With abortion rights under threat, in light of the leaked Supreme Court draft opinion voting to overturn Roe v. Wade, organizations, doctors and others are sharing information online about self-managed abortion, specifically abortion pills.
Google searches for "abortion pill" were reportedly "skyrocketing," while other organizations saw a spike in inquiries about prescription abortion pills after the Supreme Court draft opinion became public.
But what exactly is a self-managed abortion? And how safe is it?
What is a self-managed abortion?
There is a "spectrum" when it comes to self-managed abortions, Dr. Mitchell Creinin, professor and director of family planning in the department of obstetrics and gynecology at University of California Davis Health, tells Yahoo Life. They range from medication abortions that are done safely with approved prescription pills to regimens and procedures — including "instruments" and "herbs," Dr. Emily Godfrey, associate professor of ob-gyn at the University of Washington Medical Center, tells Yahoo Life — that can be ineffective, dangerous or even deadly.
But when doctors talk about self-managed abortions they typically mean medication abortions outside of a formal health care setting.
What are medication abortions?
More than half of abortions in the U.S. are now medication abortions, which surpassed surgical abortions for the first time this year. With traditional medication abortions, patients, who are supported by a clinician, follow an FDA-approved drug regimen of mifepristone and misoprostol, which can be taken up through the first 10 weeks of pregnancy.
Mifepristone blocks the hormone progesterone, which is necessary to continue a pregnancy. Misoprostol, which is taken 24 to 48 hours after mifepristone, causes cramping and bleeding to end a pregnancy, according to the Kaiser Family Foundation (KFF).
The drug regimen is a "safe and highly effective method of pregnancy termination," according to KFF — more specifically, they're effective 99.6% of the time, with a 0.4% risk of major complications.
What are self-managed medication abortions?
With self-managed medication abortions, people may obtain both mifepristone and misoprostol or misoprostol only outside of a formal health care setting.
"Self-harm should not be viewed as the only or first option to end a pregnancy post-Roe," Dr. Andrea Henkel, an expert in complex family planning in the department of obstetrics and gynecology at Stanford University, tells Yahoo Life. "Self-managed abortion uses the exact same medication a person might get from a clinician and can be purchased online."
However, "some people can only access misoprostol," says Creinin. While he notes that using misoprostol by itself may not work as well as when it's paired with mifepristone, Creinin says: "But it's not going to be very harmful."
In fact, a 2019 study found that misoprostol alone is "effective and safe and is a reasonable option for women seeking abortion in the first trimester."
According to the Guttmacher Institute, "even when used by an untrained person, misoprostol is still safer than traditional methods of clandestine abortion that are considered the least safe, such as inserting sharp objects into the uterus or ingesting toxic substances."
Dr. Deyang Nyandak, a fellow with Physicians for Reproductive Health, tells Yahoo Life that "many pregnant people may choose to have self-managed abortions." She explains that these types of abortions "look very different in the modern world compared to the pre-Roe era. There is data depicting the efficacy and the safety of self-managed abortions via medication methods."
However, she adds, "self-managed abortion can be subject to a criminal offense in many states in this country. Therefore, it needs to be decriminalized so that people are not prosecuted by the state for accessing these services outside of the health care system."
The role of telemedicine in self-managed abortions
Telemedicine has also made it easier for people to have medication abortions at home but with support from an online clinician. In addition, in December 2021, the FDA expanded access to abortion medications by permanently allowing them to be sent by mail.
A 2022 study published in the Lancet found that "self-managed medication abortion provided using online telemedicine can be highly effective with low rates of serious adverse events," with the study authors calling it a "safe and effective option for those who cannot access clinical care."
In states where medication abortion via telemedicine is legal and available, "patients do not need to come in for an in-person appointment for their medication abortion," Nyandak says. "Therefore, patients may choose to have a medication abortion since they can have the medications directly delivered to their preferred address without needing to physically see their providers."
However, according to KFF, six states — namely, Arizona, Arkansas, Missouri, Louisiana, Texas and West Virginia — have "passed laws specifically banning telehealth for abortion provision." KFF also notes that 14 other states have "enacted laws that require the clinician providing a medication abortion to be physically present during the procedure, effectively prohibiting the use of telehealth to dispense medication for abortion remotely."
How restricting abortion access leads to unsafe self-managed abortions
If Roe v. Wade is overturned, Creinin says, "We're going to get back to [unsafe] self-managed abortions where people feel an extreme loss of control and will do anything" to end a pregnancy. "How safe is it? It depends on what people do. If they feel they're trapped and have to go to some extremes, it can be very dangerous."
As multiple experts and organizations have already pointed out, abortion restrictions don't stop abortions. "These laws do not reduce the number of abortions that occur — they just increase the number of unsafe abortions," says Godfrey. "You're compromising the health and wellness of women and other people who require these services."
Creinin agrees, adding: "We know from decades of research and abortion rates that abortion doesn't become more uncommon when you make it illegal. People end up dying or doing something that's potentially harmful."
According to the Guttmacher Institute, abortion rates are "similar in countries where abortion is highly restricted and where it is broadly legal: The abortion rate is 37 per 1,000 women in countries where abortion is prohibited or permitted only to save the life of the pregnant woman, and 34 per 1,000 women in countries where abortion is not restricted as to reason."
The institute states that "legal restrictions do not eliminate abortion. Rather, they increase the likelihood that abortions will be done unsafely, as they compel women to seek clandestine procedures. Indeed, abortion tends to be safer in countries where it is broadly legal and in countries with a high gross national income."
Creinin also points out that "people with means will always be able to access abortion," while those who are "economically disadvantaged are in an even tighter position."
Those who live in states where abortion is restricted and/or criminalized and who can't afford to go to another state — including taking time off from work and finding child care (60 percent of women seeking abortion are already mothers) — will be put in a difficult position. "If we put people in a corner, they will do things that are dangerous to themselves," says Creinin.
How are people accessing abortion pills online?
There are several organizations, like Just the Pill, that provide confidential online consultations and mail abortion pills directly to a person's home in certain states.
If you live in a state that may restrict and/or criminalize abortion if Roe v. Wade is overturned, experts suggest getting the necessary medications ahead of time and holding on to them in case you need them. According to FIGO (the International Federation of Gynecology and Obstetrics), both mifepristone and misoprostol typically have a two-year shelf life.
For people who live in states where abortion restrictions are already in place, including telemedicine bans, some have gotten around this by ordering abortion pills from online pharmacies outside the United States.
"In states that restrict telemedicine, [one] way to get the medicine is through Aid Access," says Godfrey. Aid Access, which is based in Austria, provides online consultations and sends abortion pills by mail to the U.S. It also provides instructions on how to use abortion pills.
Other organizations like M+A Hotline offer confidential advice and support for self-managed abortions via phone or text. "They do not ask any information about the person calling, and it’s staffed by licensed clinicians who can provide answers to any question that patients may be experiencing as they're undergoing a self-managed abortion," says Godfrey.
Some experts also suggest having emergency contraception — medication that prevents pregnancy up to five days after having unprotected sex — on hand. "Nothing is stopping people from having emergency contraception in their medicine cabinet," says Godfrey.
Knowing your rights is also important. If you're not sure what your legal rights are in your state, you can contact the Repro Legal Helpline, which is free and confidential and provides information about your legal rights when it comes to self-managed abortion.
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