The feminist telehealth provider is cutting out pharmaceutical middlemen to make abortion safer, simpler and more accessible across borders.
Across much of the world, medical providers do not offer abortion because this care is criminalized, stigmatized or unfunded. As a result, an increasing number of women are accessing abortion pills outside of the formal medical system. At the center of this shift is Women Help Women, a global telehealth abortion service that supports self-managed abortion by providing abortion pills and information about how to use them, to women around the world, especially in places where abortion is restricted by law, stigma or lack of access.
After a decade of relying on pharmaceutical companies to supply them with abortion pills, Women Help Women is changing course by seizing control of production. Women Help Women’s coexecutive directors Kinga Jelinska and Lucía Berro Pizzarossa recently announced they have begun working directly with drugmakers in India to produce their own innovative combipack of mifepristone and misoprostol for distribution around the world.
Jelinska described this move as a strategic shift. “We were already taking the risks of disseminating the information and distributing the pills to the end users. Now we are taking over the means of production to make ourselves less dependent.”
Frustrated by the pharmaceutical industry’s lack of innovation to meet the needs of abortion seekers, Women Help Women decided to take matters into their own hands.
“We know the issue of the future is who owns the pills, who owns access to the medicines,” said Jelinska. “We know how incredibly vulnerable the pathways to access could be if they are dependent on pharma and the market. I often say, pills don’t grow on trees.”
Women Help Women is redesigning how abortion pills are packaged to reflect what users actually need: a combipack that includes one mifepristone tablet and eight misoprostol tablets for use up to 12 weeks of pregnancy. The standard blister pack of abortion pills includes one mifepristone pill and four misoprostol pills, yet some women want extra misoprostol to ensure a complete abortion. The World Health Organization recognizes that additional doses are beneficial by not limiting the doses of misoprostol.
Those extra tablets are about reassurance, said Jelinska. “We sometimes say, misoprostol doesn’t only treat a uterus. If people are not sure the pills worked, we tell them to take two more pills. It will create a little bit more cramping, but you will feel more secure.”
By building extra tablets into the pack, Women Help Women’s combipack reduces the need to seek extra medications from medical providers, which can be inaccessible or legally risky in many places around the world.
Its smaller packaging also requires less postage, is easier to mail discreetly and is eco-friendly by using 30 percent less plastic, weighing 40 percent less and taking almost 50 percent less space. “Its lighter weight reduces the carbon footprint across manufacturing, storage and distribution—an important step in aligning abortion access with climate justice,” said Berro Pizzarossa.
In contrast, the U.S distribution system is more fragmented. FDA-approved distributors only provide one mifepristone in the blister pack, forcing clinicians to prescribe a separate bottle of misoprostol pills, which is cumbersome and costly.
Jelinska said their packaging innovation will fundamentally reshape abortion care, making it easier and putting more control in users’ hands.
“It’s a huge revolution of who actually gets to decide when, how and with the support of whom they can have an abortion and until when. It centers the needs of users rather than institutions or markets. The underlying notion is that abortion can be friendly, and abortion can be easy.”
Self-managed abortion is disruptive. We were told that abortion is a difficult decision; that it has to be difficult to access, and that only doctors control it. Self-managed abortion subverts that …
Lucía Berro Pizzarossa
Since mifepristone first became available in France in 1988, access has been controlled by governments, the medical system and big pharma, which has done very little innovation to meet women’s evolving needs.
Women Help Women was designed to break that control and take power back, says Jelinska. “When we started it in 2014, we were already very aware of the potential of abortion medicines, but we knew that the paradigm of telemedicine would not suffice because it was still controlled by the medical system, the law and the market. We wanted to get the abortion pills into the hands of people and provoke a normative revolution: abortion that is safe, abortion that is friendly, and abortion that is easy to get. We wanted to decentralize abortion access.”
Women Help Women views taking production into their own hands as the next essential step toward fulfilling their mission to decriminalize, destigmatize, demystify and demedicalize abortion.
For Berro Pizzarossa, self-managed abortion is not just a workaround but a profound shift in power.
“Pills have given us a power that we didn’t have before. Self-managed abortion is disruptive. We were told that abortion is a difficult decision; that it has to be difficult to access, and that only doctors control it. Self-managed abortion subverts that because the pills are small and they’re easy to use. Anybody that has access to good information can do it by themselves. They can be their own providers, right then, in a way that is safe and different from the DIY abortions from the past. It dismantles really everything that we were told about abortion. No doctor, no difficulty. It doesn’t have to be stigmatized.”
Controlling product innovation has enabled Women Help Women to redesign abortion care around women’s experiences and needs, says Jelinska. “It’s a friendly product, branded with, ‘I love Women Help Women,’ which people very much appreciate.”
Berro Pizzarossa sees Women Help Women’s work as transformational, turning abortion from a clinical service into a question of justice and bodily autonomy. “Abortion is healthcare, but it goes way beyond issues of health. It has to do with justice. It has to do with your ability to control your own body.”
Berro Pizzarossa criticized the pharmaceutical industry’s lack of innovation of abortion pills, noting that while Viagra comes in all kinds of forms, including different colors and flavors, misoprostol remains bitter and chalky. “Pharma innovates in other areas, but for misoprostol, we have 40 years of nothingness in terms of centering the users,” said Berro Pizzarossa. “Nobody thought of experimenting with the composition, with the dosage or with the delivery mechanism to improve the experience in any way.”
When asked why the industry has left abortion pills untouched for so long, Berro Pizzarossa is blunt: “It’s not a technological gap. It’s lack of political will. Nobody cares about making people’s experiences with abortion better. There’s this ingrained idea that abortion ought to be bad so people don’t do it again.”
In a political moment defined by mounting attacks on abortion pills, controlling the product is not optional but essential, says Jelinska. “For years, feminists have been in a begging position, and distributors and social marketers have taken huge profits. We should have our own products because it’s necessary in times when we have jerks as presidents and political leaders who have powerful alliances with capitalists and pharma attacking our rights.”
To develop the new combipack, Women Help Women conducted focus groups to find out what women wanted in an abortion pill. “What does the world of abortion look like when it’s built around us, around the people that are actually using these medications?” asks Berro Pizzarossa. “It’s lighter. It’s smaller. It’s more discrete. It has the extra doses. It’s eco-friendly. It’s a social and political project of making abortion easy to access, unapologetically easy.”
Women Help Women is treating this combipack as a starting point, not an endpoint. “This is just the first product that we are putting out, but definitely not the last. We’re now working on research and development for several other products in abortion and reproductive health,” said Jelinska.
Producing abortion pills themselves not only opens the door to innovations, but also significantly reduces the cost of obtaining the medications—by 25 percent at least, said Jelinska. “It’s cutting out the middleman and our dependency on the middleman,” said Jelinska. “It’s not always about making everything as cheap as possible. It’s to make it as accessible as possible.”
Jelinska explained that taking control of production gives them the autonomy to meet women’s varied needs across the globe. “Feminist networks have been really brilliant in figuring out a tailor-made solution for different geographies. It’s not an easy system and it’s not one solution fits all. Sometimes pills are delivered by courier, sometimes they are distributed by local groups. It’s quite a patchwork. If we want to grow this movement and make sure that it’s sustainable, we need to create more diversity in points of access to products and ways of distributing products. We just have to take the matters into our own hands.”
In October, Women Help Women began distributing their new combipacks in Europe, primarily in Poland and in several other countries. Next, the combipacks will soon be rolled out in collaboration with MAMA (Mobilizing Activists around Medical Abortion), a network of 70 organizations operating in 27 sub-Saharan countries.
The new combipack marks the fulfillment of a longstanding dream for Jelinska. For years, Women Help Women facilitated access to medications, serving as an intermediary that helped groups arrange access, but they wanted to go further. “Five years ago, we had this collective dream that feminists have to own the means of production,” said Jelinska. “I remember when it seemed the world of markets and pharma was overwhelming and that we don’t belong there. But now I also see that that’s exactly what activism is: to go in places where you’re not wanted and they tell you you don’t belong, and make the difference there.”
Behind women Help Women is a global team of feminist activists, trained counselors, medical professionals and researchers spread across 15 countries across four continents. Their online counseling team includes more than 22 extensively trained counselors, many of whom are multilingual. A team of physicians with deep experience in obstetrics, gynecology and abortion provision supports the team when needed. Information and email counseling are available for free every day of the year. Abortion pills are available to people in most countries around the world for a sliding scale donation up to 75 euros (around 87 dollars). “At least ten percent of our services are without donation and more than 25 percent donate much less than €75,” said Jelinska.
Since opening in 2014, Women Help Women has provided abortion pills to more than 100,000 women around the world. “We now provide pills to about 20,000 women a year, and we are growing exponentially,” said Jelinska.
In Poland, where abortion is illegal with only narrow exceptions, Women Help Women is the largest single provider of abortion care. Last year alone, Women Help Women provided 30,000 Polish women with abortion pills or information about how to use them. “We serve as many people a day as the whole state of Poland does in a year,” said Jelinska, who now lives in the Netherlands, but is originally from Poland.
Women Help Women is also offering the combipack to telehealth abortion organizations. “By switching to the combipack, you will be supporting the feminist self-managed abortion movement,” said Jelinska.
Although Women Help Women does not currently serve the United States, it runs a U.S.-based project called SASS (Self-Managed Abortion. Safe and Supported), launched in 2018. SASS offers up-to-date information on how to self-manage abortion safely and trains local activists to share accurate information about self-managed abortion in their communities, focusing on hiring trainers in states with abortion bans.
When asked whether they would consider expanding their services to the U.S. if the Trump administration restricts access to mifepristone, Berro Pizzarossa was unequivocal: “I don’t see why not. If restrictions deepen, we should be ready together with the networks already doing this work. Let’s create normalcy in the steady abundant provision of abortion medicines.”
To support Women Help Women, email them at info@womenhelp.org. Tax deductible contribution to SASS can be made here.
Great Job Carrie N. Baker & the Team @ Ms. Magazine Source link for sharing this story.
