Autonomous for Abortion Care

Jez Blackmore

Abortion Beyond the Law:
Building a Global Feminist Movement for Self-Managed Abortion
By Naomi Braine
Verso Books, 2023, 240 pages, $24.95 paperback.

IN THE FACE of escalating restrictions and criminalization of abortion, Naomi Braine’s Abortion Beyond the Law highlights the transformative power of mutual aid and solidarity in ensuring access to abortion, despite oppressive laws.

Through interviews with activists around the world, Braine explores how informal, autonomous health networks have stepped in to provide abortion care, bypassing restrictive legal frameworks. Rooted in a harm-reduction framework, the book underscores the resilience of grassroots efforts that challenge the long history of abortion criminalization and its barriers.

This book serves as a powerful testament to the effectiveness of activism, demonstrating that collective action, community care, and self-determination are key to reclaiming reproductive autonomy in the face of systemic oppression.

Naomi Braine, Professor of Sociology at Brooklyn College, combines academic rigor with activist insight. With her background in reproductive justice, gender studies and public health, as well as experience in the non-profit sector focusing on drug use, HIV, and community-based organizations, Braine brings a deep understanding of how laws and policies disproportionately impact marginalized communities, particularly around taboo and often misunderstood issues.

Abortion Beyond the Law draws on global case studies, interviews and historical analysis. The author combines qualitative data with insights from grassroots movements and her own fieldwork to offer a comprehensive examination of abortion networks. This evidence-driven approach places self-managed abortion within broader socio-political and cultural contexts, making it a vital resource for both theoretical understanding and actionable insights.

The Power of Accompaniment

Braine places particular emphasis on accompaniment — a practice central to the success of self-managed abortion (SMA) movements.

Accompaniment refers to the act of providing physical, emotional and logistical support to individuals seeking abortion care, particularly in environments where it is criminalized or heavily restricted. Braine defines accompaniment as “a strategy and practice [that] embodies solidarity… It is a practice of witness and physical and emotional presence.”

This model goes beyond offering basic logistical help; it involves standing with individuals through the process, ensuring they are not alone when obtaining medication or terminating their pregnancy.

The self-managed abortion model, where individuals use medication like mifepristone and misoprostol to perform an abortion outside formal healthcare systems, has flourished in these accompaniment networks, with activists helping people to access abortion care safely and autonomously.

Braine demonstrates that accompaniment has become a cornerstone of global feminist movements, providing crucial solidarity and support to those in need, especially in regions where state systems actively undermine abortion access.

At the heart of the book lies the idea that “reproductive justice and bodily autonomy cannot be maintained through systems whose structures were designed to further marginalize people by framing their actions through the lens of potential criminality.”

Braine critiques how legal frameworks that regulate abortion often focus on criminalizing the act of terminating a pregnancy rather than ensuring the safety and autonomy of the individual. She argues that self-managed abortion, in this context, serves as both a practical and political act, defying laws that seek to control women’s bodies and reinforcing the right to make decisions about their own reproductive health.

Grassroots Knowledge and Medical Information

Braine underscores how the movement for self-managed abortion demonstrates, day after day, that “women can effectively combine medical information with knowledge of their own bodies to safely care for themselves and each other.”

This combination of grassroots knowledge and medical information is key to the success of SMA networks worldwide. Far from undermining the medical field, Braine argues that these networks provide critical knowledge and practical resources that directly inform the global medical community.

Notably, activist knowledge has influenced medical protocols and World Health Organization recommendations, proving that real-world experience often surpasses conventional medical understanding. As Braine puts it, “activist knowledge… is crucial — both to the broader community and to the scientific and medical world.”

In this way, grassroots activism not only fills the gaps left by the medical establishment but also shapes the direction of global health practices related to abortion care.

The global scope of the self-managed abortion movement is brought to life through Braine’s detailed case studies, including those from Argentina, Mexico, Kenya and Poland. In these countries, feminist activists have created networks to provide abortion pills and counseling, reaching those who are otherwise excluded from formal healthcare systems.

Such networks, often organized by feminist activist groups, have become vital lifelines for those in need. Braine’s exploration of these grassroots efforts demonstrates how self-managed abortion is not just a survival strategy but a form of resistance — a rejection of state control over reproductive bodies.

Braine argues that these movements are reshaping the conversation about abortion. Instead of focusing on legal reform, activists are creating an alternative framework where empowerment and community care are prioritized. In shifting the focus from the state to the individual and their community, self-managed abortion becomes an act of agency, one that centers the ability of people to make decisions about their bodies outside of legal or medical constraints.

As Braine eloquently puts it, self-managed abortion is “not just a medical procedure; it is a political act of resistance against a world that continually seeks to regulate and control women’s bodies.”

Feminist Solidarity

Central to Braine’s analysis is the concept of feminist solidarity, which has been pivotal to the success of global self-managed abortion networks. Feminists worldwide have built the infrastructure for self-managed abortion by providing not only resources and support, but also overcoming cultural and language barriers to share crucial information.

Networks fueled by mutual aid have become essential in regions where abortion is criminalized. Braine emphasizes that “the struggle for abortion rights must be viewed not only as a national issue but as part of a larger global movement,” illustrating how reproductive health is shaped by interconnected global inequalities.

The self-managed abortion movement, rooted in autonomous health networks and accompaniment, demonstrates how grassroots care can thrive even in hostile political climates. These networks offer valuable lessons for other movements seeking to build care outside state-controlled systems — whether in migrant justice, healthcare access, or other struggles — showing that collective action and mutual solidarity are powerful tools for resistance.

Abortion Beyond the Law is not just a book about abortion — it’s a call to reimagine activism and care under oppressive conditions. Naomi Braine’s work is a critical intervention, offering a nuanced, intersectional framework that challenges not only the legal and medical systems that limit reproductive autonomy but also the assumptions about what activism can and should be.

Through in-depth exploration of accompaniment networks, she shows how grassroots movements and mutual aid networks, built on solidarity and collective action, have defied legal and institutional barriers to create a new form of healthcare. Braine underscores that reproductive justice is not just about access to abortion, but about the ability to live outside the reach of oppressive systems.

While the book doesn’t provide a step-by-step guide to implementing accompaniment work, it serves as a powerful reminder for a U.S. audience that we must create our own networks and actively engage with the global movement to strengthen abortion access.

It is a compelling testament to the power of organized communities to care for one another in defiance of the state — and a powerful reminder that the fight for bodily autonomy and justice is as much about collective action and solidarity as it is about building a world where those values are lived, not just legislated.

March-April 2025, ATC 235