‘A gamechanger’: this simple device could help fight the war on abortion rights in the US

Joan Fleischman has always had people flying in from across the world to her private abortion practice in Manhattan. In the two decades her clinic has been open, she has seen clients from places such as Ireland, the Bahamas and Mexico, who couldn't get abortions in their home countries. In the past year, that has changed. Since the US federal right to abortion was overturned in June last year, she is now more likely to see patients flying in from her own country.

Often they are from Texas, sometimes Ohio, or Florida. Some with links to the city, others with none.

After years of providing abortion care, Fleischman, 60, still finds these trips shocking. "Usually, if somebody needs unusual medical care, they are willing to fly around the world for it - like for advanced neurosurgery or something. It's always struck me as incredible that people are flying to me for the most simple procedure."

There's a reason people fly to see Fleischman. She provides abortions through manual uterine aspiration - using a small, hand-held device to remove pregnancy tissue. The device is gentle enough that the tissue often comes out almost completely intact. It is a quick and discreet procedure where a patient might be in and out of the door in less than an hour.

Fleischman is a co-founder of the MYA Network, a network of primary care clinics and clinicians in 16 states. They believe the tool could be radical in the hands of more primary care clinicians - clinicians they are amping up to train.

The time to do that, they say, is now. The future of mifepristone, a major abortion pill used in more than half the abortions in the US, is in question due to a lawsuit brought by anti-abortion groups seeking to overturn the FDA's approval of the drug. It could be determined by the same supreme court that ruled last year to overturn Roe v Wade.

Manual aspiration is not new: it is used by many big abortion clinics across the US. But those are notoriously overstretched. In 2020, before Roe v Wade was overturned, 38% of reproductive-age women lived in counties with no abortion provider at all.