IF TO BE FOREWARNED is to be forearmed, Robin Marty’s Handbook for a Post-Roe America is an essential tool for anyone worried about losing access to abortion in the US of A. Practical and straightforward, the book outlines numerous what-ifs. And while it highlights a worst-case scenario in which the Supreme Court reverses Roe v. Wade, taking away the constitutional right to abortion, it also makes clear that this will not stop the practice.
This fact-of-life makes the Handbook a somewhat grim read. At the same time, it’s also a thoughtful call to action. “Losing Roe gives us the perfect foundation to start again from scratch,” Marty writes, “rebuilding the movement as local, grassroots, intersectional, and focused on de-centralizing power and resources,” with those most deeply impacted by abortion restrictions taking the lead and setting the agenda of an invigorated pro-choice movement.
Marty spoke to LARB’s Eleanor J. Bader on January 22, the day the book was released.
ELEANOR J. BADER: What first drew you to write about reproductive health and the reproductive justice movement?
ROBIN MARTY: In the early 2000s, I had a job in the marketing department of an investment banking firm. It was soul sucking and in order to make myself feel better, I started blogging for the now-defunct Center for Independent Media. I wrote about politics in my home state, Minnesota, and covered the many reproductive health bills that were being introduced in the legislature. Through this, I started writing for a daily reproductive health website called RH Reality Check (now called Rewire.News), and it just grew from there.
There’s also a personal reason for my involvement. In 2009, my husband and I were trying to have a baby. We thought we’d become pregnant but when I went to the doctor and had an ultrasound, we learned that I’d had what is called a missed miscarriage. The fetus had died in utero and I now either had to wait until my body expelled it naturally or find a doctor willing to do a D&C, a dilation and curettage, because our family doctor did not do them. At the same time that this was going on for us, there was ongoing debate over whether the Affordable Care Act (ACA) would cover abortion.
In my case, the procedure — essentially an abortion — would be covered by my insurance, but I understood that if anti-abortion lawmakers prevailed and kept the ACA from covering pregnancy terminations, a D&C would be paid for but an abortion would not. The fact that someone would not consider abortion allowable but think that removing the product of conception was okay as long as it was called a D&C seemed incredible, and I wrote about what I saw as a profound lack of logic for RH Reality Check.
Do you believe that the end of Roe is imminent?
I think that there are now enough Justices on the Supreme Court to overturn Roe, but I’m actually more concerned that Roe will remain technically legal but will be impossible to access in many states due to restrictions or because there are no providers. Over the past 46 years, we’ve seen the slow winnowing away of the right to choose, a winnowing that has placed abortion out of reach for many low-income and young people, as well as those living in rural areas. Already, six states have just one abortion clinic; 33 states and Washington, DC, ban Medicaid from covering abortion unless the pregnant person’s life would be endangered by carrying the pregnancy to term or they were impregnated by rape or incest; and 27 states mandate a wait of at least 24 hours between pre-abortion counseling and the procedure. This typically means two separate trips to the clinic. Then there are parental involvement laws. Even worse, 90 percent of US counties do not currently have a local abortion provider.
The Handbook provides concrete information on ordering abortion pills, Mifepristone and Misoprostol, to end a pregnancy. This two-medication regimen is between 84 and 95 percent effective if taken within the first 12 weeks of pregnancy, and people can take the pills at home. Complications are rare. At the same time, you write that there have been at least 20 arrests for self-induced abortion. Is it legal to use these pills? If so, why are people getting arrested?
The pills are legal if they are ordered by a physician and the pregnant person has a prescription for them. But buying them online is risky. Let me give one specific example. Several years ago, Jennifer Whalen, a mother of three from Washingtonville, Pennsylvania, was sentenced to nine to 18 months in jail after she obtained the pills online, without consulting a doctor, and gave them to her pregnant, 16-year-old daughter. Whalen and her daughter were desperate. The closest clinic was 75 miles away, there was a 24-hour waiting period after the counseling, plus the surgery was expensive. The pills cost far less, so Whalen thought this was the best option for her child. After her daughter took the pills, she had severe stomach pain so Jennifer took her to the Geisinger Medical Center. Jennifer told medical personnel there that the teen had taken the abortion pills, a fact that was quickly reported to the Child Protective Services. Whalen was subsequently charged with practicing medicine without a license, endangering the welfare of a minor child, and dispensing drugs without the proper credentials.
Of course, prosecutors always have the discretion to not bring charges, but the Whalen case showed us that it is possible for someone to be indicted and imprisoned for using abortion pills obtained online without a prescription. It’s a chilling story. Nonetheless, I want to stress that arrests tend to happen because a person tells someone — a friend, a family member, a medical professional — that she took pills that were ordered off the internet, and that person then tips off law enforcement. Still, as I write in the Handbook, Misoprostol can’t be detected in either blood or bodily fluids within a few hours of taking it, so there is really no way for medical people to know you’re not having a spontaneous miscarriage unless you tell them.
You write about many other ways that pro-choice people can help one another, including giving financial support to local abortion funds that help women pay for abortions or providing transportation to help someone travel to a clinic. You also discuss housing people who may need a place to stay when two clinic visits are required, stockpiling morning-after pills or abortion medication, and making sure to use an effective contraceptive in an effort to avoid unwanted pregnancy. What else should pro-choice people be doing?
First, regardless of whether Roe is upheld or falls, it’s always a good time to figure out the best birth control to use if unplanned pregnancy is a concern and to secure your emails and text messages. It’s always the right time to think about the what-ifs, and it is always appropriate and important for us to find ways to manage our own health care.
We need to be prepared for what might come at us. It took my generation, people who went to high school and college in the 1990s, until around 2010 to fully understand how bad it had gotten, how restricted abortion access had become, and how hard it is for many people to find a provider. This awakening happened under Obama, when reproductive justice groups — SisterSong and the National Network of Abortion Funds are just two of them — were trying to push complacent pro-choicers out of our bubble and get us active. They helped us to see that the most marginalized communities were suffering. These pro-choice feminists urged us to support the work being done at the state and local community levels. Abortion funds, the on-the-ground organizations that are raising money to help low-income women pay for pregnancy terminations, are not usually as visible as the large national organizations, but they are doing amazing work. We have to support them.
In addition to discussing the efficacy of using abortion pills, you offer a slew of warnings about how best to protect online confidentiality when doing information searches or sending emails or text messages. Do you think Big Brother and Big Sister are really watching that closely?
No. The government is not monitoring everyone’s tweets, emails, and text messages, but if you tell someone you thought you could trust about trying to abort using pills bought online, and that person betrays you by calling the police, law enforcement will have probable cause and can get a warrant to search your electronic devices. I wrote this section of the book as a heads-up to be proactive and careful.
Do you worry that the Handbook concedes that the pro-choice side has lost?
When you write a book like this, it can certainly seem like you’re focused on the negative, and I worried that people would read it and conclude that everything has already gone to hell. I feared they’d feel hopeless and defeated.
From what I’ve seen so far, though, this has not happened. I’ve received loads of texts and emails that tell me that the book has made readers feel better, that it prompted them to develop an action plan. People tell me that they’re grateful. I’m really pleased and hope that more folks will become active in reproductive justice work as a result. I also hope that those of us with race and class privilege will use our privilege to help others, even if it means doing things that involve some risk.