National Partnership for Women & Families

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Commentary discusses self-induced abortion, 'a significant, if largely hidden phenomenon'

In a commentary in The Guardian, columnist Molly Redden highlights women's experience with and the prevalence of self-induced abortion in the United States.

Redden writes that "almost as soon as the [Supreme Court] legalized abortion" with Roe v. Wade in 1973, "opponents of abortion rights began to whittle them away." For instance, she cites the Hyde Amendment, an appropriations rider dating back to 1976 that bars federal funds from covering most abortion care. Further, she explains that the coverage expansions under the Affordable Care Act (PL 111-148) "allo[w] insurers to continue to pick and choose the circumstances under which they would cover abortion and allo[w] states to ban the coverage altogether." According to Redden, "The two decisions have ensured that millions of women who have sought an abortion have had to pay for it out of pocket," while "a sweeping wave of anti-abortion laws has closed clinics in many states, cresting with an awesome force over the last five years."

Given this "hostile climate," Redden asserts, "it is no wonder that self-induced abortions are still a significant, if largely hidden phenomenon." She cites a study that suggested "potentially 4.1% of Texas women have tried to self-induce -- or at least 100,000 women."

Moreover, Redden notes that "there is some evidence -- although it is inconclusive -- to suggest that self-induced abortion attempts are on the rise." She cites an analysis that found "online queries about self-induced abortion almost doubled" between 2008 and 2011 "as the economy worsened and a wave of new restrictions choked abortion access around the country."

Citing President-elect Donald Trump's pledge to appoint Supreme Court justices willing to overturn Roe, a move that would allow states to ban abortion care, Redden writes, "History has already shown us what happens when women in the US can't access abortion. So has the present day."

Self-induced abortion care in the United States

Redden shares correspondence between Women on Web, a not-for-profit that provides medication abortion via the internet, and U.S. women seeking the organization's services. She explains that Women on Web "does not send abortion drugs to the US, because the US does not outright ban abortion." Nonetheless, according to Redden, the group received more than 600 emails from U.S. women seeking abortion care in 2015.

Redden writes, "The letters to Women on Web form a uniform chorus of desperation." She notes, "'Please' and 'help' and 'fear' appear in dozens of places, signaling the nature of how these women became stranded." However, at the same time, "[w]hat is striking about reading these emails one after another after another is the diversity of experiences that lead all these women down the same path," Redden writes. She explains, "There are homeless women and middle-class women and married women and single women, women living in cities and women separated from the nearest abortion provider by an ocean."

Redden quotes Laurie Bertram Roberts, head of the Mississippi Reproductive Freedom Fund. "When people think about low-income women seeking abortion, they have this stereotypical vision of a single woman on welfare," Bertram Roberts said, adding, "But it's also people who have two jobs. Six hundred dollars is a lot of ... money. For a lot of the people who call us -- not a majority, but many -- those barriers are just too high. Even with our help."

Redden recounts the experience of "Martina," whose name has been changed for her privacy. Martina was unable to obtain medication in the United States or through Women on Web. Eventually, Martina traveled to Mexico, buying plane tickets "for a quarter of what a US abortion clinic would charge," and then visited six pharmacies before she was able to purchase misoprostol, one of the drugs used in medication abortion, for about $20.

Paraphrasing Martina, Redden writes, "People needed to know ... that abortion restrictions had real victims." Martina said, "You're just causing women who are in these situations who feel desperate to take desperate measures."

After Roe, self-induced abortion care 'was supposed to have all but disappeared'

Redden writes, "Self-induced abortion was supposed to have all but disappeared after the supreme court established the right to an abortion throughout the country." However, while Centers for Disease Control and Prevention data suggested that "just a few years after Roe, the country seemed to vanquish [self-induced abortion]," Redden notes that "others realized that ... illegal and self-induced abortions were still a serious problem."

Redden highlights the experience of Jason Doe, an OB-GYN who goes by a pseudonym. According to Redden, Doe began his medical residency in 1976 in a remote area of Louisiana where, he explained, "'abortion technically was legal'" but "'wasn't available.'" With only one clinic "in the opposite corner of the state," Doe treated several women who had tried to self-induce abortion.

"The tide only ceased in 1980, when two abortion clinics opened a few months apart in nearby Bossier City and Shreveport," Redden writes. Doe said, "Just making it legal is not enough ... If it's not available, if a woman really does feel that she needs [an abortion], she may be willing to try just about anything." Doe's "were not isolated experiences," Redden writes, noting that "nearly every year after Roe v Wade brought isolated reports of a woman taking drastic steps to terminate her pregnancy."

Helping provide women with abortion care

According to Redden, "It is against this backdrop of tragedies that some reproductive rights activists have argued for making the same abortion drugs used routinely in clinics available to women in their homes."

She quotes Yamani Hernandez, executive director of the National Network of Abortion Funds, who said, "'It would be phenomenal if people could receive this medication in the mail with all the instructions'" and safety protocols. Hernandez said it is possible the number of women trying to self-induce abortion could increase under the new administration, should antiabortion-rights lawmakers further limit or criminalize the procedure. "We will do anything in our power to get people the information and the care they need," Hernandez said, explaining that her group already posts instructions on the safe administration of misoprostol "[f]or safety's sake."

According to Redden, "It is impossible to know what happened to all the other women who reached out to Women on Web." However, she cites a study of women who were turned away from an abortion clinic because they were past the clinic's gestational age limit that "found that most of [the women] carried their pregnancies to term" (Redden, The Guardian, 11/22).