Accompaniment on the edge: What can the US learn from Latin America about contested abortion care?

Abstract

The US has stood as a reference point for abortion rights in the Americas since 1973, however in 2022, the US Supreme Court revoked the constitutional right to abortion. Facing similar circumstances, a huge number of grass roots accompanist networks have arisen throughout Latin America. These collectives are typically organized loosely within state and national networks that provide training and medication/supplies and promote advocacy and the expansion of new collectives. Extensive evidence and lived experience support the safety and effectiveness of self-managed medication abortion. Much can be learned from the Latin American accompanist model in the modern struggle for reproductive justice in the US. Accompaniment networks in Mexico have provided transborder abortion services—via misoprostol delivery—to US-based women living in states that required long travel or high costs to access services. Now, these transborder services will take on a new level of significance. Guaranteeing safe and low-cost access to abortion services is a key tenet of reproductive justice. Instead of relying on the political process alone to eventually provide abortion access through legal channels, an accompanist model provides an icon of resistance to oppressive legal shifts, and directly provides services to women.

Abortion access in the Americas: a hemispheric and historical approach

“…This reframing must also exist alongside another successful trend coming from LAC: grassroots “accompanist networks” that have created extensive cross-regional networks to provide mainly medication abortion to women who live in areas with restrictive laws ( 84 – 86 ). Pregnant people have long travelled to access abortion, but this travel reinforces economic barriers ( 87 , 88 ).…”

“…Pharmacists in Brazil began providing misoprostol (an ulcer drug) off label to women who wanted to terminate their pregnancies in the 1990s ( 93 – 95 ). Today, accompanist networks in many parts of Latin America have expanded access to medication abortions by providing pregnant people living in restrictive legal contexts misoprostol for self-managed abortions with safety guidelines and support ( 84 , 96 – 100 ). Feminist networks are already doing the same in the United States ( 92 ), although not without legal consequences ( 101 ).…”

Applying global lessons to protect abortion access in the United States

“…Across Latin America, Africa, and Asia, public health practitioners have worked to mitigate the harms of abortion bans and stigma through self-managed medication abortion and feminist accompaniment models, which are activist driven, community based models that facilitate de-medicalised approaches to abortion, centring autonomy, dignity, and care of the abortion seeker 363738. The struggle for reproductive justice and freedom will be a long uphill battle, and relying only on political processes is insufficient; therefore, public health practitioners and activists can build programmes like accompanist models that go beyond accessing abortion through legal channels and serve as symbols of resistance 39. Advancing this as an approach requires communicating the strong evidence on the safety and effectiveness of self-managed medication abortion across the world 404142…”