Attacks on abortion access fuel the movement towards self-managed abortion

By Erin Matson and Pamela Merritt

Here we are, a full year after the most anti-abortion White House in history has taken power. Not surprisingly, the political landscape in 2017 was brutal for women’s health and reproductive justice — and marginalized women, especially those in rural communities, are paying the price. The policies enacted in the first year of the Trump administration continued to strip women of their right to reproductive care and access to abortion.

A major blow to accessible reproductive care has been the significant uptick in abortion clinic closures. Over the past five years, the number of independent abortion clinics dropped by nearly 30 percent. The Abortion Care Network, a national association of community-based abortion care providers that tracks clinic closures in the United States, confirmed a total of 19 independent clinic closures in 2017. When clinics close, women are forced to travel further distances to receive abortion care. According to the Guttmacher Institute, one in five women travel an average of 42 miles or more to the nearest abortion clinic, and in rural areas, women may travel over 180 miles to get the abortion care they need. Needless to say, many women are unable to travel this distance due to family, work, or cost. And the distance between clinics is widening.

Many of these closures are a direct result of laws aimed at shutting abortion clinics down. These regressive laws are putting clinics out of business by imposing expensive and unnecessary restrictions such as requiring abortion providers to have admitting privileges at a local hospital or demanding facility modifications for larger room sizes — none of which are required to provide safe abortions. Policymakers that support these laws are blatantly contradicting the Whole Woman’s Health v. Hellerstedt decision that said abortion care restrictions cannot place undue burden on women seeking an abortion. Still, 23 states have enacted one or more abortion clinic shutdown laws, and in 2017, Arizona, Arkansas, Kansas, Missouri, and Oklahoma added more to their growing lists of abortion restrictions. These states are making it impossible for clinics to operate and thus creating more barriers for women to access care.

There’s more. Attacks on health care continue to make abortion expensive and out of reach for many low-income women. Because of the Hyde Amendment, public health programs such as Medicaid deny coverage for abortion care. Eleven states, however, took this a step further and banned all private insurers from offering coverage for abortion as well. In 2017, after failing to pass in previous years, Texas Gov. Greg Abbott signed into law legislation that restricted all insurance providers from covering abortion with no exceptions for fetal abnormalities, rape or incest.

Hostile policies, such as those implemented in 2017, are setting the stage for a new movement in abortion access. For centuries, women have found ways to control their fertility, and self-managed abortion is the newest. Research shows that women without access to clinical abortion care are turning to self-managed abortion, in particular abortion with pills called misoprostol. Misoprostol is commonly used to treat ulcers and arthritis, but can also be used to safely induce an abortion within the first 12 weeks of pregnancy. Women are directing their own abortion care by purchasing misoprostol online or through other means, determining the most appropriate time to start the process, and taking the drug in the privacy of their own home.

While abortions outside of the medical setting may conjure up images of back alleys and coat hangers, the use of misoprostol is very safe. The World Health Organization has put misoprostol on the list of essential medicines and recommended that women be allowed to manage their abortion with misoprostol without direct provider supervision.

Self-managed abortion can be safe, effective, and empowering. State laws, however, remain stacked against women who engage in these practices. According to a recent report by The SIA Legal Team, 18 women have been arrested or jailed for ending their own pregnancies since 1973, and it is poor women and women of color who are most likely to be unjustly incarcerated. There are seven states that explicitly criminalize self-managed abortion, and roughly 40 laws throughout the country that could be used against people who take matters into their own hands.

The policies enacted in 2017 prop up a system where women are given few choices for abortion care, and then punished when they make the decision best for their circumstances. These egregious, unjust policies — both with regard to restriction on clinical abortion access and criminalization of self-managed abortion — must change.

Erin Matson and Pamela Merritt are co-founders and co-directors of Reproaction , a direct action group dedicated to increasing abortion access and advancing reproductive justice. You can follow them on Twitter @erintothemax and @SharkFu respectively.