Thursday, September 19, 2013

The Texas Underground Misoprostol Railroad

Photo: Women on Waves article "How to Do An Abortion With Pills"
Originally posted at Alternet

New Texas Anti-Abortion Law Could Create Spike in Underground Medicinal Abortion

Restricting access to abortion in Texas will probably increase illegal medicinal abortions, which few people know how to administer.

by Julie Sunday 

The Texas House of Representatives’ State Affairs Committee is a hard audience for a pro-choice speaker. Near the end of June, as they considered the draconian anti-abortion bill Wendy Davis’ filibuster would soon make infamous, Heather Busby tried to warn the assembled politicians that their actions wouldn’t stop women from trying to end their pregnancies.

She would know: Busby is the executive director of the state’s NARAL and one of the founders of the Lilith Fund, which provides financial assistance to Texas women seeking abortions. "I think we'll see an increase in the use of [illegally obtained] drugs,” Busby told the legislators, referring to an array of drugs that can be smuggled in from Mexico or purchased during a cross-border trip.

The drug best suited to these purposes is misoprostol, which is approved by the FDA as part of a two-drug medication abortion regimen, but can also be used to induce abortion on its own—if used correctly. (The second drug is called mifepristone.) Its illicit use is documented [3] among women in Texas. According to a recent Texas Tribune-New York Times article [4], a director of Whole Woman’s Health (a network of clinics in Texas) reported an increase in the number of women who took the drugs with no medical guidance. The Lilith Fund has also reported the use of pills illegally obtained, and ineffectively used.

The extent of the practice cannot truly be measured because when the drug works effectively the women don’t need further care in abortion clinics or emergency rooms. What is certain is that demand for the pills—most often used by women who cannot overcome the already existing barriers to abortion access in Texas—will surely increase with the passage of this summer’s legislative assault on abortion rights. The new bill, which Texas Governor Rick Perry signed today despite Davis’ headline-grabbing filibuster, will probably close all but five clinics in America’s second most populous state.

Texan women are already being driven to attempt hazardous cross-border pharmaceutical expeditions because Texas already sharply restricts women’s’ right to control their own reproduction. All physicians providing abortion must be registered with the Department of State Health Services, patients must receive “counseling,” and 24 hours before the abortion they must be given a state-produced pamphlet called A Woman’s Right to Know [5]. Last year legislators mandated ultrasounds 24 hours in advance, which must be performed by the same physician who will perform the abortion.

“Where abortion is permitted on broad legal grounds, it is generally safe, and where it is highly restricted, it is typically unsafe,” according to a joint report[6] from the World Health Organization and the Guttmacher Institute. In the U.S., illegal abortion recalls back-alley clinics and coathangers, which pro-choice protesters have repeatedly evoked as a symbol of what women will be forced to resort to if the law passes.

But many abortions today are induced with pharmaceuticals. The FDA-approved dosage for medication abortion includes mifepristone and misoprostol and is effective 95-98 percent of the time (as compared to 98 percent with surgical abortion). But the World Health Organization, if not the FDA, recommends misoprostol alone when mifepristone is not available. Its effectiveness [7], all on its own, is between 85-90 percent. The drug can’t be obtained at the local drug store, but it can be purchase online, or in border states, at pharmacies in Mexico where misoprostol (brand name Cytotec) is available over the counter as an ulcer medication.

When women obtain misoprostol illegally, they often just take the pills and hope for the best. But as with any medication, the details matter (for example, misoprostol is most effective within the first 12 weeks of gestation). Reputable instructions can be located online, through groups such as the National Abortion Federation, but the information is usually written for clinicians and is not accessible to those without an advanced degree.

The most reliable and accessible source of information about misoprostol and early abortion is Women on Waves [8], an activist organization that operates a ship-board abortion clinic headquartered in the Netherlands. The ship sails to international waters close to countries where abortion is illegal. The staff then provides pharmaceutical abortion to women onboard. Its website provides step-by-step instructions [9], adapted from the World Health Organization guidelines, on how to use misoprostol alone for abortion up to 12 weeks after pregnancy.

Women on Waves’ sister organization, Women on Web [10], provides medication abortion by mail to women in countries where abortion is illegal. “Medication abortion belongs in the hands of women; it is their moral property,” said Kinga Jelinska, a staff member of Women on Web/Waves. Women on Web has a physician on staff and its packages include both mifepristone and misoprostol.

The FDA-approved dosage for medication abortion includes two drugs, mifepristone and misoprostol: three 200mg mifepristone tablets on day one, and on day two if abortion has not already occurred, two 200 mcg tablets of misoprostol. Patients return 14 days after taking the medication to ensure that abortion has occurred. This administration is only approved for use up to nine weeks gestation. According to the University of California San Francisco Medical Center, the drugs, in combination, are 95-98 percent effective at causing abortion, compared to 98 percent with surgical abortion.

In places where mifepristone is not available the World Health Organization recommends [11] an alternative, misoprostol-only regimen that requires twelve 200 mcg misoprostol tablets: three doses of four tablets under the tongue for 30 minutes, three hours apart.

Like many prescription drugs, misoprostol is available from online pharmacies. A Google search for “Buy Misoprostol Online” returned more than 6 million results, including, which sells 200 mcg misoprostol, intended for animals, for $1.99 per pill., the Canadian online pharmacy often used by Americans to purchase generic drugs, sells a variety of types, including brand name Cytotec (60- 200 mcg pills for $45) and generic misoprostol (100- 200 mcg pills for $49 or 300- 200 mcg for $125).

The use of medication for illegal abortion is relatively new, but the concept isn’t a radical departure. For centuries women have worked together, often in secret, to help prevent pregnancy, and terminate it when necessary. The artist Heather Ault’s project 4000 Years for Choice [12] highlights methods that women have shared with each other, sometimes under penalty of law, to maintain control over their bodies. Today, women can provide instructions to each other on messages boards and sell drugs clandestinely through eBay or Etsy. If women can access the appropriate information online, they won’t have to rely on shady operators or unsafe personal measures.

In the era of the Internet and pharmaceuticals, the “back alley” doesn’t have to look like Kermit Gosnell’s Philadelphia clinic [13]. In Texas, research [14] has shown that women in desperate circumstances already look beyond clinics for ways to terminate unwanted pregnancies. Texas Republicans just made the state’s abortion laws even more restrictive, but women will not stop seeking abortions. Given the availability of misoprostol, women in Texas and other states may be facing a return to the days when abortions were performed by women, for women, in secret.

Thursday, June 27, 2013

When Texas Outlaws Sex Toys, Only Outlaws Will Have Vibrators: Summer Sex Toy Guide!

Happy June, Y'all! In honor of the brief triumph of democracy in the Texas Legislature and the fall of DOMA, I am thrilled to present the Summer Sex Toy Guide, Get 'em Before Texas Outlaws 'em Again Edition! Whether you participated in the Citizens Filibuster or just watched the live feed until 2am on Tuesday, I think we can all agree that, after the melee of the last week, some self-care is in order. So treat yourself to a massage, enjoy a closet-cruise at Midtowne Spa, get your nails did, buy a new pair of sandals--whatever you need to help you feel your best before we go back into the trenches for next week's Extra Special Session. But if you prefer self-care that is, well, done by yourself, why not treat yourself to a new sex toy? It'll keep you happy long after you've watched your rights stripped away in the halls of the Texas Capitol.

During this nonstop assault on Traditional Texas Values, picking out the right toy can be hard but with my years of experience, I can help you find something that will meet the unique needs of your down-there grassroots.
Iroha Sukura

You Are: A Slutty Teen Mom Who Didn't Learn Her Lesson. 
You Should Try: Sukura

Have you, in spite of your life circumstances, failed to absorb the importance of choosing life? Do you have the audacity to defend women's right to have sex without being forced by the state to bear unwanted children? Then The Iroha Sukura Vibe is for you. It takes a new approach to stimulation--designed to cup the entire vulva but with pinpointable-areas for spot-on vibration, this toy offers an alternative to the ubiquitous clit-only styles and is perfect for single moms who just can't even. Rechargeable and made from silicone. $99. Use a water-based lube like Sliquid H20.


You Are: An ALEC-funded Stepford Legislator.
You Should Try: Lelo Yva

America is about rewarding those who have worked hard. You've worked hard. You deserve the best. At least, you think you do. Lelo Yva is the best clitoral vibrator in the history of traditional family values and your (mistress's) 1% twat merits the royal treatment. Gold plated, the Yva is rechargeable, and since it's metal it warms to skin temperature for the luxurious masturbation experience God intended when he wrote the plan for your life. It's an investment in yourself! Rechargeable. $3900. Water-, Silicone- and Oil-based lubes are all fine.

You Are: The Secretly Feminist Wife of a Republican Texas Lawmaker.
You Should Try: Silk Dildo and Sasha Harness.

Sasha Harness
Pegging--i.e., a female wearing a strap on and penetrating her male partner--is becoming more widely known and also increasingly reflective of how Texas women would like to show our Republican lawmakers what it feels like to get fucked. If you're married to a republican legislator and anal-curious, the Silk dildos are excellent for butt play--the silicone is very smooth for easy entry, and it's totally washable for quick cleaning. If you want a harness that makes you feel feminine while you're giving that anti-choice douchebag what for, the Sasha from Spare Parts is the one you want. It's made of durable stretchy satin and your husband will love that it looks like a pair of sexy panties straight out of The Best Little Whorehouse in Texas. Try wearing it with boots! Silk ranges from $26 for the small, $36 for medium and $46 for large. Sasha is $150. Use with Sassy Lube, a thick, non-drippy water-based lube from Sliquid especially designed for anal play. I also recommend Violet Blue's The Adventurous Couple's Guide to Strap-On Sex ($14.95).

You Are: Waiting Until Marriage. But...
Big Boss
You Should Try: Big Boss Vibe.

Sure, you support a woman's right to be born (good one!), but who says chastity has to be boring? Fun Factory's Big Boss vibe is designed for G-Spot stimulation with its gently curved shape and it's big enough to keep any size queen--no matter how virginal--totally satisfied. This vibrator is rechargeable, waterproof, and silicone, so it is body-safe, you can use it in the shower, and you never have to buy batteries. That means your future husband will never examine your grocery receipts and realize that you spend your days at home with your homeschooled brood flicking your bean. Trust me--if you guiltily fantasize about laying with your youth pastor, you'll love this vibrator. $129 but so worth it. Use with water-based lubes only.

You Are: Gluten-Intolerant and Butthurt. 
You Should Try: Sliquid Organics Sensation.

Many lubes contain gluten, and can cause allergic reactions for those with sensitivities. Some also contain animal-derived ingredients or chemicals that can irritate the delicate skin of the butthurt regions. Sliquid's lubes are all gluten free and vegan but Sensation, which contains plant extracts that cause cooling on the skin, is totally perfect for the fucking you'll take during the punishing Second Special Legislative Session. Sliquid is also a Texas-based company so, no matter your position on making women second class citizens, your purchase stimulates our economy! $15. Water-based, Sensation can be used with any sex toy.

You Are: A Stinky Feminist Who Can't Afford to Buy a Bra. 
You Should Try: The Silver Bullet Vibe

Look, we aren't all old-money cattle barons, Dallas Thirty Thousand Dollar Millionaires, wealthy televangelists, or Houston oil executives. Some of us have to work hard for the money and in these challenging economic times, we all need to stretch our dollars and get the biggest bang for the buck. If you're budget minded and don't know why we're wasting time with legislation that has no effect on our economy, the Silver Bullet, at just $15, is exactly what you need. It takes AA batteries and has a powerful vibration that will get you from zero to filibuster in no time. Not waterproof.

As Guvnah Good Hair says, Texas is Open For Bidnis! Support one of your fine local sex toy retailers before the War on Straight's Rights comes for them too. If you're in Austin I suggest checking out my friends at Q Toys. If not, I highly recommend Babeland!

Friday, June 21, 2013

I'm Too Damn Young to Say That I'm Too Damn Old to be Protesting This Shit

I've had this button since 1992. What the fuck?
Below is my testimony from last night's HB60 hearing, delivered around 11:45 pm after I'd been waiting ten hours in the Reagan building. I want to thank all of the legislators who stayed late in to the night and the state troopers and other staff in the Reagan building who I'm sure thought they'd be going home at 5 pm as usual. To those who organized this event, congratufuckinglations! What a huge success. I'm thrilled to have been a part of it. Thank you to those who ordered pizza for us, thanks to Buzzmill coffee for donating fuel at midnight to keep the party going, and thanks to all the HB60 supporters who helped us run out the clock. There will be another hearing on Sunday at 1pm for the Senate version of the bill, so if you are in Texas and couldn't make it yesterday, dust off yer boots and come on down!

My mother is 63 years old and she went to Puerto Rico in 1969 to have an illegal abortion, an abortion that cost $700 at the time, an amount comparable to more than $7000 today. She took me to the March for Women's Lives in Washington on April 4, 1992, when the Supreme Court was preparing to hear the Planned Parenthood vs. Casey case. I attended the second March for Women's Lives in 2005, the same year I testified in the Virginia legislature against a bill just like this put forward by Ken Cuccinelli.

This mom spoke  about being pregnant and living in her car when she needed an abortion.
I am a board member for the Lilith Fund, which provides financial support to women who are most affected by the laws you pass--poor women who cannot afford to pay for their abortion. Many of them have children already, some are homeless, 7% report to us that they are rape victims, 9% report abusive relationships and this abortion is what they need to escape the man who beats her.

But no matter their circumstances, all of these Texans have the same rights as those who can afford to travel farther or take off work to comply with the laws requiring medically unnecessary treatments like forced ultrasounds. Laws like HB60 will close clinics but they will not stop abortion--merely make it harder to get and unsafe.

TWATSS, the Texas Women's Access Transportation Safety Service Proposed by Lilith Fund board member to evacuate women whose rights are abridged by HB60
My mother still has buttons from the 1970s with coat hangers on them and, I'll be honest, I always thought they were kind of over the top. Though her illegal abortion was performed by a doctor who practiced safely, she knew of women who died from having back alley illegal abortions and many others who were forced to have sex with the "doctors" as insurance that they wouldn't turn them in. I never really felt the threat of illegal abortion until I came to Texas, when it became abundantly clear that our legislature's dramatic biennial performances of "protecting life" and women's health totally outweighed the constantly grinding real need to support women and families.

Research published in 2010 in the journal Reproductive Health Matters found that women in Texas already go to Mexico to get misoprostol directly from pharmacists to induce abortion, and attempts at self-abortion using misoprostol and other, more dangerous methods are more common among women who have difficulty accessing care. These numbers will increase if this bill is passed, and dangerous clinics like those operated by Kermit Gosnell in Philadelphia will flourish because women, if you force them to, will risk everything--including their lives--to get abortions.

Susan B. Anthony, a Quaker feminist routinely valorized by pro life activists, said this in reference to abortion* in 1875: “The work of woman is not to lessen the severity or the certainty of the penalty for violation of the moral law, but to prevent this violation by the removal of the causes which lead to it”

Putting aside the myth propagated by pro life activists that Ms. Anthony was antiabortion, which she was not, I am also a Quaker woman and I challenge those who want to restrict abortion to think about the ways these laws increase to the need for this procedure and how that hurts women. Thanks to our governor, more than one fourth of women in Texas lack health insurance--were number two in basketball in the nation but number one in failing our women.

If we want to reduce abortions, especially those that happen in the late term, we can work together to increase women's access to healthcare in Texas. HB60 doesn't do that. What this bill does do is continue the Texas republicans' apparent effort to keep poor people poor and women in their place. I've seen a lot of those types of laws get passed a lot in Texas. Too bad that, tonight, it looks like that dog just won't hunt. I want to thank the legislators who worked so hard to make this night possible because with this bill you pushed Texas women to the limit and we are pissed. The Spurs lost the Finals and this is the top story out of Texas tonight.

I got the button that I'm wearing today at the March for Womens Lives when I was just 11 years old and I am too damn young to say that I am too damn old to be protesting this shit. [DROPS MIC]

If you're not in Texas and want to make a difference, why not donate $10 to the Lilith Fund?

*Anthony was also talking about infanticide, which, in the 19th century when abortion was even harder to get, was common.

Thursday, June 20, 2013

I'm Too Young to Say That I'm Too Old For This Shit

So here I am sitting in the Reagan building in Austin waiting with about 100 other people to filibuster the dumbshit HB60, the mega antiabortion bill being considered by the Texas legislature in a special session. But that's not what I want to talk about. You can read more about the bill here.

I was one of the first people here today, because I'm on a long vacation from work and was able to respond to NARAL Pro-Choice Texas's call for people to show up on little notice. One of my former students was here, along with several young Planned Parenthood Greater Texas staffers, and a fellow Lilith Fund board member.

I just did an interview for YNN news with my pal John Salazar, and when I came to sit down again--at 4:00, after I'd been here for more than two hours--two women my mother's age said how glad they were to see so many people of different ages here. "Because, you know, sometimes younger women..."

Many many other writers have talked about the weirdly persistent myth that there are no young women in the movement and have debunked this myth again and again. And yet...

I am wearing one of NOW's iconic "Keep Abortion Legal" buttons, which is just like the round sign I dragged home with me after the 1992 March for Women's Lives and hung up in my bedroom for a decade. I was 11 years old in 1992, and I hung that poster up in at least 8 dorm rooms at three different schools and always, always refused to take it down.

I also attended the March for Women's Lives in 2005 and I am far too young to say that I am too old to be protesting this shit still. But here I am,  not the youngest, and not the earliest, but here more than two decades after I first wrote an admissions essay for high school about how the attack on abortion rights was the most important issue facing the world. In 1993. So just stop with the you know, young women...stuff.

Monday, April 22, 2013

Cock Blocking in the Lonestar State: Julie's History of the Texas Sex Toy Ban!

“Cock Blocking in the Lonestar State: How Texas’s Sex Toy Ban Got Overturned in Court,” by Julie Sunday from Nerd Nite - Austin on Vimeo.

In January I did my second talk for Nerd Nite Austin on the history and ultimate demise of the sex toy ban in Texas. This video, unfortunately, doesn't show all of the *awesome* sign language interpreter's work [I was dying to see 'electronic bull ejaculator' in ASL] but I think it's fun anyway.

Tuesday, March 5, 2013

New Sex Toy Store in Town: Q Toys!

Stephanie, Q Toys Owner and All-Around Badass
It is with great excitement that I'm writing a lil' shout-out for Q Toys, a new, fantastic, gorgeous, inclusive, body safe sex toy store in Austin. This is the store I've been waiting for, the place I've wanted to shop in, the solution I needed when recommending toys and lube to people in Austin!

Q Toys is newly open on Burnet, in the same shopping center as Birds Barbershop, making NoBurn just that much cooler. The store is modern, clean, spacious, and has only high quality toys that are guaranteed to be free of toxic ingredients and to actually work--every product has a least a 1 year warranty. 

Q Toys will recycle toys, too, and give you $5 toward a new, non-toxic product. So if you've been waiting to replace that crappy jelly vibrator you bought in college, bring it in (clean it, please) and pick out something new.

But on to the goods. Stephanie, like Julie Sunday, is opposed to toxic toys so no products in her store contain phthalates. No jelly toys! She has a great selection of condoms and lube, including several that are manufactured in Texas. Shop local, y'all!

Stephanie carries Njoy, Lelo, Fun Factory, JeJoue, Vixskin dildos (which are made in Austin!), some gorgeous glass pieces, leather harnesses, Fleshlights, Tenga eggs, and more.

"My two favorite customers are the old lady coming to buy her first toy and the straight guy wanting to put something up his butt," Stephanie says. We couldn't agree more.

Stay tuned for details on a free G-Spot workshop offered by yours truly at Q Toys in April!

Photos of the space and product selection below.

Only the best lubes!


Fun Factory: Fun for Everyone!


The full selection of Vixskin Dildos. Trust me: You're worth it!

Butt plugs for cancer! Really!

Thursday, January 31, 2013

Between Herpes and a Hard Place

 From the CDC:
Genital Herpes—Initial Visits to Physicians’ Offices, United States, 1966–2010

Note: Valtrex was approved by the FDA in 2003.
The first time one of my friends told me they had herpes I was a total asshole about it. I had been writing for Go Ask Alice!, the Q & A website run by Columbia University, and I'd been assigned a question about when a person should tell potential partners they had herpes. I wrote something like "OMG YOU HAVE TO TELL THEM IMMEDIATELY!!!" because, as someone who didn't have herpes and, at the time, didn't know that I knew anyone who did, the prospect of having a partner with herpes totally freaked me out.

My friend, M, who is my sex-ed-bestie and also has herpes, took me to task. The assumption that people engaging in hookups or sex with partners that they don't ask about STI status are safe from herpes is not, in fact, a safe assumption to make, she told me, and her obligation as someone with herpes was equal to a sexually active person's obligation to ask their partners if they had been tested or if they had any STIs. That kinda blew my mind. Case law in the California tort system bears this out.

One of the two main reasons I see people for individual consultations is herpes diagnosis (the other: erectile dysfunction). Last fall I saw a student who had gotten diagnosed with genital herpes after hooking up with a guy in a prestigious, all-male social organization on campus. She told him about the outbreak, and he never talked to her again. She came to me when she was already having sex with but only "almost dating" someone new, and she started having symptoms again and wanted to know if she should tell him.

I was shocked that this girl had already started fucking this guy and consciously chosen not to tell him about the herp--exactly what the bro she'd had sex with had done to her. But why didn't the guy she was having sex with ask her if she had been tested? She, like many of the students I see, hadn't been using condoms because she was on the pill. Head, meet desk.

Consistent use of condoms, though not perfect, is the best way we have to reduce the risk of skin-to-skin STIs like herpes and HPV. But surveys of college student sexual behavior show that only 35% of students actually use condoms every time they have sex. Fully 30% of college students who report having had vaginal sex say they used "withdrawal" as a contraceptive the last time they had sex. Only .7% of survey respondents say they have were diagnosed or treated for herpes in the past year,* but at my clinic herpes diagnosis is as common as chlamydia, which is the most common STI tracked by the CDC.

Research tells us that the # 1 reason young people use condoms is to prevent pregnancy and usually only with new partners, and once another birth control method is being used people are significantly less likely to continue using condoms. But condom use has never been that high and, among certain groups, it is on the decline.

In its 2012 National Health Statistics Report on contraceptive use in the US, the CDC found that between 2006 and 2010, 30% of people with private insurance used the pill while only 17% of those with public insurance (i.e., Medicaid) and 14% of those with no insurance used it. The pill is more effective at preventing pregnancy, sure, but it provides zero protection from STIs. Conversely, 19.6% of women with no insurance used condoms compared to 16.3% of those with private coverage.

Those rates changed significantly between 1995 and 2006. In 1995, 22% of women between 0 and 149% of the poverty level used the pill; 27.5% of women 400% or higher used it. In the 2006-2010 cohort, 39.2% of women at 400% or greater used the pill while only 19% of women at the lowest tier did. Condom use declined among women in the top tier from 23.5% in 1995 to 17.7% in 2006; use among women in the lowest tier stayed basically the same.

As pill use increases, condom use decreases, both in individual relationships and at the population level. Decreasing use of condoms and increasing sexual contact with more partners--including oral sex--increases the exposure young people have to STIs and people who use the pill only are setting themselves up for infection. 

In my own experience, young people tell me the conversations they have about STIs (if they have them at all) go something like this: "Do you have anything?" or "Have you been tested?" To which the only acceptable answers, regardless of the truth,  are "No" and "Yes." Birth control, similarly, is often discussed in the same way: "Are you on the pill?" and if the person says yes sex goes forward with no concern for condoms. If the person says no...well, 1/3 of young people are using withdrawal.

I guess, for most people, talking about STI testing and condoms is a boner-killer; but I know people who have herpes and have casual sex and make this work. Here is what I've learned:
  • You are not, as a person with herpes, obligated to disclose immediately upon meeting (or, say, in your OkCupid profile) that you have herpes. 
  • People who are out and about having sex with other people have an obligation--both legally and in terms of common fucking sense--to ASK about STIs rather than assume that a conversation not had by either partner means nobody is infected. This means three things:
    • People should ask about STI status. 
    • People should get tested so they know how to answer the STI status question.
    • If one or both partner hasn't been tested since their last partner, people should use condoms until both partners have been tested.
  • Finding out you have herpes is sort of like becoming a member of a secret society: you don't know who else is in the club until you're in. The absolute best thing you can do if you find out you have herpes is get connected with a local HELP group, peer-led groups of people with herpes that are anonymous and provide support with diagnosis.
Getting diagnosed with herpes sucks, but the infection is not fatal, doesn't cause problems with later fertility, and never progresses to anything worse: the shame totally outweighs the seriousness of the infection. But the stigma is huge and there is no 'ribbon' for herpes; there is no 'walk' for herpes; there are no celebrity concerts for herpes. So if someone you know and love tells you they have herpes, don't be an asshole--chances are really good you've been exposed, too.