Paper short abstract:

This paper describes activist networks that help women access medical abortion outside formal health care systems and global health projects. Do they count as ‘doing’ global health? Do they expose limitations in the notion of a health system? What are the ethical implications of studying them?

Paper long abstract:

This paper describes activist networks around the world that help women access medical abortion and which are, by necessity and design, outside ‘the system’: outside formal health care systems, outside global health policies and projects; outside the law. Such networks may be clandestine but are often connected to formal systems via black and grey markets for drugs and services.

Medically speaking, an unsafe abortion is one that is performed by an unlicensed or untrained provider or that takes place in an inadequately resourced setting. An estimated 25 million unsafe abortions take place each year – the majority in the global south. For decades, activist networks have been providing information, off-script access to a drug called misoprostol, and accompaniment for women seeking safer, non-surgical abortions. Misoprostol now has a sound evidence base as an abortifacient and a number of organisations have sprung up to disseminate information and the drug itself. Yet many barriers to safe access to misoprostol remain -- especially for women in legally restrictive and low-resource settings (Drabo 2021).

What might medical anthropologists and global health scholars make of these networks outside health care systems? Do they count as ‘doing’ global health? How do they expose the conceits and limitations of the notion of a health system? And what are the ethical implications of studying such networks; is there vulnerability in making them visible? Approaching the empirical and analytical questions raised by activist abortion networks is a task especially well-suited for anthropologists working by the ethnographic method.