This article originally appeared on VICE Netherlands.For over three decades, doctor and activist Rebecca Gomperts, 57, has been a leading reproductive justice advocate. After working as a physician at an abortion clinic in the 1990s, she founded Women on Waves, also known as the Abortion Boat, an NGO distributing abortion pills to women across the world. Since then, Gomperts has also been helping people access abortion care online via organisations like Women on Web and Aid Access.
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In 2020, her relentless work to expand reproductive freedom has landed her on Time magazine’s 100 most influential people of the year. But Gomperts is not one to rest on her laurels. Her next adventure is maybe a little less flashy than an abortion boat, but just as ambitious: She’s researching and developing the contraceptive uses of mifepristone, a drug that blocks the “pregnancy hormone” progesterone and could be used as a flexible and mostly side-effect-free alternative to the pill in the near future.Mifepristone is one of the main ingredients in the abortion pill. Gomperts’s research project, in collaboration with the Leiden University Medical Center in the Netherlands and the Karolinska Institute in Sweden, looks at whether taking it in a low dose in the form of a weekly pill could make it a safe and effective birth control method. The project is also evaluating if the drug could be used as a one-off morning-after pill, too.Unlike the regular birth control pill, mifepristone doesn't contain any hormones. As a result, the researchers believe it should not entail the side effects linked to oestrogen and progesterone which discourage an increasing amount of people from opting for the birth control pill. The first phase of the research is underway, and we should have conclusive answers by 2026. If all goes well, the drug could hit markets about one year later.
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We spoke with Gomperts about the importance of this research, the stigma attached to the abortion pill, and the future of reproductive rights, as a strong conservative wind is blowing through the world.VICE: Hi Rebecca, you’ve officially taken your first steps in the academic world.
Rebecca Gomperts: Yes, that's right. It's a new field with many regulations, but that's also what makes it fun.How does mifepristone work exactly?
It's an anti-hormonal drug. During your menstrual cycle, your body produces the hormone progesterone, which allows your uterine lining and mucous membrane to prepare for the implantation of an egg. Mifepristone blocks progesterone receptors. Ovulation is delayed, just like with Plan B, and the egg can no longer implant, similarly to an IUD. You can use mifepristone weekly as contraception, as well as a morning-after pill if you're having sex less often.In the early 2000s, researchers already looked at mifepristone as a contraceptive, with promising results. Why didn't it take off back then?
There have been many small studies. I think pharmaceutical companies didn’t want to invest in them because the patent for the drug had expired. Research and development costs millions, and [without the protections of a patent] theoretically, any company could then have sold the drug.
Rebecca Gomperts: Yes, that's right. It's a new field with many regulations, but that's also what makes it fun.How does mifepristone work exactly?
It's an anti-hormonal drug. During your menstrual cycle, your body produces the hormone progesterone, which allows your uterine lining and mucous membrane to prepare for the implantation of an egg. Mifepristone blocks progesterone receptors. Ovulation is delayed, just like with Plan B, and the egg can no longer implant, similarly to an IUD. You can use mifepristone weekly as contraception, as well as a morning-after pill if you're having sex less often.In the early 2000s, researchers already looked at mifepristone as a contraceptive, with promising results. Why didn't it take off back then?
There have been many small studies. I think pharmaceutical companies didn’t want to invest in them because the patent for the drug had expired. Research and development costs millions, and [without the protections of a patent] theoretically, any company could then have sold the drug.
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At that time, researchers also didn't fully understand the effects of mifepristone on the uterine lining. But in the last 20 years, much more research has been done. Mifepristone is used in many countries in high doses to treat Cushing syndrome, a hormonal disease, as well as for fibroids and endometriosis. We now know that long-term changes in the uterine lining aren't harmful.So you thought, “Now is the time to pick this back up.”
We started seven years ago. The plan was to conduct a large study demonstrating mifepristone’s safety, efficacy, and how crucial it is as a birth control option. But this kind of research is incredibly expensive. We've now raised the amount we needed through crowdfunding, a grant and a group of generous wealthy women.We've reviewed all the previous studies and asked, “What's the best dosage? The best use? Weekly? As a morning-after pill?” Combined, it's a flexible contraceptive method, which is something in high demand. The research project started last autumn. A total of 1,000 women will use the drug for a year. Then we’ll begin the registration process. I think it'll take another three years.Why is this drug so important?
Hormonal contraception can have many side effects. There's an increased risk of breast cancer, depression, and decreased libido. One in 2,000 women using oestrogen-based contraceptives develops blood clots. Studies show that mifepristone actually slows down or prevents the spread of some cancers.
We started seven years ago. The plan was to conduct a large study demonstrating mifepristone’s safety, efficacy, and how crucial it is as a birth control option. But this kind of research is incredibly expensive. We've now raised the amount we needed through crowdfunding, a grant and a group of generous wealthy women.We've reviewed all the previous studies and asked, “What's the best dosage? The best use? Weekly? As a morning-after pill?” Combined, it's a flexible contraceptive method, which is something in high demand. The research project started last autumn. A total of 1,000 women will use the drug for a year. Then we’ll begin the registration process. I think it'll take another three years.Why is this drug so important?
Hormonal contraception can have many side effects. There's an increased risk of breast cancer, depression, and decreased libido. One in 2,000 women using oestrogen-based contraceptives develops blood clots. Studies show that mifepristone actually slows down or prevents the spread of some cancers.
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We already have non-hormonal birth control, the copper IUD. Why do we need this alternative?
Yes, that's a very good method, but it’s not for everyone. The IUD carries an increased risk of ectopic pregnancies. You depend on healthcare providers, insertion can be painful for some people, removal too. Besides, you usually choose an IUD if you don't want to get pregnant for a long time. With mifepristone, it's about increasing your choice and making it more flexible.Your preferred contraceptive method also changes depending on your life stage. If you're older or have children, you need different contraceptives than when you're younger. If you have a lot of sex, you need different contraceptives than when you have less sex. Many people don't want to take the pill because if you forget it, it doesn't work. Mifepristone is a very important addition to what's available.What's the exact difference between Plan B and this drug? I’ve heard people say that it's not good to use the emergency contraception too often because it's a “hormonal bomb”.
That's not true. Mifepristone doesn’t function very differently from EllaOne, the most effective morning-after pill, which also doesn't contain any oestrogen or progesterone. You can take it up to five days after unprotected sex. We expect this to also be possible with mifepristone. EllaOne can only be bought individually though, and costs at least €10 a pill.
Yes, that's a very good method, but it’s not for everyone. The IUD carries an increased risk of ectopic pregnancies. You depend on healthcare providers, insertion can be painful for some people, removal too. Besides, you usually choose an IUD if you don't want to get pregnant for a long time. With mifepristone, it's about increasing your choice and making it more flexible.Your preferred contraceptive method also changes depending on your life stage. If you're older or have children, you need different contraceptives than when you're younger. If you have a lot of sex, you need different contraceptives than when you have less sex. Many people don't want to take the pill because if you forget it, it doesn't work. Mifepristone is a very important addition to what's available.What's the exact difference between Plan B and this drug? I’ve heard people say that it's not good to use the emergency contraception too often because it's a “hormonal bomb”.
That's not true. Mifepristone doesn’t function very differently from EllaOne, the most effective morning-after pill, which also doesn't contain any oestrogen or progesterone. You can take it up to five days after unprotected sex. We expect this to also be possible with mifepristone. EllaOne can only be bought individually though, and costs at least €10 a pill.
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Mifepristone has been called a non-hormonal contraceptive, but it’s still sort of tinkering with hormones, right?
Yes, that’s not accurate. It's an anti-hormonal drug.Are there any known side effects?
Your menstrual cycle can change – most women don’t have one at all. Some people experience occasional spotting. That can be annoying.Are you investigating the drug’s effects on mental health? That’s why many people quit the pill.
Yes, we are also looking into that. Women use an app to report how they feel, and every three months, we roll out a questionnaire about mental health. We think it shouldn’t have any effects, as the oestrogen and progesterone levels in the blood remain the same. In May, we’ll do the first interim analysis and have more clarity.I’ve recently seen a lot of TikToks about natural contraception. People say the pill is bad for you and has too many side effects, but experts have warned against the spread of misinformation.
You know, I'm fine with that. Natural contraception is a bit less effective, but if someone feels good about it and is OK with taking Plan B once a year or having an abortion, what's the problem? We also need to move away from the idea that abortion is so terrible for everyone, or that it must be prevented at all costs. Everyone can decide for themselves.
Yes, that’s not accurate. It's an anti-hormonal drug.Are there any known side effects?
Your menstrual cycle can change – most women don’t have one at all. Some people experience occasional spotting. That can be annoying.Are you investigating the drug’s effects on mental health? That’s why many people quit the pill.
Yes, we are also looking into that. Women use an app to report how they feel, and every three months, we roll out a questionnaire about mental health. We think it shouldn’t have any effects, as the oestrogen and progesterone levels in the blood remain the same. In May, we’ll do the first interim analysis and have more clarity.I’ve recently seen a lot of TikToks about natural contraception. People say the pill is bad for you and has too many side effects, but experts have warned against the spread of misinformation.
You know, I'm fine with that. Natural contraception is a bit less effective, but if someone feels good about it and is OK with taking Plan B once a year or having an abortion, what's the problem? We also need to move away from the idea that abortion is so terrible for everyone, or that it must be prevented at all costs. Everyone can decide for themselves.
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Besides, the medical world only has itself to blame. If you don't take complaints about side effects seriously, then people will take matters into their own hands. Of course, there's misinformation on the internet. I haven't seen the TikToks you mentioned. But if someone is well-informed, including by a doctor, has looked at the options, and then chosen natural contraception, that's fine. But then they should also know: It doesn't always work, so sometimes you might have to opt for an abortion.Conservative parties have been making a lot of gains across the world, including in the Netherlands. Are you worried about repercussions on your research?
There's such a huge backlash against women's right to self-determination. And not just for women, but for all genders. When the registration process begins, we can only hope to deal with a scientific body, not with politics. When do you think people's right to self-determination regarding contraception will be complete?
When everyone is able to claim it in a way that they feel good about, that it fits their life. It can be a combination of methods; someone can also choose to regularly have abortions. And when the pregnant person can decide for themselves when the foetus becomes worthy of protection. If that freedom of choice is respected and facilitated, then we’re good.Do you think mifepristone will get us a little closer to that?
Yes. You don't have to take the pill every day, and you can use it in combination with an [holistic] app, as a contraceptive and also as a post-contraceptive method.Mifepristone is also used as an abortion pill. I read that potential funders for this research were afraid that women would get hold of these drugs and then resell them or use them for illegal abortions.
Yes, that's typical. This shows enormous distrust towards women, and whether they can responsibly handle these types of drugs. You know, you can also buy bleach at the supermarket. It’d be quite stupid to restrict a very important new birth control method because you think women might misuse it for abortions. Especially since the abortion pill will soon be available through the GP [in the Netherlands]. If those arguments are raised when we begin the process of officially registering the drug, we'll have to challenge them. And we will.
There's such a huge backlash against women's right to self-determination. And not just for women, but for all genders. When the registration process begins, we can only hope to deal with a scientific body, not with politics. When do you think people's right to self-determination regarding contraception will be complete?
When everyone is able to claim it in a way that they feel good about, that it fits their life. It can be a combination of methods; someone can also choose to regularly have abortions. And when the pregnant person can decide for themselves when the foetus becomes worthy of protection. If that freedom of choice is respected and facilitated, then we’re good.Do you think mifepristone will get us a little closer to that?
Yes. You don't have to take the pill every day, and you can use it in combination with an [holistic] app, as a contraceptive and also as a post-contraceptive method.Mifepristone is also used as an abortion pill. I read that potential funders for this research were afraid that women would get hold of these drugs and then resell them or use them for illegal abortions.
Yes, that's typical. This shows enormous distrust towards women, and whether they can responsibly handle these types of drugs. You know, you can also buy bleach at the supermarket. It’d be quite stupid to restrict a very important new birth control method because you think women might misuse it for abortions. Especially since the abortion pill will soon be available through the GP [in the Netherlands]. If those arguments are raised when we begin the process of officially registering the drug, we'll have to challenge them. And we will.