The fight for reproductive freedom
Women’s rights, LGBTQ+ rights, and human rights are under threat worldwide. In a world where conservative forces are – often successfully – countering the progress that feminists have made, with less and less funding and means, it is important to shed light on those working at the forefront of feminist movements, striving for an equal and just world for all. For this interview, Lilith Magazine led Dutch gynecologist Gunilla Kleiverda, known for her work for Women on Waves, in conversation with Honduran activist and psychologist Ligia Destephen Lavaire, part of Hivos’ We Lead Program.
The fight for reproductive rights often feels like a battle fought on two fronts: the deeply personal and the unrelentingly political. It’s about bodies—about who gets to control them, who gets to legislate them, and what those decisions say about power. Through their work, Gunilla Kleiverda, a Dutch gynecologist and long-time activist with Women on Waves, and Ligia Destephen Lavaire, a psychologist and feminist activist in Honduras highlight the widespread and universal reach of systemic control over reproductive autonomy. What’s striking in their stories is not just the scope of the challenges they face, but also the ingenuity and resilience of the solutions they champion. From telemedicine abortions and grassroots advocacy to reframing reproductive rights within cultural narratives, Gunilla and Ligia show how activism can reshape stigmas, provide care, and push back against systemic control.
But this isn’t just about medicine or politics—it’s about imagination. Imagination of a world where people with uteruses are free to control their bodies without fear, stigma, or punishment. A world where reproductive rights aren’t seen as a battleground but as a baseline. This conversation made me hopeful: hopeful that in the face of deeply entrenched systems of oppression, each act of resistance—each pill provided, each conversation started—pushes us closer to that imagined future.
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Description text goes hereLigia is a psychologist, feminist, activist, and facilitator of the We Lead program (Hivos) in Honduras. They aim to strengthen the position of young women who are most left behind when it comes to their sexual and reproductive health and rights. Ligia, who has a Master’s degree in Health Determinants in Adolescents from the University of Pernambuco in Brazil and a Master’s degree in Sexology and Couples Therapy from the National Autonomous University of Honduras, provides emotional and psychological support to women who are victims/survivors of violence and psychological care to adolescents, adults, and couples.
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Gunilla Kleiverda is a Dutch gynecologist, who for many years has worked for the organization Women on Waves, campaigning for women’s rights to self-determination, and advocating for free and informed choice in abortion, contraception, and childbirth. During the Yugoslavian war, Gunilla visited war-torn Bosnia in 1993. As a member of the EC Commission (and afterward), she taught supportive gynecological care after wartime rape. For her aid, she received the Aletta Jacobsprijs.
Gunilla, your career spans both clinical practice and activism. How did you decide to combine gynecology with advocacy for reproductive rights?
Gunilla: ‘Only two weeks after I started my training as a gynecologist in the ’80s, the residence where I worked received a letter about a seminar on male impotence. The letter was addressed only to the male residents. So I wrote back a letter saying that the female residents present would also like to be invited to this training. This was when I was first labeled as a “feminist”. They put this stamp on my head and I became that “feminist gynecologist”. This stamp stayed with me as I delved into issues like violence against women, unnecessary interventions in obstetric and gynecologic care, and lack of real informed consent.’
Ligia, what first motivated you to become an advocate for reproductive rights?
Ligia: ‘While studying psychology, I worked in a psychiatric hospital where I saw many women struggling with sexuality-related issues – abuse, stigma, and misinformation. Teenage pregnancies, often linked to systemic abuse and lack of education, struck me the most. I realized that personal therapy wasn’t enough; we needed structural changes in society, in the way we look at sexuality and reproductive rights, and in the way our laws are structured. As a feminist, my own experiences with limited access to sexual education also fueled my commitment. In my family, we don’t talk as much about sex or my body and choices. Not because they are conservative, but because of the stigma and lack of information.
Abortion has been prohibited in Honduras since 1982. The country’s congress further cemented the law in 2021 when they decided that to change this law, a three-quarters majority in the Congress is required. That means 96 out of 128 votes. Honduras has one of the world’s worst rates of sexual violence, but even in the cases of rape, abortion is prohibited.
Honduras also prohibits the use of emergency contraception. The law banning the morning-after pill was vetoed by then-president Manuel Zelaya in 2009, but he was forced out in a coup and the pill became illegal again. Current president Xiomara Castro put an end to this ban in March 2021.
Can you tell me a little bit more about the current situation?
Ligia: ‘Emergency contraception was available in Honduras for about ten years, from 1999 to 2009. However, after the 2009 coup d’état, the government issued a decree – not a law – that banned the sale, promotion, and use of emergency contraception. They falsely labeled it as an abortion pill.’
‘With the election of a more progressive president, feminists, and activists intensified their efforts to reverse this ban. Over the years, we’ve organized extensive advocacy campaigns – both nationally and internationally – targeting health ministers and raising awareness. After years of pressure, we finally succeeded in 2023, and emergency contraception is now legally accessible and free in health centers.’
‘However, access is still limited. The pills are mostly available in cities, and for those in rural areas, the cost of around 3 dollars is prohibitive, especially in a country where many families live on less than 1 dollar a day. Additionally, religious groups have launched misinformation campaigns on TV and radio, claiming the pills harm women’s health or act as abortifacients.’
‘Looking ahead, I’m concerned about the upcoming elections [red: general elections are due to be held in Honduras on November 30th, 2025 to elect the President, members of the National Congress, and 20 members of the Central American Parliament]. If the current progressive government is replaced, there’s a real risk the ban will be reinstated. We’ve made progress, but there’s still a lot of work to ensure emergency contraception is truly accessible to everyone across the country.’
"Ligia, if I were living in Honduras right now and discovered I was pregnant but didn’t want to continue the pregnancy, what options would be available to me?"
Ligia: ‘The first thing I would do is connect with a network of women outside the country who can support you. These international networks often provide what you could call telemedicine, giving detailed information and guidance. They may ask for an ultrasound to confirm the pregnancy and ensure that the medication is appropriate for your situation.’
‘In some cases, if you can afford the medication, they’ll provide instructions on how to use it safely. If you can’t buy the pills, some organizations may offer them free of charge, depending on available resources. Connecting with these organizations is essential because, legally, the process is complicated. I can’t openly talk about it on social media since abortion is illegal, so it’s important to work anonymously.’
‘Some women contact me directly because they know I’m involved in this work. Sometimes, I’m unsure if their requests are genuine, which makes it tricky. It’s a sensitive situation, and we have to operate discreetly. That’s why I guide them, to ensure their privacy. We’re very cautious because of the legal risks and the need to protect people’s identities.’
Gunilla, the Netherlands is often seen as a progressive country regarding reproductive rights. Are we?
Gunilla: ‘Not really. The Netherlands isn’t as progressive on abortion as many believe. Abortion is still part of criminal law. Until recently, we had a mandatory five-day waiting period before someone could proceed with an abortion. While that requirement has been lifted, significant restrictions remain.’
‘From January 2025 on, general practitioners are allowed to provide medical abortions, but the process is unnecessarily complex. They must pass special exams and obtain licenses to prescribe Mifepristone – a medication also used for treating miscarriages. This is in stark contrast to how easily they can prescribe Viagra or treatments for diabetes or pulmonary conditions, which don’t require extra training or licensing.’
‘Additionally, midwives are not allowed to perform medical abortions, and women still cannot purchase Mifepristone at pharmacies. These restrictions, combined with deeply entrenched stigma, create significant barriers. For instance, when I speak to medical students, they still carry some conservative ideas about reproductive rights. Many believe that while abortion should be legal, it shouldn’t be used more than once. Women who seek multiple abortions are seen as morally bad and are judged harshly, with some even suggesting that such women should be forced to use contraception. This pervasive stigma continues to shape discussions around abortion in the Netherlands, making it far less liberal than we like to think.’
You have been involved with Women on Waves. Since 1999 this non-profit organization has provided access to safe and legal abortion services, particularly in regions where abortion is highly restricted or illegal. You use creative and quite daring tactics to provide abortion care. What motivated you in the beginning to join this initiative?
Gunilla: ‘Rebecca Gomperts, the founder of Women on Waves, phoned me saying she was looking for feminist gynecologists for her new NGO. She wanted to charter a ship and sail it to countries where abortion was still illegal, anchor it in international waters, and then sail with women with unwanted pregnancies to international waters to provide abortion under Dutch law on the ship. This way, we could help these women, support women groups in countries struggling to legalize abortion and generate media attention for reproductive justice. I thought it was a great idea.’
What was working with Women on Waves like?
Gunilla: ‘We sailed to Ireland, Poland, Portugal, Spain, Marocco, Mexico, and Guatemala. In Portugal, we were not allowed to enter the country. So we wrote a manual on the website, on how to induce an abortion yourself using Misoprostol. Rebecca was invited to a television show in Portugal, called SIC 10 horas. On live television that evening she pulled out the Misoprostol I had gotten from the pharmacy without a prescription and explained how you could take these medicines to end a pregnancy. This was in 2004 and it was revolutionary, it was never done before. Even I, as a very progressive gynecologist, was thinking: “Is it responsible to do this, to provide women with this information?” But we did. It was the start of the second project: Women on Web. Providing internet abortion and abortion pills via the internet. In 2018, Rebecca founded Aid Access, an NGO that works with a team of US-registered abortion providers who will provide abortion pills approved by the FDA to people in all 50 states.’
So, what is next?
Gunilla: ‘Right now, we are working on a larger research to see if Mifepristone can be used as a contraceptive that you only have to take weekly at a dose of 50mg. We want women to have their fertility in their own hands. We conducted research in Moldova, involving over 2,000 women who collectively contributed nearly 2,500 cycles of usage. Participants used 50 mg of Mifepristone once weekly while engaging in unprotected intercourse, and remarkably, no pregnancies were reported. This demonstrated that the medication is highly effective. Women can use it as a weekly contraceptive. If they have sex only once in three months, they can use it as a morning-after pill. And if they have an unwanted pregnancy, they can take four tablets together with misoprostol to facilitate their abortion. Hopefully, we can start researching Mifepristone 50 mg as a weekly contraceptive in the Netherlands very soon.’
If this works, it would mean women can take care of their reproductive bodies, from start to finish. That would be groundbreaking, right? Are you excited?
Gunilla: ‘Yes, we are. We are very excited because we see the results of this study in Moldova, where the first results were promising. There are very few side effects, compared to the hormonal pill. There is minimal bleeding. But we’re not there yet. We need about 12.000 women who want to test it for one year, to prove it’s effective and safe. And of course, we need more budget and expect a lot of struggle before a marketing authorization, especially in the current political climate.’
This points towards a bigger question I wanted to keep as an overarching question above this interview: I’m stunned that almost every society wants such a far-going control on bodies that can reproduce. And the question for me, I think, that looms over everything is: why is this control so important for people who don’t have a uterus themselves?
Ligia: ‘I see this issue as deeply complex, and it’s not just about one thing. Within the framework of capitalism, I feel there’s a structural need to control everything. For example, in countries with declining birth rates, there’s this fear about who will sustain the country – who will take care of things and keep the system productive. It seems like society is so afraid of not existing anymore that it clings to certain structures.’
‘As women, we’ve historically been seen as having one primary function: bringing children into the world. So when I choose not to follow that path, it feels like I’m disrupting the natural order of things. It challenges societal expectations and the power systems built on these roles. Even people who aren’t religious often hold onto beliefs rooted in religion, especially about women’s roles and reproduction. It’s strange how those influences linger, even for people who don’t actively practice faith.’
‘I also think about machismo—how men tie their sense of power and identity to having children. If I decide not to have kids, it challenges their idea of legacy and power, and they don’t know how to handle that. It’s as if the entire system fears change, fears that the world won’t work the way it always has.’
‘This isn’t just one issue; it’s intertwined – fear of change, societal expectations, and deep cultural roots. But I believe that by asserting autonomy over my body and choices, I’m helping to push for a new way of thinking, even if it feels uncomfortable or disruptive for others.’
How do you approach this stigma surrounding abortion in a country where it's not only illegal but also morally condemned?
Ligia: ‘I’ve realized that many people repeat what they’ve heard without thinking about it. When you start a conversation, they process it for themselves instead of simply echoing others’ opinions.’ ‘For example, when I talk about abortion, I ask people to imagine it happening to someone they know – a friend, a family member, maybe their grandmother or mother. Many people think it doesn’t affect them or their loved ones, so personalizing the conversation helps break that perception.’
‘I also ask direct questions, like, “What if a relative of yours had an abortion and was sent to jail for it?” Often, they respond with, “No, that’s not okay.” Even if they initially oppose abortion, they start to reconsider when the consequences feel more real and personal. It’s about breaking down barriers, and I’ve seen people change their perspectives over time. Connecting with people in a more human, relatable way is crucial. For some, human rights or academic arguments resonate, but for many, it’s about bringing the issue closer to their reality. That’s when real change begins.’
Are there any cultural narratives or local traditions you found helpful in reframing this conversation?
Ligia: ‘Yes, we have found cultural narratives and local traditions that help reframe the conversation around abortion. For example, there are religious organizations that involve people from different faiths who support abortion rights. These groups approach the issue from a religious perspective, which is helpful because it challenges the idea that being a believer automatically means opposing abortion. When people see that you can be religious and still support reproductive autonomy, it opens up the discussion and makes them question their assumptions.’
‘We also address historical perspectives to counter the argument that abortion rights are a form of colonialism imposed by Europe or North America. People sometimes claim this is a foreign idea, but we remind them that similar practices have existed in many cultures, including indigenous ones, for centuries. Some Indigenous women are now speaking out about these traditions, emphasizing that this is not just “a white thing.” It’s deeply rooted in human history, practiced in various ways long before colonial influence.’
‘Using these narratives, we can connect with people on a deeper level and break down resistance rooted in misunderstandings or cultural stereotypes.’
Gunilla, you’ve worked as a gynecologist for a long time. Have you seen public attitudes toward abortion shift during your career?
Gunilla: ‘In Europe, abortion care has changed significantly with the introduction of medical abortion over the past 25 to 30 years. However, in the Netherlands, I feel we’ve fallen behind despite being very progressive initially. For example, during the COVID-19 pandemic, telemedical abortion became accessible in countries like Great Britain. In the Netherlands, though, it was not allowed. Even during the pandemic, women were required to visit an abortion clinic to receive their medication physically.’
‘Now, telemedical abortion is considered standard care in many parts of the United States and the United Kingdom, but in the Netherlands, it still isn’t implemented in mainstream healthcare. The only option for telemedical abortion here is through Women on Waves.’
‘Interestingly, our current health minister investigated whether telemedical abortion care existed in the Netherlands. The response wasn’t positive when we pointed out that Women on Waves was already providing it. The ministry was upset and anxious because of the potential backlash from Christian political parties, who might raise objections in the government. It became clear that the resistance wasn’t just about logistics – it was also tied to political sensitivities.’
Ligia, while we’re talking about resistance on this topic when you’re advocating for reproductive rights in Honduras, I imagine you have to come up against entrenched religious and political powers. How do you navigate these forces?
Ligia: ‘Confronting entrenched religious and political powers is part of the daily reality of advocating for reproductive rights in Honduras. The challenge is compounded by how religious institutions, political leaders, and big company owners are often deeply intertwined. They work together to uphold the status quo and negotiate our rights like bargaining chips. They might withdraw financial or political support if a law they disagree with is passed.’
‘Even when we have allies within the government, they often lack real power. For example, when our progressive president legalized emergency contraception, she faced significant backlash. Religious groups used this decision to fuel fearmongering campaigns, claiming that supporting her party would lead to laws “against family and life.” These messages dominate the media, largely controlled by the same powerful interests, making advocacy even more difficult.’
‘To navigate this, we focus on a multi-layered approach. Feminist groups and networks collaborate on advocacy campaigns and educational initiatives to raise awareness. However, since formal access to reproductive services is so restricted, we’ve had to establish networks to provide support and information. For instance, health promoters operate discreetly to help women access safe services, even though this work carries significant legal risks.’
Hivos has been working with feminist movements in Honduras for many years. Last year, they continued this work through the We Lead program. Ligia, you coordinate the program in Honduras. Now that the ban has been lifted, what is next?
Ligia: ‘We know we can’t reach everyone, but we do what we can. Still, every action – speaking on TV or organizing a campaign – invites backlash. Social media is rife with hate, and the stigma around these topics remains overwhelming. It’s a constant challenge but a fight we can’t afford to abandon.’
What would you change if you both could change one thing about the global approach to reproductive rights right now?
Gunilla: ‘Put pills in the hands of women.’
Ligia: ‘I totally agree.’
Telemed abortions
With telemedicine abortions, there's no need to visit a clinic. Your nurse consultation will take place over the phone, and you can choose to either collect the abortion medication from a nearby pharmacy or have it delivered to your home. Except for blood tests and ultrasounds (if needed), the entire process can be managed virtually. Source: Womens Clinic
This series of interviews about feminism in today’s polarized world and inspiring examples of grassroots activism is made possible by Hivos’ Walking the Talk program