Columnist Carrie N. Baker: Abortion in a post-Roe world?

Published: 5/26/2021 3:29:58 PM

The day after the Supreme Court announced they would hear the Mississippi abortion ban case, internet searches related to self-managed abortion surged across the United States, especially in states hostile to abortion rights. Online searches for terms related to abortion pills such as “misoprostol” and “medical abortion” exploded by more than 5,000% in the 24 hours after the court’s announcement.

Some fear if Roe v. Wade is overturned, the U.S. could return to a pre-Roe world when pregnant people regularly died from illegal abortions, or suffered infections or infertility. Online reaction to the Supreme Court announcement, however, is evidence a post-Roe world would be quite different because we now have extremely safe and highly effective abortion pills that are easy to obtain and use.

Abortion pills — mifopristone and misoprostol — end a pregnancy by inducing a miscarriage. Mifepristone interrupts the flow of the hormone progesterone that sustains pregnancies, and misoprostol causes contractions to expel the contents of the uterus. Used in combination, they are 95% effective in the first 10 weeks of pregnancy. Misoprostol alone is 80-85% effective.

Many people in the U.S. are now ordering abortion pills online and self-managing their abortions. Self-managed abortion means ending a pregnancy without medical assistance. Recent research reveals 7% of U.S. women have tried to self-manage an abortion. The Netherlands-based telemedicine abortion provider Aid Access helped over 57,000 people in the U.S. end pregnancies between 2018 and 2020, before the pandemic began. Online demand for abortion pills surged when COVID-19 hit in early 2020, especially in states that closed abortion clinics such as Texas, where requests for abortion pills made to Aid Access increased by 94%.

Ongoing and increasing legal barriers to abortion have fueled the rise in self-managed abortion, despite Roe still being the law of the land. Because of anti-abortion pressure, the Food and Drug Administration tightly restricts access to mifepristone. Pharmacies can’t distribute the drug: only certified physicians can. While the FDA recently allowed qualified providers to mail the abortion pill to patients, 19 states prohibit medication abortion via telemedicine and mailing pills. Meanwhile, burdensome regulations have shut many clinics, especially in the South and Midwest.

As a result, even now with Roe still on the books, more and more people are purchasing abortion pills online and self-managing their abortions at home, which has a side benefit of enabling folks to avoid insulting, scary and screaming anti-abortion protestors.

Luckily, there has never been a better time for people seeking online information and resources for self-managed abortion. As legal restrictions on abortion continue to increase, reproductive health advocates are stepping up and creating organizations and websites to guide and support people seeking to self-manage abortion. These organizations provide information on reliable websites for purchasing abortion pills and learning how to use them, and where to access medical, emotional and legal support for self-managing abortion.

The organization Plan C (plancpills.org) has a state-by-state guide on how to find medication abortion health care, including a list of vetted websites with information about cost and shipping time for each website. For as little as $105, people can order abortion medication sent directly to their homes. Reliable information about how to use the abortion pill is available online in 27 languages at howtouseabortionpill.org/. For medical support, M + A Hotline offers anonymous, confidential, private and secure communication via text or phone with pro-choice doctors that have years of experience with miscarriage and abortion.

For emotional support, there are several options. Reprocare operates an anonymous healthline seven days a week providing peer-based, trauma informed emotional support. Exhale offers a free, confidential textline to individuals who have had abortions, and to their partners, friends, allies, and family members. Staffed by peer counselors, Exhale is a space to process feelings around abortion. Connect and Breath offers a talkline staffed by people trained to “listen and provide unbiased support and encouragement of self-care.”

For legal support, Repro Legal Helpline provides detailed information on its website about the legality of self-managed abortion and offers legal support by phone or by a secure online form.

In a post-Roe world, we would become a country of haves and have-nots — where some people have access to safe abortion care and others do not. In restricted states, abortion would become almost impossible to obtain — except through self-managed options which might put people at legal risk. In states without these restrictions, abortion is likely to continue to be readily available through modern, safe telemedicine services, such as Abortion on Demand ($239) and Forward Midwifery ($150), which currently serve patients in Massachusetts (with one- to three-day delivery).

A reversal of Roe v. Wade would be terrible for women’s rights and dignity, but it would not send us back to the pre-Roe world of coat hangers and hospital wards full of deathly ill women because of new medications and innovative organizations committed to reproductive health and bodily self-determination.

Carrie N. Baker is a professor in the Program for the Study of Women and Gender at Smith College and a contributing editor to Ms. Magazine.

 

 




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