Tuesday, June 13, 2017

DIY abortion in Glamour

Hard to believe that this article is from Glamour magazine, but so it is, and given the escalating fear of loss of abortion options its readership is experiencing, it makes sense for it to publish this piece on DIY abortions:

For years pro-choice advocates have worried about what might happen if Roe v. Wade were overturned—whether women wanting to end their pregnancies would resort to the back-alley doctors and coat hangers of past eras. What we’ve learned is that it didn’t take such a monumental legal flip-flop to make that a real possibility: In the past five years, highly restrictive Targeted Regulation of Abortion Providers (TRAP) state laws have shut down at least 162 clinics or stopped them from terminating pregnancies, and made both surgical and medical abortions incredibly expensive and time-consuming in many areas. As a result, some women are taking matters into their own hands, a phenomenon that, experts say, will only become more common if the Supreme Court upholds Whole Woman’s Health v. Hellerstedt when the ruling is handed down this summer. It’s considered the most important reproductive-rights case in more than 20 years because it could decide how far states can go to control abortion care.
The first alarm bells of a self-induced-­abortion trend went off late last year, when a Texas survey suggested that up to 240,000 women in that state alone had, at some point in their reproductive years, tried to end their own pregnancies. The findings don’t surprise Amy Hagstrom Miller, founder and CEO of Whole Woman’s Health, who challenged the Texas law now before the court. (The law requires that abortion providers have hospital-admitting privileges and clinics be ambulatory surgical centers; she’ll have to close all but one of her clinics in that state if she loses the case.) “People call us and ask, ‘Can you tell me how to do my own abortion?’ ” she says. “When we tell them we can’t, they say, ‘How about if I tell you what’s in my medicine cabinet and under the sink?’ ”And it’s not just Texas. Glamour surveyed 15 providers in more than 10 states, most of whom said they knew of women trying to self-induce abortions; five had seen patients who had attempted it. “Our hotline staff regularly hears from women who have tried and failed to terminate their own pregnancies,” says Vicki Saporta, president and CEO of the National Abortion Federation, which helps thousands of women a year obtain legal abortions. And if Google reveals what we’re really up to, consider this: Last year Americans entered at least 700,000 searches for variations of the phrase “how to self-abort,” according to Seth Stephens-Davidowitz, Ph.D., an economist in New York City who saw a surge in such queries when TRAP laws started getting passed in 2011. “The search data shows an unambiguous and disturbing interest in DIY abortion in parts of the U.S. today,” he says, “and it’s highest in the places where it’s most difficult to get an abortion.”
Lots of people are resorting to black market misoprostol, a drug which induces contractions:

Many women use misoprostol, which they buy online or at flea markets and bodegas. “I saw American women purchasing it across the border in Mexico,” says filmmaker Dawn Porter, whose new abortion documentary, Trapped, will air on most PBS stations on June 20. “It’s incredibly easy to buy.” Women also get the pills through an underground network of midwives, doulas, and activists in this country. I spoke to 10 such activists, who told me that together they’ve helped at least 275 women perform abortions at home. “If I got caught for this stuff, I could be facing 25 years to life,” admitted one. “I have a seven-year-old. Going to jail is a scary thought. But I can’t just sit around and wait for things to change.”
Just to be clear, misoprostol is a 100 percent legal and approved drug when prescribed by a doctor; it’s used to prevent ulcers as well as to induce abortion. For the latter, it’s almost always given with a second drug, mifepristone, commonly known as RU-486. In this two-drug regimen, called a “medical abortion,” a woman receives a dose of RU-486 in an office or clinic; the drug helps cause the pregnancy to detach from the uterine lining. Miso, usually taken later at home, then triggers contractions that expel the tissue. Colleen McNicholas, D.O., a provider at Planned Parenthood in St. Louis, the only abortion clinic left in Missouri, and an assistant professor at Washington University, tells her patients they should expect to soak at most two maxipads an hour for a couple of hours. “The heavy bleeding doesn’t last very long,” she says, “but it can be something like a period for a couple of weeks.” The protocol is up to 97 percent effective when taken within 10 weeks after the beginning of a patient’s last period, and more than a third of women who get an abortion in the first nine weeks of a pregnancy now choose this method over a surgical procedure.When a woman attempts to end a pregnancy on her own, though, she typically uses only miso. The reason: RU-486 is so strictly regulated that a doctor must watch the patient take it—the drug never leaves the clinic—making it almost impossible to get on the black market. Miso, which experts agree is largely safe, is easier to obtain (and a lot cheaper, at as little as $2 a pill). But the drug on its own is only about 80 percent effective, meaning that in one out of five cases the pregnancy continues—and if carried to term, there’s an elevated risk of birth defects.
This is not without risk, including criminal liability:
Beyond any possible health risks of these at-home methods, there are legal ones: According to the Center on Reproductive Rights and Justice (CRRJ), at least 17 women have already been arrested for allegedly trying to perform their own abortion or helping someone do so. (In one well-known case, a Pennsylvania mother, Jennifer Whalen, was sent to jail after buying pills online for her daughter.) Some experts say that’s just wrong. CRRJ is working to decriminalize home abortions, and others argue that taking misoprostol at home is actually a practical solution for women with little access to care, a position shared by the World Health Organization.
But,
If the source of miso is known, “I don’t actually think [women taking it on their own] is that risky,” says Dr. McNicholas. While using misoprostol alone is not optimal, “many treatments in medicine are far less than 80 percent effective,” including drugs for asthma, migraines, and Alzheimer’s, points out Arthur Caplan, Ph.D., a medical ethicist at the New York University School of Medicine. “With the politics of abortion, to me, this is the road you’re going to have to travel.” Some activists even view at-home abortions as a form of female empowerment: Francine Coeytaux, a principal investigator at the Public Health Institute in Los Angeles advocates for misoprostol to be available over the counter. Her new website is a clearinghouse on self-abortion “because women can feel very alone and scared,” she says.
Women on web is a valuable resource, so is plan c.

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