‘I feel called to do this’: US providers sending abortion medication by mail
The question of why hangs over Plan C, a new documentary on efforts to expand access to medication abortion in the United States. Why seek a medication abortion? Because it’s safe, says one woman. (The two-pill combination of mifepristone and misoprostol, both certified by the FDA, are approved for the termination of pregnancy in the first trimester in 90 countries, although its use is severely restricted in the US.) Because of the comfort and safety of being in one’s own home, says another in a montage of phone calls seeking medication abortion by mail. Because the fear of facing screaming protesters at clinics, because her family’s military doctor refused to tie her tubes at 24, because “I felt more comfortable doing this at my own pace, at my own time”.
Pregnant people seeking abortion face a gauntlet of hurdles in the US, from cost to appointment scarcity to, depending on where one lives, the threat of prosecution. So, too, do providers, who because of the chaotic, cruel and patchwork reproductive healthcare landscape in the US, are forced to take on extra risk or extra work (or both) to provide basic reproductive healthcare. Still, “I feel called to do this. There’s not really a why,” says Dr K (her full name, like many others, is withheld for protection), one of the many providers featured in Plan C who mail abortion medication out of state. “It’s like, why do you pick up your kid when they’re crying? Is there a why? You just do it.”
Plan C, directed by Tracy Droz Tragos and filmed in the run-up to supreme court’s overruling of Roe v Wade in June 2022, takes its name from the organization founded by Elisa Wells, Amy Merrill and Francine Coeytaux in 2015 to advocate for medication abortion and connect women with abortion pill providers across the US. Even before the supreme court overturned nearly a half century of precedent in Dobbs v Jackson’s Women’s Health Organization, the promise secured by the 1973 ruling – that people had the right to an abortion in the US under the constitution’s guarantee of privacy – was already a fiction. Roe was gutted to the point of irrelevance in some states, abortion made too prohibitively onerous or expensive in others.
Plan C was one of several groups who stepped up to fill the gaps in a constantly shifting, increasingly ominous legal landscape. Droz Tragos embedded with Coeytaux and the group’s loose network of providers and volunteers beginning in 2018, spreading the word that mifepristone and misoprostol “are safer than Tylenol but more restricted than an opioid”, she said. And available by mail in all 50 states, though with different levels of legal risk. Fifteen states have so-called “shield laws” protecting clinicians who treat patients from states where providing abortion is illegal, and six have specific teleme
dicine protections. One state, Nevada, has criminalized self-managed abortion, while Texas deputized citizens to privately sue abortion providers or anyone who “aids or abets” abortion.
Medication abortion by mail, then, represents a crucial window for access, particularly after a federal judge suspended the FDA’s in-person dispensing requirement for mifepristone during the Covid-19 pandemic, allowing abortion pills to be legally mailed without an in-person appointment. “To be able order this online and get it to your door and do the protocol the way it’s been done for decades already, but you get to avoid having to go to a clinic, or face protesters, or get gas money, and you can do it on your own time … it makes so much sense,” said Droz Tragos. “It’s safe, it’s effective, and now it can be private, as it should be.”
The 90-minute film is a collage of activism, personal testimony and tenacious adaptation as ever-confusing legal landscape and risk calculations mutate again and again. One provider in Minnesota meets clients in a traveling van in parking lots, even after a state senator puts out a public call to run her out of town. Another takes call after call at her home for 12 hours; another demonstrates how stuffing the pill bottles with cotton keeps them from jangling in the mail. The specter of risk is ever present – as one partner of a provider in “Trumpsylvania” puts it – “she’s a force of nature, but not against a truck or a gun”.
“To navigate this patchwork of laws takes some delicacy,” said Droz Tragos. “And depending on where you live, depending on your identity, depending on the community that you’re in, people have different layers of safety, concern and risk. So everyone has to navigate this knowing their own circumstances.” Still, she and Plan C organizers remain frustrated by the lack of awareness of medication abortion access. “It gets very confusing with misinformation,” said Droz Tragos. “It’s so, so hard even to let people know that this medication exists, that telemedicine is an option.”
The film is, in part, a call to spread the word. “The thing that will always surprise me is the generosity of spirit of people being willing to share their stories for the benefit of other people,” said Droz Tragos of the many medication abortion recipients in the film who shared their experiences – how they needed help meeting the cost, usually under $150, because all their monthly income went to rent; how one Texas woman, who just received just one of the two abortion pills and was in excruciating pain for five hours, resisted going to the hospital for fear that her boyfriend would be prosecuted for aiding or abetting. “They did want to share their story, in part because medication abortion, and receiving medication abortion in the way they did, was such a game-changer,” said Droz Tragos. “There was a certain amount of outrage of, ‘Why didn’t I know about this, and I don’t want somebody else to have to go through the kind of pain and suffering and investigating to find this.’”
Plan C presents itself as one front of the reproductive rights movement now under intense, fracturing duress. In one standout, thorny scene, members of the organization grapple with how to handle the landscape in Texas, where volunteers face prosecution, as well as online criticism that the group’s hardcharging methods were pushing people too far or undermining clinics. Droz Tragos described the in-movement friction as “soul-crushing” – “Everyone is in survival mode. Things get worse and then they get worse and then they get worse, and everyone is tired, and everybody is working really, really hard to help people and do things with a moral compass,” she said. “It’s devastating to see the kind of infighting and has been and continues to be among a majority of people who believe in bodily autonomy and making sure that people have access to the care that they need.”
As bleak as the current state of reproductive healthcare in the US may be, arguably worse than when Plan C wrapped production in 2022, Plan C evinces the nationwide movement to get people the abortion care they want. In the six states where abortion rights were up to vote since the Dobbs ruling, all six have elected to keep them, even in “red” states such as Kentucky and Kansas. Just days after I spoke to Droz Tragos, Ohio voters enshrined abortion in the state’s constitution by a decisive margin. The battle for reproductive rights, and the larger fight for reproductive justice in the US, is steeply uphill. But “I really hope audiences take away a spirit of, ‘We’re not stuck,’ and what is possible when people come together,” said Droz Tragos. “There are actually options and we don’t have to sit back and take it.”
Plan C is available to watch digitally in the US on 14 November with a UK date to be announced