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Timothy Goodman has a lot of feelings. Maybe you've seen them plastered across the wall of a building in downtown New York City. Or perhaps you've worn them on a T-shirt you bought from Uniqlo last year. There's a pretty good chance you've liked them, if you're one of his 143,000 followers on Instagram, where he regularly posts videos, photos, and design work.

Goodman is probably best known for his Sharpie-style scrawlings of earnest catchphrases like, "Even my feelings have feelings," and "Don't look for love, look for pizza." But he's equally committed to his "social experiments" that turn pop-psychology emotional probings into slick, colorful websites.

The social experiments started in 2013 with 40 Days of Dating, a project in which he and fellow designer Jessica Walsh explored the perplexing realities of modern dating. Then there was 12 Kinds of Kindness, a self-fashioned 12-step program that he and Walsh developed to become kinder, more empathetic people.

Most recently, Goodman released Friends With Secrets, a new project with comedian Akilah Hughes and designer Robyn Kanner that broadcasts their experiences with text therapy. Sound intense? It kind of is.

Goodman is part of a growing set of designers whose personality (and personal life) are often indistinguishable from their design work. You might call it a personal brand, but Goodman's dedication to the form goes beyond mere hashtag to the point where it actually feels personal. We sat down with Goodman to talk about his recent project and how it feels to share so many feelings.

I think the best place to kick this off with a really general question. You're not a designer that fits into the box of "graphic designer." How do you describe what you do?
In the trajectory of my career, I've worn a lot of hats. In the beginning I was a traditional graphic designer. I worked as a book jacket designer, then I worked in branding for Brian Collins, then I was an art director at Apple. After a while, I found myself doing work on the side because I didn't want to do the things that I was doing as my full time job-things like murals and brand collaborations. Now I just tell people that my grandma calls me an artist.
How does it feel for your personal musings to become so public?
I don't know if I've struggled that much it; I just want to create art that people can connect to. I think so much of the time we make art for ourselves or for other people in our communities to see. With so many of the stories I'm trying to tell, I'm trying to make things for actual people. I think sharing your personal stories is sort of activism; when you connect to other lonely people in the world, I think there's a service involved that is really powerful. I want to continue to use my work as a vehicle for that.
Do you journal?
I used to keep a real journal for years and years, like an actual notebook, but I don't do that anymore. It's just my Notes app. I basically write down anything that comes to mind, whether I'm just writing a poem about someone or something in my life, or I'm writing ideas for projects. My Notes app is really insane.
What does it look like?
It's like walking into a teenager's bedroom where everything is thrown around and there are empty pizza boxes, posters hanging off the walls, and unwashed clothes everywhere. That's my Notes app, but I love it.
You've said before that the key to good design is emotion. I feel like some designers would disagree with that idea. Why do you think emotion is necessary when designing?
If I can't connect to someone seeing my work on an emotional level, then I don't know why I'm doing it. How do you interact with a great film or a great book or a great album? You're connecting with it emotionally. So why wouldn't I make my work in the face of that? I don't know why we define graphic designers in such a small box. I just don't know what the point of that is. There are so many ways for people to interact with one's work.
We have this phrase in journalism that's called stunt journalism, where a writer inserts herself into a situation in order to tell a story better. Do you feel like you're practicing stunt design?
With the social experiments it really raises the question of whether it is considered design. Designers are creating it, and yes, I use my tools as a designer to create something because we're building a website, we're thinking about user experience, and we're branding it. But at the end of the day it's about the content and the way an audience takes it in. And that to me is not graphic design necessarily.
Why do you think you're drawn to social experiments?
It's just really a unique desire to want to express myself as a person in this world, you know? It came from me and Jessica Walsh doing 40 Days of Dating first, and there was no strategy behind that. There was no big talk about what this meant for us, for our lives, or our careers. It was just this on-a-whim thing. We didn't know what would happen with it, but through that process we realized how enjoyable it was and how meaningful it felt to us because so many people connected to it and were saying, "Wow, I see myself in you." Having those meaningful conversations with people pushed me to want to keep creating work like that.
You're also getting a lot of positive feedback and reinforcement from putting yourself out there.
Yeah, certainly. I mean, 40 Days of Dating was very mainstream viral. All kinds of non-designers connecting to something that we created is very powerful. It wasn't like: Oh I work at Apple and people interacted with the packaging I was part of. It was so personal. To hear so people sharing their personal lives is powerful, but obviously it's not for everyone because there can be a lot of pressure and weight with that. There were times early on that we were like: Wow, this is a lot. Even with Friends With Secrets, hundreds of people were writing us or DM-ing us or commenting on our posts saying, "I've felt like this." All that kind of stuff is incredibly rewarding, but also difficult to navigate at the same time.

Does that kind of engagement shape what kinds of projects you decide to pursue ?

I don't know if it's any different than anyone else who's on the internet. Every time you Instagram or tweet, no matter who you are or how many followers you have, we're all out there trying to have our voice heard in some capacity, right?
Yeah, but you're sharing a lot of very intimate feelings.
With 40 Days of Dating, because it was a "success," and it was the first social experiment I did, it suddenly broke down a wall down that I was no longer interested in having-a wall between personal and professional. It allowed me to see what was possible going forward, and what I was interested in. That was incredibly liberating for me because I realized that there's no rules anymore. You're constantly being taught through school or mentors or people you look up to in the industry that you have to follow a certain path.

I think seeing what happened with 40 Days and all that allowed me to go forward freely in a way where I didn't care about what people might think or what would happen. And I'm so thankful for that. It really humbled me a lot-and Jessica. It taught me how big this world is. The design community is so insular that we don't think about the bigger picture enough and people who are on the other other side of this-folks from other industries and walks of life.

I feel like as an artist it's almost our job to shine the truth back on people.

This is more curiosity than critique, but do you ever feel like you're oversharing?
Sure. I also don't know if that is... does that mean it's bad? I don't know.
No, it's not a bad thing. I just wonder how it makes you feel.
If I feel like I'm oversharing that then that puts some sort of restriction on what I'm supposed to do or what I'm not supposed to. In the last four months I've talked a lot about the depression I went through earlier this year, which lasted quite a long time. Feeling at times like I could kill myself and going through that and going through therapy and healing and all of these things.

In the last couple months, even before Friends With Secrets, I made some videos of me talking about this and what therapy means for me. I shared them on Instagram, and it's just amazing how many other people say, "I'm going through this," or "I've gone through this," or "Thank you for talking about this."

So I do feel that it's incredibly important and meaningful to have these discussions around topics that millions of people go through, whether it's mental health or failed relationships or things that are going on politically. I feel like as an artist it's almost our job to shine the truth back on people and to talk about these things.
That's what you mean when you say sharing your personal stories is a form of activism?
Yeah, exactly. It's the same as a standup comedian. They're kind of living outside of the rules of society, and that's why they're able to talk about really important things in a different way. People connect to them. And I think as an artist, it's our job to do that too. Maybe not our job-I take that back. I think that it can be a responsibility, if you want it. And I think it's important, and it's very meaningful for me to be able to do so.
Let's talk about Friends With Secrets. Did you have any trepidation before you hit publish?
We were all scared, of course. I mean, it's so personal to release text therapy transcripts. We felt a little more comfortable because we are all going through it together. Text therapy is so in the zeitgeist right now, but there's so many questions about it-whether or not it's impactful or useful or even whether it's ethical.

So many people told us, "I've been thinking about doing text therapy because I know it's cheaper, and being able to see this has really allowed to take the first step." Seeing the reactions from people and seeing how people were relating to our individual stories, you can't buy that. That's what brings me the most joy as a creative person. So that's why I'm in it; to be able to have those conversations with humans as a human.
I can imagine that for anyone who is revealing a lot of themselves to the general public it can get a little exhausting.
I don't feel exhausted by talking about my life. Because you only know what you see. Even though you're like, "Wow, I know everything about this person," they don't know what it's like to be in my day-to-day life; they don't know my friends or my family, really. You know what I mean? I think it's also important to have perspective. I'm not Kim Kardashian. Like, I've still been working nonstop at my computer for the last week on a project for a client. I don't feel exhausted by my personal life being out there. I don't struggle with it in that sense.

I think it's also important to have perspective. I'm not Kim Kardashian.

Whatever personal information you''re putting out there still has a sheen of... what's the word I want to use here. It's still a brand, right? Not to diminish what you do because it's honest and helpful to so many people.
I think that's how you do it, because it is so helpful to people. Friends With Secrets only lost us money, you know what I mean? I'm not really selling anything here, but I know what you mean. Everyone has a brand on social media in some form or capacity these days, and so as long as you're being authentic about what you're interested in and who you are then I think it's okay. I think it's totally great. I've also been choosing to get more messy on Instagram lately.
What does that mean?
I've been like making videos that have been fun for me to share. I'm trying different things and not being so precious. I think that sometimes you see people who get any sort of a following on Instagram or wherever, and I feel like they become risk averse and only create work they know people like. I was doing that for a while, and when I look back I wasn't enjoying myself. I wanted to be more natural and fun and just express who I am-all the shades of that.
And it feels good?
Yeah, it feels great.

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Timothy Goodman has a lot of feelings. Maybe you've seen them plastered across the wall of a building in downtown New York City. Or perhaps you've worn them on a T-shirt you bought from Uniqlo last year.

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I was squatting on the floor of the toilet in Westfield Stratford shopping centre when I found out I was pregnant. Squinting at the test, I initially thought it said "progress", but on closer inspection, the word "pregnant" was flashing in front of me. Before long, another sign popped up, reading "2 to 3 weeks", but that turned out to be wrong. In fact, I was far further along in my pregnancy.

As soon as it dawned on me that I might be pregnant, I needed to know for sure immediately. But as I marched through Boots, frantically asking where the pregnancy tests were, in my heart of hearts I already knew. With breasts so tender they felt like they had been inflated with a bicycle pump, and my period nowhere to be seen, there were few other plausible options.

One of the first things I did after taking the pregnancy test was to call my mum. Before I'd even got the words out, she told me: "I know what you're going to say - I could see it in your face." A million different thoughts hurtled around my head as I tried to remain calm in the most uncalm of places. It felt surreal to be standing inside a shopping centre while struggling to come to terms with the fact that I was pregnant, though there was something almost comforting about the indifference of the sea of preoccupied shoppers hurrying around me.

Sod's law would have it that there was no escaping the subject of pregnancy that evening: I had to go to a family gathering, which included my cousin's wife, who was eight months pregnant. I asked how bad her morning sickness had been. "I don't know why it's called morning sickness when it's constant nausea," she replied. Those words stayed with me in the days that followed, as my normally indefatigable appetite shrank and I entered what was, for me, uncharted territory.

I had known immediately, on that toilet floor in an East London shopping centre, that I wanted an abortion. Despite being in a relationship and wanting children one day, I did not feel mentally, financially or logistically ready for a baby. For the moment, work and a career supersede the desire to have a child. This will no doubt enrage the people who do not believe women should have autonomy over their bodies, or think women's sole purpose is to be breeding machines.

However, I am not alone, with statistics released last month showing record numbers of women were turning 30 without having had a child. The data, released by the Office for National Statistics, showed that around half of women in England and Wales who were born in 1990 did not have a child when they reached 30.

As a women's correspondent, I am all too aware that there are still many people with retrograde views on reproduction and motherhood. As the far right has grown emboldened in recent years, so too have anti-abortion activists. Populist neo-fascism often has misogyny at its core. Take a troubling report by charity Population Matters last November, which warned that more countries were adopting policies that coerce women into having more children, with "right-wing, populist and nationalist administrations stigmatising women who choose to have smaller families as unpatriotic". The report noted that Viktor Orban, Hungary's far-right prime minister, promotes debt-free education for women - but only if they have at least three children.

Having written dozens of articles about countries where terminations are criminalised - even in instances of rape, incest or a threat to life - I felt both relief and guilt that I live in a place where it is legal. I assumed that the process of having an abortion would be simple, straightforward and speedy. How wrong I was.

The same day I found out about my pregnancy, I rang Homerton Hospital in Hackney, the hospital in which I was born, to try to book an appointment for an abortion. Nobody picked up the phone, but I was placated by an automated message that promised someone would call back within 24 hours.

Those 24 hours came and went, but no phone call came. Unwilling to wait, I rang up the British Pregnancy Advisory Service (BPAS), the UK's largest abortion provider. "We are currently experiencing exceptionally high call volumes," another automated voice said. I proceeded to stay on hold for 13 minutes, the soothing music playing on the end of the line having the opposite effect to that intended. In the end, I gave up and opted to send an email instead.

Two days later, I received a call from a man who told me I would have to wait three weeks for a phone consultation, meaning I would not be able to have the actual abortion until a month after requesting the procedure. This would have left me just a couple of weeks away from the 10-week cut-off point for a medical abortion, which involves taking pills. While abortions are extremely safe, it is better to have the procedure earlier on in the pregnancy.

The wait I was facing was at loggerheads with the NHS website, which stipulates: "You should not have to wait more than two weeks from when you (or a doctor) first contact an abortion provider to having an abortion." The National Institute for Health and Care Excellence (NICE), which provides evidence-based recommendations for healthcare in England, says providers should "ensure minimal delay in the abortion process, and ideally provide the assessment within one week of the request and provide the abortion within one week of the assessment".

We've had reports from across the board of unprecedented demand

The man on the phone admitted BPAS was grappling with massive delays, telling me they were receiving 1,000 requests for abortions a day. I stated the obvious - that this was a time-sensitive procedure and I wasn't willing to wait that long - and he said I could have a phone consultation for an abortion a week later. However, if I wanted something sooner, I was told I would have to travel hundreds of miles to Doncaster or Liverpool for an in-person appointment. This was beginning to feel like a nightmare.

For me, someone in stable employment, it's possible to travel that distance, but still difficult to juggle alongside a full-time job and the rest of my life. However, this would not be at all feasible for young women hiding their pregnancy from abusive parents. Or women facing domestic abuse. Or those trapped in precarious, low-paid work with an unforgiving boss. BPAS says access is a common issue across the UK, with some women even having to travel from Scotland to London for surgical abortions later in their pregnancy.

Katherine O'Brien, of BPAS, said the surge in women needing abortions was likely to be linked to the struggle to access contraception in the wake of the pandemic.

A recent study found that almost a third of women seeking long-acting contraceptives, such as coils or implants, were unable to do so during the Covid crisis. "Women are returning to normal life, but contraceptive support has not returned to normal," Ms O'Brien explained. "At the same time as the surge in demand, there are unprecedented numbers of staff off sick, isolating, or ill with Covid, and this is an issue across the whole NHS." One of BPAS's abortion services was hit with a 700 per cent rise in staff absence due to coronavirus in the first week of January, when compared to the same period last year.

As crippling exhaustion left me struggling to do day-to-day tasks, the prospect of continuing with a pregnancy I didn't want felt like torture. I found another leading abortion provider, MSI Reproductive Choices UK, which managed to get me a telephone consultation that evening.

During my telephone consultation, I explained I'd had a minuscule amount of discharge, which triggered a request to come in for an in-person appointment and a scan, rather than simply sending the abortion pills in the post. I was offered a consultation in Waterloo in central London a week later, but ended up opting for an appointment in the small Kent village of Aylesham, which meant I would be seen a few days earlier. My granny had unexpectedly died a couple of days before I'd found out I was pregnant, and I couldn't face the prospect of being in too much pain to attend her funeral.

Even the journey from London to this unremarkable village in the home counties became a gruelling five-hour round trip. Fortunately, I had my boyfriend there to support me. As we sat in the waiting room, another woman vented on the phone about the fact that she had travelled for four hours for an abortion, yet would not be seen that day.

I was called in, and the nurse and midwife tried to carry out an ultrasound, but initially did not have any luck detecting a pregnancy. My immediate thought was, "Oh God, I'm not actually pregnant. What a waste of time and stress." But deep down I knew this could not be the case. There was no mistaking the fact that I was pregnant, my mind feeling like it was trapped in someone else's body. After doing another, substantially more intimate scan, they told me I was about six and a half weeks pregnant - far further along than I had realised.

Having a medical abortion involves taking two tablets. Prior to the pandemic, getting the first tablet, mifepristone, required a visit to an abortion clinic. But after Covid hit, the government allowed the medication to be sent by post to be taken at home after a phone consultation, a system referred to as "telemedicine". Those rules were due to run out on 25 March, with ministers taking a long time to clarify whether they would be extended. The government finally declared a six-month extension for at-home early medical abortion last week. But providers were incensed that they did not make the provisions permanent. About half of all abortions are delivered via telemedicine. BPAS notes that if the system reverted to how it was before, the service would be likely to see a 43 per cent rise in abortions being carried out after 20 weeks of pregnancy.

Jonathan Lord, of MSI Reproductive Choices UK, said abortion services are in disarray. "The whole sector is really struggling at the moment," Mr Lord, who is also the co-chair of the British Society of Abortion Care Providers, told me. "We've had reports from across the board from all the NHS trusts we know of, and all charities, of unprecedented demand. As soon as things get a little less efficient, the gestation of women goes up, and more have to get surgical abortions, which are harder to provide."

Surgical abortions also require operating theatres and staff, which have been hard to secure with resources diverted for the pandemic.

I took the first abortion pill on a train hurtling back to London, and was relieved to experience no side effects. If you throw up within an hour, you have to let the doctors know, as the pill may not be effective. That evening I did feel a little strange, but it was when I took the second abortion pill 24 hours later that the all-consuming agony hit: the worst pain I remember feeling in my life.

I chose to put the second pill in my mouth for 30 minutes, rather than the other (substantially scarier) option of inserting it into my vagina. The pill pretty much wholly dissolved in my mouth in 20 minutes. Before long, I was writhing on the floor in pain, with paracetamol and ibuprofen scattered around me. No matter how I positioned myself or where I placed a cushion, there was no way to get comfortable or escape the cramps. I must have gone to the toilet about 30 times in the space of three hours - partly as a way to distract myself from the deep, roaring pain.

While the nurse and midwife had been kind, gentle, supportive and calm, they had failed to properly explain how painful an early medical abortion would be. This is something friends who have had abortions tell me they also experienced.

One in three women in the UK has an abortion yet it is so stigmatised

Crawling out of the toilet on all floors, groaning and too plagued by pain to sit up and drink water, I kept wondering if what I was experiencing was normal. What's more, the nurse and midwife's warning that I must be on guard for severe bleeding had me a little on edge, after they said I must go to the hospital if I soak through two sanitary pads in an hour and blood is "pouring out like urine". I even had a nightmare in which this happened. Fortunately, it did not happen in real life, but that did not stop me from incessantly checking to ensure I was not about to bleed to death.

But after three hours, the pain did abruptly subside; the feeling was reminiscent of a sea of calm after a violent storm. Despite the pain having gone, the next two weeks were to be devoid of fun, and filled with rules and a fair amount of bleeding. The advice isn't consistent - I was told by MSI that there must be no sex, baths, sports or heavy lifting for two weeks. As well as no tampons or mooncups until the next period.

After the abortion, when I asked MSI if this was consistent with their wider advice, they said the guidance on baths was inaccurate and you only have to wait 48 hours. MSI also explained that they have no official, generic advice on how long to wait until you exercise, and their guidance on waiting to have sex has been reviewed and is currently being updated to "whenever you feel ready".

While their advice felt perfect for me, it was completely out of sync with advice on the NHS website, which does state that you can "have sex as soon as you feel ready" - adding that "you can usually return to normal activities as soon as you feel comfortable to, including having a bath or shower, using tampons, exercising (including swimming) and heavy lifting". BPAS, on the other hand, though it says you can have sex as soon as you feel ready, does not offer any specific advice on how long to wait until you exercise.

So how do I feel now, a few weeks after having had an abortion? Deeply relieved I am no longer pregnant, and massively grateful I live in a country where abortions are legal. But this relief is bittersweet due to my frustration, disappointment and shock at how poor abortion provision is in the UK, due to this critical aspect of healthcare being neglected by the powers that be.

The lack of attention abortion care appears to receive from politicians makes even less sense when you bear in mind how common abortions are. A record number of women in England and Wales had a pregnancy terminated in 2020, with the increase sharpest among women aged 30 and older. In 2020, just over 209,900 abortions were recorded, an increase from around 207,400 the year before.

"One in three women in the UK has an abortion, yet it is so stigmatised," Ms O'Brien, of BPAS, said. "It is a standard part of women's healthcare. Everyone will know someone who's had an abortion. There isn't a concerted effort to make the service the best it can be for women. The taboo and the stigma, and almost a view that women undergoing abortion do not deserve the best care, is part of the reason the government sidelines this issue. If telemedicine was a clear benefit to one in three men, do you think we would be having this constant debate?"
If you have been affected by the issues raised in this story, the NHS signposts to support through . Or you can speak to someone in confidence at the British Pregnancy Advisory Service, the UK's largest abortion provider, by calling 03457 30 40 30 or emailing info@bpas.org. Or you can ring MSI Reproductive Choices, another leading abortion provider, on 0345 300 8090.

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I had an abortion - and my experience shows how broken the UK system truly is

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When she found out she was pregnant, Maya Oppenheim knew that, like thousands of women, she could face difficulties trying to have a termination. But what she discovered were problems at every stage of a process that experts warn is at breaking point

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Environmental Graphics

Create wayfinding signage for the Woodbury University campus to welcome students and faculty back to in-person learning and spread a positive, playful attitude while reminding them of important Covid safety protocols.

A bright-but not juvenile-color palette and use of Cera Pro for all typography fit within the school's existing brand guidelines and and possess an exuberant character. The illustrated owl takes after the school's mascot, Woody the Owl, and appears in different places throughout the branding to provide a friendly face.

At the time this was created, the school was encouraging students and faculty to travel on a one-way path through buildings as a way to enforce physical distancing. Thus, each building needed a distinct entrance and exit, which became the centerpiece of our project. Other signage that served as reminders for wearing masks and staying physically distanced included wall signs, sandwich boards, and floor dots at benches.

This project was completed as an interdisciplinary team led by Cate Roman and Jeanine Centuori. I worked with graphic designer Nya Walker and architects Adrian Rios and Iris Fung.

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Environmental Graphics Create wayfinding signage for the Woodbury University campus to welcome students and faculty back to in-person learning and spread a positive, playful attitude while reminding them of important Covid safety protocols. A bright-but not juvenile-color palette and use of Cera Pro for all typography fit within the school's existing brand guidelines and and possess an exuberant character.

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Sharing stories is at the heart of ending the stigma that too many women and pregnant people still feel when it comes to abortion.

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Salary Finance has been given a new look by Ragged Edge, featuring a "smiling" logo and a "warm" colour palette of pink and blue.

Ragged Edge has created a "playful" new visual and verbal identity for Salary Finance, a start-up co-founded by the former of head of Google UK and Ireland, Dan Cobley.

Salary Finance was established in 2015 by Cobley along with co-founders Daniel Shakhani and Asesh Sarkar, who is also the company's CEO.

The business works with employers to offer their employees a range of financial benefits that are paid directly out of their salary, as well as offering free information on topics such as pensions and mortgages.

According to Salary Finance, if an employee takes out a £3,100 loan for example, it can help them save £600 on their interest payments. In 2016, the company was named by Forbes as one of the five most exciting "socially responsible" start-ups in the UK.

Ragged Edge was briefed to create a new brand strategy and identity for Salary Finance that would help to "define their purpose" internally, externally and internationally, as it expands into the US, says the consultancy's founder Max Ottignon.

"We recognised that money shouldn't be a cause of worry. It should build self-esteem, enable possibility, and free people up for a more hopeful and sustainable future. The brand needed to retain some challenger spirit, while confidently navigating an industry of financial institutions and payday lenders," Ottignon adds.

The new identity aims to look "playful", says Ragged Edge, featuring a logotype that is set on an upward curve to look like a subtle smile.

The logo is accompanied by a "warm" colour palette of salmon pink, light pink and dark blue, and photography of "positive" hand gestures such as thumbs-up, adds the consultancy.

The new identity has rolled out across all physical and digital touchpoints.

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Rebranding a "socially responsible" finance start-up

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Salary Finance has been given a new look by Ragged Edge, featuring a "smiling" logo and a "warm" colour palette of pink and blue. Ragged Edge has created a "playful" new visual and verbal identity for Salary Finance, a start-up co-founded by the former of head of Google UK and Ireland, Dan Cobley.

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1. Abortion is common

Abortion is a simple procedure that can be delivered in a health facility or involve the use of medication (pills approved by the World Health Organization for ending a pregnancy, which be taken safely at home). The WHO , when carried out properly through one of the recommended methods, abortion is a safe health care intervention.

Ultimately, the right to safely choose whether to carry a pregnancy to term is central to a person's autonomy.

The United Nations Human Rights Committee has that access to abortion is a matter of human rights, and regularly calls on countries to decriminalize abortion in all cases.

Deaths from unsafe abortion care are far more common when abortion is illegal or heavily restricted. For instance, according to the Guttmacher Institute, in the countries with the least restrictive abortion laws, of abortions are typically unsafe. In the most restrictive, that number goes up to 31 percent.

In the United States, eight of the ten states with the highest maternal mortality rates have passed highly restrictive abortion access legislation.

of abortion laws around the world here. Globally, the United States is an outlier, as very few other countries have restricted abortion in recent years. Instead, access to the procedure has been expanded in countries such as Colombia, Mexico and Ireland. Some countries, such as the Democratic Republic of Congo and Kenya, previously banned abortion in all cases but now allow it in certain situations, such as to preserve the woman's life or physical and mental health, in cases of rape or incest and when there are severe fetal anomalies. All told, more than 50 countries have eased abortion restrictions since the early 1990s.

810 Women

die each day in childbirth.

97%

of unsafe abortions currently take place in developing countries.

39,000+

women and girls across four countries were provided with post-abortion care under one IRC program.

In some countries, the IRC provides life-saving treatment for people suffering from the complications of miscarriages and unsafe abortions - often called post-abortion care.

The WHO estimates that 30 women die for every 100,000 unsafe abortions in developed countries, that number rises to 220 deaths per 100,000 in developing countries.

The WHO estimates that approximately 810 women die each day in childbirth, and that 94 percent of maternal deaths happen in low or middle income countries.

Among those most impacted will be the refugees and immigrants that the IRC serves through our 29 offices across the country. In line with our humanitarian principles to deliver the highest quality care, the IRC will continue to provide information and services to refugees and immigrants that promote their ability to regain control over their lives and futures. assists clients in learning to navigate the U.S. health care system and to access services that enable their health and wellbeing, including their sexual and reproductive health. For example, the IRC in Atlanta offers the Health Improvement Project for Teens (HIPTeens) an evidence-based, sexual risk reduction intervention for adolescent girls that enhances knowledge, increases motivation, and teaches skills needed to reduce pregnancy, HIV and STI risk

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Four reasons safe abortion is critical health care

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All over the world, the IRC has seen the devastating impact of abortion restrictions. After the Supreme Court decision overturning Roe v. Wade, get the facts.

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The growing COVID-19 pandemic forced us to rethink our plans for the next phase of work - in particular, our plan to hold in-person workshops. We changed tact and ran a series of digital workshops with the HBO team instead. We nailed down answers to fundamental questions about the brand, including defining their personality, values and purpose.

During the workshops, we hit upon a key insight. In the face of significant challenges, queer people in the US are increasingly confident about living their lives in public. This led us to our brand purpose: "to celebrate our proudest, queerest selves."

This purpose became the rallying cry for everything that followed.

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HBO Human By Orientation brand - Human After All design agency London

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The growing COVID-19 pandemic forced us to rethink our plans for the next phase of work - in particular, our plan to hold in-person workshops. We changed tact and ran a series of digital workshops with the HBO team instead. We nailed down answers to fundamental questions about the brand, including defining their personality, values and purpose.

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The Turnaway Study is ANSIRH’s prospective longitudinal study examining the effects of unwanted pregnancy on women’s lives. The major aim of the study is to describe the mental health, physical health, and socioeconomic consequences of receiving an abortion compared to carrying an unwanted pregnancy to term. The main finding of The Turnaway Study is that receiving an abortion does not harm the health and wellbeing of women, but in fact, being denied an abortion results in worse financial, health and family outcomes. Highlighted resources include:

Factsheet: The Harms of Denying a Woman a Wanted Abortion

A Summary of Publications on The Turnaway Study

What is The Turnaway Study?

The Turnaway Study: Ten Years, A Thousand Women, and the Consequences of Having - or Being Denied - an Abortion

Before the Turnaway Study, there was little quality research on the physical and social consequences of unwanted pregnancy for women. Most of the research that did exist focused on whether abortion causes mental health problems such as depression and post-traumatic stress disorder, or alcohol and drug use. That body of work often used inappropriate comparisons groups—comparing, for example, women who obtain abortions with those who continue their pregnancies to term by choice—and used retrospective designs that depended on women’s reporting of pregnancies and abortions in hindsight. Such comparisons are inherently biased and paint a distorted picture of life following an elective abortion or pregnancy continuation.

Key Findings

ANSIRH has published more than fifty scientific papers in peer-reviewed journals using data from the Turnaway Study. Our annotated bibliography provides a complete list of publications. Issue briefs on the mental health and socioeconomic consequences of having an abortion versus carrying an unwanted pregnancy to term are also available in Spanish (salud mental and resultados socioeconómicos).

The Turnaway Study team of scientists from The University of California San Francisco have also created a lecture series which examine the consequences of receiving versus being denied an abortion in the United States, found here.

Findings of the Turnaway Study, the largest study to examine women’s experiences with abortion and unwanted pregnancy in the United States—have also been collected and described in a new book The Turnaway Study: Ten Years, A Thousand Women, and the Consequences of Having - or Being Denied - an Abortion, available now in bookstores and online. A factsheet on the Turnaway Study's findings can also be found here.

The study finds that many of the common claims about the detrimental effects on women’s health of having an abortion are not supported by evidence. For example, women who have an abortion are not more likely than those denied the procedure to have depression, anxiety, or suicidal ideation. We find that 95% of women report that having the abortion was the right decision for them over five years after the procedure.

The Turnaway Study does find serious consequences of being denied a wanted abortion on women’s health and wellbeing. Women denied a wanted abortion who have to carry an unwanted pregnancy to term have four times greater odds of living below the Federal Poverty Level (FPL).

In addition, women denied abortion are:

More likely to experience serious complications from the end of pregnancy including eclampsia and death.

More likely to stay tethered to abusive partners.

More likely to suffer anxiety and loss of self-esteem in the short term after being denied abortion.

Less likely to have aspirational life plans for the coming year.

More likely to experience poor physical health for years after the pregnancy, including chronic pain and gestational hypertension.

The study also finds that being denied abortion has serious implications for the children born of unwanted pregnancy, as well as for the existing children in the family.

Study Design

From 2008 to 2010, we recruited from 30 abortion facilities around the country—from Maine to Washington, Texas to Minnesota—to select about 1,000 women who sought abortions, some who received abortions because they presented for care under the gestational limit of the clinic and some who were “turned away” and carried to term because they were past the gestational limit.

Research assistants interviewed participants by phone over a period of five years, ending in January 2016. The interviews were wide-ranging, covering topics from physical and mental health to employment and educational attainment to relationship status and contraceptive use to emotions about pregnancy and abortion. We conducted nearly 8,000 interviews over the course of the project, and the stories that women shared with us about their lives are fascinating.

Participants were interviewed every six months about their mental and physical health, education, employment, economic situation, social support, and family relationships. In order to address the issue of appropriate comparison groups, the women we recruited fell into three categories:

1. Women who sought an abortion up to three weeks over the gestational limit and were turned away without receiving an abortion (Turnaways).

2. Women who sought an abortion up to two weeks under the facility’s gestational limit and received an abortion (near-limit abortion comparison group).

3. Women who received an abortion in the first trimester of pregnancy (first trimester abortion group).

We recruited the first trimester group to enable us to compare the outcomes of women who receive later abortions to those of women who obtain abortions early in pregnancy, since the vast majority of abortions in the United States occur in the first trimester.  Women who were seeking abortion care for a fetal abnormality or demise were not eligible for the study. More information about recruitment for the Turnaway Study can be found here. In addition, the New York Times Magazine published an excellent piece on the study in June 2013.

Implications

As women’s access to abortion care—whether in the first or second trimester—becomes increasingly restricted, it is extremely important to document the effect of unwanted pregnancy, abortion, and childbearing on women and their families. The Turnaway Study is an effort to capture women’s stories, understand the role of abortion and childbearing in their lives, and contribute to the ongoing public policy debate on the mental health and life-course consequences of abortion and unwanted childbearing for women and families.

The success of the Turnaway Study inspired ANSIRH researchers to collaborate with colleagues around the world to launch the Global Turnaway Studies, designed to adapt the innovative study design for use in different cultural, legal and socioeconomic contexts.

Acknowledgments

The Turnaway Study would not have been possible without the hardworking and dedicated staff. Rana Barar directed the study for ten years. Heather Gould conducted qualitative interviews and research management. Sandy Stonesifer and Jasmine Powell directed the study at the very beginning and end. Interviewers include Mattie Boehler-Tatman, Janine Carpenter, Jana Carrey, Undine Darney, Ivette Gomez, C. Emily Hendrick, Selena Phipps, Brenly Rowland, Claire Schreiber, and Danielle Sinkford. Debbie Nguyen, Elisette Weiss and Michaela Ferrari coordinated the study. John Neuhaus and Chuck McCulloch  provided statistical consulting and Jay Fraser provided data management.

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The Turnaway Study is ANSIRH’s prospective longitudinal study examining the effects of unwanted pregnancy on women’s lives. The major aim of the study is to describe the mental health, physical health, and socioeconomic consequences of receiving an abortion compared to carrying an unwanted pregnancy…

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A French doctor's invention and post-Roe America.

In March, a Republican lawmaker named Danny Bentley took the floor of the Kentucky House of Representatives to advocate for a bill that would strip many forms of reproductive-health care from residents of the state. A pharmacist and one of the bill's sponsors, Bentley promised to clear up some "misconceptions" about RU-486, or mifepristone-a synthetic steroid that is the critical ingredient of the abortion pill, a two-dose regimen that allows people to safely end early-stage pregnancies without surgical intervention. Bentley claimed that RU-486 was created during the Second World War, and that it was initially called Xyglam B-an apparent reference to Zyklon B, the lethal gas used in concentration camps. "The person who developed it was a Jew," Bentley said, adding that the inventors were likely motivated by "making money."

The abortion pill was created in the nineteen-eighties; mifepristone was the 38,486th molecule developed by the French drug company Roussel-Uclaf, hence the name RU-486. It was never called Xyglam B or Zyklon B. Bentley's fabulations were likely inspired by anti-abortion groups that have long tried to exploit a tenuous link between the two products: Roussel-Uclaf was owned by a German company that once belonged to another German company, a subsidiary of which helped manufacture and sell Zyklon B.

Bentley was correct, however, that RU-486 was developed by a Jewish scientist. He was born Étienne Blum, in Strasbourg, in 1926 and took the name Émile Baulieu upon joining the French Resistance in the nineteen-forties. As Étienne-Émile Baulieu, he led an extraordinary life: dodging Fascist paramilitaries; hobnobbing with art-world luminaries; enraging the Pope; and, in the course of a seven-decade career in biochemistry and neuroscience, becoming a seminal figure in the fight for reproductive rights. Last month-exactly two weeks before the Supreme Court's decision in Dobbs v. Jackson Women's Health Organization overturned Roe v. Wade -I visited Baulieu, known as the father of the abortion pill, in his office, in Paris. He told me that he wasn't much bothered by misrepresentations, such as Bentley's, of his legacy. (Bentley apologized for his comments after complaints from anti-defamation organizations.) He had absorbed worse: the Vatican once denounced RU-486 as "the pill of Cain: the monster that cynically kills its brothers." Baulieu's policy had always been to brush it off. But he was deeply troubled by the threat to reproductive freedom in the United States. "It's scandalous," he said. Later, he wrote to say that the Dobbs decision "calls into question a fundamental right of women that we would have thought was legally, politically, and morally guaranteed."

Bentley's bill passed the Republican-dominated Kentucky legislature easily, but was temporarily blocked by an injunction in federal court. For the moment, abortion remains legal in the state; however, Republicans are supporting a ballot measure that would amend the state constitution to make it harder to challenge these laws in court.

The abortion pill-not to be confused with the morning-after pill, which delays ovulation, is typically taken in two stages. First, mifepristone blocks the body's receptor for the hormone progesterone, thereby disrupting the gestation process in its early stages. Misoprostol then provokes contractions so that the uterus expels what's left of the pregnancy, causing heavy bleeding and cramping. (According to Planned Parenthood, medication abortion feels, for most people, "like having an early miscarriage.") In 2020, medication abortions accounted for an estimated fifty-four per cent of reported American abortions, making it, for the first time, the most common means for ending pregnancies in this country.

According to some experts, mifepristone has been overregulated since it was approved for use in America, particularly "given the very low rate of adverse events associated with its use." During the pandemic, the F.D.A. suspended a rule requiring health-care professionals to dispense the medication in person-a change that the agency has since made permanent. Abortion pills can be taken at home, so those who need them may not require transportation, child care, or significant time away from work or school. They are safe, effective, and can be mailed or passed around, making them relatively difficult for authorities to trace. As my colleague Jia Tolentino has written, abortion pills are "among the reasons that we are not going back to the era of coat hangers."

Greer Donley, a scholar of reproductive justice at the University of Pittsburgh's law school, told me, "Historically, abortion was done by procedures, which meant that, if you could control doctors, you could really control abortion provision. But now that abortion pills exist, a state's abortion ban is not going to have the same effect as it used to." Baulieu's so-called little white bombshell doesn't remedy the injustice and inequity of the Court's decision. But it is now the most powerful tool available to the estimated thirty-three million Americans whose reproductive autonomy the ruling attempts to negate.

I visited Baulieu at his research facility, INSERM Unit 1195 at the Hôpital Bicêtre, on the southern outskirts of Paris. The antechamber to his office was lined with brightly colored binders ("Abortion," "Menopause," "Ethics Committee") and folders containing decades' worth of press clippings ("Furor Over Award for Abort-Doc Pill, Pro-Lifers Rip 'Human Pesticide,' " the New York Post wrote, in 1989). On a desk sat a glass container that had once held pâté and was now used to store paper clips.

The doctor appeared wearing gray slacks, a white button-down, and a bluish-gray sport coat. He used a walking stick, but, at ninety-five, he is otherwise in good shape. He has spent the latter part of his career studying depression and Alzheimer's. He has also investigated the anti-aging properties of the hormone dehydroepiandrosterone (DHEA), without conclusive results, but he doesn't rule out a positive influence. "I take it every day," he said, leading the way to his office.

Long tipped for the Nobel Prize for his work on mifepristone, Baulieu never won it, but he has collected nearly every other honor a scientist could imagine, ranging from the Lasker Award to the presidency of the French Academy of Sciences. In 1989, during a visit to Baulieu's office, the Times reporter Steven Greenhouse noted Baulieu's "breezy, almost brash manner and hyperkinetic nature," which gave him "the air more of a populist politician than of a meticulous medical researcher." Although he has mellowed since then, Baulieu hasn't entirely lost the savvy, self-assured persona that made him, in the words of one French journalist, one of the great "public enemies of the Catholic, anti-feminist, extreme right." Plaques, memorabilia, and piles of books commingled in his office with bulbous sculptures by the feminist artist Niki de Saint Phalle. "I lived with her," Baulieu said casually, taking a seat near a window that overlooked a former prison where the Marquis de Sade was once held. He didn't mention Sophia Loren, whom he once drove around in an Austin Morris, fleeing paparazzi. (In the nineties, Vanity Fair reported, over Loren's denials, that they became involved in an intense affair, causing Baulieu's wife to remark, "What could he do? He fell in love.")

Baulieu was conceived on the Nile-he knows this because his parents honeymooned there while his father, Léon Blum, a specialist in kidney disorders, was in Egypt treating King Fuad I for diabetes. During the First World War, Léon, an Alsatian, had been drafted into the German Army. Concocting a medical pretext, he asked officers to submit urine samples by mail. He used the postmarks to track their movements, which he transmitted to the French, who then recognized him with a Legion of Honor when the war was over. Léon died when Baulieu was three. His mother-a lawyer, pianist, and friend of the suffragettes who had "felt hemmed in by Alsace" and by Léon's professional life-moved the family to Paris. "I was allowed to think about any career I wanted," Baulieu later wrote. "Except medicine."

When Hitler's Army occupied France, in 1940, Baulieu was a teen-ager. He joined the Communists, distributing anti-German pamphlets and narrowly avoiding capture as he shot at German cars and delivered arms. In November, 1944, he was part of a group of ex-resistants who kidnapped Charles Marion, a Vichy official who was in prison awaiting trial, and executed him. "The prefect conducted himself with dignity, dressed in a beautiful loden coat that I never forgot," Baulieu later recalled in " Libre Chercheur," a book-length conversation with the journalist Caroline Fourest. As the youngest member of the group, Baulieu was assigned to shoot photos, rather than fire at Marion. He ultimately considered the killing "justifiable in the context," but remained haunted for years by other horrors he witnessed, such as the forced shaving of women accused of collaboration.

Eventually, Baulieu felt drawn to his father's profession. He threw himself into medical studies, eating bananas for every meal "to go faster," and quit the Communist Party after the Soviet invasion of Hungary, in 1956. He recalled, "The best way to help society, I felt, was at the level of the individual." Later, he loved Primo Levi's work on the integrity of science, which he paraphrased as, "Science has an essential virtue. It respects what is."

Baulieu's first major discovery involved DHEA, the hormone to which his work would later return. Secreted by the adrenal glands, DHEA plays a key role in manufacturing both testosterone and estrogen, and DHEA levels can serve as an indicator for certain diseases. Other scientists, searching for a detection technique, had tried examining the oily fluids from the adrenal glands. Baulieu tried to measure it by looking at the water-soluble form, likening his method to "probing a vinaigrette: looking in the vinegar instead of the oil." His discovery made him a tenured professor by the age of thirty. Soon, he was headed to New York, for a yearlong fellowship at Columbia University's medical school. (He had to wait for Kennedy's election to get a visa, given his Communist past.) While in the U.S., Baulieu got to know Gregory Pincus, the inventor of the oral contraceptive pill, who became a mentor. By night, he ran around with a group of striving New York artists: Jasper Johns, Robert Rauschenberg, Frank Stella. "Like them, I was adding form to a blank space with only vague notions of where it would lead me," Baulieu later wrote of his research.

Before long, Baulieu decided to focus on sex hormones. He chose them expressly because of their social implications, hoping that they would yield new possibilities for reproductive autonomy and for alleviating the "pain and punishment" that had long been the lot of those who chose to end a pregnancy. ("Teach her a lesson she'll remember," he'd once heard a surgeon say, instructing his assistant to forgo an abortion patient's anesthesia.) "My intention was to give women a choice that, through a pill, respects their privacy and physical integrity and allows them to totally avoid the aggression of surgery," he told me.

Baulieu came up with the idea to create a molecule that would effectively impersonate progesterone, occupying the uterus's progesterone receptors and thus preventing it from retaining a fertilized egg. "Rather than disrupt a pregnancy with a sharpened spoon or a suction tube, why couldn't the natural process be reversed by altering the balance of the same hormone that caused it to begin?" he explained. The top executive at Hoechst, Roussel-Uclaf's parent company, was an ultraconservative Catholic who opposed abortion, so, in company meetings, Baulieu focussed on other potential applications for his new product, suggesting that, because anti-progesterones can inhibit the production of cortisol, it might be a great thing to give astronauts to control stress. After several months of experimentation, the in-house chemist at Roussel-Uclaf succeeded in synthesizing RU-486. In clinical trials, the drug, paired with its contraction-inducing partner, had a success rate of nearly a hundred per cent.

Baulieu had previously served on a government committee (made up of thirteen male doctors, assisted by two female secretaries, he recalled) that helped push through the legalization of birth control in France. He knew that public positioning would be important to RU-486's success. The ability to end a pregnancy by medication was revolutionary for patients ("The Pill that Changes Everything," read a cover of Time magazine), and it would also be more palatable than surgery to some of the constituencies policing their reproductive choices. Baulieu called his scientific breakthrough "contragestion," a method that occupied "the middle ground between preventing fertilization and surgically removing a fetus." He became one of the most prominent advocates for RU-486, sometimes to the annoyance of colleagues, who accused him of hogging the spotlight. Always willing to vulgarize his work in the name of wider understanding, he used various metaphors to explain how the medication worked-jamming a radio signal, creating a false key-but the simplicity and elegance of mifepristone hardly needed illustration. For Baulieu, it was "the œuvre I dreamed of with artist friends in New York."

The fight to bring RU-486 to market was brutal and nonlinear. French authorities approved the drug for sale in September of 1988, amid an already febrile atmosphere. The next month, in Paris, Catholic extremists set fire to a movie theatre showing Martin Scorsese's "The Last Temptation of Christ," while others deployed tear gas in a screening of Claude Chabrol's "Une Affaire de Femmes," a film based on the life of Marie-Louise Giraud, a laundress from Normandy who was guillotined by Vichy authorities on July 30, 1943, for having performed twenty-seven abortions. Facing pressure from the Catholic Church and threats of a boycott, Roussel-Uclaf wavered. "You are turning the uterus into a crematory oven!" read a sign that one protester brandished outside a shareholders' meeting. Less than a month later, having already promised to supply RU-486 to a number of countries, the company decided to pull it from the market.

Baulieu heard about the decision from a lab technician who burst into his office to relay the news. He soon took off for the World Congress of Gynecology and Obstetrics in Rio de Janeiro, which, upon his arrival, effectively transformed into what the New York Times described as a "pep rally" for RU-486. Within days, the French government, which held a thirty-six-per-cent stake in Roussel-Uclaf, intervened, threatening to force the drugmaker to cede the patent for RU-486 to another company. Roussel-Uclaf reversed its decision and put the drug back on the market, preparing the way for worldwide distribution. The French health minister declared, "From the moment government approval for the drug was granted, RU-486 became the moral property of women, not just the property of the drug company."

America was especially fraught territory for RU-486-an enormous free market with deep-seated sensitivities. Faye Wattleton, who served as the president of the Planned Parenthood Federation of America from 1978 to 1992, told me that she made three trips to Paris to try to persuade company officials to make the pill available to her group for clinical trials. "I think Roussel-Uclaf was uncomfortable with their product being released to our organization, if you want my opinion," she said. "There was a fair amount of squirming in their seats." At first, some proponents pitched the drug as a contraceptive, suggesting that it could be taken in the final days of one's cycle to prevent unwanted pregnancy. Still, news of the drug "arrived like a splash of gasoline on a blazing fire," Baulieu recalled. He threw himself into the fray, briefing F.D.A. specialists and allying with activists. (He didn't have a financial stake, not being entitled to the drug's profits under his consulting agreement with Roussel-Uclaf.) Once, in New Orleans, he was scheduled to give a talk but switched slots with another speaker. He was sitting in the auditorium among a crowd of pediatricians, listening to the other speaker, when a small bomb went off. "Boom!" he later recalled. "Those pro-life idiots didn't even notice that we had changed the presenter and the theme!"

During the Reagan and Bush years, RU-486 was a banned substance and federal research into it was largely forbidden. At one point, activists set up a makeshift lab in a New York suburb, where an anonymous volunteer scientist who went by Dr. X tried to manufacture the pill using information gleaned from the patent application. The parent company of Roussel-Uclaf refused to sell the drug in America and declined to partner with Planned Parenthood, Wattleton told me. She added, "What if they gave it to an organization headed by a Black woman and it blew up in their face?" she said. Eventually Roussel-Uclaf transferred the U.S. rights to a nonprofit organization. "I believed from the beginning that RU-486's eventual destiny would be shaped in the United States," Baulieu wrote, citing the country's history as the birthplace of oral contraception alongside its high rates of teen-age pregnancy.

Over the objections of such figures as the congressman Robert Dornan ("The taking of a pre-born life will be as easy and trivial as taking aspirin") and Dr. John Willke of the National Right to Life Committee ("We're really very simplistic, visually oriented people, and if what [abortions] destroy in there doesn't look human, then it will make our job more difficult"), the F.D.A. finally approved RU-486 in 2000, making it available to Americans a decade later than their peers in countries such as China, Russia, and the U.K. "Ideology and machismo, alas, weigh more heavily than rationality and scientific proof," Baulieu said, when I asked if he had drawn any lessons from that fight. "A method that makes the termination of pregnancy less physically traumatic for women and less risky to their health has always been rejected by pro-lifers: what they really seek is to harm and punish women."

Four decades after its invention, the abortion pill is more important than ever. "It's a method that the person who needs the abortion can use to self-manage an abortion," Elisa Wells, a co-founder of Plan C, an organization that provides information about at-home medication abortion, told me. "So there's no clinician or gatekeeper, and no permission is really needed to exert control over their own reproduction."

Exactly how powerful medication abortion will be in subverting abortion bans will depend on how readily people can access it. According to the Kaiser Family Foundation, eighty per cent of American adults, including two-thirds of women aged eighteen to forty-nine, don't know that medication abortion exists. Even those who do may not possess sufficient financial or technological means to get it. Already, Black and Hispanic people, teen-agers, and people who live in rural areas face disproportionate difficulty. "There are those who say, 'Well, we can pass it in the mail,' " Wattleton said. "I say to them, 'Have you heard of the Comstock laws?' There will be a thousand ways to Heaven-or to Hell-to figure out how to frustrate every effort for women to control our bodies."

The legal status of abortion pills will be fiercely contested now that Roe has fallen. Last week, Attorney General Merrick Garland said that states cannot ban mifepristone, but the matter is unsettled. Pro-choice lawsuits are likely to pursue the preëmption theory, invoking the supremacy clause of the Constitution to argue that the F.D.A.'s rulings take precedence over those of state authorities. But abortion is a time-sensitive process-the F.D.A. has approved RU-486 for use only within the first ten weeks of pregnancy-and pills, especially when procured through online pharmacies or international providers, can take weeks to arrive. Moreover, women have been prosecuted both for managing their own abortions and for selling abortion pills. The coming "War on Abortion Drugs," as the Brookings Institution described it, is likely to be "as racist and classist" as the war on narcotics. Donley, the reproductive-justice scholar, said that she sees increasing criminalization and the likely targeting of providers and helpers-a mother who procures abortion medication for her teen-age daughter, for example-as the major post-Roe obstacle to accessing medication abortion. "Unfortunately, there is no risk-free option for people who are living in states that ban abortion and who seek abortion care," she said.

In recent years, providers and activists have been devising new ways to distribute abortion pills. Aid Access, a service run by Rebecca Gomperts, a Dutch physician who has helped provide abortions in international waters, has also experimented with robots and drones as means of delivering mifepristone and misoprostol. After an online consultation, Gomperts sends a prescription to a pharmacy in India, which ships the pills directly to the patient. Since Gomperts is licensed and based abroad, she is beyond the scope of American law enforcement. "Unjust laws should not be respected," Gomperts has said.

In states where medication abortion is legal, startups such as Hey Jane and Choix are trying to do for abortion pills what Warby Parker did for eyeglasses, making them convenient, affordable, fast, and unintimidating. Hey Jane, for example, offers "modern abortion care"-a text, phone, or video consultation with a medical provider, followed by the delivery of pills in an unmarked box-for medically eligible patients over eighteen in New York, California, Washington, Illinois, Colorado, and New Mexico. (Contraindications to medication abortion include the presence of an ectopic pregnancy, chronic adrenal failure, and inherited porphyria.) The price is two hundred and forty-nine dollars, less than half of the average cost of treatment at a clinic. Other providers propose advance provision of abortion pills: getting them to people as a precautionary measure so that if an unwanted pregnancy occurs, the pills will be on hand. (The pills have a shelf life of around two years.) A recent editorial by researchers at the University of California, San Francisco advocates this approach, arguing that "the model would effectively shorten the time between the decision to have an abortion and obtaining care to zero days."

For residents of states that restrict abortions, accessing medication abortion will be harder and riskier, but still possible. For the moment, it is legal, if expensive and time-consuming, to travel to another state and receive abortion pills there. (Some states are already preparing legislation to try to prevent patients from crossing state lines.) Just the Pill, a telehealth abortion provider that advertises "Abortion Delivered," plans to dispatch mobile-abortion clinics-bulletproof trucks with pills, as well as vacuum-aspiration devices-to the Texas border. "People will use creative methods to obtain these medications that are approved by the US Food and Drug Administration and which are so easily available to their counterparts across state borders," Abigail R. A. Aiken and Ushma Upadhyay write in the British Medical Journal. They cite workarounds such as virtual mailboxes that allow a person in, say, Oklahoma to have pills delivered to California and then forwarded to their actual home. Faced with the threats of surveillance by the government and harassment from anti-abortion activists (for example, in the form of Web sites for fake clinics), patients are also turning to the kind of face-to-face community networks that have insured reproductive autonomy from the beginning of time.

In 1989, Baulieu was optimistic about the future. "You can't hold back scientific progress," he said. "You can't put it back in the drawer." His faith endures, even as lawmakers do just that. "It is up to scientists and doctors to always continue to invent new methods and to pursue progress," he told me. When Baulieu created RU-486, one politician called it a "death pill." Now, it is a critical means for preserving American lives, and American life as we have known it since Roe. ♦

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The Complicated Life of the Abortion Pill

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A French doctor's invention and post-Roe America. In March, a Republican lawmaker named Danny Bentley took the floor of the Kentucky House of Representatives to advocate for a bill that would strip many forms of reproductive-health care from residents of the state.

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The decision of the Supreme Court of the United States in Dobbs v. Jackson Women's Health Organization, which overturns Roe v. Wade and reverses the constitutional right to abortion, is undeniably a violation of human rights and autonomy and sends a signal to the rest of the world that the United States does not support women, girls and all people being afforded the opportunity to direct the course of their own lives.

This is a decision that first and foremost impacts the law and the health and rights of people in the U.S.; but it also threatens global progress on sexual and reproductive health, rights and justice (SRHRJ). For better or worse, the U.S. as the largest global health funder has an outsized influence on the world. By moving against the global tide that is liberalizing abortion, it is emboldening an already organized and well-resourced opposition, potentially causing a "chilling effect" for global health care providers that may rely on U.S. funding, and harming its own credibility and influence on the global stage. Countries that have relied on U.S. leadership, including the precedent of Roe v. Wade, to advance reproductive health and rights domestically may now see their progress threatened, and countries that have sought to restrict rights may now point to the U.S. in regress as an example to emulate.

But even as we move backwards at home, the U.S. can and must continue to lead with humility and renewed urgency to fulfill its commitments to advance SRHRJ, including through foreign policy, by:

1. Advancing funding for global SRHRJ and permanently ending harmful policies. The U.S. is the largest funder of reproductive health globally. Even and especially in a post-Roe world, we must continue to robustly fund this work in our federal budget, including full support for the critical work of UNFPA, the UN agency on sexual and reproductive health. We must also ensure that this funding is maximized and not stymied by harmful and regressive policies like the global gag rule or the Helms amendment. While the global gag rule was rescinded as an early action by the Biden-Harris Administration, it has yet to be permanently repealed by Congress, which is essential in preventing the policy from being reinstated on the whim of a future conservative administration.

Progress here has begun: for the second year in a row, the U.S. House of Representative's State, Foreign Operations, and Related Programs spending bill increases funding for international family planning and reproductive health programming and for UNFPA; and addresses longstanding and harmful foreign policy restrictions by removing the Helms amendment and permanently repealing the global gag rule. Thanks to the leadership of Reps. Barbara Lee and Rosa DeLauro, this is a strong step in the right direction as federal appropriations season gets underway.

Combatting the "chilling effect": The fall of Roe v. Wade could exacerbate the chilling effect that still lingers from the global gag rule, causing NGOs receiving U.S. global health funding to potentially become skittish about providing comprehensive health care due to lack of clarity on what is permitted and for fear of losing significant donor funding. A recent Fòs Feminista report found that even though the global gag rule was officially reversed as an early action of the Biden Administration, there were months of delays and roadblocks in effectively communicating this to on-the-ground partners causing comprehensive care, including abortion care, to remain out of reach for those who needed it; even though legally, it was no longer restricted by the gag rule. The report found: " Organizations needed urgent and immediate guidance from the [U.S. government] in January 2021 that clearly instructed them to cease implementing the [global gag rule] and explain how to modify ongoing programs to align with the policy change as well as mitigate harmful impacts on communities around the world."

The U.S. can learn from these findings and act swiftly and clearly to communicate to international partners that its own domestic abortion restrictions are not, in fact, restricting the work of global health funding recipients - and that these partners should continue to provide rights-based and comprehensive care that is needed in their communities. This can happen on multiple fronts. Leaders across the administration, including at the Department of State and its U.S. embassies around the world, USAID and its global missions, and Health and Human Services, can all make clear that the U.S. unequivocally supports SRHRJ and can clarify what is permitted under current law through foreign assistance, including allowances for foreign aid to support abortion in the cases of rape, incest and life endangerment.

3. Advocating for SRHRJ in global fora. Undoubtedly, the U.S.'s role as a global leader on SRHRJ has been dealt a blow by the fall of Roe v. Wade. It has lost credibility on health and human rights and, as the aftermath of the decision continues to roll out, it is likely this credibility will fall further. But the U.S. must still show up in force - again, with humility and recognizing the reality on our home front - to champion SRHRJ as an expectation in diplomatic relations, global negotiations, and multilateral convenings. This includes continuing to counter harmful regressive efforts like the so-called Geneva Consensus, and pro-actively harnessing the solidarity expressed by political leaders around the world to coalition-build to continue global momentum for reproductive freedom.

4. Doubling down on equity. In the U.S., Roe v. Wade has always been the floor, not the ceiling, and an insufficient one at that - legality has not equated to accessibility for abortion care in the U.S., especially for BIPOC communities. Similarly, it has not equated to support for abortion in U.S. foreign policy. Despite regression domestically, the U.S. can and must move forward a progressive and transformative foreign policy agenda that goes beyond legality with an eye toward justice and equitable access, including the asks from the Blueprint for Sexual and Reproductive Health, Rights, and Justice, a comprehensive policy agenda endorsed by more than 90 organizations; and the framework of a Feminist Foreign Policy that puts gender equality, bodily autonomy, and human rights at its core. It can also center SRHRJ in the implementation of the first-ever National Strategy on Gender Equity and Equality. To do this meaningfully, the U.S. must engage BIPOC and LGBTQIA+ justice movement leaders in visioning, strategy, priority-setting and resource decision-making; and, indeed, shift foreign assistance to support BIPOC-led and LGBTQIA+-led organizations, feminist movement leaders, and human rights defenders in local contexts around the world who have the deep knowledge of what their communities want and need - the strongest path to countering opposition and driving systemic and enduring change.

The overturning of Roe v. Wade is a devastating regression in human rights and autonomy here in the U.S., with significant impacts globally. But we cannot let the regression seep into our foreign policy, too. The U.S. has ample opportunities to stay true to its commitments on SRHRJ. It must not delay on seizing them.
Learn more about the Universal Access Project and get involved at www.universalaccessproject.org.

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The decision of the Supreme Court of the United States in Dobbs v. Jackson Women's Health Organization, which overturns Roe v. Wade and reverses the constitutional right to abortion, is undeniably a violation of human rights and autonomy and sends a signal to the rest of the world that the United States does not support women, girls and all people being afforded the opportunity to direct the course of their own lives.

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In the U.S., medication abortion usually consists of two drugs. One of them has always mattered more.

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Fact sheet on abortion: scope of the problem, consequences of inaccessible quality abortion care, expanding quality abortion care, and WHO action.

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WHO / SRHR / Uma Bista
A woman (left), with her mother-in-law, at their home in rural Nepal. Two years ago, the woman had a safe abortion with the help of a nurse/midwife. She continues to receive sexual and reproductive health services from the same nurse.

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Abortions are safe if they are done with a method recommended by WHO that is appropriate to the pregnancy duration and if the person providing or supporting the abortion is trained. Such abortions can be done using tablets (medical abortion) or a simple outpatient procedure.

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Introduction

Fulfilling sexual and reproductive health and rights (SRHR) in Venezuela is a complex challenge. A Venezuelan woman needs more than 15 times the average monthly salary to buy a month's worth of contraceptive pills, and she would also have to go to several pharmacies or online vendors to find them. Due to chronic supply stock-outs, many people have to resort to clandestine markets or high-end pharmacies to find sexual and reproductive health (SRH) supplies. These shortages include other SRH essentials such as condoms for preventing sexually transmitted infections, pads for menstrual health management, and the full contraception mix to prevent unwanted pregnancies. Many of these SRH supplies are considered luxury items in Venezuela. Their inaccessibility exemplifies how complex humanitarian emergencies deepen socioeconomic disparities in the free exercise of bodily autonomy and sexual and reproductive rights.

The World Health Organization [WHO] defines "complex humanitarian emergencies" as significant disruptions in livelihoods, the product of a combination of political instability, violence, social inequities, and underlying poverty that lead to large-scale displacements. Several human rights organisations have used this term to define the Venezuelan situation, given the complexity of the political crisis that turned the country's economy into one of the most volatile in the world. Causes of the crisis include the mismanagement of foreign exchange reserves and national budgets, the decline of oil revenues in 2013, and the international economic sanctions in 2017. As a result of this situation, in 2020, many people earned a monthly minimum wage equivalent to US$ 1.50 that was continuously losing value, with the cumulative yearly inflation rate reaching 3,713%. Consequently, more than half of the Venezuelan population live in conditions of extreme poverty, or heavily dependent on remittances in $US. This situation has led many to migrate in order to access essential public services, reliable water and sanitation services, nutrition, and health care, including maternal and child health, as well as SRH.

Women's, adolescents' and young girls' health is disproportionately affected by the crisis. In terms of SRH indicators, in 2019, UNFPA reported 95 births per 1000 women aged 15-19, a figure considerably higher than the regional average for Latin America (62 per 1000 women aged 15-19). This adolescent fertility rate coexists with one of the highest maternal mortality rates in the region (125 deaths per 100,000 live births). Data gathered by civil society suggests that 13% of all maternal mortality in Venezuela is due to unsafe abortion. The SRHR context has also driven a significant number of women to migrate or temporarily move to nearby countries to give birth, obtain safe abortions, buy contraception or flee from gender-based violence. Nevertheless, this is a far from sustainable solution since it relies on forced displacement. It does not improve existing healthcare services and livelihoods in Venezuela, which would enable these women to freely exercise their sexuality in a safe environment.

In this context, Venezuelans have been turning increasingly to digital tools to find information, supplies, and healthcare services, including SRH. Digital health is an umbrella term that refers to the use of information and communication technologies for health to advance access to universal health coverage. According to Váyalo Foundation, 51% of adolescents and young people in Venezuela use the internet and social media as primary sources to access SRH information. In addition, a diverse network of abortion hotlines in Venezuela provides information on safe medical abortion and virtual accompaniment through digital means (phone and instant messaging platforms), and the demand is considerable. In 2019, the hotline Faldas-R received a total of 1142 calls with information requests. Digital self-care tools could have a prominent role in facilitating information provision and strengthening accompaniment models, considering that one of people's first contacts with SRH content, including abortion, is through the web or mobile devices.

This commentary aims to highlight the importance of understanding the context when designing digital tools for SRH self-care in humanitarian settings. We draw insights from the contextual analysis that was essential to the design process of Aya Contigo, a digital self-care tool that provides information and virtual accompaniment during the medical abortion process up to the first trimester. The overall research and design process included the following phases: (a) contextual analysis and stakeholder engagement and mixed-method exploratory research, (b) user-centred design principles to design and develop the mobile-based digital tool, and (c) mixed-methods feasibility and acceptability pilot study. We focus on findings from the exploratory research. In this phase, we conducted a contextual analysis through a desk review of Venezuela's complex humanitarian emergency; a mapping of national SRH and abortion legislation, policies, programmes, and main stakeholders; and in-depth interviews with local activists, SRH service providers, and prospective users. We also facilitated workshops where stakeholders shared their inputs on the pertinence of digital self-care tools in the Venezuelan context.

The main takeaway from the contextual analysis and stakeholder interviews was that community members (grassroots organisations, collectives, local providers, and prospective users) must be at the centre of each digital SRH self-care development phase. Digital health implementers must acknowledge that these tools function within an ecosystem of already existing networks of care, providers, and community activists that deliver SRH information and services. Likewise, the overall research and design process of digital health tools should be flexible to adapt to the rapidly changing environment of humanitarian settings, which often have poor communications infrastructure and electrical supply, deficient public transportation to mobilise, and a political environment that hinders open advocacy for reproductive justice, including abortion rights.

Sexual and reproductive health and abortion access in Venezuela's complex humanitarian emergency

Globally, in 2020, about 34 million women of reproductive age (15-49 years old) were in need of humanitarian assistance to cover not only shelter, clean water, and food but also primary health care that includes SRH services. Humanitarian settings are contested spaces when it comes to guaranteeing access to these services, especially abortion. Even though abortion is part of essential healthcare protocols such as the minimum initial service package (MISP), which aims to serve as an initial point for SRH programming to save lives, prevent illness, disability, and death in humanitarian settings, it remains neglected, due to different factors like a perceived lack of need, inadequate protocol implementation, and restrictive legislation. Although indicators for mortality and morbidity due to unsafe abortion in humanitarian settings are hard to determine, several studies show that of the estimated 73 million abortions happening each year, half occur in unsafe conditions and cause between 8% and 11% of almost entirely preventable maternal deaths. Furthermore, about 97% of unsafe abortions take place in low- and middle-income countries (LMICs), where humanitarian emergencies are more likely to occur. Additionally, LMICs are more likely to have restrictive abortion laws, leaving those who need to terminate a pregnancy with a high unmet need for comprehensive abortion and post-abortion services. Systematic reviews also evidence non-systematic implementation of the MISP related to abortion, contraception, and adolescents' health in humanitarian settings.

Venezuela is no exception to this generalised neglect of abortion services in humanitarian settings. With a healthcare system that has been rapidly deteriorating since 2013, many public hospitals and points of care cannot provide a safe space for abortion seekers. This service deficiency is due to legislation that only allows abortion to "save the mother's life" [p68], a lack of skilled healthcare professionals, SRH supply chain disruptions, and chronic hospital infrastructure failure, evidenced by interruptions in running water and electrical supply. Meanwhile, many abortion seekers, especially adolescents, cannot afford the high prices of the private sector for clandestine abortions and other SRH services. These precarious conditions contributed to an increase of 66% in the maternal mortality indicators from 2015 to 2016 on current estimates, with no reliable official data. The Venezuelan Ministry of Health has not published official epidemiological reports on maternal health since 2017. Data collected by civil society organisations estimate that 16% of maternal deaths in the country result from unsafe abortions. However, this figure can increase by up to 60% in rural and indigenous communities. While abortions can be safe when the proper protocols and quality of care are in place to allow abortion seekers to exercise their reproductive autonomy, this panorama illustrates how a number of abortions remain unsafe in humanitarian settings like Venezuela due to structural and institutional barriers.

Under circumstances of restrictive abortion legislation, poor healthcare infrastructure for obstetric care, and limited coverage and quality of SRH services to prevent unwanted pregnancies, the need for safe termination of pregnancy options increases. Furthermore, providing safe abortion care and information in humanitarian settings is not only a matter of public health outcomes, but also a matter of protecting human rights. According to testimonies from our contextual analysis interviews with key stakeholders, many Venezuelan women face sexual and reproductive coercion. For instance, many women are forced to continue unwanted pregnancies, and young women opt for tubal ligations because it is the only contraceptive option available in many healthcare facilities. These forms of reproductive coercion are considered torture and a major violation of Venezuelan women's human rights.

Self-managed medical abortion: an alternative to exercise reproductive autonomy in humanitarian settings

According to the WHO, self-managed medical abortion is a safe procedure that offers a non-invasive and acceptable option to terminate a pregnancy during the first trimester by using pills (misoprostol alone or in combination with mifepristone) outside the formal healthcare system. Medical abortion as a self-care intervention becomes especially relevant when more than half of abortions happen outside of a health facility. This figure might be significantly higher in Venezuela, given the highly restrictive legal framework and the chronic shortage of SRH supplies and services to prevent unwanted pregnancies. In the current humanitarian emergency, self-managed medical abortion can be an alternative to less safe options like clandestine in-clinic procedures with unskilled providers.

However, acquiring abortion medication in Venezuela is a complex endeavour. Even though misoprostol is registered in the country, its purchase remains highly inaccessible and widely stigmatised. According to the desk review and data from interviews, most people buy the pills online through informal vendors who offer no quality controls, price regulations, or accurate usage information. The illicit nature of this exchange exposes abortion seekers to counterfeit medication or getting the wrong amount of pills. In addition to this, until July 2020, the misoprostol dosage cost for one first-trimester abortion ranged from US$ 80-200, without allowing for sanitary pads for bleeding management, pain medication, or extra dosages if necessary. This amount is undoubtedly restrictive, given that a substantial out-of-pocket expenditure would be required to obtain the pills. Nevertheless, medical abortion remains more affordable than in-clinic procedures that cost from US$ 100-500, according to our interviewees.

Due to profound health inequities, self-managed medical abortion in Venezuela acts as a tool for harm reduction but also as an act of resistance to reproductive injustice. Despite the restrictive abortion legislation, a diverse network of feminists, reproductive justice activists, abortion accompaniers, and health providers offer information on safe medical abortion through digital means like hotlines, instant messaging platforms, and social media. These community-based organisations play a crucial role in providing evidence-based information and accompaniment. This community-based strategy is a way in which abortion seekers can have safer procedures at home or in safe places of their choice. This model of care is not new; it has already been documented that hotlines can provide high-quality abortion care in contexts like Venezuela, where legal restrictions intersect with humanitarian crises.

Digital self-care tools specially designed to facilitate information on medical abortion could expand and optimise access to accurate guidance on how to use the abortion medication safely. These tools can strengthen the essential work of hotlines, accompaniers, and healthcare providers in Venezuela who are implementing harm and risk reduction, post-abortion care, and feminist accompaniment protocols in their communities. Digital self-care innovation could also potentially reach more abortion seekers in hard-to-reach areas where they may not immediately go to a healthcare facility.

Aya Contigo: a digital self-care tool for medical abortion

Digital health is a broad field that uses information and communication technologies for health. Evidence has suggested that digital tools can increase SRH information, improve the correct use of interventions, and empower individuals to manage their health and realise their sexual and reproductive rights. In the specific case of medical abortion, the use of digital health tools such as safe abortion hotlines and telemedicine models of care has a long history. Over the last decade, there has been an increase in the outreach of these tools through using mobile-based texting, calls and, social media to provide harm reduction counselling for medical abortion, emotional support, referrals, and even other SRH services. Furthermore, during the global COVID-19 pandemic, it has become even more apparent that digital health can provide a reasonable and feasible alternative that does not compromise the quality of care and can help connect people to trusted healthcare providers. In Venezuela, the use of digital tools for self-managed medical abortion is palpable in the rich network of hotlines, collectives, and communities of care that provide safe abortion information and care that otherwise might not be available.

During this first phase of exploratory research, Aya Contigo's research team conducted a contextual assessment that included: a desk review of current civil society and government reports and literature about SRH in Venezuela; a mapping of key actors, organisations, and local collectives aimed at the promotion and provision of SRH services; and a series of in-depth interviews and group meetings with these stakeholders. This process was crucial to understanding how Venezuelans interact with digital tools for health and to identifying the challenges they face when looking for contraception and abortion information and services. For example, while unstable internet, high cost of phone data, limited access to modern smartphones, and web censorship emerged as barriers that prevent many abortion seekers from accessing information, hotlines, and potential providers, digital resources are extremely useful when an online connection is available, and the internet is one of the leading referral channels used by safe abortion hotlines to connect with their users. Digital innovations are thus an appropriate self-care intervention with the potential to demonstrate a virtual accompaniment model as a safe, acceptable, and feasible tool to support users' quality of care through a self-managed medical abortion.

This contextual assessment enabled us to identify and understand how these barriers impact access to SRH care as well as the dynamics of the existing networks of hotlines and abortion accompanier collectives in Venezuela. During interviews, participants mentioned that a tool like Aya Contigo could help expand the outreach of safe abortion information and strengthen their accompaniment models, since their work is volunteer-based and demand sometimes exceeds their capacity to take care of all the requests promptly. This feedback encouraged the design team to include within Aya Contigo information that helps users identify gestational age, their eligibility for a medical abortion, how many pills they need, and assess the abortion outcome. This information is compatible with the resources and accompaniment given by hotlines. Similarly, it led the team to include a list of resources to connect with trusted local providers for other SRH needs like contraception or counselling.

Having an exploratory research process that included a diversity of stakeholders ranging from SRH providers to safe abortion activists has been an essential element of this research and design process. The process enabled us to ensure prospective users are represented and that the information shared through Aya Contigo is medically accurate, responds to the needs of abortion seekers, is accessible, easy to understand, protects users' privacy, and is free from stigma. Digital self-care interventions are not exempt from complying with quality of care guidelines, and all the more so if they are being implemented in humanitarian settings where abortion is legally restricted, and issues like privacy are a priority.

As with any other self-care intervention, digital tools for self-managed abortion do not work in a vacuum. They function and develop within an ecosystem of different stakeholders, institutions, policies, and legislation. Engaging community members and key stakeholders in the design process is thus not only a technical requirement but a political commitment to the networks of care already working on expanding access to abortion in humanitarian settings like Venezuela. In this sense, a community-driven approach to digital health brings a breadth of opportunities and challenges that may make the research and design process for the tools more complex, but represents the only way to guarantee that high quality of care is present outside the clinical setting.

Concluding remarks

Abortion, apart from being a healthcare service, is a community-bounded process and, as such, is heavily influenced by the sociopolitical environment and local legislation. Working towards increasing access to high-quality abortion care through digital self-care tools requires a careful understanding of the context, especially in humanitarian settings where SRH needs are often neglected, and the adoption of digital self-care innovations faces several implementation challenges. For instance, in Venezuela, reproductive injustice is accentuated by a complex humanitarian emergency that prevents people from exercising their rights to health, reproductive autonomy, and dignified livelihoods. Considering the complexity of the crisis, identifying, partnering, and building trust with local stakeholders throughout the research and design processes is critical. This community engagement is an essential part of having a comprehensive understanding of the SRH landscape and how people navigate it. Furthermore, having an in-depth knowledge of both the context and community needs strengthens the potential of digital self-care interventions to support the delivery of pertinent and high-quality abortion services.

From this first exploratory research phase, our contextual analysis shows that more formative research is needed to identify improvement points and challenges for digital SRH self-care implementation in humanitarian settings. Including diverse community members in the design and research process of digital SRH self-care interventions is necessary to identify, map, and understand the unique SRH needs of populations like youth and adolescents, persons with disabilities, people with diverse sexual orientations and gender identities and expressions, as well as those who are from indigenous communities, or live in rural areas. Similarly, it is necessary to deepen our understanding of how individuals from these groups access and interact with information about abortion. This further research will help identify challenges and opportunities in designing digital self-care tools that are true to inclusive and intersectional values and practices.

We acknowledge that digital health innovations for abortion access are far from being a quick fix to all the burdens and human rights violations abortion seekers endure in their journey to exercise their reproductive autonomy, especially in humanitarian settings. Digital tools for abortion self-care like Aya Contigo expand the toolbox. Communities and networks of care can take ownership of these digital innovations to strengthen their accompaniment models by emphasising the empowerment of abortion seekers through self-care practices. Finally, we envision digital self-care not as a replacement to comprehensive clinical care, but as an opportunity to explore new and alternative models of abortion care.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by Grand Challenges Canada [grant number POC-OPT-1902-31941].

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Safe abortion within the Venezuelan complex humanitarian emergency: understanding context as key to identifying the potential for digital self-care tools in expanding access

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Fulfilling sexual and reproductive health and rights (SRHR) in Venezuela is a complex challenge. A Venezuelan woman needs more than 15 times the average monthly salary to buy a month's worth of contraceptive pills, and she would also have to go to several pharmacies or online vendors to find them.

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Our bodies and minds are deeply connected. How we care for our bodies impacts our mental health just as our feelings can affect our bodies. Read more now!

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1. Abortion is common

Abortion is a simple procedure that can be delivered in a health facility or involve the use of medication (pills approved by the World Health Organization for ending a pregnancy, which be taken safely at home). The WHO , when carried out properly through one of the recommended methods, abortion is a safe health care intervention.

Ultimately, the right to safely choose whether to carry a pregnancy to term is central to a person's autonomy.

The United Nations Human Rights Committee has that access to abortion is a matter of human rights, and regularly calls on countries to decriminalize abortion in all cases.

Deaths from unsafe abortion care are far more common when abortion is illegal or heavily restricted. For instance, according to the Guttmacher Institute, in the countries with the least restrictive abortion laws, of abortions are typically unsafe. In the most restrictive, that number goes up to 31 percent.

In the United States, eight of the ten states with the highest maternal mortality rates have passed highly restrictive abortion access legislation.

of abortion laws around the world here. Globally, the United States is an outlier, as very few other countries have restricted abortion in recent years. Instead, access to the procedure has been expanded in countries such as Colombia, Mexico and Ireland. Some countries, such as the Democratic Republic of Congo and Kenya, previously banned abortion in all cases but now allow it in certain situations, such as to preserve the woman's life or physical and mental health, in cases of rape or incest and when there are severe fetal anomalies. All told, more than 50 countries have eased abortion restrictions since the early 1990s.

810 Women

die each day in childbirth.

97%

of unsafe abortions currently take place in developing countries.

39,000+

women and girls across four countries were provided with post-abortion care under one IRC program.

In some countries, the IRC provides life-saving treatment for people suffering from the complications of miscarriages and unsafe abortions - often called post-abortion care.

The WHO estimates that 30 women die for every 100,000 unsafe abortions in developed countries, that number rises to 220 deaths per 100,000 in developing countries.

The WHO estimates that approximately 810 women die each day in childbirth, and that 94 percent of maternal deaths happen in low or middle income countries.

Among those most impacted will be the refugees and immigrants that the IRC serves through our 29 offices across the country. In line with our humanitarian principles to deliver the highest quality care, the IRC will continue to provide information and services to refugees and immigrants that promote their ability to regain control over their lives and futures. assists clients in learning to navigate the U.S. health care system and to access services that enable their health and wellbeing, including their sexual and reproductive health. For example, the IRC in Atlanta offers the Health Improvement Project for Teens (HIPTeens) an evidence-based, sexual risk reduction intervention for adolescent girls that enhances knowledge, increases motivation, and teaches skills needed to reduce pregnancy, HIV and STI risk

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Four reasons safe abortion is critical health care

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Abortion is a simple procedure that can be delivered in a health facility or involve the use of medication (pills approved by the World Health Organization for ending a pregnancy, which be taken safely at home). The WHO , when carried out properly through one of the recommended methods, abortion is a safe health care intervention.

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This is a documentary about seven women who were part of a clandestine network. Using code names, blindfolds and safe houses, they built an underground service for women seeking safe, affordable, illegal abortions calling themselves JANE.

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Police arrested seven women who were part of a clandestine network. Using code names, blindfolds and safe houses, they built an underground service for women seeking safe, affordable, illega... Read all Police arrested seven women who were part of a clandestine network. Using code names, blindfolds and safe houses, they built an underground service for women seeking safe, affordable, illegal abortions calling themselves JANE. Police arrested seven women who were part of a clandestine network. Using code names, blindfolds and safe houses, they built an underground service for women seeking safe, affordable, illegal abortions calling themselves JANE.

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The Janes: Directed by Tia Lessin, Emma Pildes. With Abby, Judith Arcana, Heather Booth, Richard J. Daley. Police arrested seven women who were part of a clandestine network. Using code names, blindfolds and safe houses, they built an underground service for women seeking safe, affordable, illegal abortions calling themselves JANE.

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This workshop was spent conducting some initial research into campaigns and abortion specific campaigns that already exist.

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The Sweet Feminist es el proyecto de la pastelera, activista y -habría que añadir- artista, Becca Rea-Holloway. Su perfil de Instagram es adictivo por los mensajes feministas con los que Becca decora sus tartas, los colores vivos que utiliza y, por supuesto, las altas dosis de azúcar que implica. Hacer scroll en tu timeline de Instagram y de pronto encontrar una galleta con forma de corazón en la que se puede leer "las mujeres ambiciosas no son anormales" o "expresar tus emociones es una fortaleza, no un defecto" te alegra de pronto el día y sí, vamos a decirlo, también te anima a empoderarte un poco más.

La labor que The Sweet Feminist realiza a nivel local en Washington D.C. como pastelera, y a escala global como inspiración feminista tiene una gran importancia. En primer lugar porque esa importancia le ha sido históricamente negada a todas las actividades,tareas y trabajos etiquetadas como "femeninas", lo que aquí conocemos como "labores". Coser, tejer, tricotar, cocinar, hornear, decorar o cualquier actividad relacionada con la moda, la cocina o los cuidados, ha sido continuamente menospreciada, considerada menor,frecuentemente no remunerada, y relegada al ámbito de lo privado a menos, claro está, que la desempeñase un hombre a nivel profesional. Pero a la vez han sido habilidades que han creado comunidad, lazos entre mujeres, traspaso de conocimiento y red, y por lo tanto en ellas palpita la fortaleza femenina. En su web, Rea-Holloway lo explica claramente: "las mujeres siempre han empleado las artes creativas como las manualidades y la repostería como espacios de resistencia, y yo entiendo mis tartas como una continuación de esa rica tradición".

"Las mujeres siempre han empleado las artes creativas como las manualidades y la repostería como espacios de resistencia"

De hecho fue así, por herencia familiar femenina, que Becca se inició en su actual profesión. "Me interesé por la repostería por primera vez viendo a mi abuela Jane hacer empanadas y galletas increíbles cuando era una niña. ¡Pero soy autodidacta!". Flours In Your Hair fue su primer proyecto , un blog donde compartía sus deliciosas recetas que todavía sigue online. "Siempre he tenido buen diente para lo dulce, y tengo muy buenos recuerdos de paseos con mi padre para ir a por un helado cuando era niña. Me encanta hacer pasteles para la gente a la que quiero y siempre estoy probando recetas nuevas", confiesa Becca, que trabaja en el equipo de una pastelería durante el día.
The Sweet Feminist nació cuando Becca buscaba un nuevo reto. "Quería encontrar una forma creativa de poner a prueba mi energía, ideas y emociones", nos cuenta Rea-Holloway. "¡Después de sopesar algunas ideas me di cuenta de que había hecho un montón de tartas! Así que se me ocurrió poner mensajes, hacerles fotos y compartirlas en Instagram. Veo mi trabajo en The Sweet Feminist como una manera de dar a la gente una visualización especial de sus propios pensamientos, experiencias o ideas. También espero que sirva de inspiración a otras personas. No necesitas ser una experta pastelera para hacer lo mismo. ¡Todo lo que necesitas es una tarta, glaseado y tu voz!

"No necesitas ser una experta pastelera para hacer lo mismo. ¡Todo lo que necesitas es una tarta, glaseado y tu voz!"

VOGUE.es: A menudo se acusa a las feministas de no ser lo suficientemente dulces. ¿Tiene esto algo que ver con tu proyecto The Sweet Feminist?
BECCA REA-HOLLOWAY: Es muy común decirle a las feministas que sus ideas y valores no son agradables, o que tienen que decir las cosas de una forma determinada para que la idea sea aceptada (lo cual, por supuesto, no es verdad). ¡Las tartas son un excelente medio, porque estamos acostumbrados a ver palabras en ellas! Por eso mis tartas combinan algo familiar y casi universalmente querido, (tartas + glaseado), con ideas que desafían a la gente. Quiero pensar que poner grandes ideas en tartas las hace más accesibles y tangibles para un mayor número de personas.
VOGUE.es:¿Cuál es la tarta que has hecho para The Sweet Feminist de la que estás más orgullosa?

BECCA REA-HOLLOWAY: Me encanta mi tarta 'La ira es una reacción racional'. Creo que conecta con la idea de que la ira femenina no es algo vergonzoso, ni algo que enterrar, sino algo que habría que reconocer y honrar.
VOGUE.es:Históricamente, las habilidades y trabajos llamados 'femeninos' no han sido tomados en serio, y han sido formas de arte subestimadas. ¿Cuáles son tus pensamientos al respecto?
BECCA REA-HOLLOWAY: Me da pena que los medios de expresión relacionados con las mujeres, como las manualidades, la repostería, etc., sean categorizados como formas de arte menores. Especialmente cuando estas formas de arte permitieron a las mujeres construir comunidad y expresarse en situaciones en las que no se les permitía hacerlo de otro modo. ¡Son medios especializados, y deben ser reconocidos como tales!
VOGUE.es:Tienes ya una gran comunidad en Instagram (48,5k seguidores). ¿Qué tipo de feedback sueles recibir de la la gente?
BECCA REA-HOLLOWAY: ¡La gente me suele mandar fotos de tartas que ellos mismos han decorado para un acto benéfico con amigos y es algo maravilloso! Es increíble ver las cosas que se les ocurren. Estoy particularmente orgullosa de haber sabido, por parte de un grupo de universitarios que celebraron un descanso de los estudios con cupcakes inspirados por Sweet Feminist.

VOGUE.es:¿Alguna vez practicar una forma de activismo relacionado con las llamadas 'labores femeninas' te ha ganado alguna crítica?
BECCA REA-HOLLOWAY: He recibido alguna de gente que ve las tartas como algo frívolo, pero generalmente la gente se emociona con ellas y las ve como un medio de expresión legítimo. Creo que hay un grupo significante de personas a las que les gusta la repostería y también el feminismo, así que hay una estupenda oportunidad de conectar con esa intersección.

VIDEO: Cuando estamos JUNTAS
500 libras al año, una habitación propia y un rincón a la luz del sol que pueda compartir contigo Todo lo rosa que hay en el feminismo ¿Qué es la carga mental, cómo te está afectando y qué hemos aprendido sobre ella con el programa de Marie Kondo en Netflix?

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The Sweet Feminist: la pastelera que lucha contra el patriarcado con tartas bonitas que querrás hacer en casa

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The Sweet Feminist es el proyecto de la pastelera, activista y -habría que añadir- artista, Becca Rea-Holloway. Su perfil de Instagram es adictivo por los mensajes feministas con los que Becca decora sus tartas, los colores vivos que utiliza y, por supuesto, las altas dosis de azúcar que implica.

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bake a cake and make some branding ideas for that? could be an idea for testing ideas out.

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ALL Proceeds of This Miley Cyrus and Marc Jacobs Sweatshirt Go to Planned Parenthood

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Room For Rebellion by Caterina Bianchini

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NEED HELP IN TURNING IT ON? YOU CAN FIND INSTRUCTIONS HERE FOR YOUR BROWSER.

ABOUT

Room For Rebellion is a monthly run night that is fighting for the reproductive rights of women of the Republic of Ireland and Northern Ireland. With their main aim to repeal the 8th, which will give women in Ireland the right to have an abortion.

The most important element the posters had to embody was hope. Following this, they needed to inspire justice and create excitement around the events. The artwork was designed to feel beautiful and expressive with each poster taking on a completely new design. The type sits in tune with the illustrative aspects, thick and thin lines combined with bold and more delicate fonts create an interesting balance across the artwork.

Featured recently in Crack Magazine, The Guardian, It's Nice That and resident advisor.

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Room For Rebellion by Caterina Bianchini

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Room For Rebellion by Caterina Bianchini OOPS - LOOKS LIKE YOU HAVE JAVASCRIPT OFF. THIS SITE WON�T WORK WITHOUT IT. NEED HELP IN TURNING IT ON? YOU CAN FIND INSTRUCTIONS HERE FOR YOUR BROWSER. Room For Rebellion is a monthly run night that is fighting for the reproductive rights of women of the Republic of Ireland and Northern Ireland.

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Need an abortion? We're here for you

Hey Jane is the most-trusted virtual clinic offering safe and private abortion care from home. Get FDA-approved abortion pills discreetly delivered fast, plus ongoing medical and emotional support.

Pay $139 with financial assistance

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Abortion Pill Delivery | Hey Jane | Online Abortion Clinic

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Need an abortion? We're here for you Hey Jane is the most-trusted virtual clinic offering safe and private abortion care from home. Get FDA-approved abortion pills discreetly delivered fast, plus ongoing medical and emotional support. Pay $139 with financial assistance

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Theresa May - it’s time to make abortion free, safe and legal in EVERY part of the UK. Northern Irish women’s voices have been ignored for too long. #timeitsnotacrime

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PLAN C: Learn to access at-home abortion pill options online

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Plan C is an information resource for self-managed, at-home abortion with pills. Learn how people in the U.S. are accessing abortion pill options online.

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When people can safely get an abortion, it not only improves their own quality of life, but that of their families, communities and even countries. In a recent collaboration with partners at Rutgers University and London School of Economics, Ipas conducted a global review of research on the impact of abortion access at the individual, community, and country levels. Findings show that when abortion access is achieved by making it legal, available and affordable, the trickle-down benefits are vast and far-reaching.

This comprehensive assessment of global research specifically looked at the impact of abortion access and abortion policies on economic outcomes.

"This expansive body of evidence shows the wide variety of factors that compound each other to impact costs, access and stigma for people who need abortion care," says Brittany Moore, scientific and technical division advisor for Ipas. "We see this work as a valuable resource for advocates and hope it will inspire further research-especially for places where no studies have been done on the impacts of abortion access. While the results of this review were significant, it is clear there is still so much space to do more."

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Beyond the individual: Research shows abortion access has widespread benefits

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When people can safely get an abortion, it not only improves their own quality of life, but that of their families, communities and even countries. In a recent collaboration with partners at Rutgers University and London School of Economics, Ipas conducted a global review of research on the impact of abortion access at the individual, community, and country levels.

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Last year, Wigan Council commissioned us to craft, design and launch a new vision for the economic future of the borough, which we launched with them in March 2019 through a new prospectus, website and breakfast event with North West Business Insider.

The online hub, WE ARE WIGAN, and bespoke prospectus illustrate the essence of Wigan featuring bold visuals that playfully integrate the 'W' from the word Wigan. This graphical element playfully evolves and begins to become a pattern that sits as the essence of the place brand look and feel. A suite of imagery was also developed to work alongside these graphical elements capturing portraits of dynamic local entrepreneurs and businesses captured by photographer Duncan Elliot.

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Last year, Wigan Council commissioned us to craft, design and launch a new vision for the economic future of the borough, which we launched with them in March 2019 through a new prospectus, website and breakfast event with North West Business Insider.

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An information site for Wigan folk and ex-pats includes forums, pictures, news and more...

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We are fighting for womens rights to a safe and legal choice. In many countries, women die as a result of abortion being criminalised. The facts are are often gruesome and always humiliating violations of human rights.