Shauna Miller is a writer based in Washington, D.C. She is the former managing editor of CityLab.
Carafem, a new pharmaceutical-only abortion clinic in D.C., aims to foster an environment that is calming, supportive—and unabashedly advertised.
When the Washington Post's Sandhya Somashekhar first reported this week that there would be a new, "spa-like" abortion clinic opening this week in D.C.'s upscale Friendship Heights neighborhood, the characterization raised some eyebrows.
Carafem, the first branch of what founder Christopher Purdy hopes will grow to be a chain of providers handling only medication-assisted abortions, "recalls high-end salons such as Aveda," all wood floors and modern decor. Appointments can be booked online and clients can be out of the clinic in as little as an hour, according to the Post. Appointments are available for after work and on weekends.
The actual service that Carafem provides is not new. The two-step "pharmaceutical abortion"—achieved with a dose of mifepristone followed by a later dose of misoprostol—has been around since the FDA approved it in 2000. "People thought this model would spread more once it was approved by the FDA," says Vicki Saporta, president and CEO of the National Abortion Federation. Many Planned Parenthood affiliates did add pharmaceutical abortion care to some of their more rural clinics, Saporta says, in order to add abortion access in places where they had only been providing contraception services.
"Medical [pharmaceutical] abortion has proven to be a very safe and very effective method of terminating an early pregnancy," she says.
It's Carafem's environment and mission statement that are taking some by surprise—and causing others to celebrate bringing pharmaceutical abortion out of the shadows. Americans have a complicated relationship with abortion, which has been legally protected since 1973's Roe v. Wade: Forty-nine percent of Americans consider abortion to be "morally wrong." Still, 63 percent want abortion to remain legal and accessible, and protected by law.
Carafem’s website is well-designed, modern, full of easily accessible information and even chat support. "Carafem's goal is to change the way abortion care is provided in the United States," a letter from Purdy posted on the website reads. "Our strategies are simple but effective. Carafem will operate with great mutual respect for our clients, as well as our employees and partners. With that element firmly entrenched in everything we do, we will be able to serve, educate, and provide non-judgmental, welcoming, and unapologetic care to our community." The site also notes that its services are intentionally advertised: "We boldly inform women about the availability of our services."
Recent restrictions on abortion providers in several states have focused on forcing clinics to meet stricter guidelines that raise them almost to the level of hospitals, subject to the same stringent building codes and requiring doctors to have hospital-admitting privileges at a site near the clinic. Many of these restrictions were part of a court ruling last year that effectively shut down two-thirds of all abortion clinics in Texas, requiring women in some places to drive 300 miles round-trip to access abortion services.
Saporta says there are still "few" clinics across the country that perform only pharmaceutical abortions. However, she notes that any provider of pharmaceutical abortions could be subject to the same restrictions as those who perform surgical abortions, depending on state laws. "In Virginia, for example ... if you did more than five abortions a month, they didn't care if they were medical or surgical—they wanted you to be a hospital-category level provider."
In the District of Columbia, Carafem will follow recommendations laid out by the NAF, of which the business is a member. Clients must be no more than 10 weeks pregnant. And the cost will be around $400, with financial assistance available.
Purdy told the Post that the Carafem concept came out of his experience working for years with DKT International, a family-planning nonprofit working in developing nations:
Overseas, he said, getting an abortion is often as simple as visiting a pharmacy. In the United States, however, some states strictly regulate the abortion pill, citing concerns about its safety, making it virtually impossible to get in some rural areas.
“I was flabbergasted,” Purdy said, to find “that it was easier to get an abortion in Ethiopia compared with the United States.”
It is jarring to hear abortion and a "spa-like" atmosphere referred to in the same sentence. It is shocking to hear an abortion provider talk about building a brand. But Americans have indeed stigmatized abortion and the women who have them—that's one in three women by age 45—to the point where harassment has been codified in building codes that further limit their choices.
Recent restrictions on abortion clinics are effective: There is now only one abortion clinic in the entire state of Mississippi, and it has been burglarized, vandalized, and picketed daily by anti-abortion protestors.
If Carafem proves to be a replicable model, there is little doubt it will become a target of abortion opponents. The real question may be whether such facilities will actually help increase access in the places where it is extremely limited, as opposed to just offering a new option in cities and states where abortions are already relatively less difficult to come by.