Some women turn to self-administered abortions as access declines

In states where abortion is banned, some women with unwanted pregnancies are pursuing an unusual solution: “self-managing” their abortions by seeking the necessary information online and obtaining medications without a clinic or doctor’s supervision.

At first glance, the practice is reminiscent of the days before Roe v. Wade, when women were often forced to take dangerous measures to avoid unwanted pregnancies. But the advent of medical abortion — performed with medication rather than in-office procedures — has changed reproductive care, posing a major challenge to anti-abortion law.

Even before the Supreme Court’s decision to overturn Roe v. Wade, medical abortions accounted for more than half of all abortions in the United States. Federal regulators made the pills easier to obtain during the outbreak by waiving in-person attendance requirements and allowing the drugs to be mailed to patients after virtual appointments.

But many states do not allow telehealth abortions at all, and new laws ban abortions in all forms of the procedure, including medications. So women in increasingly restrictive parts of the country are buying the pills any way they want, often online, despite government restrictions.

over there There are no reliable estimates According to the Guttmacher Institute, which studies and advocates for abortion, the number of women who self-medicate.

Reversal of Roe v. Wade, Abortion It is now banned in at least 10 statesAccording to a database maintained by The New York Times. Voters in Kansas on Tuesday rejected it. Voting measure This would remove abortion rights protections from the state constitution.

However, in at least half of the US states, restrictions of one kind or another are expected, and therefore both sections of the spectrum strive to increase self-administered abortion.

In any case, critics of abortion argue that medical abortions are more dangerous than claimed, and even more so without medical supervision. The procedure should not be carried out after 10 weeks of pregnancy, it should not be carried out without a doctor’s visit, because it is not always possible to accurately detect pregnancy.

Other medical complications can be overlooked, they say – including ectopic pregnancy, implantation of the fertilized egg outside the uterus.

The claim that medical abortion is safe is based on “false and incomplete information that puts convenience and cost over the health and safety of patients,” said Dr. Christina Francis, president of the American Association of Pro-Life Obstetricians and Gynecologists. All abortions except to prevent permanent injury or death to the mother.

Pro-abortion doctors tell a different story: There’s plenty of evidence that medical abortions are safe, and even if women go to a doctor to get the medication, they often perform the procedure alone at home. Proponents argue that self-governance is no different.

“Based on our research, the national data provided by the states and the Guttmacher Institute, and the experience of other countries, it is very safe and effective,” said Dr. Beverly Winnikoff, founder of Genuity Health Projects. A study of medical abortion accepted in the United States 20 years ago.

The procedure typically involves taking two drugs: mifepristone, which blocks the hormone progesterone, to stop the pregnancy, followed a day or two later by misoprostol, which causes the uterus to form.

In 2020, more than half a million women in the United States will have a medical abortion, and more than half will have serious complications, less than 1 percent, according to research. Medical interventions such as hospitalization or blood transfusions Less than 0.4 percent of patients need itIn the year A 2013 review of dozens of studies involving tens of thousands of patients.

Medical abortion is “non-invasive, doesn’t cause sepsis and doesn’t cause internal organ rupture,” Dr. Winnikoff said, unlike illegal abortions in the pre-Roy era.

“It’s not that people don’t bleed profusely and need occasional care, but these are not the dire conditions that people had 50 years ago,” she added.

Although the drugs are controlled by the Food and Drug Administration, they are intended to be taken under the supervision of a physician. The agency is banning online purchases of mifepristone because patients “bypass necessary safeguards,” officials said in a statement.

But the FDA doesn’t recommend buying misoprostol (brand name Cytotec) online, which is used to treat a variety of health conditions. Misoprostol can end pregnancy on its own, recent studies show.

While no treatment is 100 percent safe, taking the pill “on your own at home doesn’t affect your risk,” says Dr. Carolyn Westhoff, an obstetrician and gynecologist at Columbia University and editor-in-chief of the journal Contraception.

But self-management means a woman doesn’t have a known health care professional nearby to call in case of emergencies or complications. Dr. Westhoff and other experts fear that in states where abortion is criminalized, women who have their own abortions will be reluctant to seek medical help.

Cassie, 20, who uses the pronouns they and them and asked that only the first name be used because they live in Texas, where most abortions are prohibited after about six weeks of pregnancy, managed their own abortion in January.

Cassie, who had just given birth and was struggling financially, ordered an abortion pill online from Aid Access, based in Europe. The drugs took longer to arrive than expected, and when they arrived, Cassie was already 12 weeks pregnant.

“I just took it and prayed for the best,” Casey said. They experienced heavy bleeding, nausea and “the worst cramps I’ve ever had in my entire life.”

“I was crying, curled up in a ball of pain in the middle of my bed,” they said.

When the bleeding did not stop, Cassie’s partner took them to the hospital and the remaining tissues were removed.

“It’s a horrible experience of my own making, praying they don’t know or suspect it’s me,” Cassie said.

Both the knowledge and tools for abortion are easy to access.

Women in states where abortion is legal can turn to telehealth providers in the US. Abortion on demand And Hey JaneIt provides detailed information for women seeking abortions and offers pills by mail after a video tour in states where these services are legal.

MYA Network Provides physicians with answers to questions about self-administered abortions, and Abortion information Provides tips for personalizing online research.

For women in states where abortion is prohibited Plan C The organization offers a number of solutions, including a list of online pharmacies that sell their trial abortion drugs and tutorials on how to mail transfer in another state to receive the drug.

The site also mentions people Access to helpBy screening women online and even in states where abortion is illegal, abortion pills from foreign pharmacies are sent in envelopes without an address. The group charges $150 or less depending on the income.

Hannah, a 26-year-old from Oklahoma, said she was able to have her own abortion with a pill from Aids Access late last year, when local clinics couldn’t handle the influx of patients from Texas.

Hanna, who asked not to be identified because abortions are now banned in her state, said she suffered from depression at times before she got pregnant, but that she had fallen to new levels and was suicidal.

“I couldn’t afford a pregnancy and I wasn’t physically or mentally strong enough to carry a pregnancy,” she says. “For me, it was no worse than a normal period,” she says.

A medical abortion is indistinguishable from a miscarriage, and traces of the drugs are undetectable if taken orally, said Dr. Rebecca Gompers, a Dutch physician who founded Aid Access.

If a woman needs care after taking the pill, she says, “We always tell people to say they’re having a miscarriage.” “The symptoms are exactly the same, and the treatment is exactly the same.”

A study of thousands of women who took the abortion pill without a physical visit during the epidemic in the United States. That the practice is safe.

Complications are rare. Another recent study was in Nigeria, where abortion is illegal except to save the life of the mother, and in Argentina (which legalized abortion up to 14 weeks by the end of 2020).

That’s 20 percent of the nearly 1,000 women who participated in the study. Seek hospital care after the procedureBut many just wanted to make sure the abortion was complete. About 4 percent reported ongoing pain, fever, or bleeding. According to the study, published in The Lancet Global Health in late 2021, 17 abortions required 17 procedures, 12 required an overnight hospital stay, and six required blood transfusions.

The surprising finding was that while some women took the mifepristone-misoprostol combination, the success rate of those taking misoprostol alone—a widely used drug that can be bought without a prescription in countries like Mexico and is less expensive—was higher than the two-drug combination.

Most state laws restricting abortion make abortion a crime, not for patients. Only three states — South Carolina, Oklahoma and Nevada — have laws that clearly make it a crime to terminate one’s own pregnancy.

Other states, however, have enacted child endangerment laws or other laws against women suspected of terminating their pregnancies.

In Indiana, Purvi Patel In 2015 In 2015, he was sentenced to 20 years in prison for instigating self-administered abortions. Her conviction was overturned in 2016. In Texas, Liesle Herrera was charged earlier this year with murder in connection with a self-administered abortion, but prosecutors said they would not pursue the case.

At least 11 states have laws with broader language that covers fetuses, said Dana Sussman, deputy executive director of National Advocates for Pregnant Women. At least six — Kentucky, Louisiana, Ohio, South Dakota, Texas and Wyoming — define fetuses as persons in their criminal laws, making it easier to prosecute women who terminate their own pregnancies.

Both the American Medical Association and the American Board of Obstetricians and Gynecologists, which support abortion as an essential part of health care, oppose the criminalization of self-administered abortions, arguing that doing so would discourage women from seeking treatment.

Currently, health care providers are not legally required to notify patients they suspect may self-administer abortions, according to If/When/How, an abortion rights group. But laws are in process.

“We’re operating in an environment of total uncertainty,” Ms. Sussman said.