When Dobbs v. Jackson Women’s Health Organization was decided in the summer of 2022, ending the constitutional protection of abortion rights in the United States, calls for the creation of underground networks of abortion helpers echoed across communities supportive of reproductive freedom. These calls were largely centered on the history of the Jane Collective, a diffuse but highly organized group of women in pre-Roe Chicago who helped others access abortion care by learning to provide safe and effective abortions themselves. However, underground networks of abortion helpers and patients did not disappear in 1973 when Roe v. Wade was decided, and neither did the need or desire for accessing abortion care outside the world of professionalized medicine.
During the years that abortion was constitutionally protected by Roe, abortion was legally available but not materially accessible for many. The anti-abortion right wing strategically chipped away at abortion rights through state and federal legislation that made it difficult if not impossible for clinics to remain open and for patients to access abortion care. Throughout the decades of constitutional protections for abortion, countless pregnant people were forced to remain pregnant against their will as a result of barriers to accessing abortion.
In these years between Roe and Dobbs, people across the United States self-managed their abortions, just as they did before Roe and continue to post-Dobbs. Self-managing an abortion refers to abortion outside the medical establishment. Methods vary, including procedural abortion and medication abortions completed via abortion pills.
Amid renewed attention to reproductive rights in the United States in 2022, many longtime abortion advocates responded to the calls to create new networks with the assertion that efforts should be going toward supporting the networks that already exist, including abortion funds that work together to pay for abortions and help patients navigate the various logistics that can arise when accessing abortion, especially if travel is involved. Pro-abortion activism during this time period also focused on the idea that self-managed abortion with pills could be done safely, effectively and privately. However, some advocates have pointed out the limitations of focusing solely on medication abortion as a strategy.
There were three strategies with rich histories and demonstrated successes that were largely unrepresented in mainstream abortion activism after Dobbs was decided: 1) procedural abortions performed in community settings by “self-help” groups comprised of both clinic workers and laypeople; 2) addressing power imbalances between providers and patients; and 3) organizing clinic defense to protect the clinics that remain open from the consolidated groups of emboldened anti-abortion demonstrators that harass patients and invade clinics.
In Deep Care: The Radical Activists Who Provided Abortions, Defied the Law, and Fought to Keep Clinics Open, published by AK Press in October 2023, feminist historian, critic and poet Angela Hume weaves together three historical threads of reproductive activism and care on the West Coast from the 1970s through the first decade of the 21st century, outlining the lessons for the current reproductive justice movement that become apparent when these three strategies are analyzed together. Hume describes a “seamless overlap of self-help and clinic defense,” sharing not only values but even some of the same people. They argue a similar continuity exists between abortion performed in the context of self-help abortion groups and the abortions provided within the walls of the licensed Feminist Women’s Health Centers (FWHCs) via their “participatory” health care that challenged the hierarchical patient-provider relationships that define modern medicine.
Self-helpers were comfortable with “holding open the liminal space between not-pregnant and pregnant.” The “idea the body is simply pregnant or not is a patriarchal, mainstream medical one.”
By describing and theorizing this “multipronged” radical abortion defense movement, Hume complicates many of the binaries and categorizations that the abortion rights movement has come to rely on, including strict distinctions between abortion and birth control; lines drawn between activism, intellectual work and direct service provision; and the boundaries between health care worker and patient or layperson. Self-helpers were comfortable with blurred boundaries, including their commitment to “holding open the liminal space between not-pregnant and pregnant” and showing that the “idea the body is simply pregnant or not is a patriarchal, mainstream medical one.” Liminality refers to a state of in-betweenness, being somehow not on either side of a threshold but rather existing in the murkiness of the middle. “For self-helpers, challenging the pregnant/not-pregnant dichotomy was a political act,” Hume told Truthout, including the understanding that aspiration abortion, usually referred to as “menstrual extraction,” could be performed without conducting a pregnancy test.
Moving forward with an aspiration procedure without first confirming a pregnancy meant pregnancy termination could be achieved without any confirmation an abortion had indeed taken place. Women in the 19th-century U.S. used similar strategies to evade medical and state control over their fertility by framing abortifacient herbs and methods as ways of “restoring” a menstrual cycle that had been “blocked,” allowing them to end pregnancies before they were ever labeled as such without legal or social risks.
In revealing the porous nature of these categories, Hume and the activists interviewed in Deep Care demonstrate that our fight for abortion access is most effective when based on values of bodily autonomy and community solidarity, and when carried out by autonomous, grassroots networks of people whose work is informed by lived experience.
Hume describes the feminist abortion care provided both inside and outside the clinic as “complementary and revolutionary” components of a larger political movement in alignment with the current perspectives of members of the grassroots activist collective NYC for Abortion Rights (NYCFAR).
Despite working in a different geographic region and time period, the experiences and values of the activists described in Deep Care are echoed by the members of NYCFAR. Starling, one NYCFAR member who spoke with Truthout, views clinic defense and self-managed abortion work as “intrinsically linked” with shared goals of demanding bodily autonomy and building relationships and community power. “Both practices are built around the idea that we’re empowered to make the decisions that are right for ourselves and the communities we’re a part of,” Starling explained. (The activists interviewed for Deep Care are referred to by Hume by their first names only due to the legal and safety risks associated with radical abortion activism and care work. The NYCFAR members interviewed by Truthout face similar risks of legal action and anti-abortion harassment, and some preferred to be identified by their first names only.)
Bodily autonomy can only be secured through coordinated community defense, not via the courts, law enforcement or elected officials.
Niharika, another organizer with NYCFAR, also detailed clear connections between the values and objectives of clinic defense and supporting self-managed abortion. For them, both are “community and peer-based work, as opposed to relying on institutional methods” and are forms of “abolitionist praxis” that can lead us toward a “world beyond the current institutional structures of power.”
West Coast abortion self-helpers interviewed by Hume shared this view. Self-help was based on radical ideas of community care and politics. “The abortion self-help movement was an outgrowth of civil rights, New Left organizing, and women’s liberation,” as well as the Gay Women’s Liberation movement, and the “self health” survival programming of the Black Panther Party, Hume told Truthout. A self-helper interviewed by Hume asserted that abortion provided in community settings “directly challenges physicians’ control of routine health care and healing,” including abortion. The FWHCs that worked with self-helpers to facilitate their access to both training and supplies emphasized informed consent, harm reduction and resisting power imbalances between provider and patient also worked to “transfer restricted knowledge about gynecology and abortion to laypeople,” Hume explained.
Abortion self-help groups allowed community members to give and receive care reciprocally instead of relying on the medical establishment, and clinic defenders similarly focused on relationship-building with each other and with independent clinics in order to maintain safety for patients and workers in the wake of intensifying anti-abortion violence.
When the highly organized Operation Rescue campaign of the 1980s and 1990s that repeatedly ambushed clinics arrived in the Bay Area, they were met with a “militant street response” of clinic defenders, Deep Care notes. Feminist clinics targeted with violence, including arson, found that law enforcement did little to respond or investigate. Even after the Freedom of Access to Clinic Entrances Act was passed in 1994, making it a federal crime to obstruct the entrances of reproductive health clinics, police still failed to protect clinics from anti-abortion groups.
The Bay Area Coalition Against Operation Rescue understood that bodily autonomy could only be secured through coordinated community defense, not via the courts, law enforcement or elected officials. NYCFAR member Starling shared this perspective, asserting “cops don’t keep us safe,” but rather “they’re the ones issuing permits to anti-abortion organizations and providing them with an armed escort when they lead processions to harass local clinics,” referring to the NYPD protection provided for the monthly “Witness for Life” processions organized by the Archdiocese of New York against whom NYCFAR defends clinics. Starling raises another problem with relying on law enforcement to protect abortion access in any capacity: “Cops are the ones violently enforcing anti-abortion legislation across the country.”
Anti-abortion conservatives often invoke the past by misrepresenting the history of abortion and portraying it as a modern issue rather than a practice that has been commonplace across cultures, geographies and time.
The violence of Operation Rescue forced clinic defense groups to “develop tactics to hold clinic doors open and help patients get to and through them, despite the chaos that the mobs of antis [anti-abortion activists] created,” Hume said. Now, clinic invaders that work directly with Witness for Life from groups, including the Progressive Anti-Abortion Uprising and Red Rose Rescue, have taken inspiration from Operation Rescue, requiring clinic defense groups including NYCFAR to reimagine their own strategies to protect patients. Just as in the past, legal efforts to curtail the anti-abortion activities of Red Rose Rescue have not been effective. In June 2023, New York State Attorney General Letitia James sued the members of Red Rose Rescue, and in December 2023, a court issued an injunction prohibiting Red Rose Rescue members from entering within 15 feet of any reproductive health clinic in New York.
However, shortly after the injunction was granted, NYCFAR member Greta Flowers told Truthout there were no police present during a December 2023 clinic defense at the Planned Parenthood clinic in Downtown Brooklyn. Red Rose Rescue member Brianna “Bernadette” Mangat blatantly violated the injunction by standing only a few feet from the clinic entrance while impersonating a clinic escort. Based on “past conversations” with the NYPD that show “they don’t even really understand what’s going on, why Brianna Mangat is a threat, what Red Rose Rescue is, or what the hell an injunction is,” Flowers said she would have hesitated to talk to the police about enforcing the injunction had they been present.
Understanding our history of reproductive resistance and oppression not only provides insight into actionable lessons and strategies for those working toward liberation, but also expands our imagination as we internalize the reality that the status quo has not always existed and can be changed. Anti-abortion conservatives often invoke the past by misrepresenting the history of abortion and portraying it as a modern issue rather than a practice that has been commonplace across cultures, geographies and time.
NYCFAR member Niharika views the distinction between direct service and advocacy work in the mainstream reproductive rights movement as “harmful” because this false binary perpetuates the patriarchal devaluation of care work and obscures the value of allowing politics and care to mutually shape each other, explaining that their “direct service work in self-managed abortion and as a doula” forms the basis of their abolitionist organizing and reproductive health policy work. They argue this dichotomy also “hides the deep histories of organizing for reproductive freedom — from herbal abortion amongst enslaved people to Mexican abortion pill networks” as being separate from the work of “political actors.” Niharika argues that understanding care work as political shows that “change can, and does, come from communities stepping up to help one another and shifting our understanding of power and reproductive autonomy.”
Their research for Deep Care, Hume said, showed that “small groups of people who can work securely and dynamically together can make amazing things happen.” NYCFAR member Starling understands NYCFAR’s clinic defense in the same way: “Clinic defense is really just a bunch of ordinary people getting together to do something extraordinary.”