When you hear the phrase “self-induced abortion,” it’s hard not to envision the iconic image of a coat-hanger, the tool women were sometimes forced to use to end an unwanted pregnancy before abortion was legal in the United States. And although abortion has been legal for over 40 years now (since the Roe v. Wade decision in 1972), it’s almost always been more difficult for low-income women, Native American women, and women in the military to access safe abortion care because of the passage of the Hyde Amendment in 1976, a regulation which drastically limits public funding for abortion. Frustratingly, safe abortion care has become even more challenging to access. That’s why there are a growing number of people attempting do-it-yourself (DIY) methods to self-induce an abortion, according to an article in Broadly.
When a person in the U.S. has a medication abortion under the care of an abortion provider, she will usually receive two medications: mifepristone, which she takes orally at the doctor’s office or clinic, and misoprostol, which she takes on her own a day or two later. Medication abortion works about 93 to 98 percent of the time when used before 10 weeks of pregnancy. If it doesn’t work, the person will need an aspiration procedure to complete the abortion.
A self-induced abortion can be done by using misoprostol, either in combination with mifepristone or on it’s own. This method works best in the first 12 weeks of pregnancy and it is the safest method of DIY abortion care. There are other “DIY” methods including menstrual extraction (most effective before 6 weeks) and herbal abortion (most effective before 8 weeks), both of which can be painful, extremely time intensive, and possibly unsuccessful thus requiring a trip to the hospital. There is simply not enough research, at this point, to know exactly how many DIY abortions (and what types) are happening in the US. We do know that people are seeking out options for abortion care outside of legal health care providers and it’s not something we can or should ignore. Notes the article in Broadly,
A report released this past summer by the now shuttered Reproductive Health Technologies Project called self-use of misoprostol, one of the components of medication abortion, “the new ‘best kept secret’ in efforts to expand US women’s access to reproductive health care options.” While the current standard of care for medication abortions is the combination of mifepristone and misoprostol, the report’s authors write, some medical experts recommend the use of misoprostol alone if mifepristone is not available — according to the International Women’s Health Coalition, misoprostol is about 75–85 percent successful in inducing abortion in the first trimester when taken alone.
It’s not much of a secret, though. The World Health Organization (WHO) has even issued guidelines for safe abortion care using only misoprostol. The WHO cautions not to use it if you’re by yourself, and to be sure to use it only if you’re within two hours from a hospital. Still, inexpensive availability of misoprostol from pharmacies, in countries with more punishing abortion laws like Mexico and Brazil, means it’s been a fairly well-known option for some people.
The WHO created and published the misoprostol protocol because women continue to die from a lack of access to safe abortion care. There are 22 million abortions performed — illegally and unsafely — every year, according to the WHO. Of those, approximately 47,000 result in the death of the woman and disabilities for 5 million more women. These rates of unsafe abortion reflect the high number of anti-abortion laws and lack of access to contraception, mostly in developing countries.
Where abortion is criminalized, women faced with an unwanted or unintended pregnancy are forced into untenable circumstances. If continuing the pregnancy will harm the pregnant person or the baby, that doesn’t suddenly change. Most don’t suddenly decide they want or can take care of a baby. They must decide between carrying a pregnancy to term that they don’t want or are not able to carry without harm to their health or seeking out illegal abortion options.
As the WHO notes,
The legal status of abortion has no effect on a woman’s need for an abortion, but it dramatically affects her access to safe abortion.
That’s what we continue to see in the United States as well. We live in a country that provides the constitutional right to safe and legal abortion access for all people. Unfortunately, it’s a hollow right for most given geographic, legal, and economic barriers to access. More than half the states are “extremely hostile to abortion rights” according to the Guttmacher Institute. Most US counties have no abortion provider. The people who have the least access to safe, legal abortion care are low-income women, because of the unjust and harmful Hyde Amendment I mentioned earlier.
After comparing the multiple barriers to in-clinic abortion access to the possibility of self-procuring misoprostol (sold under the brand name “Cytotec” in the US) at a pharmacy or online, or even misoprostol and mifepristone together online, for some women the choice is clear.
Still, there are other reasons why people who need or want to end a pregnancy, chose to pursue a self-induced abortion. Erin, who is a birth and abortion doula and a part of the reproductive justice organization Full Spectrum Doulas in Seattle (the organization mentioned in the Broadly article), told me,
There are people who seek out alternative medicine for their day to day health care needs, and that doesn’t necessarily change just because they’re seeking abortion care. One of Full Spectrum Doulas’ values is that we believe pregnant people have the wisdom and right to make their own decisions about care overall. So we trust that people are able to identify and access the best care for themselves, whether it’s in a clinic or outside a clinic. A lot of people look for care outside of Western medicine and abortion isn’t necessarily any different.
There are other reasons people may not want to go to a clinic for care. The Broadly article explains that people who identify as LGBTQ or gender-nonconforming may have negative experiences dealing with “formal medicare care…and may feel uncomfortable having such an intimate experience in that setting.”
And as we enter a new age of even more restricted reproductive rights access in the US, it seems likely that women will continue to pursue information about self-induced abortion care as an option.
There is a lot of uncertainty and anxiety about what abortion access will look like in the coming years, under a new President. However, access has been restricted, denied, and chipped away at for decades. It’s the same threats but on a different level. As doulas we focus on providing emotional support in any context, whether in someone’s house or in a clinic setting. That’s what we do and we will continue to do that for people, no matter what.
FSD is part of a growing movement to support women who seek self-induced abortion information and care, a movement that includes the Self-Induced Abortion (SIA) Legal Team. SIA was created to improve information sharing, as well as to legalize and facilitate self-induced abortion care. In a blog post for the Women’s Health Policy Report Jill Adams, Chief Strategist for SIA says,
“Abortion is a very common experience,” and given the diversity of people seeking abortion care, “it’s really irrational to expect that there’s a one-size-fits-all model to abortion care that’s going to work for everyone.”
There are, however, very real legal consequences of self-induced abortion for the person seeking the abortion and for people who, in some way, help the pregnant person along the way. According to an article in The Nation, the SIA “has identified 40 laws nationwide — including fetal homicide, chemical endangerment, accomplice liability — that are potentially broken when someone terminates a pregnancy with help from a doula, babysitter, or someone else in a support role.”
Purvi Patel is probably the most recognizable name among those who have been prosecuted for a DIY abortion. Patel was charged with feticide (and, antithetically, child neglect) and sentenced to 20 years in prison in Indiana for inducing her own abortion. Her sentence was eventually overturned but there have been 17 known arrests or convictions related to at-home abortions according to the SIA.
According to The Nation article, last year there were 700,000 Google searches for how to self-induce abortion and interest continues to grow. The formation of SIA and the support provided by doulas like Erin and Full Spectrum Doulas also offer the chance to create safe, legal (out-of-clinic abortions are not necessarily legal), and supportive spaces for women who need to have an abortion outside of a clinic.
For women who fought long and hard to legalize abortion on the federal level in this country, to create access to safe, legal abortion within healthcare settings, focusing on DIY abortion care may be difficult to conceive. It certainly may feel like a ghost of the Jane Collective, an underground abortion collective of laypeople which arose to provide abortions to women who needed or wanted them, before abortion was legal in the United States, in the latter part of the 1960s.
But given the state of abortion access in the United States now people are increasingly forced to find ways of ending an unwanted pregnancy without the help of a health care provider. And just as importantly, people need access to clear, credible information and support to keep them as safe and healthy as possible. Self-induced abortion may not be the ideal option for many people. The ideal option may vary from woman to woman. All people should have access to safe, effective, and legal abortion care that gives them the best chance of, frankly, staying alive, healthy, and having the most comfortable experience possible. People who decide to terminate a pregnancy should not fear arrest or prosecution. However, as we see more and more assaults from anti-abortion advocates on a person’s right to terminate a pregnancy, DIY abortion options including using misoprostol alone, or misoprostol and mifepristone together, need to be understood, accessible, and supported.
This article should not be used as medical advice. If you are pregnant and need or want information about terminating a pregnancy, please visit a trusted health care provider (and steer clear of Crisis Pregnancy Centers which will offer you free pregnancy tests and other free services but are extremely anti-abortion) or check out the resources below, many of which have phone and online support, can help you access local resources or, potentially, funding for your abortion.