The Most Critical Abortion Provider in America Is an Activist-Doctor. Who Lives in Amsterdam

The first time Rebecca Gomperts ever assisted on an abortion, it was 1994 and she was a medical student in her mid-20s interning in a hospital in Guinea, the West African nation that surrounds Sierra Leone on the coast. The procedure was and remains outlawed in Guinea with few exceptions, but she was shadowing a French doctor who performed covert abortions on women in the private hospital where he worked. Rebecca Gomperts was born and raised in the Netherlands and was training to be a doctor in Amsterdam. Guinea was different. Its extremes shocked her. She treated women suffering the consequences of botched abortions. She watched women bleed out and die. She rushed to help women who staggered into the hospital, hemorrhaging.

So when given the chance, of course she wanted to learn how to perform safe terminations. Almost three decades later, what she remembers most about her training is how the French doctor instructed her—how he reached for a curette, a metal instrument that looks like a dollhouse teaspoon, and showed her how to use it to scrape the uterus of tissue.

No textbook. No manual. Just a woman and her doctors and a centuries-old tool. This was not medicine to be practiced at a bloodless remove. This took guts.

The doctor picked up the curette and inserted it. He scraped. Then she did. How would she know when she was finished? Whether it was working? Gomperts is a fast talker, but she slows down here. He told her: “This is the feeling.”

In the whir of that hospital, she realized the stakes of her chosen career. Rebecca Gomperts, MD, PhD, is now one of the limited few providers of medication abortion in almost two dozen states in America. Her mandate is abortion for whomever wants it, wherever. What a mistake it had been for pro-choice activists to frame an act of basic health care as some rare occurrence or horrible last resort, she thought. The movement should have been frank. Bolder. Or as Gomperts puts it: “We should just have said, ‘No, it’s not difficult. It’s just a decision we make as women. Fuck off. You have nothing to do with it.’”

Instead liberals spent decades on the defensive while abortion access was rolled back not just in the United States but in countries like Poland and El Salvador and Brazil, where medical professionals are required to collect evidence and report to the police when rape victims seek an abortion. Gomperts, now 56, graduated from medical school soon after that internship concluded. The scenes in Guinea have stuck with her, haunting her into action. She is the founder of a trio of organizations that have made it their mission to deliver abortion care to people who need it—no matter the protestations of local governments. She has facilitated thousands of abortions, each one allowing a person to have a little bit more control over her future. Even now, one lesson from that hospital room in Guinea obtains: She is a person who operates on instinct.

Such shrewd sense has served her well. In the international movement for reproductive justice, Rebecca Gomperts is not just an icon but one of its most relentless innovators. In 2001 she embarked on a quixotic mission with her organization Women on Waves, founded in 1999, to provide abortions on ships parked in international waters near countries where the practice was outlawed. In 2005, after medication abortion came into use throughout Western Europe and won FDA approval in the United States,  Gomperts seized on the radical potential of the pills mifepristone and misoprostol, and founded what The New York Times once termed “an online help desk” called Women on Web to connect women to medical professionals who would prescribe and ship them for a reasonable fee. In 2018, when a series of punitive laws forced reproductive health care clinics in the United States to close, Gomperts unveiled the telemedicine service Aid Access to serve American women in particular.

Then came Dobbs.

In June 2022, the US Supreme Court overturned Roe v. Wade with its decision in Dobbs v. Jackson, breaking with generations of precedent and obliterating the constitutional protection that allowed people to control the basic functioning of their own uterus.

The consequences were near-instantaneous and catastrophic. Within four months of the decision, at least 66 clinics in 15 states stopped providing abortion services. An untold number of people were denied care or forced to travel ruinous distances to get it. In Ohio, a middle schooler had to be referred to a practice in Indiana to get an abortion after she was raped. Activists mourned. Pro-choice providers considered the possible legal repercussions for so much as describing where abortion was available to their patients.

But in Amsterdam, Gomperts didn’t rend her clothes. She didn’t even take to the streets. She has her own methods. Women in America—women her daughter’s age—had not lived through what their grandmothers had. In this moment of renewed crisis, she would return to their more subversive tactics. “The new generation will have to understand that…it is not enough to wave flags and shout because nothing will happen,” she says. Gomperts kicked Aid Access into overdrive.

For an operation that deals with such a complicated and vexing issue, Aid Access runs according to simple rules: In states where medication abortion is legal, patients who use its website are referred to local doctors who prescribe the pills, which an online pharmacist fills. Costs max out at $150. Women who can’t afford that rate get reduced pricing—something Gomperts insisted on when she added other providers to the service. In states where abortion is illegal, the requests come into Gomperts herself. She writes the prescriptions, making use of her Austrian medical license. A distributor in India ships the medication into the United States. “I’m doing Texas and all the states where it’s banned,” Gomperts adds, with evident pride.

That work means schooling her patients in how the medication—and Aid Access—works. “We know a lot,” she says. “Most people don’t.” Women hear “abortion is illegal” and stop asking their doctors about it. Some have no idea that the process can be nonsurgical. Some end up on Google and find Aid Access. There are other services that use mail forwarding or connect patients with pill providers via other means, but Aid Access stands out for its clinician support. People have questions. Its staff answers. The consultation portal is bare-bones, prioritizing function. Users fill in their responses with utter devastation. 

Gomperts starts to tell me the stories that have stuck with her. One woman wrote that she had been in jail and was coping with addiction. Another uploaded a picture of her beaten and bruised face; she wanted to demonstrate to Gomperts that she could under no circumstances afford the retail cost of the pills. “I would never ask for something like that. But she felt that was what she had to do in order to get a free prescription,” Gomperts recalls.

She is about to list off more examples of women in dire straits—the violence, the sexual assault, the impoverished families, the people with no shelter. But she stops herself. These are the kinds of narratives that politicians hold up to make an emotional case for abortion. It is not her preferred mode of persuasion.

“These are the exceptions,” Gomperts tells me when we speak over the summer. “These are the tragic cases. I know that sometimes the injustice is so fundamental that it’s like, ‘This should not happen. This should not be the case.’ But this is not why I’m doing this work. I’m also doing it for the woman that says, ‘I just don’t want to have a child, period.’”

What rattles Gomperts most is the bitter awareness that, for all the people who find her, countless more do not. “That is the hardest part because there is a huge side of the population that won’t get help,” she says.

Still, in those same 16 weeks in which clinics shuttered and the trigger laws in 13 states took effect, Aid Access reached pregnant people who did not want to be, from Alabama to Idaho, circumventing aggressive anti-abortion statutes with an ease that should make anti-choice activists quake. Gomperts reported over the summer that Aid Access received just under 30,000 requests for abortion pills per week.

State officials can rant and rave. Plain, unlabeled Aid Access boxes arrive in the deepest red zip codes all the same. In the meantime, Gomperts remains far outside the reach of American authorities—untouchable in her sunlit office in Amsterdam.

The morning I visit her there, a heat wave is suffocating much of Europe. Her headquarters is not some bustling Planned Parenthood nor is it attached to a hospital. There are no logo-stamped pens, not even a real waiting room. Instead of having a formal exam area, Gomperts divides her office in two with a blue partition and sees patients behind the pulled curtain. Before noon, three women arrive and find haven in the air-conditioned cool. She continues to see patients in person. Most who find her now tend to be undocumented—who are barred from accessing the health care that makes abortions free for Dutch women.

What did I expect from the doctor whom Politico deemed “the most controversial abortion provider in America—even though she isn’t in America”? Not a mother of two whose professional decor consists of a cheerful strand of Christmas lights and an apricot-colored tea kettle. Not a woman who will later invite me for a boat ride and then leave me to drive that boat (I can’t even drive a car) while she strips down to a purple bikini and swims in the Dutch canals.

Around a square table where she serves me lunch,  Gomperts and I nosh on a chocolate bar unearthed from under the 21st edition of a book on contraceptive technologies. We lick the caramel ooze from our thumbs. We discuss the tenuous American future. We talk about how the hell she ended up here.

Gomperts grew up in a seaside town that she spent much of her adolescence itching to escape. In high school she wanted to be an artist, but she liked the idea of medicine. It struck her as an intimate, even radical, profession. She read the diaries of Che Guevara, the Argentine Marxist who was also a doctor and leader. She enrolled in medical school, finding the work intense but rewarding. She traveled to Suriname, the former Dutch colonial outpost in South America that became an independent state in 1975. Deep in the tropical rainforest, resources were so scarce as to be nonexistent. You had to be flexible, so she became flexible. Conditions were desperate. At the clinics and hospitals, she improvised.

But back in Amsterdam, medical institutions had not just the needed supplies but also well-developed bureaucracies. It should have been a comparative paradise, but the hierarchies depressed her. School got harder. She felt stifled. 

In search of an outlet, she enrolled in art school at night. In the end, she graduated from that course first and medical school second. It turned out to be a revealing accident of timing. To some extent, that is who Rebecca Gomperts remains: the conceptual artist whose medium became medicine.

Gomperts pursued more work in hospitals. She was hired as a radiologist but used the imaging devices to collaborate with an artist friend on a series based on MRI scans. She labored over a novel. She cared about painting and performance, but didn’t prize one artistic form over another. What interested her were the stories that undergirded the works—the narratives that deepened canvases and tapestries and performance and drama.

“And with those stories,” she says now, “how to change or how to create alternative realities that are better or more beautiful.” She edited her book. She went looking for more work that would support her while she wrote. Around the corner from where she was living, an abortion clinic had posted an advertisement: It wanted to hire a doctor.

“It grabbed me,” Gomperts says. This was not a remote scan, with her patients in one room and her at a distance. It was intense and visceral. She was up close, with them. “There are these moments in people’s lives that are so intense. There’s so much around it. It’s taboo; it’s sex; it’s joy; it’s sadness. It has a whole range of emotions; it’s relief.”

When she wrapped up at the clinic, she decided to set sail with Greenpeace, hoping to get a firmer grip on what motivated her and what she wanted to do next. She traveled with the organization to Mexico and then to Costa Rica and Panama. In all three countries she met women who whispered to her about their black-market procedures. A girl described how her mother had died from an illegal abortion, leaving her to care for her siblings. “It was just a huge amount of trauma,” Gomperts says, “and that is when I started getting this awareness about the impact of the law.” She wanted to help, and the boat became a clue: If a ship moved into international waters, what set of laws could govern it? Whose rules would Gomperts be breaking?

The first attempt was a bust—a well-documented but failed attempt to bob in the international waters off Ireland, where abortion was illegal until 2018, and to offer medication abortion. In 2003 she sailed to Poland for another go at it. In 2004 she went to Portugal, where a Portuguese minister sent two warships to greet her.

Undaunted, Gomperts sat for a television interview. With the cameras turned on her, she held up the pills with which she had stocked her boats and explained how the sequence of medications could be taken to induce abortion. When an anti-abortion guest fumed, she told him she had had an abortion once—and that she was pregnant now. “You have never given birth,” she reminded him on air. What did he know about choices?

The clip went as viral as an interview on a Portuguese talk show could go in 2004. She got emails from people who wanted Women on Waves to come to their countries. Who begged her. Gomperts had a better idea. No ship, no furious defense ministers, no public outcries. With the help of the internet and the postal service, she launched Women on Web. It was an immediate success.

Gunilla Kleiverda, a Dutch ob-gyn and researcher, has known Gomperts for decades and joined her on that maiden and thwarted trip to Ireland. The two had just met—a pair of feminist doctors in a region that still had few. Ireland turned out to be harder than expected. A media blowup threatened the entire enterprise. But Gomperts resolved to make the best of it. Kleiverda observes of her friend: “The more difficult the situation is, the more creative she becomes.

“She has a good sense of what is important,” Kleiverda continues. “She has an enormous network and she is able to connect all of these people. And that I think is one of the strengths that makes her able to develop new plans, new ideas, new solutions—her broad scope. Finding people from all over the world and with all kinds of experience and knowledge, she’s able to stimulate them.”

That expansive outlook is imperative. Gomperts has never taken solace in borders. It is a fiction to believe that threats to women’s lives observe lines on maps and that people in places like the Netherlands are protected because the United States is across the ocean. Countries learn from one another. The danger is global. Patriarchal structures do not trust pregnant people to make their own decisions. Their hands are held. More now—their hands are tied.

Enter doctors, whom Gomperts believes should be banding together, organizing with pharmacists, and using their skills and voices to the loudest possible effect. “What is missing now is a kind of mobilization,” Gomperts says. “There’s a lack of coordination and centralization and meeting up and putting it into action to see what the possibilities are.”

There are possibilities. Gomperts has used drones and robots to deliver abortion pills, operating them from Amsterdam, sometimes with the help of her son. Batting her lashes in mock innocence, she assures me: “We have so much fun. You have no idea.”

What other technologies might be weaponized to similar effect? She has started pushing providers to offer abortion pills to patients who are not pregnant so that people can keep packets of them in their linen closets like Tamiflu. In her latest and most audacious move, she and Kleiverda are working on research that endeavors to demonstrate the effectiveness of a 50-milligram dose of mifepristone as a form of contraception, which would collapse the distinction between birth control and abortion. Doctors would prescribe this pill in place of ones like Low-Ogestrel or painful IUDs. It would allow people to exert more control over their own reproduction while confounding their movement foes. It would expose this dichotomous split between birth control and abortion as the farce that Gomperts believes it to be.

It strikes me as the scariest possible outcome for people who oppose abortion, and I tell her so.

“We have to go there,” Gomperts shoots back. “We have to become more and more radical in what we demand.”

She is gleeful at the prospect. This would be a revolution. She glows with its potential.

In the hours I spend with her, I feel it too. A little intrepidness rubs off on me. I start to wonder what we all are capable of. What more I can do. What I am willing to risk.

And then I see some breaking news alert or a horrific headline and I deflate. I think of the sheer number of people who will suffer before recourse can reach them. I know, as the experts do, that women will die for this decision. It agonizes me. Gomperts is not blind to the realities of the moment. She won’t be able to fix it alone. But she has earned her measured optimism. She has seen the gains that her work makes possible.

When she was just starting out, governments lined up to oppose her. Ireland opened an investigation. She went to court. The outcome was conclusive: “I won and then we continued. We carved out this space. This is normal now.”

Later, when Gomperts started prescribing abortion pills, people tried to warn her off. “People said, ‘This is going to be dangerous. You’re not going to do an ultrasound,’” she remembers. She plowed ahead. “With our research that we immediately started publishing, we [proved] that it is safe, that there’s little complications and that women know how to deal with them.”

She trusts her patients like other doctors trust them to take the appropriate dosage of Advil. Millions of women have proved themselves capable.

It is possible that states will move to criminalize self-managed abortions. That would make even the act of receiving medication abortion a crime, imperiling the lives of Gomperts’s patients. Dozens of women have been investigated or arrested for purported attempts to end their pregnancies. That trend will accelerate.

To protect abortion providers, several states have passed laws that detail their refusal to cooperate with states who seek to sue them for performing abortions on patients who have traveled from states where it is outlawed. Some progressive legislatures are looking into telemedicine shield laws that would even cover doctors who prescribe medication abortion to patients in states that have banned it. Massachusetts has acted fastest, passing a law that would stop red states from suing health care workers who meet the needs of patients “regardless of the patient’s location”—meaning whether a person is receiving pills in Houston, for example, or traveling to Boston to obtain care. Such provisions invite a host of legal questions.

While advocates attempt to answer them, Gomperts is the best bet—one-woman insurance for millions of American patients. Her organization is nimble. It has no corporate donors and no general counsel urging her to reduce her personal risk. For now, she has all the information she needs to proceed—and one piece in particular: her steadfast conviction that her side will prevail.

“I have great trust in the resilience of women, and that gives me hope,” Gomperts tells me. “At some point, we will all have to decide, ‘You know what? We’ll do it regardless. We don’t care. You want to control us. We are not controllable.’”

Mattie Kahn is a writer based in New York. Her forthcoming book Young and Restless—about the girls on the vanguard of America’s protest movements—will be published in June 2023.