Lizzie Presser Reveals the Underground Work of Home-Abortion Providers

Lizzie Presser Emily Kassie

Before abortion was legal across the United States, underground networks of women—such as the Jane Collective in Chicago—worked secretly to help end unwanted pregnancies. They used herbs, surgical procedures, and homemade devices to discreetly provide abortions at the homes of the women who needed them. Then, in 1973, the U.S. Supreme Court ruled on the landmark case Roe v. Wade, asserting a woman’s constitutional right to an abortion. Soon, clinics opened and doctors started providing abortion care openly. Many women who had fought hard in the legal battle for abortion rights thought the days of underground medical care were over.

Forty-five years later, that hasn’t been the case. Today, approximately 200 women are operating outside the law and the medical establishment to provide cheap and accessible home abortions. But the reasons this work is thriving are more complicated than just access to legal abortion procedures: These women serve clients who can’t afford clinical care, live far from clinics, or simply dislike and distrust medical settings.

In March 2018, investigative reporter Lizzie Presser brought their work into the light.

During six months of reporting, she spoke with nearly a dozen women who are part of an underground network, learned about their home visits to clients and read their 800-page training manual.

Many times she doubted whether her reporting would ever become a story. There were legal issues to consider in reporting on an illegal practice. There were practical issues of getting permission from the women to tell their stories. Once they agreed, there were ethical issues with anonymizing the subjects of her story enough to protect them from harm, but still including the details that would bring the story alive.

Ultimately, the piece was published in The California Sunday Magazine, in partnership with the Investigative Fund, under the headline: “Whatever’s Your Darkest Question, You Can Ask Me.

Here, Presser talks to Aneri Pattani about how she was able to get access to such a sensitive story, how she reported it out with diligence and compassion, and how other investigative reporters can do the same. (This interview has been edited for length and clarity.)


Given that this is a secretive network, how did you come across this idea?

It’s really hard to talk about that for a story like this. But essentially, I was interested in what it was like to seek an abortion in parts of the country that were becoming increasingly hostile to abortion. I’ve done very little on reproductive healthcare in my previous reporting, but I had a few friends whose experiences I kept thinking about. One is an abortion doula in New York City. After hearing about her work, I was curious to know what that work looked like outside of major coastal cities.

So I started to reach out to people who supported women through abortion, like abortion doulas and others, in red states. After a series of phone calls, one of the women who I had been speaking to said, “You should really talk to a friend of mine.” She didn’t say much more, but I got on the phone and that woman explained to me that she was part of this network. I hadn’t heard of the network before. The story grew from there.

What type of questions were you asking in those initial calls that led the woman to point you to this network?

I didn’t really know what to be asking. I was coming into these conversations really blind. I was just trying to talk about the emotional experience of women who were finding it difficult to seek abortions and the emotional experience in the aftermath. A lot of my conversations were about what’s happening at home—the before and after. I would imagine that signaled to that one person in particular that I wasn’t focused on clinical care so much as I was focused on the experiences of the people who were seeking abortions.

Did the recent political climate, with attacks on women’s reproductive health ranging from defunding Planned Parenthood to conversations about criminalizing abortion, affect your motivation to do the story?

Definitely. That’s really what got me thinking about covering abortion in parts of the country where they were seeing tighter restrictions on abortion care and a more hostile public response to abortion. I think when I started I thought I was going to be writing a story about lack of access and women who weren’t able to make it to clinics. It took me a fair amount of time to realize that the story was much bigger than that. This wasn’t a network that was developed to only meet demand from women who couldn’t access clinics, but also to meet demand from women who felt they weren’t getting the kind of care they wanted in clinics. It wasn’t only about how political pressure has limited clinics, but also how political pressure has changed the experience of care.

What do you mean by “changed the experience of care”?

One of the anecdotes I included in the article was about a young woman, who I called Melissa. She had gotten pregnant, was broke, and decided to get an abortion. She searched online for a clinic and ended up at a crisis pregnancy center, which was a faith-based organization where there were no doctors on staff. There, she was told, “Would you rather call your mom and tell her you’re pregnant or have us tell her you died on the abortion table?” She was traumatized by this experience.

For her, when she got pregnant again years later, it wasn’t that she couldn’t get to a clinic. It was that she didn’t want to be in a setting like that again.

How were you hoping this article would contribute to the national conversation around abortion care?

Some studies I had read suggested a full third of abortion patients tell no one, which is just a devastating statistic to me. So I wanted to create a space where people felt comfortable talking to me about not only their own abortions, but for someone who is providing home abortions to be able to explain to me the emotional reactions that their clients were having and the range of that experience. That’s what I was really hoping to capture in this piece.


A lot of them were telling me a level of detail about their lives where I ultimately had to make a decision on what was appropriate to write or what could potentially be identifying. That’s a scary place to be.


Were you concerned about revealing a practice that was kept secret in order to protect those who need it? How did you balance that concern with your desire to tell the public an important story?

There were several points in reporting this story when I wondered if it’d be better to pull out of the piece. I was mainly nervous that the story could put people in danger, and I was terrified of that. Each time, though, in conversations with my sources and my editor, I came around to the conclusion that to shut down the piece because of my concerns would be almost arrogant—as if I knew better than my sources what the impact of this piece would be. None of us knew, and still these women wanted to tell this story. They were frustrated by the way home abortion was usually represented in the press, they wanted more people to know about the possibility of accessing home abortions, and they believed in the kind of holistic care they were providing. If I didn’t tell their story, someone else would.

The tricky part was having a lot of really hard conversations with the women whose work I was covering. We discussed what they were afraid of and under what circumstances they might feel they could be anonymized characters. In a way, it was a bit of a negotiation—me explaining what I think would be really helpful for the story and how I could protect them, and them thinking it through and coming back to me.

I had those conversations many, many, many times, which I actually think was really helpful for everyone. I got to hear what they were nervous about and they got to think through what felt comfortable for them.

What happens after that is complicated though, because they don’t have creative control and they have to trust me. A lot of them were telling me a level of detail about their lives where I ultimately had to make a decision on what was appropriate to write or what could potentially be identifying. That’s a scary place to be.

How did you decide what was appropriate or what might put the women at risk?

As I was writing, I was checking on every single detail I was using to make sure it could not be identifying. I couldn’t promise that I wouldn’t compromise the women’s work, since it’s impossible to predict the consequences of writing the article. But I could promise that I would be paying very close attention to the level of detail I was using to minimize the risk. For example, I had agreed to conceal their supply chains. So if a woman told me the price she paid for misoprostol [a pill used for home abortion], I was careful not to include that price to the penny because someone could look at manufacturers and see who is providing that pill at that exact price. So that’s the level of attention to detail that I’m talking about here.

Why did you decide to anonymize all the characters instead of just those who requested it?

My editors and I chose to keep them anonymous because the work that they are doing is illegal. Self-induced abortion is illegal in some states, and they’re breaking other kinds of laws too, like practicing medicine without a license or sending pills in the mail. It’s unclear if distributing information about self-induced abortion could be deemed illegal as well. It hasn’t been tested in the courts, but we wanted to make sure we weren’t the ones bringing that into any courtrooms.


It’s tiny, the sliver of the world you can see on the internet. So when a topic or question is interesting enough, just try to talk to as many people as you possibly can because you don’t really know where it’s going to take you.


How did you navigate conversations with sources about levels of anonymity and the types of details you wanted to include in the story?

I’ve never had a project like this where I was in such deep conversation with characters about what to include or not and why. There were certain things I wanted to be clear about. I wanted to be able to explain to them their legal risk. I had conversations with lawyers and I would bring it back to them. I wanted to explain I’ll be writing this for a regional magazine but we don’t know how wide a reception it might get online. I was warning them about things I thought were important to know and they might not be thinking about, such as posting the story to social media when it published. If one person did that, it could potentially identify the others. But of course, I didn’t want them to totally shut me out.

I think I was able to get them more comfortable with the idea of being in the piece by showing them that [their] location wasn’t going to be included. Then there were other things we had to discuss more, like what types of degrees they had and if that was okay to include. In some cases, we decided no.

I lost some of my favorite details in that process. They’re my favorite details because they make the story seem more vivid and alive and come off the page in another way. Part of what you’re losing when you’re obfuscating detail is its ability to take a reader into their world and to feel like you’re sitting in that room with them. But ultimately I agreed because that’s what felt more comfortable for everyone.

Were there any details women requested to have removed that you didn’t agree to?

There were a few things that some of the women got nervous about during the fact-checking process. We had to talk through [whether] they felt like some details could [actually] be identifying. If it was going to be identifying, then I was totally happy to take those out.

For some of the other details, those just had to be conversations. One of the questions was: “Why do you need to write that the training manual was 800 pages?” I had to explain: “Here’s why I think it’s important. It really helps to demonstrate the type of care you’ve put into this work. You’ve built this thick resource that looks at the history of this work, the science of this work, how to do this work, what to do if something goes wrong. I don’t think it’s incriminating.”

How did you build enough trust with women that they were willing to give you access and let you share their stories?

I think a large part of it is time. I was really lucky to have a grant from The Investigative Fund at The Nation Institute. My expenses were fully funded. I could buy one-way tickets and stick around for as long as I wanted. That was really nice because when I was working with people who had a lot of other scheduling constraints, I could just say, “Hey, I’m gonna hang out here. When you have time we’ll talk and when you don’t that’s cool.”


Anna became interested in home birth and home abortion after having been poorly treated in a hospital. Lisette Poole for The California Sunday Magazine


That willingness to show up I truly believe is critical to this kind of reporting. In the case of the character named Anna, I spent about three consecutive weeks with her. Over time, I could tell there were shifts in the way they responded to me. It became clear that my intention wasn’t to expose them, nor was it to write about home abortions as a response to desperation, which is what they were really afraid of. They see this work as a quiet service. It’s not in service of desperate women but actually an attempt to expand the rights of women. As they saw I was interested in the side of their narrative that they felt most strongly about, they opened up with me.

How much reporting did you do outside of the women in the network? And how did you do that reporting without tipping anyone off about the network?

The background reporting for this piece was extremely extensive. I wanted to be speaking with at least a half-dozen ob-gyns. I wanted to be speaking with the major international NGOs that work with public health employees. I wanted to be speaking with folks who had worked for some of the telemedicine groups that were sending out misoprostol pills. I wanted to speak with lawyers who had started to map out the legal landscape for home abortion.

I had to time it, though, so I was speaking to the experts late enough in the game that I wasn’t exposing these women’s work before they felt ready for me to publish the story, while also early enough that the experts could help guide me in how I was writing about this.

In terms of keeping the abortion network under wraps, I often just told experts I was writing about home abortion without any specifics. I would often phrase my questions saying, “Hypothetically, if there were a group of women who were doing this, how would you feel about it?” That was actually a really helpful frame because it allowed me to ask the specific questions I wanted to ask without feeling as if I were saying too much.

What advice do you have for other journalists looking to pursue investigative projects, especially on sensitive subjects that put sources at great risk?

One thing I’ve been learning as I do this work is to get on the phone, like all the time. There’s only so much you can see from the internet. It’s tiny, the sliver of the world you can see on the internet. So when a topic or question is interesting enough, just try to talk to as many people as you possibly can because you don’t really know where it’s going to take you. And that absolutely was the case for this piece.

Another important thing to know is that sometimes the journalistic code of ethics isn’t sufficient. For me, I had a lot of anxiety writing this story. I would imagine any journalist would. But I think one thing that’s really helpful is explaining to sources what the journalistic code of ethics is. Like what does it mean when someone says something is on background? What does it mean to be off the record? Explaining what those terms are allows people to have a kind of informed consent that they don’t necessarily have otherwise.



Aneri Pattani
Aneri Pattani Conner Jay/AAJA

Aneri Pattani is a TON fellow sponsored by the Burroughs Wellcome Fund. She is a health reporter at The Philadelphia Inquirer, where she covers health issues in young people. In the past, she has worked as an assistant producer on the health team at WNYC, a James Reston reporting fellow on the health/science desk at The New York Times, and a reporting companion to columnist Nicholas Kristof in Liberia. She has also written for The Boston GlobeThe Texas Tribune, CNBC, and The Hartford Courant. Originally from Connecticut, she graduated from Northeastern University in Boston in May 2017. Outside of reporting, Pattani loves to travel, cook, and practice Indian classical dance. Follow her on Twitter @aneripattani.

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