TThe question of why hangs over Plan C, a new documentary about efforts to expand access to medication abortion in the United States. Why Seek a Medication Abortion? Because it is safe, says one woman. (The two-pill combination of mifepristone and misoprostol, both certified by the FDA, is approved in 90 countries for termination of pregnancy in the first trimester, although its use is severely restricted in the U.S.) For comfort and safety of being in your own home, says another in a montage of phone calls requesting abortion drugs by mail. Because of the fear of being confronted by screaming protesters in clinics, because her family’s military doctor refused to perform a tubal ligation at the age of 24 because “I felt more comfortable doing this at my own pace and at my to do in your own time.”
Pregnant people seeking abortions in the US face a range of hurdles, from cost to scarcity of appointments to, depending on where one lives, the threat of prosecution. That includes health care providers, who, because of the chaotic, cruel, and patchwork nature of reproductive health care in the U.S., are forced to take on additional risks or extra work (or both) to provide basic reproductive health care. Yet I feel called to do this. There’s not really a why,” says Dr. K (her full name, like many others, is withheld for protection), one of many Plan C providers who ship abortion drugs abroad. “It’s like: why do you pick up your child when he’s crying? Is there a why? You just do it.”
Plan C, directed by Tracy Droz Tragos and filmed in the lead-up to the Supreme Court’s June 2022 overturn of Roe v Wade, takes its name from the organization founded by Elisa Wells, Amy Merrill and Francine Coeytaux in 2015 to advocate for medication abortion and connect women with abortion pill providers in the US. Even before the Supreme Court overturned nearly half a century of precedent in Dobbs v. Jackson’s Women’s Health Organization, the promise secured by the 1973 ruling—that people in the U.S. had a right to abortion under the Constitution’s privacy guarantee—was already a fiction. . Roe was stripped to the point of irrelevance in some states, while abortion was made too unaffordable or expensive in others.
Plan C was one of many groups that stepped up to fill the gaps in an ever-changing, increasingly ominous legal landscape. Droz Tragos joined Coeytaux and the group’s loose network of health care providers and volunteers starting in 2018, spreading the word that mifepristone and misoprostol are “safer than Tylenol, but more limited than an opioid,” she said. And available by mail in all 50 states, albeit with varying levels of legal risk. Fifteen states have so-called “shield laws” that protect doctors who treat patients from states where offering abortion is illegal, and six have specific telemedicine protections. One state, Nevada, has criminalized self-managed abortion, while Texas has appointed citizens to privately sue abortion providers or anyone who “aids or encourages” abortion.
Medication abortion by mail thus represents a crucial window for access, especially after a federal judge suspended the FDA’s in-person dispensing requirement for mifepristone during the Covid-19 pandemic, which allowed abortion pills to be legally mailed without an in-person appointment. “To be able to order this online and have it delivered to your home and be able to do the protocol as it has been done for decades, but you don’t have to go to a clinic, or meet protesters, or get gas money, and you you can do it on your own time… it makes so much sense,” said Droz Tragos. “It’s safe, effective and now it can be private, as it should be.”
The ninety-minute film is a collage of activism, personal testimonies and dogged adaptation as the increasingly confusing legal landscape and risk calculations mutate again and again. One provider in Minnesota is meeting customers in a van in parking lots, even after a state senator made a public call to run her out of town. Another answers one call after another at her home for twelve hours; another shows how filling pill bottles with cotton keeps them from clinking in the mail. The specter of risk is ever-present – as one service provider partner in “Trumpsylvania” puts it – “she’s a force of nature, but not against a truck or a gun.”
“It takes some delicacy to navigate this patchwork of laws,” says Droz Tragos. “And depending on where you live, depending on your identity, depending on the community you’re in, people have different layers of safety and concern and risk. So everyone has to navigate this knowing their own circumstances.” Yet she and Plan C organizers remain frustrated by the lack of awareness about access to medication-assisted abortion. “It gets very confusing when it comes to misinformation,” says Droz Tragos. “It’s so hard to even let people know that this medicine exists that telemedicine is an option.”
The film is partly a call to spread the message. “What will always amaze me is the generosity of people who are willing to share their stories for the benefit of other people,” Droz Tragos said of the many abortion drug recipients in the film who shared their experiences – how they needed help meeting the costs, usually less than $150, because all their monthly income went to rent; how a Texas woman, who had just been given one of two abortion pills and was in excruciating pain for five hours, resisted going to the hospital for fear that her boyfriend would be prosecuted for aiding or abetting. “They wanted to share their story, in part because medication abortion and receiving medication abortion the way they did was such a game-changer,” Droz Tragos said. “There was a certain level of outrage: ‘Why didn’t I know this, and I don’t want anyone else to have to go through this kind of pain and suffering and have to investigate to find this out.'”
Plan C presents itself as one front of the reproductive rights movement that is now under intense, wrenching pressure. In a striking, thorny scene, members of the organization grapple with how to deal with the Texas landscape where volunteers face persecution and online criticism that the group’s harsh methods are pushing people too far or undermining clinics. Droz Tragos described the friction within the movement as “soul crushing” – “Everyone is in survival mode. Things get worse and then they get worse and then they get worse, and everyone is tired, and everyone is working very, very hard to help people and do things with a moral compass,” she said. “It is devastating to see the kind of infighting that is and continues to be a majority of people who believe in bodily autonomy and ensuring that people have access to the care they need.”
As dismal as the current state of reproductive health care in the US may be, perhaps even worse than when Plan C halted production in 2022, Plan C is a testament to the nationwide movement to get people the abortion care they want. In the six states that have had to vote on abortion rights since the Dobbs ruling, all six have chosen to keep them, even in “red” states like Kentucky and Kansas. Just days after I spoke with Droz Tragos, Ohio voters enshrined abortion in the state constitution by a decisive margin. The fight for reproductive rights, and the broader fight for reproductive justice in the US, is going steeply uphill. But “I really hope that the public takes away the spirit of ‘We’re not stuck,’ and what’s possible when people come together,” Droz Tragos said. “There are actually options and we don’t have to sit back and take it.”