Since this week, women can order the abortion pill online, via Thuisabortus.nl. The initiative received a lot of criticism within a few days. Doctors’ federation KNMG questioned the legal validity of the plan, GPs fear that all pre- and post-care ends up on their already overly full plate and abortion doctors want to be able to look at women when they prescribe such a pill. NRC spoke with the initiator, general practitioner and sexologist Peter Leusink, after those few first turbulent days.
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The abortion pill can be ordered online from this week. How does that work?
You must have imagined differently over the past few days.
“I definitely did not see the criticism coming, no. It gave me sleepless nights, you know that. But there is also another side: in the first few days we received about thirty requests for an abortion pill per day. Before Thuisabortus started, about sixty pills were prescribed per day throughout the Netherlands. So we already provide half of that entire supply. When I saw that, tears welled up in my eyes. I thought: gosh, what we have had all this time. not seen?”
Well, what didn’t you see?
“We are overloaded with emails and phone calls from women who are grateful to us that they are finally in control of their own pregnancy. Apparently, all along there was too little attention to the fact that women still feel accountable for this. Let me be clear: this is not the case in abortion clinics, the doctors there are sweet, committed people without judgement. But in recent days I have read so many reports in the media from people who say: the GP must first have a good conversation, you have to look the woman in the eye stop that!
“A GP compared our initiative in this newspaper to a Snickers that you put on the counter. As if a woman thinks so lightly about her abortion. Every woman thinks about a possible future life and every woman is sad when she has an abortion. But sadness is not the same as regret. Of course she weighs it up, but that decision is hers. That is not something between her and a doctor. Damn, we live in 2026. The pastors no longer have a role.”
You do understand that people are concerned if medicines can suddenly be ordered without contacting a doctor, right?
“I have been a medical advisor for Soapoli online for fifteen years. I know how online medical care works, and for years I have been prescribing PreP in exactly the same way as with Home Abortion, a drug against the transmission of HIV. The same applies to hormone treatments for transgender care, drugs against hair loss, against vaginal fungus. In all those years, I have not been reprimanded by any colleagues. I have not seen a journalist. How is it possible that we have been having commotion in the Netherlands for days now? Abortion, it is about abortion! We still do not see termination of pregnancy as a concern.”
Waiting times sometimes run up to ten days. That’s a long time, if you’ve already made a decision
If abortion is healthcare, doesn’t it belong to a doctor? Now it disappears behind the woman’s front door.
“Certainly, it absolutely belongs there. But the Netherlands has fourteen abortion clinics, some provinces have none. Waiting times sometimes run up to ten days. That is long, if you have already made a decision. General practitioners have been allowed to provide the abortion pill for a year and a half, but they do not take up their role. 3.5 percent of all general practitioners provide this pill and they are always protected with: the abortion pill is not standard care for general practitioners, we do not have to do it.
“Do you know what is also not standard care? The flu shot, inserting an IUD, traveler vaccinations. The general practitioners’ association organizes national training days for all this care. When it comes to abortion care, they really let women down.”
So if general practitioners had provided the abortion pill en masse, your platform would not have existed?
“That is not why we started, we really do this for the women. But I do know one thing: if they had been able to go to their own doctor for the abortion pill, we would not be writing thirty prescriptions a day.”
Halfway through the interview, Leusink’s phone rings. “Yes, that’s right, Home Abortion. That’s absolutely correct.” The sixth pharmacist that day, he says, who sees a prescription for an abortion pill for the first time. “They don’t trust it, because they don’t know it. GPs don’t prescribe it.”
GPs accuse you of putting extra work on their plates. You only provide the pill, the pre- and aftercare is for them.
“That is pure misinformation. By providing the abortion pill, we are in fact replacing the general practitioner who should have prescribed the drug, but does not do so. The pre- and aftercare of an abortion has always belonged to their own general practitioner, whether the women receive the pill through us or the abortion clinic. We have no reason to assume that the number of abortions will increase as a result of our initiative, so I do not see how that will add to the workload.”
In the General practitioner care guidelines for an unintended pregnancyof which you yourself were the secretary, emphatically states that the GP must pay extra attention to vulnerable women: addiction, psychological problems, undocumented migrants. You can’t filter out those women with just an application form, can you?
“No, not all of them, but we have also had that unpleasant feeling via such a form in recent days. We sometimes saw e-mails that made you think: there is more going on here. Sloppiness in the questionnaire, pregnancy test dates that are incorrect, someone who says: give me three boxes of abortion pills at once, or someone who sends three e-mails to different e-mail addresses in three hours. Then we say: guys, who can call this lady? But of course we can don’t filter out all those cases.”
Can’t you easily hide a substance addiction in a form?
“If women do not indicate that they are addicted, then they are not addicted to us. Addicted women also have the right to an abortion pill. We assume that their own GP has such women under his or her care.”
Given all the criticism from healthcare providers, don’t you think that patients do not dare to tell their GP that they want to use, or have used, an abortion pill through Thuisabortus?
“Yes, I fear that that will soon come out of our evaluation forms. The fear of that pedantic finger again.”
As a general practitioner, don’t you find it complicated that you cannot look these women in the eye?
“Yes, sometimes. But I wish women this, that they don’t have to tell a nice story if they don’t want to. If she has doubts or needs a conversation, then she shouldn’t be with us. We say that clearly. You can have all kinds of opinions about that, but that is my view on self-determination: women can make that assessment themselves.”
In recent days, a lot of emphasis has been placed on what can go wrong
Even when she is in trouble, is being pressured by a partner?
“A lot of emphasis has been placed in recent days on what can go wrong. From research in the United Kingdomwhere abortion pills have been offered in this way for much longer, it appears that women are not coerced more often than offline. Even then it is sometimes difficult to estimate.”
You have probably also thought about what could go wrong.
“We are waiting for the first male journalist who manages to get his hands on the pill. Or someone at 17 weeks of pregnancy, who then gets very nasty bleeding and cramps and has to go to the emergency room in a panic. I once lost an 11-month-old patient because I missed a meningitis. Every day, general practitioners miss heart attacks. Uncertainty is part of the job and of course it is annoying when something goes wrong. That says nothing about our model. I really believe in it.”
But what do you say if something goes wrong?
“With fraud and violence, anything is possible. You can now also go to a garden center or drugstore and tomorrow your partner will be dead. Are we going to close the drugstore?”
Health lawyers argue that your initiative is at or even over the edge of the law. Doctors’ federation KNMG also says it doubts the legal tenability, especially because there is no telephone or video contact with the patient.
“I know the Medicines Act and the Termination of Pregnancy Act. Bureau Clara Wichmann has tested everything for us. There is currently a tolerance policy regarding online prescribing of medicines. That is still a gray area.
“I have had the inspection on the sidewalk before. That was around 2003, when I had just started erection.info. I was the first doctor in the Netherlands to prescribe erection pills online, even before there was legislation regarding online prescribing of medicines. I did that because I felt that erectile dysfunction, like the rest of sexual health, was not being taken seriously by doctors. There was no good help. When a directive was issued five years later, I simply closed down my website again. I am someone who thinks: if everyone else doesn’t pick it up and there is a need from the patient, then I will do it. Let’s just get started. If we need to tighten up later, we will do so.”
On Friday afternoon, a day after the interview, Thuisabortus temporarily ‘closed’ to scale up work processes, due to the large number of requests.
