods there. Then the folks at Planned Parenthood and NARAL want to tell us that we're winning victories and should keep donating because the score is only 75-0, instead of 115-0. On the left, we need to stop taking the defensive side--stop letting our opponents frame the debate, start advocating for more access, more clinics, more freedom to make a very personal and intimate decision in a more personal and intimate way.
So we have to start playing offense, which is really just exercising the rights we should have in the first place?
Well, it's not just that. Here's something big: Very few medical students today are getting any training in performing abortions. Most schools don't even offer it, and the ones that do have it as "opt-in" training—because, as we know, most people training to become doctors just don't spend enough time studying and are dying to take on an extra opt-in course that could be a politically sensitive issue for others in the school. So getting that education back into our medical schools, and pushing for state laws so that medical abortions can be delivered in many different environments, by many different levels of healthcare providers, should be a big priority. Right now, the way you get a medical abortion in the United States involves spending hundreds of dollars and, often, several clinic visits—and then a doctor puts a paper cup with pills into your hand. There's no reason it should take a doctor to do that. Nurses and nurse-midwives should also be able to perform abortions nationwide. And that's just one of many ways we can fight back against the decline of access. Even "blue" states are losing clinics to regulations and to the greying of abortion providers, who are now, on average, senior citizens. We need to think of creative, structural ways to make it easier to make an informed choice about pregnancy. Oh, and that's another thing—pro-choice people too often focus only on one side of the choice equation, to the detriment of all women.
Oh, wow, I can't believe it's not even taught in medical schools. Don't midwives do abortions in other countries?
They do! And especially when it comes to medical abortions, where the extent of the "skill" involved is literally putting pills in someone's hands after making sure they are giving informed consent. It boggles the mind that this is a task we're requiring doctors to fly hundreds of miles to perform.
I want to go into that last bit a little more, about how the pro-choice movement has focused too much on one side of the equation. When we hear "pro-choice," we're really saying "pro-legal abortion." But I really am pro-choice. I am. I believe any woman—any woman at all—should be able to make the choice she prefers about keeping or terminating a pregnancy. And I have to think that we've been letting a lot of women down, because a whole lot of women are getting abortions in the first place because there's no paid maternity leave, there are almost no daycare subsidies. This country is brutal to mothers, especially mothers living in poverty. They are damned if they have an abortion and damned if they don't. A lot of anti-abortion people talk about women's abortion-related trauma and how a lot of women wish they'd chosen differently. Well, no kidding. A lot of these women are essentially economically coerced into termination. If we're really pro-choice, that means working hard for maternity leave policies and daycare subsidies, as well as expansions of SNAP [Supplemental Nutrition Assistance Program, aka Food Stamps] benefits and the WIC [benefits for women with children] program. If we're really only talking about choice when it comes to the rich, then we may as well not be fighting this battle at all. Everyone knows that rich women, even pre Roe, were able to travel and obtain safe abortions. Today, many poor women are stuck in a double bind: unable to afford to keep a pregnancy, unable to afford to terminate it. We need to work on both sides of that double bind if we want a country that has not just a legal notion of "choice," but real reproductive justice.
That seems like an important piece. So tell me about this diaphragm thing—we don't really need to get them fitted?
Yeah, looking into alternative forms of birth control one day, I found out that diaphragms are actually way cooler than I'd ever known—and all because of some fairly recent studies. In the last ten years, a series of studies, mostly in the journal Contraception, have explored a new method of using the diaphragm that makes it as effective as some forms of hormonal birth control, less messy, less complicated, and allows for more spontaneity. What's more, these same studies found that a huge majority of women—almost 90%—could use a single size of diaphragm, 70mm. If it doesn't fit, you'll know, because you will have discomfort and it will be too big. And a new diaphragm model, the Caya, has a contoured fit that will work for even more women without needing to be fitted. It was always a myth that you needed a re-fit every time you gained or lost weight, but—much like the also-outdated annual Pap smear—it got you to pay your gynecologist on the regular even if you weren't relying on him or her for pill packs. Since diaphragms are available without a prescription in the UK, they're not too hard to get shipped here. Mine cost under $20, and has been going strong for two years now. Better for the environment, too. When I started looking into diaphragms, I thought they were this old, 70s-style contraception. Instead, I found out that they're 21st-century-ready. They offer a great non-hormonal option that works significantly better than condoms and is woman-controlled.
I've never even seen one. Are they like my instead cup? Or more like a diva cup? [For the uninformed: Menstrual cups are alternatives to tampons that are worn inside the vagina and collect menstrual fluid. You dump them out and reinsert a couple times a day and some of us find it much nicer than having wads of bleached rayon in our twats.]
A lot like an instead cup. In fact, you can even use one for mess-free period sex, and as a low-flow menstrual cup.
How do you know if it fits or if it's working?
If it fits, the rim of the diaphragm will lay basically flat, without bending and bulging in the rim. A too-small diaphragm won't stay in when you go about your daily business. A too-large one will bend and bulge.
Is it really safe to just leave them in all the time? It doesn't trap bacteria?
You rinse it once daily with water. Generally, during my period, I also soak it in a hydrogen peroxide solution. A normal vagina is an ecosystem that's unlike anything else in the human body, and the material is totally inert. As long as you're washing it and introducing it only to one vagina (yours), the only bacteria there after your rinse will be trace amounts of your very own flora.
That's pretty amazing. I talk to so many people that have trouble with hormonal birth control, trouble with IUDs [intrauterine devices], etc., and here the answer is right under our nose for only $20. It's almost like there's a conspiracy.
Well, I think that a diaphragm poses a pretty big threat to a lot of OB/GYNs, since they don't need to be fitted and they don't need to sell spermicidal jelly with them. Turns out that spermicidal jelly was actually making the diaphragms less effective, not more, because it was irritating delicate tissues and women took them out too soon after sex. A form of birth control that costs less than $50 and can last five years if properly kept? I think it's not exactly something our OB/GYNs, who mostly have pens with birth control pill logos and clipboards with "Mirena" on them, would go for.
It is a conspiracy! I knew it!
This information belongs to women—it’s ours, thanks to Jane Doe. Go download it and pass it around so it can’t be taken from us. Tara Burns is the author of Whore Diaries: My First Week as an Escort and Whore Diaries II: Adventures in Independent Escorting. Follow her on Twitter.