How Women Lead

Our Bodies, Our Power, Our Pills

Weeks ago, my friend Heidi Harmon, climate champion and former mayor of San Luis Obispo, sent me the link for an upcoming event hosted by How Women Lead titled “Our Bodies, Our Power: Abortion & Reproductive Health and Justice.” She knows me well and subscribes to my newsletter. I’m so grateful she does and that she let me know about the event. I checked it out and signed up immediately, even though it would be over zoom; since retiring from teaching September 1, 2021, after zooming with students for a year and a half, I had vowed: NO MORE ZOOM. I’m glad I made an exception.

On their website, How Women Lead describe themselves this way: “We are a national organization of top executive women activating individual and collective power to influence the change we want to see in the world through personal leadership, investment, and philanthropy.” In a world where women can sometimes be each other’s worst enemies (cue the 2016 election), I find How Women Lead’s credo very cool: “Be fierce advocates for each other. Say yes to helping each other.” They understand and promote the idea that “when women are in positions of power and influence, it is better for people, profits, and the planet.” During the event, one of the hosts reinforced that credo: “Get out there and be unabashedly visible,” she said. “Build your LinkedIn. Build your thought leadership. Network as part of your workday. The old days of women being invisible are over. There is nothing indelicate about standing in your power, owning your voice.”

I’m not a leader, a go-getter, a CEO, an organizer. I haven’t run a nonprofit or even worked for one. I was an adjunct lecturer for 20 years. I did not have tenure and only spoke at one conference. I have written two unpublished novels and am an unknown, mostly unpublished writer. I do not have power or influence, have never had power or influence, unless you count raising children (and even there, I’m considered a push-over). I was the only person at the meeting having trouble with my internet and wearing a hoodie.

Yet I was thrilled to be in the company of these women and wholly impressed by their knowledge and expertise, and with the way they introduced one another, interacted, gave the floor. The two hours flew by, a whirlwind of smart panelists working with incredible organizations all with the same goal: protecting and expanding reproductive rights.

Dr. Gretchen Sisson provided an overview of the past few months and what might be on the horizon. A sociologist, Gretchen works with Advancing New Standards in Reproductive Health (ANSIRH), a collaborative research group at the University of California, San Francisco’s Bixby Center for Global Reproductive Health. She recapped the recent abortion rights Supreme Court cases from Texas and Mississippi that I’ve written about here in The Quickening (the Mississippi case is a 15-week ban; Texas a six-week ban.) The Court’s decisions are expected in June, and everyone is bracing for the overturning or gutting of Roe v. Wade, which would open the door for many other states to pass restrictive abortion laws. All the panelists know and feel this to their core, and yet that makes their work and their organizations’ work more relevant and more crucial than ever.

Gretchen pointed out that if Roe is overturned, we’re not going returning  to “back alleys”:

“The future of illegal or extra-legal abortion is not a coat hanger; it’s a pill you buy on the internet. We have a good amount of evidence that women can take these pills at home and manage them quite safely. And that’s good news because that’s safer for them. It might not be the abortion experience we want people across this country to have—we’d like them to be able to go to their provider and be open and not have to worry about doing it on their own. But I will also say that women are doing this already, and some of them like doing it on their own; they like doing it at home. I would push everyone on this call to start getting comfortable with those ideas.”

In terms of philanthropy, she encouraged people not to reinvent the wheel: “We have a really good infrastructure of organizations across the country. I’m coming from the Bay Area, where everyone’s an entrepreneur and wants to start something new, but what we really need to do is invest in the organizations that have been doing this, and doing this well, and have been preparing for this moment for a really long time.” She also has a very cool Substack, Gretchen’s List, where she makes recommendations about political candidates who support reproductive rights. She was interviewed on NPR by Mary Louise Kelly in December. She just seems like a smart, caring, and credible person.

I ended up spending a day researching all the panelists and their organizations and yes, even did a little networking, which has always been anathema to me (The lines of Emily Dickinson’s poem resound in my mind: “I’m Nobody! Who are you?”) but if I can make myself useful in this world, especially when it comes to reproductive rights, then I’ll get over my bad self and network.

I could write an entire newsletter on each panelist and their organization. One emphasized that democracy and women’s rights go hand in hand: where democracy expands, women’s rights expand; where it contracts, so, too, do women’s rights. One encouraged women to have open, frank conversations about abortion to destigmatize it. Another spoke of the importance of getting women elected; another of investing as women in women. Again and again the conversation turned to the fact that the people most penalized by restrictive abortion laws are the most marginalized: Black, transgender, poor. One lawyer spoke of the need to provide funds for legal support for those people being criminalized now—and for those who will be criminalized under the stricter abortion laws that are likely coming.

But for this week, since Gretchen talked about abortion pills being a likely response to those highly restrictive abortion laws, I want to focus on one panelist in particular, Susan Yanow. She’s the project manager of SASS (Self-managed Abortion; Safe and Supported), which is the U.S. project of an organization she cofounded:  Women Help Women, “a global nonprofit organization that supports the rights of people around the world to have information about and access to safe abortion with pills.” The host described her as a “badass.” I concur.

She explained that yes, abortion is being restricted now, but that abortion “has been inaccessible to many in the United States for decades due to geography and cost.” That’s where abortion pills come in. Nowadays, “if a person goes to a clinic or hospital that provides abortions in the United States and they are under 12 weeks pregnant, they’re offered the choice of a surgical—aspiration abortion—or an abortion with pills.” She explained that abortion with pills cause a miscarriage: “They cause the uterus to contract and push out the pregnancy.”

“This simple technology of ending an unwanted pregnancy with a pill,” she explained, “has the potential to upend traditional systems of law and medicine that restrict access to safe abortions through criminalization, over-medicalization, and stigmatization.” She called it a “deeply transformative practice that can place the power and control with users”—and emphasized that the practice could flatten health disparities because it’s so much cheaper to end an abortion with a pill.

Susan’s backdrop on her Zoom: abortion pills

Even though they were approved by the FDA in the United States in 2000, she said that they’ve been used around the world since the 1980s: “These abortion pills are very safe, and people know that they are safe. In the 1980s, women in Brazil started using misoprostol, which is registered to treat ulcers and arthritis, but it also causes uterine contractions—a miscarriage, an abortion.” Apparently, misoprostol is available over-the-counter around the world! Millions have used it in countries where abortion is illegal or restricted.

But of course, abortion pills are not available over-the-counter here: “In the United States, abortion pills are restricted to doctors who have to register to provide them—only for political reasons, not for medical reasons. These pills are safter than aspirin; they are safer than Viagra.”

So why would people choose self-managed abortion, especially if they live in a place that doesn’t restrict abortion? Privacy, she explained. You don’t have to wade through protesters. Cost—it’s cheaper than surgical abortion. More control over when and where. Then she fast-forwarded to today, reminding all of us what we know —that more abortion restrictions are coming:

“Self-managed abortion alone, either with misoprostol alone or in combination with mifepristone, is a safe option. We no longer have to talk about back-alley abortions. There are many different sources for the pills in the United States, although they are not over-the-counter.”

So what are the barriers?

“Only a third of people in the United States know that abortion pills exist. So people need accurate information about the fact that there are pills, how to use them, what to expect when using them, and the signs of a complication.”

She understands that self-managed abortion isn’t a panacea. She concluded with these words:

“We have to keep fighting to keep clinics open and to make sure that people have choices about how and where to have their abortions. We want to support those people who are able to travel out of state, but remember that regardless of funding, many people cannot travel out of state. Self-managed abortion pills are an ever-increasing resource for those who want to safely end an unwanted pregnancy regardless of the legal status in their state. It can be a tool for empowering people and destigmatizing abortion. I really encourage you to learn more about these pills; the anti-abortion movement cannot stop them.”

Later, when we were assigned breakout rooms—always nerve-racking for me—I found myself in a room with five women, including Susan Yanow. I introduced myself, told her about my newsletter, and asked her something that had been worrying me about the use of abortion pills in states where abortion is restricted—what to do if a medical complication arises?

She lauded the fact that I was writing a newsletter (inclusive! kind! supportive!) and then answered me. She said that one of the safest things a person can do is to take abortion pills to expel an unwanted pregnancy. We know that 15 to 20 percent of pregnancies end in miscarriage. Often this is a devastating event for a person who wanted to have a child; my own mother and several friends have suffered miscarriages at varying stages in their pregnancies, with heartbreak. A woman taking abortion pills to terminate an unwanted pregnancy is essentially inducing a miscarriage, and because miscarriage is so common, if there were to be a complication—and Susan emphasized that this is rare—a person could go to a clinic or hospital and it would appear that she was experiencing complications from a miscarriage, not a self-managed abortion.

What about criminal repercussions? I asked. She explained that there is no blood test for abortion pills. Doctors, she said, cannot recognize the difference between a spontaneous miscarriage and a pill-induced abortion that causes miscarriage. She explained that if a person dissolves the pills in her cheek—versus her vagina—the pills cannot be detected. (That a person may have to lie to get medical care in this country is a sad, sad reality.)

She also added, notably, that while here the FDA has only approved use of abortion pills for terminating pregnancies within the first 11 or 12 weeks, they can be used safely during later stages of pregnancy, and indeed, around the world, pills have been used to induce miscarriage after 12 weeks. All in all, speaking with her directly in the zoom breakout room was one of the most educational and impactful moments I’ve had since starting my newsletter.

On the zoom chat, a doctor wrote the following:

“Hello I work in El Salvador I am an OBGYN and we have the most restrictive laws in the world, abortion is not permitted in ANY case, I am looking forward to learn more tools to continue my work in reproductive health for women in my country.”

It made me think of Texas, which, with its ban on abortion after six weeks, does not make exceptions for cases of rape or incest. And now I realize just how salient Susan Yanow’s message is about self-managed abortion through pills. The pills are safe and available. We just need to get the word out.