Some women with unwanted pregnancies in states that have banned abortion are self-managing their abortions, seeking out the necessary know-how online and obtaining the medications without the supervision of a doctor.
When women were forced to take risky measures to end an unwanted pregnancy, it may be recalled. The advent of medication abortion has changed the way reproductive care is provided, posing a challenge to anti-abortion legislation.
More than half of abortions in the United States were done with medication. During the Pandemic, federal regulators made it easier to get the pills by dropping the requirement for in-person visits and allowing the drugs to be mailed after a virtual appointment.
New laws prohibiting abortion are applied to all forms of the procedure, including medications. Women in parts of the country that are more restrictive are buying the pills online even though they are not allowed.
According to the Guttmacher Institute, there is no reliable estimate of how many women take their own medication abortions.
The New York Times database shows that abortion is now banned in at least 10 states. A measure that would have removed abortion rights protections from the state constitution was defeated by voters.
In at least half of the U.S. states, limits of one sort or another are expected, and so both sides of the divide are bracing for an increase in self-managed abortions.
Critics of abortion in any form insist that medication abortions are riskier than they are believed to be. They note that dating a pregnant woman accurately is not always possible and that the procedure should not be done past 10 weeks.
ectopic pregnancies, in which the fertilized egg implants outside the uterus, can be missed.
The chair of the American Association of Pro-Life Obstetricians and Gynecologists said that the claims that abortion is safe are based on flawed and incomplete data.
There is a lot of evidence that medication abortion is safe and women already carry out the procedure at home even if they don't see a doctor. Supporters say self-management isn't so different.
According to Dr. Beverly Winikoff, the founder of Gynuity Health Projects, it is safe and effective.
The procedure usually involves taking two drugs, one to stop the pregnancy and another to cause the uterus to contract.
More than half a million women had medication abortions in the United States in 2020 and less than half of them experience serious problems. A review of dozens of studies involving tens of thousands of patients found that medical interventions such as hospitalizations or blood transfusions were needed by less than 1% of patients.
Dr. Winikoff said that medication abortion doesn't cause sepsis and doesn't cause the kind of internal organ damage seen with illegal abortions.
She said that excessive bleeding and need to get care occasionally are not dire circumstances for people from 50 years ago.
The FDA regulates the drugs and they are supposed to be taken by a doctor. The agency discourages internet purchases of the drug because it will be passed along to patients.
The F.D.A. doesn't advise against online purchases of a drug used to treat a number of medical conditions. Recent studies show that it is possible to end pregnancies by itself.
While no treatment is 100 percent safe, taking the pills on your own at home does not affect your risk of complication.
A woman doesn't have a health care professional nearby to call in the event of an emergency. Women who perform their own abortions may be hesitant to seek medical help in states that criminalize abortion.
In Texas, where most abortions are banned after about six weeks of pregnancy, a 20-year-old who uses the pronouns they and them asked that only a first name be used.
In order to get abortion pills from Aid Access, which is based in Europe, a person had to fill out an online request form. The drugs took a long time to arrive, and when they did, they were already 12 weeks along.
The woman said she just took them and prayed.
They said that they were curled up in a ball of pain.
The partner drove them to the hospital when the bleeding didn't stop.
It was terrifying to pray that they wouldn't know or suspect that I caused it.
The know-how and the tools for performing an abortion are easy to find.
Abortion on Demand and Hey Jane are U.S. based providers that offer detailed information to women seeking abortions and provide pills by mail after a video visit in states where these services are legal.
There are two websites that offer tips on keeping online research private.
Plan C offers a number of alternatives for women in states with abortion bans, including a list of online pharmacies that sell abortion drugs and instructions on how to send the drugs to another state.
Aid Access, which screens women online and orders abortion pills from overseas pharmacies that are sent in envelopes without return addresses, is also referred to by the website. $150 or less is what the group charges.
When local clinics were overwhelmed with patients from Texas, Hannah used Aid Access to get an abortion.
Hannah, who asked to not be identified because abortion is now banned in her state, said she suffered from depression at times before she became pregnant, but had plummeted to a new low and was suicidal after giving birth.
She said she couldn't afford a baby and wasn't well enough to have one. Her abortion was not worse than a normal one.
Rebecca Gomperts, a Dutch physician who founded Aid Access, said that a medication abortion can't be compared to a miscarriage.
She said that if a woman needs care after taking the pills, they always tell her that she had a miscarried. The symptoms and treatment are the same.
A study of thousands of women who received abortion pills from a provider without an in-person visit during the Pandemic found that the practice was safe.
There are rare exceptions. In Argentina and Nigeria, abortion is banned except in cases of rape and if the mother's life is in danger.
Most of the women who took part in the study only wanted to confirm the abortion was complete and not seek care at the hospitals. There were about 4% who reported ongoing pain. There were 17 procedures to complete the abortion, 12 of which had to be stayed in the hospital overnight, according to the study.
It was surprising to find that the success rate for those taking the drug alone was higher than that of those taking the combination.
Doctors are not allowed to perform abortions under most state laws. Three states have laws that make it a crime to end a baby's life.
Some states have laws against women who end their pregnancies.
Purvi Patel was sentenced to 20 years in prison for inducing a self-managed abortion in Indiana, but her conviction was thrown out. In Texas, murder charges were brought against Lizelle Herrera in relation to a self-managed abortion, but prosecutors decided against pursuing the case.
The deputy executive director of National Advocates for Pregnant Women said that at least six states have introduced legislation establishing a fetus as a person.
Both the American Medical Association and the American College of Obstetricians and Gynecologists, which support abortion as an essential component of health care, oppose criminalizing self-managed abortion.
If/When/How, an abortion-rights advocacy group, says that health care providers don't have to report patients who self-manage an abortion at the moment. Laws are not the same every day.
We are in an area of complete uncertainty.
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