Some women turn to self-managed abortions when access is exhausted

In states that ban abortions, some women with unwanted pregnancies are pursuing a unique solution: They “manage” their abortions, search for the necessary know-how online, and buy drugs without Requires clinic or doctor’s supervision.

At first glance, the practice may be reminiscent of the days before Roe v. Wade, when women were routinely forced to take risky measures to end unwanted pregnancies. But the advent of medical abortions – performed with pills, rather than in-clinic procedures – has transformed reproductive care, posing a significant challenge to anti-abortion laws.

Even before the Supreme Court’s decision to overturn the Roe v. Wade case, medical abortions accounted for more than half of all abortions in the United States. Federal regulators have made access to drugs easier during the pandemic by removing the requirement for in-person visits and allowing medication to be sent to patients after a virtual appointment.

But many states never allowed televised abortions, and the new law banning abortion applies to all forms of the procedure, including pills. So women in increasingly restricted parts of the country are buying drugs any way they can, often online, despite state bans.

There There are no reliable estimates According to the Guttmacher Institute, which researches and supports access to medical abortion.

With the reversal of Roe v. Wade, abortion now banned in at least 10 states, according to a database maintained by The New York Times. Kansas voters on Tuesday were denied a voting measure that may have removed abortion rights protections from the state constitution.

Limits of one kind or another are still expected in at least half of the US states, and so both sides of the divide are bracing for an increase in spontaneous abortions. manage.

Critics of abortion in all its forms insist that medical abortion carries a greater risk than claimed, and even more so without medical supervision. They note that the procedure should not be performed beyond 10 weeks of gestation or done without a doctor’s examination, as it is not always possible to accurately determine the duration of pregnancy.

They say other medical complications can be missed – including an ectopic pregnancy, in which a fertilized egg implants outside the uterus.

Claims that medical abortions are safe “are based on flawed and incomplete data that prioritize convenience and cost over patient health and safety,” says Dr. President of the American College of Obstetricians and Gynecologists, says he opposes all abortions except to prevent permanent harm or death to the mother.

Abortion-supporting doctors tell a different story: There is plenty of evidence that medical abortions are safe, and women have performed the procedure almost entirely alone at home, even when they come in. See your doctor for medication. Advocates of self-management are not so different.

“It’s fairly safe and effective based on the studies we’ve done, national data provided by states and the Guttmacher Institute, and the experience of other countries,” said Dr. founder of the Gynuity Health Project, who did much of the research on medical abortion that led to its approval in the United States over 20 years ago.

The procedure usually involves taking two drugs: mifepristone, which stops a pregnancy by blocking a hormone called progesterone, followed by a day or two with misoprostol, which causes the uterus to contract.

Studies show that more than half a million women have had medical abortions in 2020 in the United States, and less than half of 1 percent experience serious complications. Medical interventions such as hospitalization or blood transfusion less than 0.4 percent of patients needaccording to a 2013 review of dozens of studies involving tens of thousands of patients.

Dr. Winikoff said: Medical abortion is “non-invasive, does not cause sepsis, and does not cause internal organ rupture”.

“That’s not to say people can’t bleed profusely and need care from time to time, but that’s not the dire plight of people from 50 years ago,” she added.

However, these drugs are regulated by the Food and Drug Administration and are taken under the supervision of a doctor. The agency discourages the purchase of mifepristone over the internet because patients would “skip important protective measures,” officials said in a statement.

But the FDA doesn’t advise against buying misoprostol (brand name Cytotec) online, which is used to treat certain medical conditions. Recent studies have shown that misoprostol can terminate pregnancy.

Dr Carolyn Westhoff, an obstetrician and gynecologist and professor at Columbia University and editor-in-chief of the journal Contraception, said: “While no treatment is 100% safe, self-medication in home did not affect the risk of complications.

But self-management also means that women don’t have familiar healthcare professionals nearby to call in case of an emergency or complication. Dr. Westhoff and other experts are concerned that women who have abortions on their own may be reluctant to seek medical help in states that have criminalized abortion.

Cassie, 20, who uses the pronouns last and last name and asks to use only her first name because she lives in Texas, where most abortions are banned after about six weeks of pregnancy, has managed the pregnancy herself. abortion in January.

Cassie, who has had a baby and is struggling financially, filled out an online abortion pill request form from Aid Access, which is based in Europe. The medicine took longer than expected, and when they received it, Cassie was 12 weeks pregnant.

“I just took them and prayed for the best,” Cassie said. They experienced heavy bleeding, nausea and “the worst cramps I’ve had in my entire life.”

“I cried, curled up in a ball of pain in the middle of my bed,” they said.

When the bleeding didn’t stop, Cassie’s mate drove them to the hospital, where the remaining tissue was removed.

“It was a terrifying experience in itself to pray that they wouldn’t know or suspect it was me who did it,” Cassie said.

Both the know-how and the tools to perform an abortion are becoming more and more accessible.

Women living in states where abortion is legal can turn to US-based telehealth providers such as Abortion on demand and Hello Janeprovides detailed information for women seeking abortions and postal delivery of drugs after watching videos in states where these services are legal.

MYA Network provided to physicians who answer questions about self-administered abortion, and Information about abortion pills provides tips on keeping online research confidential.

For women in states with a ban on abortion, OLD plan offers several workarounds, including a list of online pharmacies that sell abortion pills that the organization has tested and instructions for setting up mail forwarding in another state to receive the drugs.

The site also mentions people Aid Access, which screens women online and orders abortion pills from pharmacies abroad sent in envelopes with no return addresses, even to states where abortions are illegal. Teams charge $150 or less, depending on income.

Hannah, 26, of Oklahoma, said she got herself a medical abortion from Aid Access late last year, when local clinics, overcrowded with patients from Texas, couldn’t take her in.

Hannah, who asked to remain anonymous because abortion is currently banned in her state, said she suffered from depression sometime before becoming pregnant, but fell to new lows and committed suicide.

“I can’t afford to get pregnant and I’m not healthy enough, physically or mentally, to get pregnant,” she said. Her self-administered abortion “was no worse to me than a regular period.”

Dr Rebecca Gomperts, a Dutch doctor who founded Aid Access, said: “Medical abortions cannot be distinguished from miscarriages, and traces of the pills cannot be detected if they are taken orally. .

If a woman needs care after taking the pill, “we always tell people they’ve had a miscarriage,” she says. “It’s exactly the same symptoms and the same treatment.”

A study of thousands of women in the United States who received abortion pills from a provider without in-person visits during a pandemic that the practice was safe.

Complications are the rare exception. Another recent study looked at self-administered abortion in Argentina and Nigeria, where abortion is banned except for saving the mother’s life (and in Argentina, in cases of rape).

20% of the nearly 1,000 women in the study seek hospital care after the procedure, but most just want to confirm the abortion is complete. About 4 percent reported ongoing pain, fever or bleeding. According to research published in The Lancet Global Health by the end of 2021, 17 procedures are needed to complete an abortion, 12 people stay in the hospital overnight, and 6 need blood transfusions.

The surprising finding was that while some women took the mifepristone-misoprostol combination, the success rates of those who took only misoprostol, a widely used drug that can be purchased in countries like Mexico without a prescription, and pretty cheap – higher than that. of a combination of two drugs.

Most state laws restricting abortion make abortion a crime against the doctor, not the patient. Only three states – South Carolina, Oklahoma and Nevada – have laws explicitly making it a crime to end one’s own pregnancy.

However, other states have adopted child endangerment or other laws against women suspected of having aborted.

In Indiana, Purvi Patel was sentenced to 20 years in prison in 2015 for voluntary abortion; Her conviction was overturned in 2016. In Texas, murder charges were brought against Lizelle Herrera earlier this year related to self-administering abortions, but prosecutors said. they will not pursue the case.

According to Dana Sussman, deputy executive director of National Advocates for Pregnant Women, at least six states have enacted legislation that makes a fetus a human, which would make it easier to prosecute women. self-abortion.

Both the American Medical Association and the American College of Obstetricians and Gynecologists, which advocate abortion as an essential component of health care, oppose criminalizing self-administered abortion, because they say doing so will discourage women from seeking medical care.

Currently, healthcare providers are not legally required by any state to report patients they suspect have self-administered abortions, according to If/When/How, a group advocating abortion rights. But the law is always changing.

“We are operating in an area of ​​total uncertainty,” Ms. Sussman said.

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