The recent article in New York magazine, warning that “Abortion’s Deadly DIY Past Could Soon Become Its Future,” makes a compelling case about the rise in DIY abortions we are likely to see, given the dire threats posed by the incoming administration to health-care coverage, reproductive rights, and access to abortion services. As National Advocates for Pregnant Women has warned, making abortion illegal or less accessible won’t stop abortions: History has shown that women will take extreme measures to end a pregnancy that they feel is not right for them or their families.
Indeed, some women are already bypassing the stigma and many challenges of accessing an abortion in the United States and finding ways to “do it themselves.” But rather than returning to the scary, dangerous back alleys of yesterday, these women are availing themselves of medication abortion, which didn’t exist as an approved medical regimen in the pre-Roe days of coat hangers and knitting needles.
Thanks to the advent of these pills—mifepristone plus misoprostol or misoprostol used alone, which are safe and effective even when used correctly outside of the medical system—women are not likely to die or be injured by taking matters into their own hands. Rather, the opposite. Women who can access these pills through friends or online are discovering that they can safely and effectively terminate a pregnancy of up to ten weeks in the privacy and comfort of their own homes. This allows them to bypass the health-care system altogether and all of the harassment, delays, and costs that a clinical visit increasingly entails.
This practice of “do it yourself” (DIY) medication abortion is not without risks, but the risks are largely legal rather than medical. Women who self-induce abortion can face risk of prosecution and imprisonment. According to Self-Induced Abortion Legal Team attorney Farah Diaz-Tello, “the laws that govern abortion are complicated and vary from state to state. But one thing that is consistent is that if prosecutors want to punish a woman, they will find a way to do it.” This may be particularly true for women from socially and economically marginalized communities, who may be at higher risk for surveillance and punishment.
Roe has collapsed in Texas, and that's just the beginning.
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To date, there have been 17 known arrests or convictions in the United States related to a DIY abortion. Two years ago, a mother in Pennsylvania was sentenced to 12 to 18 months in prison for ordering abortion pills for her daughter online. According to Diaz-Tello, prosecuting women for having or helping with a self-induced abortion is unjustified: “Women who have ended or lost a pregnancy are treated differently from people in nearly every other medical context. In no other context is someone threatened with jail for administering their own medical care.”
We believe no woman should be prosecuted for obtaining and using these pills, the very same pills that are available through clinics that can be purchased without a prescription for other uses in pharmacies in some other countries. The Self-Induced Abortion Legal Team is beginning to address this important area through its work “using law and policy tools to ensure people throughout the U.S. can end their own pregnancies outside of the formal health system with dignity and safe from the threat of arrest for themselves or anyone who assists them.”
As we gather—potentially by the millions—across the country to march for women’s rights on January 21, let us embrace this game-changing technology and take concrete steps to make it widely available. Rather than feeling desperation and dread about the future of abortion access under a Trump regime, let’s build these efforts. Informing women that it is a safe and effective option is a first step toward building demand; changing laws and routes of access so women can manage their health without fear of prosecution is the next.
And let us destigmatize DIY abortion and instead promote this new technology, with its radical potential to place reproductive care where it belongs—directly in the hands of those who want it.
Authors’ note: Francine Coeytaux and Elisa Wells, at the Public Health Institute, are part of a coalition of women’s health advocates that has recently launched www.PlanCPills.org, informing women about safe home abortion with pills.