If it wasn’t clear before the Supreme Court’s decision greenlighting Texas’ draconian abortion ban, it’s certainly clear now that we are in the middle of a safe abortion care crisis. And it’s only going to get worse as other conservative state legislatures aim to follow Texas’ lead. Ironically — and fortuitously — we are also in the middle of a burst of innovation around abortion care, largely focused on new ways to access medication abortion, also known as abortion pills. The current crisis in abortion access must push us to accelerate our progress toward over-the-counter abortion pills.
Medication abortions have are a safe and accessible method of terminating pregnancy, but they have been targeted by onerous FDA restrictions. Medication abortions have been proven to be a safe and effective method of terminating pregnancy, and because they can be completed without doctor supervision, they serve as a crucial alternative for those who have had other abortion services shuttered in their state, or who do not feel safe accessing traditional health services.
A study, led by Dr. Abigail Aiken at the University of Texas at Austin, took advantage of a natural pandemic experiment. In spring 2020, Britain began allowing health care providers to administer medication abortions via telemedicine, with pills mailed to the patient’s home. Aiken and her colleagues compared thousands of medication abortions in Britain for two months before and after the new protocol went into effect. The groups had equally high success rates for completing their abortions (above 98 percent) and similarly low rates of significant complications (0.02 percent of the telemedicine-only abortions, and up to 0.04 percent for the ones with in-person visits).
Thanks to medication abortion, people in Texas and elsewhere can and are able to have safe, self-managed abortions at home — legal or not. Saying illegal abortions are “unsafe” is not only incorrect in many cases, but detrimental to pregnant Texas women who are desperately seeking abortion services in the wake of these clearly unconstitutional bans. Instead of using an outdated talking point to discuss what we all stand to lose as a result of abortion bans like the one in Texas, we should be pointing people to reputable and safe networks that can help them access the care they need.
Between 1969 and 1973, feminists in Chicago with no formal medical training formed an underground abortion service called Jane that performed nearly 12,000 safe illegal abortions. Today, as many states increasingly restrict medical professionals’ ability to offer abortion, women are once again finding ways to access safe abortion on their own. A big difference between the two eras, however, is abortion pills—mifepristone and misoprostol—that can simply, safely and effectively end a pregnancy at home, with or without medical supervision.
A growing number of people are using pills to end their pregnancies without involving medical providers. Advocates say this practice — called self-managed abortion — is safe, effective, and should be more accessible. But it’s sometimes criminalized.
The pandemic has brought into sharper focus the inequities and outright gaps in people’s access to health care of all kinds, including abortion care. If politicians truly cared about public safety and wanted to flatten the curve, they would follow guidance from the American College of Obstetricians and Gynecologists and other reproductive health experts: Abortion should be treated as essential health care, telemedicine options should be expanded, and the criminalization of self-managed abortion should end.
Nowadays it is safe and easy to induce an early abortion at home thanks to the advent of medication abortion, also called “the abortion pill.” (The term is a misnomer, as medication abortion actually involves two different drugs, usually taken about 24 hours apart, which cause a miscarriage.) Almost 40% of abortions in the U.S. are done via this method, which is approved for use up to 10 weeks of pregnancy. These abortions take place in the privacy of one’s home.
Coronavirus is making it harder for people to access abortion services, especially for those who live in one of the states whose government officials have used the pandemic in an attempt to effectively ban the procedure. These extra barriers appear to have created a surge in interest in self-managed abortion, a method that typically involves buying abortion pills online, and administering them on one’s own without medical supervision.
The global response to the spread of COVID-19 has changed life dramatically. Evolving restrictions on travel and physical distancing mean that access to contraception and abortion services will become even more difficult for people facing challenges accessing reproductive health care. This pandemic will leave a permanent impact on the health sector—but it presents an opportunity to adopt evidence-based strategies to expand access to information about and access to self-managed medication abortion at home.
As abortion restrictions across the country seemingly grow by the day, self-managed abortion is over three times as prevalent in Texas than the rest of the country, according to a January study released by the University of Texas at Austin’s Texas Policy Evaluation Project (TxPEP).
The number of abortions performed in American clinics was lower in 2017 than in any year since abortion became legal nationwide in 1973, new data showed this week. But that does not count a growing number of women who are managing their abortions themselves, without going to a medical office.
A new report from Guttmacher suggests an upward trend in women trying to self-induce; the organization’s latest survey on abortion rates, from 2017, found that 18% of nonhospital facilities said they had treated at least one person for an attempted self-induced abortion, up from 12% when the data were last collected, in 2014.
Four months after the U.S. Food and Drug Administration (FDA) warned online service Aid Access to stop shipping abortion pills to patients in the United States, dozens of reproductive rights advocates have come out against unnecessary regulation of medication abortion by mail. In an open letter released Monday, the organizations and experts explained the online service’s importance as states continue to pass laws putting abortion care out of reach for many.
On Monday, 75 organizations, doctors, and researchers joined that public fight, signing an open letter that stands behind the work of Aid Access and articulates something healthcare providers have known for a while: that right now in the United States, the risk involved with seeking a self-managed abortion is legal— not medical.
On the 46th anniversary of Roe v. Wade, amid a landscape in which the fate of abortion rights becomes increasingly uncertain, a nearly decade-long effort to amend an archaic New York state law came one major step closer to fruition. The New York State Senate voted Tuesday to pass the Reproductive Health Act, amending a law that effectively criminalizes self-managed abortions and abortions performed after 24 weeks.
The imagery makes Jill Adams, founder of the Self-Induced Abortion Legal Team, shake her head. “If I never see another coat hanger at a press conference again…” she said in a recent interview, trailing off wistfully. Adams is part of a new movement that advocates for a woman’s right to perform her own abortion. The women refer to home abortion as “self-managed” or “self-induced”—the sinister-sounding “back alley” isn’t in their vocabulary—and argue that it is both safer and more accessible than ever before.
The US Food and Drug Administration is cracking down on organizations that sell medical abortion pills over the internet. In a warning letter released Tuesday, the agency requested that the online abortion pill provider AidAccess.org immediately stop selling unapproved versions of the abortion drugs mifepristone and misoprostol and respond to FDA concerns within 15 working days outlining how it will correct its regulatory violations.
Finally, a small glimmer of good news for women: The ACLU is working to make the abortion pill more accessible across the country. On Tuesday, the organization filed a federal lawsuit to make Mifeprex available by prescription in retail pharmacies, arguing that the FDA’s current restrictions against offering it there mean that women are delayed—or prevented altogether—from obtaining their legal right to abortion.
The coat hanger – often with a red line through it – is a powerful feminist symbol. Conjuring images of women suffering unspeakable consequences of unsafe abortion, the coat hanger sends a foreboding message about a past we must not return to. The implications are clear: abortions women give themselves when they cannot access legal services are dangerous.
Are federal rules that limit access to “medical abortion” justified? According to the American Civil Liberties Union (ACLU), the answer is no. Earlier this month, the ACLU filed a lawsuit against the U.S. Food and Drug Administration (FDA), challenging regulations that restrict access to the drug mifepristone. Mifepristone is marketed in the United States under the brand name Mifeprex. It can be administered in combination with the drug misoprostol to induce miscarriage.
At a time when access to abortion is being restricted on many fronts, advocates say being able to terminate a pregnancy through telemedicine and mail-order drugs would provide a welcome new option for women.
With the retirement of Justice Anthony Kennedy from the U.S. Supreme Court, it’s crucial that we consider what would happen in a state that effectively outlawed abortion. We still hear stories about the dangers of unlawful abortion in the U.S. before Roe v. Wade made the procedure legal in all 50 states. The specter of the back-alley abortion and the imagery conjured of the coat hanger have loomed large. Whether used as a rallying cry to protect abortion rights, a warning, or a solemn remembrance of women’s lives lost, these symbols persist in the public imagination and the stories they represent are told and retold by those who lived through the era.