When Abortions Are Hard to Get

Originally published in The American Prospect on April 13, 2016.
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It’s been a rough couple of years for abortion access. State legislatures enacted 288 abortion restrictions between 2011 and 2015, and more than 330 have been introduced so far this year. Amid the onslaught of mandatory waiting periods, abortion clinic closings, and other prohibitive regulations, reproductive-rights advocates say that women’s constitutional right to end unwanted pregnancies is under threat. Last month, the Supreme Court justices debated whether the package of abortion restrictions passed by the Texas legislature in 2013 creates an unconstitutional burden for women to access safe and legal abortion. (A ruling is expected soon.) And just last week, Planned Parenthood and the ACLU filed suit against the state of Indiana for a new law that blocks women from obtaining abortions if sought for genetic abnormalities—another law the plaintiffs say is unconstitutional.

In addition to decreased access to safe and legal abortion, advocates worry that more and more women are resorting to unsafe, under-the-table methods to end their pregnancies. Making it harder for women to get abortions won’t end the practice, advocates say; it will just force women to find other ways to do it.

Quantifying the impacts of the new state abortion restrictions has been difficult—in part because the stigma surrounding abortion makes it very challenging for women to speak openly about their experiences. Still, a few studies suggest that, at the very least, policymakers and health advocates should be keeping their eye on the issue of self-induced abortions. Especially since some women are already being criminally punished for it.

In March, Seth Stephens-Davidowitz, a former Google data scientist, wrote a New York Times article entitled “The Return of D.I.Y. Abortion”—in which he reported that there were more than 700,000 Google searches for self-induced abortions in 2015. Moreover, the searches tracked closely with states that have passed abortion restrictions. Eight of the ten states with the highest Google search rates for self-induced abortions are ranked by the Guttmacher Institute as “hostile” or “very hostile” to abortion.

(Stephens-Davidowitz cautions that his work is preliminary and that it “will take years” before researchers can fully understand how to interpret this new information.)

In November, the Texas Policy Evaluation Project, a research initiative at the University of Texas at Austin,published a study that said between 100,000 and 240,000 women living in Texas ages 18 to 49 have attempted to terminate a pregnancy in their lifetimes. Of the women surveyed, 1.7 percent reported having attempted to self-induce an abortion, and 4.7 percent said they were sure or suspected their best friend had. The researchers also found that Latinas living near the Mexican border and women facing barriers to accessing reproductive health care were significantly more likely to try to self-induce an abortion or know someone else who had. The methods to self-induce an abortion most commonly used were home remedies like herbs, teas, and vitamins, and medications bought from Mexico, where a prescription is not required.

Daniel Grossman, one of the study’s lead investigators and professor of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco, told The American Prospect that his study does not prove that the new abortion restrictions in Texas, specifically those that passed in 2013 being adjudicated now in the Supreme Court, caused an uptick in self-induced abortions. “We’re looking at these findings more like a baseline measure,” he explains.

In 2008, the Guttmacher Institute conducted a nationally representative survey of patients at abortion clinics and found that just 1.2 percent of patients seeking an abortion had used medication to induce a miscarriage, and 1.4 percent had attempted using other methods, like herbs or Vitamin C.

The figures seemed low, but this survey was not one of the general population, just of women who were already at abortion clinics seeking care. If a woman had successfully induced an abortion, she would be unlikely to head to an abortion clinic later as a patient.

“Overall, there’s been very little research looking at self-induced abortions among the general population,” says Grossman.

Self-induced abortions in 2016 are less likely to be the horrific coat-hanger operations in back alleys that were all too common before the procedure was legalized in 1973. The most effective way to self-terminate a pregnancy, researchers say, is to use misoprostol, an ulcer medication that can induce a miscarriage. Rachel Jones, a senior research associate at the Guttmacher Institute, says clinical studies show misoprostol is 70 percent to 94 percent effective when it comes to ending pregnancies.

Despite its success rate, there are still many reasons why women should not be taking the drug in secret and on their own. There are medical risks if a woman takes misoprostol too late in a pregnancy, particularly if she has had a prior C-Section. And if the woman does not take the proper dosage of the drug, then she might not have a complete abortion, which could lead to her child being born with defects.

“The woman may not have accurate information or know how to take the drug properly,” says Grossman.

For now, without solid data, advocates are left to rely on anecdotal evidence about the challenges that women face accessing safe and legal abortion; the surveys conducted so far likely do not capture the full picture of how many women self-induce and how they go about doing it. Stephens-Davidowitz also found there were still several thousand Google searches in 2015 for directions on how to abort using a coat hanger—so even the more gruesome methods may still be used in some parts of the country.

We don’t know enough about the state of self-induced abortions today, but we know enough to be concerned.

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