Welcome to Bustle's Abortion AMA column, where reproductive rights advocate and Romper editor Danielle Campoamor will speak to experts and medical professionals to answer people's questions about abortion in a way that is educational, unvarnished, and judgement free. Ask us anything.
As with giving birth, there's more than one way to have an abortion. And, as for women who give birth, women who have abortions have various reasons why they might choose one way over another. However, unlike childbirth, legislative restrictions often limit women's options when it comes to accessing safe abortion methods. So if you've asked yourself, "Can I give myself an abortion?" please know that you're not alone. But there are risks — medical, legal, or both — to illegal, unsupervised abortion care.
Before going any further, let's unpack what "give myself an abortion" means. Right now, women across the country are safely and legally conducting their own abortions via medication abortion — using two FDA-approved oral medications (mifepristone and misoprostol) — but at least part of that process is supervised in person in a clinic by a licensed medical practitioner. According to a 2016 report from Reuters, in 2014 medication abortions made up 43 percent of all pregnancy terminations, an almost 10 percent increase from the 35 percent documented in 2010.
And now, with the advent of telemedication abortion — a service that allows women to have medication abortions without a physician physically present by either communicating with them via Skype (or another online service) from a nearby clinic or, in some cases, having the medications shipped directly to them — more women are self-managing their abortions at home, safely, effectively, and legally.
Neither of the scenarios above constitutes a wholly self-induced abortion, as they are both legal and overseen by medical professionals in at least some capacity. A self-induced abortion is one undertaken without medical consultation or assistance. And there is evidence that interest in them is growing.
"An illegal self-managed abortion involves not being in touch with a provider, so you can't ask questions or you don't know who to go to in case of an emergency," Colleen Denny, M.D., a clinical assistant professor in the Department of Obstetrics and Gynecology at NYU Langone Health, tells Bustle. "It involves getting medicines that you don't know what they are, you don't know the strength for the dosing, or how to take them. You don't know what to expect at home, and no one is helping you manage expectations to know what is normal and what isn't normal and needs more care. That's why there's a category of defined safe, legal abortion and things outside of that."
Denny says that an illegal abortion can also involve inserting instruments into the vagina and cervix blindly either by yourself or by an individual who isn't a trained medical professional, but thankfully, the advent of medication abortion is making this very dangerous, extremely unsafe practice a thing of the pre-Roe past.
In 2015, Researchers from the Texas Policy Evaluation Project found that an estimated 100,000 to 240,000 women of reproductive age in Texas have attempted a self-induced abortion at some point in their lives by using medications procured from Mexico, herbs, teas, or vitamins. While Texas has extremely restrictive abortion laws, including a ban on legal telemedication abortion, women attempt illegal self-induced abortions around the country for various reasons.
Denise, 20, from Jackson, Mississippi, didn't even know medication abortion existed when she tried to self-induce her own abortion at the age of 16. She tells Bustle that she was a sophomore in high school, and her boyfriend had just passed away, so while she knew she didn't want to continue with the pregnancy, she didn't want to go to a clinic and, instead, chose to induce an abortion using herbs she obtained from a family member. (The practice of attempting to terminate pregnancy using herbs — parsley, mugwort, and many others — has been around since ancient times. It's an unreliable abortion method, can cause serious side effects including poisoning and fetal abnormalities, and is not recommended by physicians.)
"One of the main reasons why I felt more comfortable handling my own abortion is because at home people talk, and my family is very well known," Denise says. "So I didn't consider going anywhere because anyone could see me and anyone could tell anyone and it could've got back to my family. It felt easier." She fortunately did not experience any complications, and she did end up terminating her pregnancy effectively.
"The majority of what I knew about sex and what to do when you get pregnant was from church," she says. "They don't talk about abortion, and the only abortion they talk about, if they do talk about it, is the procedure abortion. So that was the only option that I had been acquainted with before, and no one had ever really talked to me about all the options that I had." Denise says that if she were to talk about abortion, the conversation would have been cut off even before it started.
Situations like Denise's are why there is so much interest in and advocacy around legal medication abortion. But recent changes on the Supreme Court have left many worried that instead of access to this service being expanded, it will be substantially curtailed.
When Donald Trump was elected in 2016, the websites for many reproductive rights advocacy organizations, including Planned Parenthood and the Center for Reproductive Rights, saw a major uptick in traffic and donations. But so did an organization that helps women access medication abortion regardless of the laws where they live.
After Justice Kennedy announced his retirement from the Supreme Court, Women Help Women — a group that provides information about abortions and helps women obtain abortion pills and contraception, mostly in countries where abortion of any kind is illegal — saw a 40 percent increase in online traffic to AbortionPillInfo.org, a website it created in 2016. According to the organization, the goal of the site is to provide the instructions and information on safe medication, safe dosage, side effects, and dealing with complications that physicians like Denny don't see available to women who initiate an illegal medication abortion. (Reports indicate that the drugs often come from the black market or from Mexico, which is why Women Help Women offers information on the relative reliability of different sources of medication.)
"After the election, we expanded to have this unique website for the United States," Susan Yanow, a reproductive rights activist and the U.S. spokeswoman for Women Help Women, tells Bustle. The site is part of SASS — Self-Managed Abortion; Safe and Supported, an initiative that provides advocates on behalf of women in the U.S. self-managing their abortions. The organization's argument is that women will always need abortions, even if the state bans it, and so women should be provided with safe, accurate information in the event that they decide to have an abortion outside the law. "We will be here, regardless of what the court does, because people have always found a way to end their pregnancies," says Yanow.
What Yanow and others advocates for expanded medication abortion rights balk at is the notion that self-managed abortions are not safe and are even equivalent to the self-induced abortions of the past, when there is evidence that the opposite is true.
"We saw [self-abortions] happen certainly prior to legalization of abortion in this country and, the way that we heard about it most frequently was with instrumentation," Jamila Perritt, M.D., an OB-GYN in Washington, DC and Fellow with Physicians for Reproductive Health, tells Bustle. "And as a result of that, there is this strong feeling of correlating self-managed abortion automatically with unsafe abortion, because that's been part of this country's history." But Perritt points to medication abortion, induced using the FDA-approved medications, as a reason why self-managed abortions, even without the assistance of a doctor or in a medical setting, are safe. With medication abortion, the risk of side effects such as extremely heavy bleeding, nausea, vomiting, or diarrhea, is minimal. "In my practice, as an OBGYN and an abortion provider, I've spoken with patients that have reported that they've induced their own abortion in the past" using mifepristone and misoprostol, she says. "I haven't seen anyone experience major complications, and that's largely because it's very rare."
On top of the low risk of complications, according to providers and patient advocates, the great benefit of expanding legal medication abortion would be to mitigate for more women the two main things people worry about before seeking safe abortion care: privacy violations and having to have a surgical procedure in an abortion clinic. "If a patient is worried about patient confidentiality, they should know that most abortion providers are incredibly good at keeping patients' information safe and not talking to people outside of the patient herself about any personal details and making sure that they help her maintain her privacy even from her partner, if that's important to her," Denny says. "And if [a patient] wants to be in the privacy of her own home, then medication abortion is perfect for her. She just gets the pills, and she's in her [house], and it's comfortable and very private."
Another worry for patients is, of course, cost, and legal medication abortion isn't cheap. According to Planned Parenthood's website, the abortion pill can cost up to $1,000, although it's usually less. But that's another reason why connecting women to sound information about medication abortion and increasing access is so important. There are payment plans available to most if not all patients, and it's cheaper than a surgical abortion, but many women, deterred by the price and unaware of these financing options, turn to cheaper, unregulated methods to self-induce.
Cost was definitely a concern for Keslea McLain when she needed an abortion. Due to personal shame and stigma, McLain, a storyteller for We Testify, a program of the National Network of Abortion Funds (NNAF) that supports and empowers women to speak openly about their abortions, didn't want to involve anyone in her abortion decision and called a nearby clinic about medication abortion. "When I found out how expensive it was, I felt defeated," she tells Bustle. "Due to my situation at the time — I was unemployed, I was about to lose my apartment and move in with my mom and her husband, and I had just paid for health insurance that didn't cover abortions — I felt like I was out of options." McLain started Googling alternatives and speaking to friends, eventually trying a supplement she heard could induce miscarriages. Ultimately, however, McLain decided to involve her mom and her boyfriend and ask for help. McLain ended up obtaining medication abortion and safely ended her pregnancy.
"Being pregnant when I didn't want to be felt very out of control," she says. "I have never felt more out of control of my body or my situation in my entire life, and it was incredibly distressing to be pregnant when I didn't want to be and just not be able to go get the abortion when I wanted to get it." According to McLain, that overwhelming stress caused her to push past her feeling of shame and reach out to her boyfriend and mom to get the financial help she needed to obtain a medical abortion via a licensed physician.
Then there are the legal implications of self-inducing. Studies have shown that medication abortion used at home without medical supervision is safe, but individuals who choose to break the law and self-manage their abortions without consulting a physician can and often do face prosecution, even if advocates and physicians consider that an abusive enforcement of the many restrictions on the legal right to terminate a pregnancy. "Even though abortion is legal for the time being, at least, throughout the United States, people who end their own pregnancies [illegally] and those who assist them are in danger of facing unjust arrest and jail time," Jill E. Adams, Chief Strategist for the SIA Legal Team, a group of lawyers and advocates that assists in providing legal protection for individuals who decide to end their pregnancies outside the healthcare system, tells Bustle. "We know at least 21 people throughout the United States that have been arrested, and some have even been imprisoned for ending their own pregnancies or helping someone do so." According to Adams, SIA Legal has identified 15 states that have criminal abortion laws that could be applied to someone who self-managed their abortion — and not all of those states are "red." Massachusetts recently repealed its criminal prohibition of what was called self-abortion, but New York still has a law, originally passed in the 1800s, that allows the state to investigate, prosecute, and incarcerate women who end their own pregnancies.
Recently, the American College of Obstetricians and Gynecologists (ACOG) came out in opposition of the criminalization of self-induced abortion, writing in a position statement:
ACOG is firmly opposed to criminalization of self-induced abortion because it fails to respect a woman’s decision making autonomy and impinges on the sanctity of the patient-provider relationship.
Shortly after, the American Medical Association passed a resolution opposing the criminalization self-induced abortion, which the AMA defined as "women attempting to induce abortion without medical assistance," writing:
The American College of Obstetricians and Gynecologists (ACOG) has taken a very strong position that women should not be prosecuted for trying to end their own pregnancies. ACOG additionally opposes forcing physicians to share information about patients due to its burdensome interference in the patient-provider relationship, therefore be it RESOLVED that our American Medical Association oppose the criminalization of self-induced 7 abortion as it increases patients’ medical risks and deters patients from seeking medically 8 necessary services.
Doctors argue that prosecuting women who self-induce makes them reluctant to seek care when they actually need it. "If you're at home having a miscarriage in the midst of losing your pregnancy — whether it's desired or not — and you say, 'Well, I don't wanna go in to tell my doctor, I don't wanna see my provider, I don't wanna go in the hospital and seek help' because of fear of criminalization, then that's dangerous," Perritt says. Most patients don't know that the symptoms of an abortion are the same as a miscarriage, and an OB-GYN or other health care provider uninvolved in the abortion wouldn't be able to tell one from the other. So patients who are experiencing a rare side effect, such as extremely heavy bleeding or fever, should absolutely go to an emergency room and get the help they need. You are not required to mention the abortion at all.
Still, women who manage their own abortions without the help or care of a physician are at legal risk, which is why it's essential that anyone considering self-managing an abortion know the potential consequences. Adams encourages women to visit the SIA Legal website and take advantage of their Legal Helpline that allows individuals to talk with an advocate and discuss the potential legal repercussions before proceeding. "We know that managing your own abortion with the use of the abortion pill is safe — the medications are safe and the complications are really low," Perrit says. If you have access to the FDA approved medications and the correct dosage, "the risk is not a medical risk. The risk is absolutely a legal risk."
Since it's impossible to physically detect if a person has had a medication abortion, Perritt says, "It's purely the suspicion of the individual who's reporting it that results in police inquiry, prosecution, and incarceration of individuals. And that's particularly going to hit certain communities more than others; communities that are historically marginalized and suspected of anything — we're talking low income women, women of color, immigrants, and young people."
If you are seeking to manage your own abortion legally, at home, privately, and at a low cost, there is information and support available to you. You can call your local Planned Parenthood or visit their website to discuss your abortion options and payment plans, and you can locate an abortion provider via the NNAF website. Even if you don't want to share your need for an abortion with anyone else, there are confidential, safe, legal, and private ways for you to obtain the care you need. You are not alone.
Have questions about abortion? You can email them safely and anonymously to Abortion AMA at firstname.lastname@example.org, and we'll answer them. Together.