The safety of self-managed abortions has improved despite abortion bans

As the U.S. Supreme Court reversed Roe v. Wade in the 2022 Dobbs decision, protesters advocating for abortion rights displayed signs featuring wire coat hangers. This symbol served as a reminder of the dangers women faced in the pre-Roe era, when unsafe methods were the only available means to terminate unwanted pregnancies.

In a 2008 article published in the New York Times, a retired gynecologist confirmed that the symbol of a wire coat hanger used for self-induced abortions was not a myth. He shared his experiences from the years between 1948 and 1953 when women would often visit his office with a coat hanger still lodged in their cervix. It wasn’t just coat hangers that were used, but also crochet hooks, soda bottles, and darning needles in desperate attempts to terminate pregnancies.

According to Dr. Carole Joffe, a professor in Advancing New Standards in Reproductive Health (ANSIRH) at the University of California–San Francisco, the post-Roe world, following its overturn in 2022, was not expected to resemble the dark times before Roe. Instead, Dr. Joffe suggests that while there may be fewer injuries, there would be an increase in surveillance due to medical advancements such as the availability of abortion pills.

In 2023, researchers emphasized the significant changes in self-managed abortion (SMA) compared to the pre-Roe v. Wade era. One of the key factors contributing to this transformation is the accessibility of medications, particularly misoprostol and mifepristone. Despite the limited options available nowadays, experts aim to raise awareness that medication-induced abortion remains a viable alternative. With the advancements in telehealth and the availability of drugs like mifepristone and misoprostol, self-managed abortions conducted through medications have become safer than ever before.

Elisa Wells, co-founder and co-director of Plan C, a non-profit abortion access group, emphasized the safety and effectiveness of abortion pills in a phone interview with Salon. According to Wells, older methods of self-managing abortions are still being used, but using abortion pills is much safer now.

According to Wells, there has been a significant increase in interest for receiving abortion pills by mail. She co-founded a non-profit organization that aims to enhance access to medication abortion in the United States by providing educational resources and information. Wells mentioned that the pandemic played a crucial role in this surge, as the FDA eliminated the in-person requirement for obtaining abortion pills.

According to the speaker, there was a significant increase in website traffic after the Dobbs decision overturned Roe v. Wade. The surge in interest was particularly notable among individuals seeking information on obtaining abortion pills in states with restrictive abortion laws. Furthermore, the speaker mentioned that each time there is an unjust action by courts or legislators, there is a noticeable spike in visitors to their website.

Medication abortions usually involve the use of Mifeprex, a brand-name drug that contains mifepristone and misoprostol. This process is carried out in two steps. Firstly, the individual takes a pill containing mifepristone. Then, after 24 to 48 hours, they take a second pill containing misoprostol. This two-step process can be performed within 70 days after the start of the individual’s last menstrual period.

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A self-managed abortion is when someone takes action to end a pregnancy without seeking formal healthcare. This can involve various methods such as obtaining medications on their own or using natural remedies like herbs, plants, vitamins, or supplements. It may also involve the use of physical objects.

According to Lauren Ralph, an associate professor in the department of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, a self-managed abortion refers to any action taken by an individual without the guidance of a healthcare professional in an attempt to terminate a pregnancy. In a study conducted in 2017, Ralph and her team discovered that approximately 7 percent of self-identified women in the United States had attempted to end a pregnancy on their own.

According to Ralph, the availability of medication abortion for self-managed abortion has increased significantly. This has been happening even before Dobbs. However, what sets the current situation apart is the greater accessibility to these medications. Ralph explains that there is substantial evidence to support the safety and effectiveness of self-managed abortion with medications like mifepristone and misoprostol, or misoprostol alone. In fact, these methods are found to be just as effective as medication abortion provided through formal healthcare channels.

Earlier this year, a group of researchers conducted an analysis of data collected between April 2021 and January 2022. The data included information from 6,000 patients who had obtained abortion pills through telehealth clinics. The findings revealed that in 99.8 percent of cases, there were no serious adverse effects observed, and in 98 percent of cases, no follow-up care was needed. Interestingly, these results were comparable to those seen in patients who received medication abortion at a traditional doctor’s office or abortion clinic.

According to data by the Society of Family Planning, prior to the Supreme Court’s decision to overturn Roe v. Wade, approximately 4 percent of abortions were conducted through telehealth. However, from April 2022 to September 2023, there was a significant increase, with 16 percent of abortions in the U.S. being performed via telehealth. Interestingly, among those who opted for a telehealth medication abortion, 43 percent expressed that telehealth played a crucial role in enabling them to undergo a timely abortion.

Ralph stated that the increased availability and awareness are helping to offset the loss of access to clinic-based or facility-based abortions after the Dobbs ruling.

As states such as Florida continue to enforce strict abortion bans, self-managed abortions play a vital role in preserving access and options for women. With abortion funds and clinics in surge states being inundated with patients, self-managed abortions have become a critical component in ensuring that women have the means to terminate their pregnancies. Megan Jeyifo, executive director of the Chicago Abortion Fund, emphasizes the importance of self-managed abortions in this challenging landscape.

According to Jeyifo, self-managed abortions have been practiced by people throughout history. Abortions have always existed as an option for individuals. It is important for people to recognize that these medications are highly safe and effective, unlike the dangerous back-alley abortions of the past. Modern abortion procedures have significantly evolved from those experiences.

Access to mifepristone hangs in the balance as the U.S. Supreme Court considers whether to restrict access or not. A decision is expected by late June. In the meantime, it is crucial for people to be aware that abortion pills can currently be obtained by mail in all 50 states, according to Wells from Plan C.

According to Wells, even in states with abortion bans, the pills remain a safe and effective option for early self-managed abortion. He emphasized the availability of resources to guide individuals on obtaining the pills, providing instructions on usage, addressing medical queries, and offering legal support for those concerned about using the pills in states with restrictive laws.

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